Speaking about the CO 2 laser, it is necessary to note its generally recognized effectiveness in soft tissue surgery. The beam of this laser with a wavelength of 10,600 nm is most sensitive to water molecules (H 2 O). Based on the fact that soft fabrics human beings are 60–80% water, the absorption of CO 2 laser radiation in them occurs most pronouncedly and efficiently, causing the ablation effect, in other words, the “laser scalpel” effect. Soft tissue ablation is a necessary and clinically significant condition for performing various types surgery.

The versatility of the “laser scalpel” technique

The versatility of our operating department allows the use of this technique – the “laser scalpel” technique – in surgery, gynecology, plastic surgery, urology.

Let us highlight the features and advantages of the interaction of the “laser scalpel” with biological tissues:

there is no direct contact with the tissue, which means there is no risk of infection. The beam cannot be a carrier of viruses and bacteria (including HIV, viral hepatitis B and C). The incision made with a laser is sterile under all conditions;
sterilization of tissue in the surgical field that has been treated with laser radiation, and the ability to work with infected tissue areas. This opportunity is truly enormous for surgeons.;
possibility of one-stage removal of an infected dermal cyst with the application primary seam provided there is no blood loss and fear of wound hematoma;
coagulating effect of radiation, allowing to obtain virtually bloodless cuts. Convenience and speed of work. Bloodlessness is a condition that allows the surgeon to work comfortably where necessary. From personal experience: correction of congenital and acquired lip deformations can be performed qualitatively and symmetrically only with a laser beam;
minimal thermal effects on surrounding tissues and the known biostimulating effect of the laser determine rapid wound healing and a noticeable reduction in the postoperative period.

Thanks to the innovative capabilities of modern CO 2 lasers, namely modulated laser pulse shapes, independent adjustment of ablation depth, power and pulse length, it has become possible to make laser operations as effective and physiological as possible when working with various types of tissues and indications.

It is important to understand that the patient’s safety depends on the competence of the specialist, therefore training doctors in laser technology is necessary condition application of laser technologies in medical practice.

As a classical surgeon, I had an ambivalent attitude towards the laser beam. During my professional growth, I had to work with several laser systems, but I can consider the beginning of my conscious approach to laser surgery to be the moment of introduction into clinical practice our Center for CO 2 laser system SmartXide2 from DEKA. The choice of this system was due to its versatility for different areas of medicine and the presence in it of a number of innovative capabilities that directly affect the increase in efficiency and individualization of approaches in surgical practice:

modulated laser pulse shapes Pulse Shape Design and the ability to select and change them,
stepwise adjustment of ablation depth, so-called stacks,
independent adjustment of laser radiation parameters: power, pulse length, distance between points, pulse shape, stacks, geometry of the scanned area, scanning order.

The first use of CO 2 laser in my practice was the removal of benign skin lesions. The use of a laser system has provided undeniable advantages, including the simplicity and speed of the process, clear visualization of the edge of the formation, the ability to work on any part of the body, including the mucous membranes and the mobile part of the eyelid, the aesthetics of the result, and rapid healing.

A disadvantage of laser exposure is the difficulty in taking a biopsy.

Thus, laser exposure can be considered the most acceptable way to remove benign formations.

The use of the SmartXide2 DOT laser to remove subcutaneous formations such as atheroma, fibroma, etc. is also effective. The laser beam allows for precise dissection of layers of skin. The cyst membranes are well visualized. This method is indispensable in the presence of perifocal inflammation and increased bleeding due to tissue plethora. In all of these cases, the formation was completely removed; the postoperative wound was dry and free of bleeding, including capillary bleeding. The wounds were sutured without drainage in all cases. Antibiotic therapy was prescribed. During follow-up examinations, positive dynamics and wound healing by primary intention were noted.

Clinical examples

Clinical case 1

Patient, 32 years old. Transconjunctival bilateral blepharoplasty using laser has been proposed. Through the lower vault conjunctival sac Periorbital tissue was accessed (SP 3 W), the excess was ablated (SP 6 W). The wound was closed with single Vicryl 6.0 sutures. IN postoperative period Swelling and bruising were noted to a lesser extent compared to the classical technique. There were no risks of electrical injury to the eye, since an electrocoagulator was not used.

Minuses: the need to use disposable conjunctival screens, which in turn increases the effects of postoperative conjunctivitis.

Conclusions: The technique greatly facilitates the surgeon’s work and ensures less tissue trauma during surgery. With single-stage fractional laser exposure to the skin of the periorbital area (pseudoblepharoplasty) this method irreplaceable.

Rice. 1 a. Photo before surgery

Rice. 1 b. Photo on the 6th day after the operation.

