The safe and efficacy of Nd-YAG laser with hook-shaped contact tip was evaluated in 6 laparoscopic cholecystectomies. Hook-shaped contact tip was useful especially in the dissection between gallbladder and liver.
There was no complication in peri-and post-operative period. We concluded that Nd-YAG laser with hook-shaped contact tip is a useful tool for laparoscopic cholecystectomy.

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Six cases of facial palsy (2 cases of Hunt syndrome II, 3 cases of Bell' s palsy, one case of traumatic facial palsy) were treated with low reactive-level laser therapy, The low reactive-level laser used was a Ga-Al-As laser (wavelength 830nm, out-put power 60mW). The laser was irradiated to the palsied face, the stellate ganglion area and the stylomastoid foramen. After irradiation had been carried out, it was noted that the palsied face temperature had increased. Four of the cases which were treated daily for 5~6 weeks almost healed, One case which was treated less frequently in the out-patient clinic improved, while the other case treated for 2 weeks improved slightly. No clinically significant adverse effect resulting from the low reactive-level laser therapy was noted. Our results suggest that low reactive-level laser therapy would be an effective and safe therapy for facial palsy.

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From January 1986 to September 1993, fifty-nine lesions in 48 patients (Pts) with roentgenologically occult lung cancer (ROLC) were treated with photodynamic therapy (PDT) using hematoporphyrin delivative (HpD). All histological types were squamous cell carcinomas expect one malignant mixed tumor, salivary gland type. The 25 lesions were treated with argon dye laser (ADL), and the other 34, with excimer dye laser (EDL). 35carcinomas out of (59.4%) achieved complete response (CR) after the initial PDT. We investigated which factors influenced the favarite results, including bronchoscopic findings, mucosal appearances, the depth of invasion, the length and location of tumor and sources of PDT. The univariate analysis showed that the tumor size (≤10mm) was the most important factor (P<0.01) to obtain CR, and those less than 5mm, without relapse. When analyzed by the multivariate method, also there was a significant difference (P<0.01) contributing CR and CR without relapse only in the tumor size. Five years survival rate was 75.5%. According to WHO common toxicity criteria (grade 2), 2(4.2%) pts experienced sunburn,1 (2.1%) pts liver disfunction and 7(14.6%) pts pulmonary toxicity, however these toxicities were transient. WHO grade 3 or 4 toxicities caused by PDT were not observed. In conclusion, PDT was effective for ROLCs which were shorter than 10mm in its maximum size. Otherwise it was recommended as the safety methods for patients with pulumonary disfunction. It would be neccessary to study on the ramdomized trial of PDT and curative resection.

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Laser endoscopic surgery has now achieved a status as effective treatment modality for lung cancer. The effectiveness of photodynamic therapy (PDT) using photofrin as a photosensitizer was demonstrated in our institution in 1979 for the treatment of lung cancers, and increasing attention has been focused on this new treatment technique. Over the past decade, 202 patients (243 lesions) with central type lung cancers have been treated in our hospital. Age distribution ranged from 36 to 85 years and there were 188 males and 14 female. Fifty nine patients had early stage lung cancer, 26 had stage I, 10 had stage II, 80 had stage III and 24 had stage IV. Complete remission was obtained in 37.9%of the 92 lesions, significant remission in 60.9% and no remission was obtained in 1.2%. However among 69 early stage lesions CR was obtained in 45 (65.2%) and 41 cases were disease free in 1 to 152 months. In advanced lesions the opening of bronchi obtained by tumor was achieved in 61 of 81 lesions (75%). Thirteen patients with gottic cancer were also treated by PDT. CR was obtained in 8 cases out of 9 (89%) for T, cases. We describe the overview of laser endoscopic surgery especially photodynamic therapy for gottic cancer and lung cancer as well as evaluate the effectiveness of these therapy.

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In order to improve the therapeutic effectiveness of photodynamic therapy (PDT) with Photofrin II and laser light for early gastric cancer, we employed an excimer dye laser instead of an argon dye laser. The rates of cure obtained by PDT with the EDL were 100%(13/13) in mucosal cancer, 86%(6/7) in submucosal, and 95%(19/20) in total, while the rates of cure obtained by PDT with the ADL, were 59%(13/22) in mucosal cancer, 53%(8/15) in submucasal, and 57%(21/37) in total. These data suggest that EDL is superior to ADL in teams of photodynamic action, We postulate that the most important factor determining photodynamic effect is peak power.

