Endoscopic Laser Surgery versus Serial Amnioreduction for Severe Twin-to-Twin Transfusion Syndrome

Monochorionic twin pregnancies complicated by severe twin-to-twin transfusion syndrome at midgestation can be treated by either serial amnioreduction (removal of large volumes of amniotic fluid) or selective fetoscopic laser coagulation of the communicating vessels on the chorionic plate. We conducted a randomized trial to compare the efficacy and safety of these two treatments.
Methods
Pregnant women with severe twin-to-twin transfusion syndrome before 26 weeks of gestation were randomly assigned to laser therapy or amnioreduction. We assessed perinatal survival of at least one twin (a prespecified primary outcome), survival of at least one twin at six months of age, and survival without neurologic complications at six months of age on the basis of the number of pregnancies or the number of fetuses or infants, as appropriate.
Results
The study was concluded early, after 72 women had been assigned to the laser group and 70 to the amnioreduction group, because a planned interim analysis demonstrated a significant benefit in the laser group. As compared with the amnioreduction group, the laser group had a higher likelihood of the survival of at least one twin to 28 days of age (76 percent vs. 56 percent; relative risk of the death of both fetuses, 0.63; 95 percent confidence interval, 0.25 to 0.93; P=0.009) and 6 months of age (P=0.002). Infants in the laser group also had a lower incidence of cystic periventricular leukomalacia (6 percent vs. 14 percent, P=0.02) and were more likely to be free of neurologic complications at six months of age (52 percent vs. 31 percent, P=0.003).

Lasers in Gynecology

The laser is gaining acceptance as a surgical tool by surgeons in all disciplines. As this energy transfer system is explored and tested, its potential applications in medicine become increasingly apparent. In gynecology, the laser is being used with much success by colposcopists in the management of neoplastic disease of the cervix, vagina, and vulva.

It has also been adapted to the operating microscope for reconstructive surgery of the female reproductive tract.

Laser application in obstetrics and gynecology

Laser therapy in gynecology and obstetrics is well established. CO2 laser devices are used in the treatment of vulvarand cervical lesions such as condylomata acuminata and intraepithelial neoplasia.The main advantage is a better cosmetic result(noscars,very accurate preparation). Nd:YAG laser energy can be used for endometrium ablation but the main focus lies on the treatment of twin-to-twin transfusion syndrome in monochorionic twins.The application of laser therapy in gynecology and obstetrics is being progressively challenged by the development of high-frequency electric surgery. In the early 90s,coagulation by laser was considered to be the gold standard in gynecology and obstetrics. With the enormous improvements in high-frequency electric surgery,the clinical focus may change away from the laser towards high-frequency electric surgery [6]. Concerning clinical handling and practicability at our department high-frequency electro surgery has proven as the method of choice for endoscopic ablative procedures[38]. In hysteroscopic surgery high-frequency electric surgery can be considered as an equivalent alternative to laser, where as the treatment of vulvar and cervical lesions as well as intrauterine therapy of twin-to-twin transfusion syndrome is still considered to be advantageous using laser energy.

Treatment of herniated lumbar disc by percutaneous laser disc decompression combined with synchronous suction technique through syringe

To compare the outcomes of percutaneous laser disc decompression(PLDD)and PLDD with synchronous suction through syringe in the patients with herniated lumbar disc(HLD).
Methods: Forty-two patients with HLD on MRI and those who did not respond to conservative treatment for 6 weeks were randomly divided into group A and group B. In group A,the patients were treated with PLDD and those in group B with PLDD and synchronous suction through syringe. GaAIAS diode laser at 810 nm was used for the ablation in both groups. The treatment effect was evaluated by modified MacNab’s criteria on the 7th,30th and 90th day.
Results: Evaluated by modified MacNab’s criteria, the percentages of the excellent and good cases in total patients treated for group B and A were 80.95%and 57.14%on the 7th follow-up day,85.71%and 66.67%on the 30th follow-up day, and 95.24%and 71.43%on the 90th follow-up day,respectively. Conclusion: Synchronous suction technique through syringe during PLDD improves the overall outcome in the treatment of herniated lumbar disc.

