THE CO₂ LASER AS A VERSATILE SURGICAL MODALITY

抄録

The carbon dioxide laser (CO₂ laser) was one of the first 4 major lasers to be developed, and is now successfully employed for surgical procedures not only in the fields of plastic and general surgery field, but also in many other specialities, including dermatology, gynecology and otorhinolaryngology. In dermatosurgery, CO₂ laser resurfacing for rejuvenating photoaged skin remains the gold standard. The CO₂ laser produces a beam of mid-infrared energy at a primary band of 10,600 nanometers (nm) or 10.6 ˜ μm, at which wavelength the laser beam is very highly absorbed by water. Since human tissue comprises between 75% to 90% water, it follows that the CO₂ laser beam can play many important roles in the surgical field, from cutting, through ablation to tissue welding and photobiomodulation. Its basic action in tissue is photothermal, almost instantaneously vaporizing target tissue (at appropriate power densities) by raising temperatures to well over 100°C. Because of the selective absorption in water, however, minimal damage is caused to adjacent tissue. The CO₂ laser offers the following benefits: reduction in trauma; almost bloodless surgery compared with the conventional scalpel; improved therapeutic results; reduced risk of infection; less scarring; precisely controlled surgery which limits injury to normal skin; and safe and effective recovery for many surgical conditions, often faster than conventional approaches and therefore achieving shorter hospital stays. From his experience with the CO₂ laser encompassing some four decades, the author presents herein his accumulated knowledge of all types of CO₂ laser surgery, even in patients with any of the coagulopathies. The CO₂ laser is thus well- and widely-adapted for current, and future, clinical indications, offering a versatile and practical alternative to traditional scalpel surgery in many medical fields.