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An effectiveness of photodynamic therapy (PDT) using Hematoporphyrin Derivative (HpD) and Argon-dye or Excimer dye laser for the superficial esophageal carcinoma which cannot be treated by any surgical procedure has been reported.
Laser beam (630nm) has been endoscopically irradiated on the lesions 48 hours after an injecion of HpD with the power of 100 joule per 1 cm².
PDT under this condition has been performed on 17 cases with the superficial esophageal cancer (17 lesions). The esophageal cancer in 13 cases of them has been radically treated in the first PDT, but in 4 cases, a local remnant of the cancer was recognized and the remnant cancers of 3 cases of them were completely removed after the second PDT. Four cases were died from; pneumonia, advanced cancer of the other organ respectively and lymphnode metastasis of the esophageal cancer in 2 cases. In the cases in which the local remnant of the cancer was detected in the biopsy specimens after the first PDT, the size of their lesions was more than 4 cm². The fetal complications were never observed, but sunburn due to the photosensitive reaction was found after the sun exposure.
From these results, PDT is considered to be an excellent treatment for the mucosal esophageal cancer less than 4 cm² without lymphnode metastasis in the inoperable cases.

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The incidence of CIS and dysplasia of the uterine cervix is increasing among young women in the recent years. Most of these patients want to preserve their fertility, and some of them are inoperble or refuse surgery. To avoid surgery, high power laser with CO₂ or YAG laser are most often used, but just like the conventional conization, these therapies cause unexpected bleedings and may destroy uterine cervical glands indispensable for pregnancy and delivery. Photodynamic Therapy (PDT) with the use of Excimer Dye Laser EDL-a type of low pulse laser, has a considerably higher degree of tissue penetration, even compared to the PDT using Argon Dye Laser. It also has a special feature : selective destroying of malignant cells with almost no effect on normal tissue. Furthermore, PDT is performed without anesthesia, since it causes no pain or bleeding.
This method has been studied on 43 patients until now. PDT is performed 48 hours after the intravenous injection of photosensitizer Photofrin 11 (PHE). Out of 27 CIS and 16 dysplasia patients, there were 42 CR (97, 67%)and only one NC case. The first CR case was four years ago and no recurrence has been observed yet.
PDT seems to be most appropriate known method in treating early stages of uterine cervical cancer, as it satisfies our main condition of fertility preservation. With little side effects, no bleeding or pain, and with certain improvements in administration methods, better choice of photosensitizer which would shorten the shading time, PDT promises a brighter future both for physicians and their patients in fighting cervical cancer.

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The results of two types of photodynamic therapy, in which hematoporphyrin derivative is activated by an argon-dye laser, for superficial bladder tumors were reported. Focal photodynamic therapy was performed on 60 tumors in 22 patients associated without carcinoma in situ and/or dysplasia in normal looking areas of the urinary bladder. Treatment with 100 to 250J/cm² obtained a complete response in 15 of 16 tumors 1cm in size or less. For tumors up to 2 cm in size the accumulated energy intensity of argon-dye laser light dose should be 100J/cm². No tumors more than 2 cm in size achieved a complete response. Integral photodynamic therapy was performed on 40 patients who had resistant transitional cell carcinoma of the urinary bladder, mainly carcinoma in situ. The total energy density used was 10 to 30J/cm². Of the 40 patients 29 (72.5%) achieved a complete response and 5 (12.5%) a partial response at 3 months. In 9 of the 29 patients there was no recurrence with an average tumor-free interval of 15.8 months, ranging from 5 to 84 months. Bladder capacity was decreased to approximately 150 ml for 3 months after the integral photodynamic therapy without any evidance of hydronephrosis on excretory urograms, except for 2 patients who had a contracted bladder before photodynamic therapy. Integral photodynamic therapy may prove to be useful for the treatment of carcinoma in situ of urinary bladder.

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