Laser application in medicine

Lasers are useful in medicine for two

reasons: 1-their amazingly high
temperatures 2-
and their incredible precision.
As illustrated below
1-Their ultra-high temperatures allow pulsed-
energy laser beams (aka excimer lasers) to
literally vaporize organic matter on contact -
a self-cauterizing cut that leaves no rough
edges and no burnt tissue; the target matter
is literally there one instant and gone the
next. One can imagine how useful this might
be in getting perfect fits between metal
prostheses and bone.

2-The incredible precision allows for such

things as the virtually molecule-by-molecule
removal of tissue such as that found in a
brain or spinal cord to remove tumors or
scars from old injuries.

-Cancer detection and treatment I

Photo dynamic therapy
Besides thermal and mechanical effects, laser can
also induce chemical effects witch are used for
photodynamic therapy (PDT) a photo sensitive
drug is administrated to a patient and then is
.selectively accumulated in cancerous tissues
When the tissue is illuminated by a particular
wavelength
The drug in the cancerous tissue will emit
fluorescence light disclosing the presence of the
malignant tissue (fisher et al 1995) in this way defuse
.deseeded tissue can be detected

Depending on the drug, another particular

wavelength can be used to induce the chemical
process that release a toxic component which kills
the malignant cells that contain the drug
For this therapy it's important that the target tissue is
illuminated as uniformly as possible
Special defusing fiber tips have been developed that
.are optimized for the geometry of the target organ
.These are usually spherical or cylindrical
The power density of the tissue surface should
exceed the threshold level for activation
Of the photodynamic drug in the tissue, but the heat
input shouldn't result in hyperthermia
Usually the tissue is exposed to several hundreds of
milli watts /square cm for several minutes the power
should also be limited to prevent damage to the
defusing tip sense a part of energy is absorbed in the
.defusing material
At this time
The only PDT approved in most contras is photofrin
This drug is activated near 630 nanometer which is
commonly generated with argon- ion-laser-pumped
dye laser whoever dye lasers pumped with pulsed
laser systems like copper vapor frequency –doubled
Nd: YAG (KTP) and excimer lasers are also attractive
(because of there efficiency (over 30%
A side effect of photofrin is that the patient is not
allowed in bright daylight for several days up to
weeks since the drug also sensitizes the skin
New generation PDT drugs with less side effects are
already under clinical investigation
Fisher et al 1995) they can be exited with the near)
IR wavelengths of diode laser
Such lasers are much preferred to the bulk laser
currently in use
Clinical trails with PDT drugs are being performed to
treat cancers in the skin, lungs, oesophagus, bowels
and bladder and the results are promising

Illustration of laser and treatment of

cancer cells
The results are promising

Dermatology and aesthetic

surgery
Localized superficial skin lesions
Focusing hand pieces coupled to CO2 lasers are used
for precise vaporization of skin Lesions like warts and
.condilomata

The hand-pieces have relative short focal length lenses

.((100-150
The spot size on the tissue will be determined by the
focal length and the distance between the lens and the
tissue
Since the power density is proportional to the square of
the distance from the focus
The distance is very critical for a controlled tissue
.effect
Typically over a distance of several centimeters the
spot size ranges from 0.1-3mm
A900 fold variation in power density to keep the power
density constant a combination
Of two lenses is used to create a collimated beam
These collimation hand pieces decrease the diameter of
the beam, while
The spot size is fixed and relatively independent of the
.distance to the tissue

Large superficial skin lesions

Wrinkles of the skin can be smoothed by scanning a
carbon dioxide laser beam across the skin (Weinstein
1994). This application has recently become very
popular in aesthetic surgery within 45 minutes the
whole face of the patient can be treated using the
.scanning device to remove the epidermis

.Although the superficial skin is peeled ablation

There may Also be a considerable thermal effect
The heating induces shrinkage of collagen strings in the
dermis resulting in a stretching of the wrinkles at the
surface
its still unknown what will happen to the thermally )
(damaged collagen in the future

The scanning system consists of reflectors on a two

axis system, which irradiate large surface area quickly
and in a controlled manner from a distance using a
.processor-controlled pattern
This pattern can either be preset from a menu of
options or programmed for a specialized treatment. The
tissue is irradiated more evenly, more accurately and
.faster than can be achieved manually

Co2 laser scanning devise

Depending on the type of carbondioxid laser there are
two strategies
In case of continuous wave co2 lasers ablative-1
temperatures are obtained instantly, by focusing the
beam to a small spot with a very high power density
the beam is moved in spiral shape at high speed to
obtain a superficial ablation and even surface

For pulsed co2 laser systems the scanners have a

choice of pre-set patterns with adjustment for size and
overlap between individual spots in combination with
the pulse energy and repetition of the pattern the
ablation depth and adjacent thermal effects can be
controlled
The speed of tissue ablation over a large surface is
impressive