Clinical case 2

Patient, 23 years old. Post-traumatic deformation of the lip. An attempt was made to symmetrize the lips. In an operating room with an electrocoagulator using markings, a simulation was carried out upper lip. The operation lasted 20 minutes, stable hemostasis – +40 minutes. Result: patient is 80% satisfied. After analyzing the results, the patient was offered lip correction using the SmartХide2 laser. In Smart Pulse 6W mode, using a 7” nozzle, ablation of excess and scar tissue of the upper lip was performed. Sutures were placed with Vicryl Rapide 5.0. The patient is recommended to care for the wound until the swelling disappears (up to 14 days). Two months after the operation, the result is 100% satisfactory for the patient and the surgeon.

Minuses laser method corrections: not identified.

Conclusions: on at this stage I consider correction of lip deformations with CO 2 laser the best method of the possible.

Clinical case 3

Patient, 44 years old. Plastic surgery of the upper eyelids has been proposed. Excess skin was excised upper eyelid. Ablation of a section of the orbicularis oculi muscle, its dissection and removal of excess paraorbital tissue. The advantages of using a laser are the speed of the operation and the cleanliness of the wound.

Minuses: in connection with large size The laser manipulator requires perfectly calibrated and precise movements by the surgeon to obtain a smooth surgical edge.

Rice. 2 a. Photo of the patient before surgery

Rice. 2 b. Photo of the patient 4 months after surgery

Conclusion

The demonstrated clinical cases and results of laser surgery using the SmartXide2 system demonstrated a tangible comparative advantage of this method over the classical surgical method due to better aesthetics, reduced rehabilitation time, less tissue trauma, excellent wound healing and, as a result, a high percentage of satisfaction with the procedure for the doctor and the patient.

Thus, I consider it clinically appropriate and economically justifiable to implement medical practice considered laser technology. I am sure that the dynamic development of laser technologies has already determined a great future for laser surgery.

Circumcision (circumcision) is surgery, during which the male penis remove the foreskin. This procedure is optional, but sometimes it is carried out according to various reasons: medical, religious, etc. Today, circumcision is performed using a traditional scalpel or a modern laser. Which one is better and safer?

The laser method is used not only in circumcision, but also in removing various cosmetic defects(moles, papillomas, warts, etc.), erosion of the neck of the shirt. The laser beam “burns” the layers of skin, resulting in the elimination of tumors.

During the operation, the surgeon pulls back the foreskin and pulls it tightly. He then applies a laser beam to the skin and the foreskin is excised. Self-absorbing sutures and a disinfectant bandage are applied to the site of exposure.

The operation is performed under local anesthesia and lasts 20-30 minutes. The advantages of laser circumcision are:

Minimal trauma. The laser beam excises soft tissue as smoothly as possible, without cutting, unlike a scalpel. Thanks to this, pain and swelling in the first days after surgery are not so pronounced.
No bleeding. The blood vessels are coagulated by the laser, so bleeding does not occur.
Sterility. Laser radiation heats the layers of the skin, and as a result, all pathogenic microorganisms die under the influence of high temperatures.
Fast recovery. Rehabilitation after laser circumcision lasts several times shorter than after scalpel circumcision. Patients return to their normal lifestyle (with some restrictions) after 3-5 days.
High aesthetic result. After laser circumcision, there are no sutures, scars or scars left, since the edges of the wound are sealed and self-absorbing sutures are applied.
Safety and minimal risk of complications. After laser exposure, it is very rare to experience inflammatory processes and other pathologies, so this method is the safest.

The only disadvantage of this procedure is its relatively high cost - scalpel circumcision is much cheaper.

The scalpel is the main surgical instrument during operations. It is a small, sharp knife used to cut and excise soft tissue.

Before surgery, the patient must be given painkiller injections. Then the penis is tied with a special thread near the head, so as not to accidentally touch tissue with a scalpel that does not need to be cut off.

After bandaging, the surgeon pulls back the foreskin and excises it with a scalpel. After this, self-absorbing sutures are applied to the site of exposure. Previously, soft tissues were blotted with tampons during surgery to stop bleeding. Today, during the operation, coagulators (electrodes) are also used, which cauterize the blood vessels and stop the bleeding.

Comparison

Laser and scalpel are used to remove foreskin penis - this significantly reduces the risk of developing infectious diseases genitourinary system, the hygienic condition of the penis improves (since dirt and various secretions stop accumulating under the head, which are a favorable environment for the growth of bacteria), and sexual intercourse is lengthened.

Both methods are equally popular today. The scalpel method is chosen by many patients, since it is more familiar, and many know its principle of action. However, this method, compared to laser, has a number of disadvantages:

Causes bleeding (but blood droplets are cauterized by electrodes).
There is a risk of infection.
The operation takes 2 times longer.
The doctor may accidentally cut off excess skin.
Longer rehabilitation period (up to 1 month).
Unpleasant sensations after surgery are more pronounced than after laser exposure.

