SURGERY WITH THE LASER SCALPEL - PHYSICAL AND CLINICAL ASPECTS

Background The conventional surgical method for cutting vascularized t issue with scalpel and scissors may now be improved by use of the lase r scalpel. In particular, the frequent interruptions necessitated and the poor visibility caused by bleeding may be mitigated owing to the h aemostatic properties of laser light. This instrument may be of partic ular value for tasks involving extrabulbar structures, such as extraoc ular muscles and lacrimal tissue, as well as for facial surgery. Mater ials and Methods The mode of action and physical properties of a new l aser scalpel are described and its characteristics compared with those of other instruments on the market. The probe consists of a clad, scu lptured silica fibre with a core diameter of 0.6 mm and a conical 0.15 mm-diameter cutting tip. Radiation generated by a low cw-Nd:YAG laser module is fed into the probe, at the exit point of which a maximal po wer density of 57 kW/cm2 is attained. Radiated laser energy penetrates the tissue as an incision is made, thereby inducing an efficient bloo d flow stasis which is amplified by thermal energy diffusing from the immediate surroundings of the scalpel tip. Results In this report, the laser scalpel is implemented for the excision of a vascularized, amel anotic, facial naevus. Both the cutting and haemostatic effects were f ound to be excellent, occurrence of the latter phenomenon being suppor ted by ultrastructural findings. The healing response was comparable t o that observed after conventional surgery. Conclusion The new laser s calpel represents an inexpensive and effective cutting and haemostatic tool powered by a standard cw Nd:YAG laser module, with a wide spectr um of potential applications.