Minimally invasive treatment combined with a well-tolerated, low-cost procedure in the treativent of HLD(hemiated lumbar disc)has been developed to offer good clinical results. Percutaneous laser disc decompression(PLDD)is one of the minimally invasive treatments currently available. The role of PLDD for the treatment of contained herniation has been widely assessed[1-3].Choy first reported PLDD in 1984 for minimally invasive therapy of lumbar disk hernia[4,5].Lasers vaporize a small portion of the intervertebral disk, thereby reducing the volume and pressure of the affected disk. Successful rates of PLDD in larger studies vary from 75%to 87%[6,7].Because of insufficient improvement 2 of symptoms or recurrent herniation, 4.4%to 25%of the patients received additional surgical treatment[2,3].In order to increase the therapeutic effect of PLDD we combined PLDD with synchronous suction through syringe. The aim of this study was to compare the outcomes following PLDD and PLDD with synchronous suction through syringe.

Experimental basis of percutaneous laser disc decompression

Percutaneous laser disc decompression (PLDD) is one of the so-called “minimally invasive” treatment modalities for lumbar disc herniation. The treatment is performed percutaneously; therefore, morbidity and convalescence period are postulated to be less than for conventional surgery. Because of the minimally invasive nature and the fact that return to work is usually possible within a few days after treatment, PLDD appears to be an interesting alternative to conventional surgery. However, PLDD still encounters a considerable amount of skepticism. Opponents usually dismiss PLDD as being an experimental treatment with unproven efficacy, while those advocating the use of PLDD tend to present it as some kind of miracle treatment. While well-designed clinical trials focusing primarily on the efficacy of PLDD are scarce [1], the amount of preclinical studies investigating the technical and biophysical aspects of PLDD has been growing steadily since its introduction in the late 1980s. By grouping the results of these preclinical trials, this review attempts to provide a comprehensive basis for further clinical research.

Comparison of the bio-heating effectiveness to nucleus pulposus between 1064nm Nd YAG laserand 980nm diode laser

Percutaneous laser disc decompression(PLDD) was firstly introduced by Choy in 1987,Choy and Ascher reported the experiment outcome and the clinical application in 1987. Since then,PLDD has been generalized all over the world, lots of basic study and clinical cases have been reported one after another. PLDD is the product of laser technique and medical science,it’s a effective,micro-invasive skill to cervical spondylosis and lumbar spondylosis. The rudiment of PLDD is to vaporize the nucleus pulposus using the laser which is inserted into disc under X-ray or CT, then decrease the pressure of disc to make the herniated disc recovery,decrease the pressure on nerve root to improve the symptom.There always has a focus about which kind of laser to use in PLDD and how about the safety. At present,the 1064nm Nd:YAG laser and the 980nm diode laser are used widely in PLDD,they both have the close wavelength,but the comparison of bio-heating effectiveness to nucleus pulposus between them have seldom been seen. The fresh goat intervertebral lumbar discs were radiated by Nd:YAG laser and 980nm diode laser in this study, the ablated quality of nucleus pulposus and the morphous of the cavity after radiating and the changes of temperature around discs during radiating were observed to compare the ablation ability to nucleus pulposus and the safety between two lasers.

Clinical application of percutaneous laser disk decompression

To evaluate the therapeutic effects of lumbar disk herniation treated by semiconductor laser. Methods One-hundred cases of lumbar disk herniation diagnosed by clinic and CT or MRI within three months underwent percutaneous laser disk decompression, including 65 cases of L4-5 and 35 cases of L5-S1 disk. Results In this group of patients, the successful rate of penetration was 100% and the rate of efficiency was 72%. There was no complication in the following 6-18 months. Conclusion Percutaneous laser disk decompression with semiconductor laser was a convenient, safe, efficient and minimally invasive technique.

In recent years, the author of semi-conductor laser therapeutic apparatus using percutaneous laser disc decompression (percutaneous laser disk decompression, PLDD) treatment of lumbar disc herniation, has achieved some results. Automatic aspiration of the technology and compared to excision, a simple, safe, injury, etc., are presented below.