(Vascular lesions (port wine stains

Port wine effect are caused by an excess of blood

vessels near the surface of the skin these can be
preferentially destroyed by using a laser wavelength
.that is strongly absorbed by the blood
The leather beam is scanned across the surface in a
controlled manner
Various scanning systems have been developed for
the selective treatment of these vascular lesions a
scanning system (scannall) developed by visiray
(Hornsby, Australia) video captures and digits the
.lesion prior to treatment
A computer calculates the optimal treatment and path
.for scanning of the stain
The scanning speed is adjusted for the proper energy
.dose per unit area
The yellow beam from the copper laser (578 nm) is
focused and scanned over the skin of the patient. The
exposure time per p [position is just sufficient to heat
.and damage blood vessels
The minimal thermal relaxation in the surrounding
area to have an optimal preferential effect .a French
research group has developed the Hexascan (mordon
.(ET el 1993
The skin is erradiated with consecutive pulses of tens
of milliseconds duration .the 1 mm diameter spots fill
up the hexagonal shape in such way that each
following spot is fired as far away as possible from the
previous one
Thus heat accumulation can be prevented in one area
((apfelperg and smoller 1993
The total diameter of hexagon can be preset from 1to
13 mm the light energy wish is usually from an argon
laser is transported through 400 micrometer fiber to a
hand peace in wish the scanner is incorporated
The exit end of the fiber is moved around in the object
.plane of a lens
The image focused as a spot on the surface of the
target tissue will scan the surface according the
motion of the fiber in the object plane the exposure
time of the mechanical shutter is a minimum of 30 mill
seconds

Similar to the hexascan, a scanner has been

developed specially for copper vapor laser
applications the exposure time is controlled both with
a mechanical shutter and the scanning speed of the
spot Along the surface .the effective exposure time is
in the range of 1 to 100 ms .in combination with a
large copper vapor laser system producing over 10
watt of yellow light therapeutic fluences of 10 j /cm2
can be obtained a few milliseconds thus
Preventing collateral thermal damage this
combination is a good alternative for
The flash lamp pulsed dye laser (Ross et al .
(1993

Laser device for treating vascular lesions

By using Nd: YAG

Opthalmology
Inner eye treatment
Optharmology was in the early sixties next to
dermatology the first field for the application
.of laser
Lasers have been applied successfully since
then as there unique characteristics enable
treatment of the rear of the eye without any
surgery for example: diabetic patients often
.have a growth of blood vessels on the retina
To stop this, laser energy can be focused on
.the retina through the transparent eye
Causing partial coagulation of the offending
vessels similarly ruptures of dissections
Of the retina can be sealed this procedures
are performed on an out clinic bases within
very short times

Anther simple procedure is the treatment

of secondary glaucoma. due to an adverse
reaction of the human body on lens implants
a refuse membrane encapsulates the
artificial lens blocking clear vision by precise
focusing of the beam from a Q_switched Nd:
YAG laser a micro explosion is induced in the
membrane, tearing it apart the effect is
similar to the opening of a curtain the
patient walks out of the doctors office within
10 minutes with a restored vision

Cornea shaping

By adapting the curvature of cornea the aye

can be corrected for near and far sight by
Up to 4-5 dioptres . Pulses of UV laser light
can be used to reshape the cornea by
selective removal of tissue the 10 ns pulses
of the 193 nm ArF eximer laser light only
Endoscope device

Ablate a few micrometers of tissue at a time (van

(saarloos and constable 1993
The beam is delivered by a mirror system and
the spot cover the whole cornea
One method of ablating the cornea is to the
desired shape is by using a varying
diaphragm. By a plating the pattern of rings
in the surface of the cornea
The curvatior is adjusted
Anther method uses a contact lens with the
negative shape for the adapted lenses this
contact lens is ablated on the top of the
cornea, at some point the beam will
perforate
The thinner parts of the contact lens and
.start to ablate the cornea locally as well
Thus the depth of ablated cornea is
controlled by the local thickness of the
contact lens
Keyhole. Surgery for superficial
lesions
Mucosa defect in mouth, larynx and ear

As shown before the co2 laser is effective for

superficial applation of small lesions for example
in mucosa this spots can be reached by directing
the laser beam through natural (openings in
human body) to provide clear vision on area of
treatment the distal end of an articulated arm can
be coupled onto and operating microscope
The beam is aligned along the optical path of the
operating microscope using a small 90 degree
deflector

A joystick is needed to Gide the beam through the

field of view by slightly tilting the angle of the
deflector . The beam is focused on the target
tissue using optics with focal length compatible
,, with the optics of the microscope
Usually in the range from 200-400nm , again the
spot size (power density)will determine the
resulting tissue effect .the view through the
microscope enables precise ablation of
microscope manipulators are commonly used by
ENT surgeons (ossoff et al 1994), for example to
ablate lesions on the larynx, and by
gynaecologists, for example , for cervix
..………ablation

Endoscopic procedures

To enable exposure of tissue inside the body , the

articulated arm of co2 laser is coupled onto a rigid
. endoscope coaxially with the optics for viewing
The laser energy can be used in cavities which are
filled with air as in laparascopic (lanzafam 1990)
and thoracoscopic procedures

Sometimes the fluid in cavities like the knee or

bladder is temporarily replaced with co2 gas to
enable laser exposure in general surgery this
delivery technique is applied to treat small
superficial lesions on intestine while in gynecology
endometryces on the outside of the uterus or
bladder ablated