Both laser and scalpel circumcision can be performed any age- the operation is performed even on infants a few days after birth.

The contraindications for both procedures are the same:

Oncological diseases.
Blood diseases, blood clotting disorders.
Immune disorders.
Viral and colds.
Infectious and inflammatory pathologies.
Sexual infections.
Venereal diseases.
HIV and AIDS.
Unhealed injuries in the circumcision area.

After circumcision (by any method), visit the sauna, bathhouse, swimming pool for a while, take a bath (wash in the shower), physical exercise. Restrictions are usually lifted 2 weeks after surgery.

What's better

Today, laser is safer and in a modern way removal of the foreskin - it does not cause bleeding, carefully excises soft tissue, and has a short rehabilitation period. Therefore, it is preferable to choose this method.

The scalpel method is suitable for those who are not willing to pay for the procedure a large amount. Sometimes surgery medical indications carried out free of charge in public hospitals.

Before the operation, you will need to pass some tests (for sexually transmitted infections, HIV, blood and urine tests) and undergo a series of examinations to exclude contraindications. You should also definitely consult your doctor and decide together which method of circumcision to use - laser or scalpel. Sometimes it happens that the foreskin can only be removed with a scalpel. Also, together with the doctor, the patient decides how much foreskin can be removed.

Circumcision must be carried out experienced surgeon. The inexperience of the doctor can lead to serious complications. It is best to pay money and have the operation done in a specialized clinic. It is worth considering that the clinic must have a license.

Lasers have been used in surgical practice for a long time, and many clinics actively use this technology. But patients still wonder how painless and effective it is? Deputy Chief Physician for Surgery of the MEGI network of clinics for adults and children, Doctor of Sciences Aidar Gallyamov gave an interview to the ProUfu.ru newspaper and answered this question.

– How does a medical laser work?

– A laser device is a unique device that emits a thin beam of light. It contains a huge amount of energy that can cut and weld tissue and stop bleeding. The so-called laser scalpel is based on this operating principle.

Using a laser is actually painless and effective, because it provides:

1. The operation is bloodless, since when making an incision, the edges of the dissected tissues are coagulated and the dissected tissues are sealed blood vessels. Blood loss is practically zero.

2. Precision of the surgeon's work. The cut line turns out to be absolutely even, regardless of the density of the tissue (for example, when it hits dense tissue or a bone area, the beam, unlike a conventional scalpel, does not deviate to the side).

3. Complete sterility, it is achieved due to the fact that when manipulating the laser there is no contact with tissues, in addition, the radiation has an antibacterial and antiseptic effect.

4. Painless. Laser exposure It occurs almost painlessly and does not require long-term postoperative rehabilitation.

– There is an opinion that with the help of a laser you can only remove moles, papillomas and treat varicose veins, is this true?

- Only partly. It all depends on the clinic. Some specialize only in these laser procedures, others use laser for more wide range operations. In any case, it is very important which medical laser center you choose. The main thing is that the clinic has the most modern equipment. In Ufa, the MEGI network of clinics for adults and children recently opened a Laser Surgery Center. This center presents the latest equipment: seven semiconductor laser systems, four of them from IPG (IPG), the best in the world in terms of quality and equipment capabilities.

- What is it like? medical use laser radiation in your center?

- By using laser devices at MEGI they can provide you with medical care in the following areas: proctology, urology, gynecology, mammology, surgery, phlebology.

In proctology, hemorrhoids are removed with a laser, fissures in the anal canal are excised, neoplasms of the rectum (polyps and condylomas) are removed; minimally invasive operations and vaporization are performed with the help of a laser hemorrhoids without a single cut.

In urology, endourological laser removal of polyps and tumors is performed Bladder, neoplasms of the urogenital area (polyps and condylomas), are used when performing circumcision. Using a laser to destroy stones urinary tract, this is called contact laser lithotripsy.

In gynecology, lasers are used to remove uterine fibroids and perform ovarian surgeries. It is also used in the treatment of cervical erosion and removal of tumors.

In mammology, almost all operations are performed using laser systems. At cystic mastopathy The puncture method of treatment is widely used - laser ablation of cysts and other neoplasms of the mammary glands.

In surgery, neoplasms of the skin and soft tissues (papillomas, various moles, atheromas, lipomas, fibromas) are removed; used in operations in abdominal cavity(for endoscopic operations, the laser is indispensable for operations on the liver, spleen, pancreas), removing age spots and tattoos.

In phlebology, lasers are used to treat varicose veins, phlebectomy, laser radiofrequency obliteration of veins and “ spider veins", as well as sclerotherapy.

– How to decide to undergo medical laser surgery?