100 cases of 100 patients with intervertebral disc, the success rate of puncture was 100%, follow-up period was 6 to 18 months. Reference MacNab [1] to evaluate the standard cure, 72% efficient. Of which 22 patients were cured and 50 cases of effective, 28 cases were followed up for 6 months without improvement in symptoms was considered null and void, without any complication. According to the affordability of different patients, respectively after 3,6 months or 1,3,6,12-month CT or MRI follow-up visit, some cases (24/100) 1 month for only the performance of the Department of nucleus density circular lower three months after the performance of some patients to varying degrees for the disc back to Steiner (49/100), part of cases (23/100) had no significant disc back satisfied, but to improve symptoms in varying degrees.

Transcanalicular diode laser-assisted dacryocystorhinostomy

Objective: We present a prospective, non-comparative case series study of 126 consecutive diode laser-assisted transcanalicular dacryocystorhinostomy (TCL-DCR) procedures on 122 patients. We analyzed success rate, procedure time and amount of laser energy needed for a 5 mm osteotomy.

Materials and Methods: One hundred and twenty-two patients with nasolacrimal duct obstruction were included in the study. The procedure was performed under general anesthesia, and the nasal mucosa was anesthetized. An endoscope was used for examination of the lacrimal pathways. The site of osteotomy was determined with transillumination of the lateral nasal wall. We achieved osteotomy by applying laser energy via an optic fiber. We used a 980 nm diode laser with power of 10 Watts. We inserted a bicanalicular silicone stent as the last step. Success of procedure was absence of epiphora (subjective), or patency of the lacrimal drainage system on irrigation (objective).

Results: We performed 126 successive endoscopic laser (EL-DCR) with bicanalicular intubation in 122 patients. The average procedure time was 12 min, and on average 245 Joules of laser energy was needed. The silicone stents were removed three to eight months after surgery. We observed absence of epiphora and a patent nasolacrimal duct on irrigation in 105 out of 126 treated eyes. Eighteen patients had epiphora despite a patent nasolacrimal duct on irrigation. This yields a success rate of 83.3%, with an average follow-up period of 12 months.

The minimally invasive surgical treatment of nasopharyngeal angiofibroma

Nasopharyngeal angiofibroma better method of minimally invasive surgery. Methods: 4 cases of nasopharyngeal angiofibroma using endoscopic techniques supplemented by arterial embolism, anesthesia and controlled hypotension by means of semiconductor laser therapy lessons. Results: 1 case of bleeding 3 000ml, residual tumor, further into the way the hard palate and root of nasopharyngeal angiofibroma excision. The other 3 patients were cured, the blood loss 100 ~ 500ml, no postoperative complications, up from 4 to 31 months without recurrence. Conclusion: The endoscopic treatment of nasopharyngeal angiofibroma is a better method of minimally invasive surgery. It should be noted the choice of indications, adequate preoperative preparation and intraoperative certain operating skills Key to successful operation.

Nasopharyngeal angiofibroma is a rare benign tumor occurs in adolescent males, tumor blood vessel-rich, easy bleeding, also known as “male puberty bleeding nasopharyngeal angiofibroma.” Disease of unknown cause, because of primary base of the skull, part of deep, strong expansion of tumor growth, bleeding fierce, sinister clinical manifestations. Treatment based on surgery, surgery is difficult, prone to complications.

