The Role of Lasers in Surgery

The role of lasers in surgery has been expanding ever since their first use in medicine to treat disease of the retina in 1967. Initially the rate of take-up by surgeons was slow, as old habits die hard. Now, with many different surgical laser systems offered, their use is becoming commonplace. Technology is changing on an almost weekly basis, and laser users need to be at the very front of their field to take full advantage of this. The use of lasers in Ear, Nose and Throat (ENT) surgery is now commonplace, it is this specialism, along with eye surgery, which uses laser technology in surgery the most.

There are now ideal lasers for most applications in ENT surgery and in many cases the correct laser in the correct clinical situation offers significant advantages to the patient over standard non-laser methods. It is at these specific areas that the London Laser Clinic is aimed.

The London Laser Clinic has been proposed and developed by Mr Michael Dilkes MS FRCS and colleagues, all of whom have particular skills in their own fields. Surgeons affiliated to the clinic will be either trained in the clinic, or be particular experts in their own field of laser surgery. The aim is to provide a high quality service, remaining independent from all other laser users, except those who have demonstrated their skill and application in the field of laser surgery, or those who have been trained by The London Laser Clinic. This avoids potential discreditation by association as much as possible. In order to keep the quality of laser surgery at the highest level, the clinic runs a yearly “London Laser Course” for ENT surgeons, and also sponsors other events, such as the anterior and lateral neck dissection course.

The London Laser Clinic has access to the best types of laser for each of the procedures performed. These procedures are offered on the basis that in each instance, the use of a laser is directly beneficial to the patient. Some other non-laser operations performed in ENT surgery are also offered, since technological advances in these areas also give a benefit to patients over old-fashioned surgery. The number of procedures offered is expanding as technology advances. The main direction of the clinic’s surgery is in ENT and facial plastics.

The London Laser Clinic will concentrate on day case surgery in this area, with the emphasis being on a high quality service minimising disruption to the patient's lifestyle. This includes a streamlined approach to consultation, treatment and postoperative care. Open access to trained nursing and medical staff will be a feature both pre- and post- operatively, along with a comprehensive information sheet designed for each operation.

Training of other medical and nursing staff is a priority of the clinic, since it is intended to be a state of the art centre of excellence, from which others can learn to use lasers within the clinic's guidelines.

Why Lasers?

Laser energy can also be very delicately delivered due to accurately focussed lenses or small diameter fibres (down to 200 microns). Laser light can also be short pulsed (less than 1 millisecond) by computer control of the beam, reducing unwanted damage. Due to these facts alone or in combination, diseased tissue can be removed whilst reducing normal tissue damage, in some cases diseased tissue can be treated with almost no normal tissue damage.

Lasers also have the ability to stop bleeding simultaneously with a cutting action, allowing rapid, bloodless operations, reducing anaesthetic time. This leads to a quick recovery, and often little pain in the early postoperative period. This is a very useful advantage when performing surgery as a daycase, which all of the Clinic’s operatios are designed to be.

Anaesthetic

Lasers offered at LLC

1. Carbon Dioxide (CO2): This system involves the production of laser light from a gas medium that is mostly CO2 as found in the atmosphere. Light can be delivered in a very delicate manner, either by fine pulsing or scanning. Because there is minimal absorption of light at this wavelength (10,600 nanometres), very accurate removal of tissue is possible. The CO2 laser is the workhorse of most ENT laser surgery. At LLC we use this laser for cosmetic skin surgery, tonsillectomy, some snoring treatment, cancer or benign disease of the voice box, some nose unblocking surgery, and several other procedures.

2. Holmium-Yttrium Aluminium Garnet (Ho-YAG): As its name suggests, this laser produces light from a crystal (garnet), containing the rare earth metal Holmium. Light at this wavelength (2,300 nanometres) produces a beam that vapourises tissue and also stops bleeding (coagulation), a property that is very useful in areas that have a good blood supply. The Holmium-YAG laser is ideal for lingual tonsil treatment, throat and mouth/tongue cancer surgery, and for tonsillectomy when a tissue sample is needed.

3. 810 Diode: A relatively new concept in lasers, this system uses a physical property of tissue in which specially prepared chips containing Gallium Aluminium Arsenide are stimulated by electricity to produce laser light. These systems are small, lightweight and easy to use. They therefore lend themselves to being carried from clinic to clinic. Diode lasers offer delicacy in contact mode, or good coagulation in non-contact mode. We use this system primarily at 652 nanometres for photodynamic therapy.

4. KTP Aura laser: At 532 nanometres (visible green) this laser is useful for treated blood vessels in the skin, particularly when using new scanning techniques.

5. Photodynamic Therapy: This form of laser treatment uses a drug and light combination to treat suspicious or overtly cancerous tissue. Lasers used are often diode lasers, or even non-laser light sources. The treatment is designed to give maximum penetration with minimal normal tissue damage. The actual drug/light combination used varies depending on the disease, site and required depth of effect. A period of skin sensitivity to light occurs with the more powerful drugs (approximately 4 weeks).