– As a surgeon, I affirm that there is no need to be afraid of the laser. If you have chosen a good clinic with modern operating rooms, where surgical methods treatments are carried out quickly and painlessly for the patient, rest assured excellent result. Our MEGI center has created all the conditions for this. If necessary and desired, in the early postoperative period the patient can spend some time in the ward under the supervision of experienced medical personnel.

The unique properties of laser radiation have made lasers indispensable in a variety of fields of science, including medicine. Lasers in medicine have opened up new possibilities in the treatment of many diseases. Laser medicine can be divided into main sections: laser diagnostics, laser therapy and laser surgery.

The history of the advent of lasers in medicine - what properties of the laser caused the development of laser surgery

Research into the use of lasers in medicine began in the sixties of the last century. At the same time, the first laser medical devices appeared: devices for irradiating blood. The first work on the use of lasers in surgery in the USSR was carried out in 1965 at the Moscow Oncology Research Institute named after. Herzen together with NPP Istok.

Laser surgery uses lasers that are quite powerful and can greatly heat biological tissue, causing it to evaporate or cut. The use of lasers in medicine has made it possible to perform previously complex or completely impossible operations effectively and with minimal invasiveness.

Features of the interaction of a laser scalpel with biological tissues:

No direct contact of the instrument with the tissue, minimal risk of infection.
The coagulating effect of radiation makes it possible to obtain virtually bloodless cuts and stop bleeding from bleeding wounds.
The sterilizing effect of radiation is prophylactic infection surgical field and the development of postoperative complications.
The ability to control the parameters of laser radiation allows one to obtain the necessary effects when the radiation interacts with biological tissues.
Minimal impact on nearby tissues.

The use of lasers in surgery makes it possible to effectively perform a wide variety of surgical interventions in dentistry, urology, otorhinolaryngology, gynecology, neurosurgery, etc.

Pros and cons of using lasers in modern surgery

The main advantages of laser surgery:

Significant reduction in operation time.
There is no direct contact of the instrument with the tissues and, as a result, minimal damage to the tissues in the area of the operation.
Reducing the postoperative period.
No or minimal bleeding during surgery.
Reducing the risk of formation of postoperative scars and scars.
The sterilizing effect of laser radiation allows you to comply with the rules of asepsis.
Minimal risk of complications during surgery and in the postoperative period.

Disadvantages of laser technologies in surgery:

A small number of medical professionals have received special training to work with lasers.
Purchasing laser equipment requires significant material costs and increases the cost of treatment.
The use of lasers poses a certain danger to medical professionals, so they must strictly follow all safety precautions when working with laser equipment.
The effect of using lasers in some clinical cases may be temporary and further surgery may be required.

What laser surgery can do today – all aspects of the use of laser in surgery

Currently, laser treatment is used in all areas of medicine. Laser technologies are most widely used in ophthalmology, dentistry, general, vascular and plastic surgery, urology, and gynecology.

Lasers in dental surgery are used in the following operations: frenectomy, gingivectomy, removal of hoods for pericoronitis, making incisions when installing implants and others. The use of laser technologies in dentistry makes it possible to reduce the amount of anesthetics used, avoid postoperative swelling and complications, and speed up the healing time of postoperative wounds.

The advent of the laser radically changed the development of ophthalmology. Using a laser, you can make ultra-precise cuts down to a micron, which even a very experienced surgeon cannot do. Currently, with the help of a laser, it is possible to perform glaucoma, retinal diseases, keratoplasty and many others.

Laser technologies can successfully eliminate various vascular pathologies: venous and arteriovenous dysplasia, lymphangiomas, cavernous hemangiomas and others. Thanks to lasers, treatment vascular diseases became practically painless with minimal risk of complications and good cosmetic effect.

A laser scalpel is used when performing large quantity operations:

In the abdominal cavity (appendectomy, cholecystectomy, excision of adhesions, hernia repair, resection of parenchymal organs, etc.).
On the tracheobronchial tree (removal of tracheal and bronchial fistulas, recanalization of obstructive tumors of the bronchi and trachea).
In otorhinolaryngology (correction of the nasal septum, adenectomy, removal of cicatricial stenoses of the external auditory canal, tympanotomy, removal of polyps, etc.).
In urology (removal of carcinomas, polyps, scrotal skin atheroma).
In gynecology (removal of cysts, polyps, tumors).

Lasers are also used in. Almost all clinics performing such operations have laser equipment in their arsenal. Making incisions using a laser scalpel allows you to avoid swelling, bruising, and reduce the risk of infection and complications.

It is difficult to name an area of medicine where the properties of laser radiation have not been found effective application. Continuing improvement of laser technologies, training of more and more medical workers to work with lasers, may in the near future lead to the predominance of laser surgery over traditional methods surgical intervention.