Semiconductor laser treat chronic rhinitis under nasal endoscope

In clinical work, but not for chronic rhinitis and sinusitis patients, often with conventional surgery, electrocautery, microwave, freezer and other treatment [6]. Drawback is that easy to intraoperative and postoperative bleeding, local tissue reactions after re-take repeated dressing changes 2 to 3 weeks.
Semiconductor laser is just the last few years developed a new generation of lasers, it not only inherits the YAG laser less bleeding, shorter operation time, trauma, etc, and also has equipment small size, high power, easy to operate, through the optical fiber into operation field, no cooling device, the advantages of moving at any time, by many scholars of all ages. Author with endoscopic guidance, vision clear, the back end of the nasal cavity lesions were visible range. In operation, the author found that the semiconductor laser has its own unique advantages. First, it overcomes ,CO2 laser can not be conducted by the shortcomings of optical fiber and semiconductor laser fiber small, flexible operation at any angle and inferior turbinate contact any shaping operation can be of inferior turbinate, nasal ventilation to expand the area to establish an effective airway. Second, with the YAG laser compared to the penetration depth of about 1 ~ 2 mm, while the YAG laser is 4 ~ 6 mm, so the surrounding tissue may result in less chance of injury, this group of patients after nasal edema and infiltration a relatively light, fewer dressing changes, patients recovered rapidly. Third, its a light touch can reduce the inconvenience of surgery in the light focus, not damage surrounding tissue, to facilitate accurate operation. Semiconductor laser wavelength 810nm, very close to the infrared part of the machine’s electro-optical conversion rate is high, it solidified the role of blood vessels better. The gasification and solidification of the function to less bleeding. The group of 32 patients without bleeding in one case the situation more or repeated bleeding. However, allergic rhinitis or accompanied by severe septal deviation, turbinate bone hypertrophy, a simple semi-conductor laser treatment can not improve the nasal congestion, must be combined with other treatments.

Semiconductor laser therapy on the recurrence rate of nasal polyps

Principles of treatment of nasal polyps surgery mainly at home and abroad, according to statistics in recent years, the recurrence rate as high as 15% ~ 25%, how to solve the problem of recurrence of nasal polyps is the key to treatment. Some scholars, research has confirmed that ND-YAG laser, CO2 laser surgery can effectively reduce the recurrence rate of nasal polyps, but the recurrence rate of the semiconductor laser on the impact of nasal polyps, at present there is no research in this regard. High-power semiconductor laser is the second ND-YAG laser, CO2 laser, after the latest generation of medical knife, it can not be overcome by the CO2 laser fiber conduction defects, 810nm semiconductor laser coagulation is a ND-YAG laser two-fold. Its energy can be bent by the optical fiber transmission to the laser probe, part of the energy absorbed by a special probe for the vaporization organization; another part of the energy from the probe revealed a starting role in coagulation to stop bleeding, so that a certain proportion of the energy distribution, enabling vaporization and coagulation to stop bleeding at the same time, blood loss less easy to control the border, resulting in less smoke. This operative field clear and easy to complete removal of polyps, especially for olfactory cleft, middle turbinate back-end, the rear nasal septum, inferior turbinate, and other deep in the back-end, small area. As the semiconductor laser fiber-optic endoscopy and the space occupied by a relatively small, flexible operation, and can minimize the damage to the surrounding normal tissue, and without postoperative nasal packing, easy to patients, which is lower than conventional surgery one of the reasons the relapse rate. As the laser energy is highly concentrated and thus less damage on healthy tissue, postoperative congestion and edema, pain and other reactions lighter, secondary complications, less bleeding and nasal adhesion, medication less frequently, patients recovered faster .

Endoscopic laser treatment under the care sinus cyst

The group of 26 patients, including 15 males and 11 females, aged 33 to 71 years. Were confirmed by CT or MRI, pathology for the mucocele. Ethmoid cyst in 11 cases, frontal sinus cyst in 8 cases, 5 cases of sphenoid sinus cyst, 2 cases of cysts butterfly screen; paper sample of 24 cases of bone destruction, destruction of sella broke into the middle cranial fossa in 1 case. 26 patients were dizziness, headache, blurred vision, decreased visual acuity, eye shift. Surgery under local or general anesthesia. Ethmoid cyst: 0 ° endoscopic resection of the uncinate process, ethmoid bulla open, open, while fully exposed before and after the ethmoid anterior cyst wall, the semiconductor laser resection and bone wall to flush stoma. Sphenoid sinus cyst: 0 ° endoscopic laser ablation of the posterior part of the middle turbinate anterior sphenoid sinus exposure, locate the sphenoid sinus opening as a center around the laser ablation of sinus mucosa, point by point to bite than an open sinus bone, laser resection wall. Frontal sinus cyst: a thorough screening before opening fully open frontal sinus openings, in the 30 ° endoscope to the bottom wall of the frontal sinus expanding bite addition to bone, laser ablation of the wall. After all expansion foam packing, 48h after the extraction. Under the periodic dressing of conventional endoscopy, blood around the stoma clean scab, secretions, mucous membrane vesicles, and edema. Postoperative results were satisfactory, dizziness, headache, ocular symptoms improved significantly improve visual acuity in 20 cases, five cases of recurrence after reoperation, three cases of orbital hemorrhage after 1 week after treatment were cured. Follow up of 1 to 5 in both sinus drainage was adequate and no cyst recurrence.

Laser photocoagulation treatment of hemorrhoids vaporization clinical study

Objective: To evaluate laser vaporization of pure solidification method hemorrhoids treatment clinical efficacy. Methods: 83 patients underwent laser treatment for hemorrhoids and conduct effective analysis. Results: 83 patients with anal margin of postoperative edema subsided after 2 ~ 3 d, and healing, mixed hemorrhoids and external hemorrhoids 5 ~ 6 d necrosis, 8 ~ 10 d healing. Conclusion: Laser treatment of hemorrhoids effective, reliable, low preoperative preparation, surgery is simple, postoperative pain and light, less pain, is a safe and feasible method of treatment.
Hemorrhoid treatment after several hundred years of development, types have been varied, the treatment associated with an endless stream. We use laser vaporization solidification method to treat hemorrhoids, simple operation, operative time is short, minimally invasive technology, the patient less pain, fewer operative and postoperative bleeding, operative field clear, easy to miss lesions, relapse rate is low, the clinical efficacy of reliable, these are as follows.

Hemorrhoids surgery treatment for three degrees, four degrees internal hemorrhoids or mixed hemorrhoid, external hemorrhoids is still used in treatment of internal hemorrhoid ligation and stripping method is applied circular ring hemorrhoid hemorrhoidectomy, but the surgical treatment of large wounds, bleeding and more Yi infection, anal stenosis, fecal incontinence, urinary retention and other complications, which indications for surgery should be strictly controlled. With the in-depth understanding of the disease, new treatments endless, mucosal protective agents (commonly used in anal suppositories for Carraghenates), infrared irradiation, copper ion electrochemical treatment [1] and the application of stapling device.

The Diode Laser in an ENT Practice

For almost 15 years, I have been operating a surgical ENT practice between Potsdam and Berlin, and have been based at the “Ärztehaus am Rathausmarkt” medical center in Kleinmachnow for approximately five years. We have frequently hosted laser workshops here (and, since 2008, in Babelsberg), for fellow ENT specialists interested in this subject. Most of our workshops are attended by an international group of experts. The majority of participants has previously used conventional surgical methods and is interested in expanding their surgical expertise by learning what can be achieved with diode lasers.

At these workshops, I always use a diode laser manufactured by biolitec AG in Jena for demonstration purposes. For approximately the past thirteen years, I have been making regular and extensive use of this laser to enhance and perfect the range of surgical procedures I offer in my places of work (a private and “panel” practice with out‐patient laser clinic, an out‐patient surgical center and a private hospital in Potsdam). Before deciding in favor of this particular laser, I spent some considerable time testing virtually all of the leading laser systems on the German market that are of relevance for out‐patient ENT surgical treatment. During my clinical training, most of my experience as head of laser therapy at the ENT clinic in Potsdam was with CO2 lasers. Under the expert guidance of Herr PD Dr. med. Gundlach, my supervisor at that time, I focused my attention in particular on the use of CO2 lasers in conjunction with modern scanner systems in the surgical treatment of tumors in the ENT field.

Effect of diode laser coagulation treatment on grade III internal hemorrhoids

Objective : To evaluate the curative effects of diode laser coagulation on grade III internal hemorrhoids .
Methods : From March 2004 to December 2004,86 patients with grad III internal hemorrhoids were divided into two groups, received laser coagulation(laser group, n=64) or received hemorrhoidectomy (control group, n=40 ). Complications , symptom relief ,pain scores and satisfaction scores were compared between the two groups six months after operation.
Result : Pain scores were lower in laser group than that of the control group on the first day and seventh day after operation. Small amount of bleeding occourred in the laser group(12 cases) and control group(35cases), however,non of them required special hemostasis. Laser coagulation and closed hemorrhoidectomy were equally effective in controlling symptomatic prolapse. There was no difference in terms of continence scores and patients’ satisfaction between the two groups (P>0.05).
Concludion : Diode laser coagulation can be considered as a safe and effective procedure for the treatment of grade III hemorrhoids.

Comparison of Semiconductor laser Cordectomy and Partial Laryngectomy

Objective To explore the efficacy of semiconductor laser for T1N0M0 glottic carcinomas by transoral endoscopie.
Methods 10 patients with biopsy-proven T1N0M0 glottic carcinomas were treated with semiconductor laser by transoral endoscopie. The techniques used for laser cordectomies were in accordance with the classification proposed by the European Laryngological Society in 2000. 1 was in type Ⅰ, 3 were in type Ⅱ, 2 were in type IV , 4 were in type V. It was comparied and studied with 14 patients who had been applied with partial laryngectomy during the corresponding period. The patients had been proven in T1N0M0 glottic carcinoma by biopsy.
Results The group treated by Diode laser had shorter operation time , less bleeding in the operation , and shorter postoperative days in hospital than that of the group with part laryngectomy. No patient had tracheotomy or gastrogavage in laser group. No cases were recurrented in both groups.

Diode laser in uvulopalatopharyngoplasty

To explore the therapeutic effect of diode laser in uvulopalatoplasty. Methods: Laser assisted uvulopalato-pharyngoplasty(LAUP) were performed on the patient suffering from obstructive sleep apnea syndrome(OSAS).The apnea hypopnea index(AHI),SaO2and clinical symptoms before and after treatment were observed. Result: The therapeutic effect was high, with less bleeding, quick recovery and few complication.
Conclusion :diode laser for UPPP can enlarge the horizontal air passage of soft palate.

Surgical treatment of obstructive sleep apnea syndrome (OSAS) The purpose is to narrow the site of the upper airway to expand [1]. Laser cutting has a good function and hemostatic function, can be used to uvulopalatopharyngoplasty (UPPP). April to August, 2006 our hospital 30W diode laser uvulopalatopharyngoplasty surgery (LAUP) 29 cases, there is efficiency of 86.21%.

Clinical observation of the effect of semiconductor laser treatment on 39 case of vocal cords leukoplakia

It has been reported Nd: YAG laser treatment of benign laryngeal lesions reported, but the treatment of laryngeal benign lesions, high-power semiconductor laser has its own unique advantages. On the one hand semiconductor laser with a wavelength of 810nm, is different from the traditional YAG / KTP solid-state laser (wavelength 1064nm and 532nm), 1064nm wavelength (YAG) laser coagulation effect is better, but vaporization ineffective, 532nm wavelength (KTP) laser vaporization effect of a more Well, while the coagulation effect is not ideal. 810nm wavelength laser can simultaneously complete the vaporization and coagulation to achieve the best results. Because of organizational absorption of light in the 810nm wavelength than in the 1064nm wavelength is about 3 times higher, so with the traditional Nd: YAG laser compared to absorb the good, low power required for surgery, operative time is short. On the other hand there are a variety of semiconductor laser mode, which can be in the treatment of disease according to the size and nature of the different work practices. In the irradiation through an effective, natural carbonation probe surface membrane, increased evaporation, solidification rate, avoiding the traditional cutting YAG laser probe due to adhesions often slipping phenomenon. In the non-contact mode, vaporization, coagulation depth is determined by the nature of laser and organization, Rastegar study of the semiconductor laser and Nd: YAG laser on the effects of different tissues, indicating the depth of the semiconductor laser projection of Nd: YAG laser transmission depth of half the This means that semiconductor laser irradiation on the surrounding tissue more secure. In the temperature effect study found that the surface of the semiconductor laser in the organization of the temperature is 150℃, while the Nd: YAG laser compared to 95 ℃, and thus the semiconductor laser energy more concentrated. From the changes in temperature and organizing in-depth analysis of the semiconductor laser temperature curve steep, that is, the temperature dropped rapidly, while the Nd: YAG laser temperature drop will slow. As the solidification temperature of hemostatic effect is caused by decreased drastically, which explains why the semiconductor laser over Nd: YAG laser coagulation hemostasis good effect, while the depths of the organization more secure.

Application of semiconductor laser in endoscopic transnasal dacryocystorhinostomy

The use of endoscopic sinus STORZ Germany, 0 °, the diameter of 4mm. National production of semiconductor lasers, wavelength (810 ± 10) nm, output power of 1 ~ 30 W, fiber diameter of 400 or 600μm, optical head can be aimed at red light, a diameter of 635 nm, used for positioning, no damage to the mucosa. DCR stoma Office location: (1) middle turbinate axilla as a reference point, away from the top of about 2 Department for the lacrimal sac mm stoma Department; (2) small laser fiber by the heart-rending, the tears of small tubes inserted Entry to the lacrimal sac, through the observation of optical fibers of the red hair targeting light to determine the lacrimal sac Lateral wall of the nasal cavity is the projection Office stoma. All patients were using local anesthesia, nose Nasal septum in the first endoscopic submucosal resection of nasal septum surgery, and then Select continuous mode laser conditioning, power for 8 ~ 12W, with laser cut nose Hill Mucosa, lacrimal sac exposed position, the 11 cases in which the direct use of the laser (more than 15 cases of At the same time with osteotome use) to remove the parts of bone, bone-wall windows of about 10 mm × 8 mm, to exposure to tear blue wall to wall tear up lacrimal probe, Uncinate process cut open with wall to wall tears after the expansion of the diameter of 8 ~ 10 mm. Incision on both sides of the tears turned to the wall, using laser wall will tear around the nasal mucosa and mucosa welding, punishable stoma filling gelatinsponge particles. With three cases of preoperative lacrimal probe found that heart-rending exploration of small spinal stenosis, surgery canalicular Probing of the narrow tube and nasal lacrimal sac into the expansion tube stoma and fixed in the lateral wall of nasal cavity; more than 23 cases of non – put expansion tube. Deviation of nasal septum in patients with postoperative nasal packing line, 1 ~ 2 d after the pull-out.

Serum lipid changes following laser lipolysis

Widely used in Europe and Latin America, laser lipolysis (also called laser lipoplasty) was introduced in North America in 1994 (1,2). Laser lipolysis with a pulsed 1064-nm Nd:YAG laser and more recently with a continuous wave (CW) 980-nm diode laser has proven to be a safe and effective method (3–5). After adequate infiltration of an anesthetic solution, a flexible fiber optic delivered through a small caliber cannula is inserted inside fat tissue. Trans-illumination from a red aiming beam makes the 1-mm cannula easily visible. Laser energy is transmitted to and absorbed by the adipocytes, leading to volume expansion and rupture (6). Histologic analyses of the effects of lasers on human fat tissue have shown areas of reversible cellular damage (tumefaction), irreversible tissue damage (lysis) and a reduction in bleeding when compared to conventional liposuction (7–9).

The safety of the procedure has been addressed regarding patient selection, complications and results (3–5). Little is known about the impact of laser lipolysis on lipid metabolism during and immediately after the procedure. This study aims to evaluate, in patients operated on for large-volume laser lipolysis, the levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides at different intervals after the procedure (1 day, 7 days, 14 days and 30 days).

Laser Lipolysis With a 980 nm Diode Laser

Laser lipolysis is designed to provide selective adipose damage, while simultaneously facilitating fat removal, enhancing hemostasis and increasing tissue tightening. The procedure is increasingly gaining recognition as an effective, non-surgical solution for reshaping specific body areas.
Laser lipolysis should not be regarded as a replacement for traditional liposuction, nor should it be seen as an alternative to a traditional weight loss regimen. Its role is to treat localized fat deposits (e.g., hips, flanks, etc.) that have shown resistance to diet and exercise. In addition, laser lipolysis can be used to correct body asymmetries (e.g. asymmetry of the knees, male breasts, etc.) or irregular contour (e.g. due to prior liposuction).
Historically, lasers have been used to target relatively small structures, such as blood vessels and pigment; fat deposits represent a much larger target and require a different focus. Targeting adipose tissue requires one to heat a large volume of tissue; therefore, it is crucial that the wavelength used can propagate adequately into the tissue allowing for enough absorption to maintain sufficient control of the heated area. The heat generated in the fat should transmit to the skin in order to maximize the controlled heating of the skin. The controlled temperature rise in the skin is necessary to achieve optimal skin contraction. Finally, the ideal wavelength should also have the ability to seal small blood vessels which minimized blood loss during the procedure.

Laser lipolysis versus traditional liposuction for fat removal

Liposuction is second only to breast augmentation as the most commonly performed cosmetic procedure in the USA. Liposuction removes fat through very small skin incisions, with atraumatic, blunt-tipped cannulas. Simplicity, quality of results and relatively rare complications are but a few benefits that explain its success. Its main limitation is the minimal skin retraction achieved after the procedure. Laser lipolysis is based on a thermal effect. The laser can vaporize, melt tissues and coagulate blood vessels. More importantly, the laser stimulates the formation of collagen in the region, enhancing skin elasticity and promoting skin contraction in the treated areas. This review aims to describe traditional liposuction and laser lipolysis, and discusses the difference between the two techniques.

Versatility of an 810nm Diode Laser in Dentistry

The breakthrough for dental laser systems came in the mid 1990’s. Among the various laser types with corresponding wavelengths, diode laser systems quickly began establishing themselves as compact, competitively priced and versatile additions to the dentist’s repertoire, predominantly for performing soft tissue applications. Research has shown that near infrared (NIR) wavelengths are ideally suited for numerous soft tissue procedures due to their high absorption in hemoglobin. This fact gives NIR laser the ability to precisely and efficiently cut, coagulate, ablate or vaporize the target tissue. The added advantage of laser performed surgical procedures is the sealing of small blood and lymphatic vessels, resulting in hemostasis and reduced post-operative edema, disinfection of target tissue due to local heating and production of eschar layer and decreased amount of scarring due to decreased post-operative tissue shrinkage. Among the available NIR wavelengths, research has shown the wavelengths around 810 nm to be one of the most versatile with regard to the number of possible treatment options, as this wavelength range can be effectively used in the field of soft tissue surgery, periodontics, endodontics, implantology and tooth whitening. The versatility of the instrument, combined with the latest achievements in diode laser technology, compact design and affordability, should appeal to dental professionals seeking to optimize the procedures they currently perform and expand the number of services they offer.

Low level lasers in dentistry

A wide range of different lasers are used in modern dentistry. The Erbium:YAG laser has a potential of replacing the drill in selected situations; the carbon dioxide laser is a valuable tool in oral surgery; the Argon laser is used in minor surgery and composite curing; the Nd:YAG is used in pocket debridement, tissue retraction and more. This is just to mention a few of the possibilities of the dental laser.
The major drawback so far has been the high cost compared to the conventional therapies and the fast development in the field. The high cost of the investment may not have paid off until the next generation of lasers is on the market. So far the majority of the dentists using lasers are mainly the entrepreneurs and the enthusiasts.
All the above listed lasers are using, or have the possibility of using high powers, ranging from fractions of a watt to 25 watts or more.
Interest from media and patients has been considerable during the last decade, party because of a general interest in “high-tech” and partly because of the eternal dream about an escape from the discomfort experienced in the dental chair.

Lasers in Periodontal Therapy

For patients who are concerned about conventional blade surgery for treatment of periodontal disease, the new laser treatment can be a life-changing event. They’re able to save their teeth, preserve their natural smile, and avoid the potentially life-threatening systemic effects of untreated periodontal disease. Laser treatment gives these patients another option.We are the first and currently the only periodontal practice in Philadelphia to offer this new laser treatment. We look forward to participating with you in laser treatment planning for your patients. Of course, we welcome your questions,comments and suggestions.

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