Nd: YAG laser and diode laser irradiations to the umbilical cord were studied for hemostasis after cordocentesis. The umbilical cords which were obtained from 11 healthy pregnant women were cut 10cm long and were applied 20mmHg in pressure with saline or saline with Indocyanine green (ICG) (0.1mg/ml). These 10cm long umbilical cords were connected to the differential gage to measure volumetric flow of leakage from puncture holes. After punctures of 20 gauge needle, laser irradiations with a 1064nm Nd: YAG laser (6W; 40s) and a 792nm diode laser (5W; 10s) were performed on the puncture holes with contact and non-contact methods. When applying pressure with the saline, the laser irradiations gave no change on the puncture holes and volumetric flow of leakage. When applying pressure with the saline with ICG, however, both laser irradiations made the puncture holes shrink and made the volumetric flow of leakage decrease significantly[Nd: YAG laser; from 6.11±1.34ml/min to 0.737±0.540ml/min (n=5, t-test, P<0.001), diode laser; from 5.66±1.09ml/min to 1.48±1.33ml/min (n=6, t-test, P<0.001)].
Because the laser irradiations with both Nd: YAG laser and diode laser are strongly absorbed into blood, although almost no absorption into the umbilical cord itself, we think both lasers are useful for hemostasis after cordocentesis.

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Operative laparoscopy was performed on ninety-eight cases with gynecologic benign disease. Laser equipments (Nd: YAG, KTP/YAG, Ho: YAG), electrocautery (monopolar, bipolar, Argon beam coagulator) and Harmonic scalpel were used. For the treatment of ovarian cyst, drainage, ethanol fixation, ablation of lining, stripping of lining (intra or extracorporeal) and adnexectomy were performed on them. For adhesion, lysis, and/or TUSL (Transection of Utero-Sacral Ligament) were carried out. For myoma, adenomyosis, carcinoma in situ of uterine cervix and descensus uteri with adhesion, LAVH (Laparoscopically Assisted Vaginal Hysterectomy) were carried out. In the group of endometriosis with endometrioma, 69.2%(18 of 26) reported over 50%pain relief and 11.5%(3 of 26) reported no pain from menstrual pain after the surgery. Recurrent endometrioma was found in 42.3%(11 of 26). In the group of endometriosis, 71.4%(15 of 21) reported over 50%pain relief and 23.8%(5 of 21) reported no pain from menstrual pain. In the group of pelvic inflammatory disease and dysmenorrhea, 57.1%(4 of 7) reported over 50%pain relief and 28.6%(2 of 7) reported no pain from menstrual pain. In the group of ovarian cyst, recurrent cyst was found in 5.9%(1 of 17). All patients after the LAVH had no complaints.
Their complications during and after operation were minimal.
There was no difference between the Laser group and the other group in the results and the complications.

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Seventy to 80% surgeries in our department have been performed as laparoscopic surgery and application of laser has become an effective and important tool in minimally invasive surgery. The KTP/532 is especially usuful in such techniques as to divide and separate tissues precisely and accurately without much bleeding under laparoscopy. It also enbles to cut and coagulate simultaneously and can divide many tissues in the pelvis without bleeding. We have applied laser laparoscopic surgery with KTP for various gynecologic operations including the treatment of endometriosis, myoma uteri, ovarian cysts, ectopic pregnancy, polycystic ovarian syndrome and so on. In cases of laparpscopically assisted vaginal hysterectomy (LAVH) for endometriosis, laparpscopic adhesiolysis is more easily performed than under laparotomy and blood loss was significantly smaller compared with that for abdominal hysterectomy and the patients were discharged earlier after the surgery. In cases of cystectomy for endometrial cyst and myomectomy for uterine myoma, little bliid loss noticed comoared with that of laoarotomy. The results were at least equal or better comoaerd with laparotomy for patients with stage-matched endometriosis, The procedure can not only minimize the amount of surgery for the patient, but also lead to objective as laparotomy. Thus, operative laparoscopy using KTP laser may be the treatment of choice for women undergoing gynecologic surgery.

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Since the advent of lasers in clinical medicine, they have become popular in a wide variety of applications. In gynecology, solid lasers such as the Nd-YAG and KTP are in use, while gas lasers such as CO₂, and Argon devices are popular.
Recently a combination of the KTP/YAG has become svailable. The advantage of the KTP/YAG devices are the availability of selecting the mode most appropriate for a given procedure, allowing a wider spectrum of precision usage. However, various opinions concerning a comparison of laser devices and cutting current devices in actual surgery have adherents to either one or the other. Since the growing popularity of laparoscopic surgical procedures, the use of laser devices are coming under renewed scrutiny.
The recent increase in interest in the lasers is due to their wide choice of selective distinctive properties. They are also adaptable to small caliber devices allowing wide application in laparoscopic surgical procedures. The decreased smoke evoked during usage when compared with cutting currents make them more acceptable during laparoscopic procedures. Solid lasers such as the Nd-YAG are little affected by liquids making them utile even during concurrent lavage.
The KTP/YAG device has the advantage of containing two separate frequencies which can be used interchangeably depending on the procedure being performed. This device and be adapted to fiber optic applicaton making it possible for small caliber probes with adequate clinical utility. Further, as it incorporates two different modalities in one device, backup apparatuses become less necessary.
I will discuses our experience using the various lasers during laparotomies and laparoscopic procedures, their strong points and weak points and our further expectations concerning the use of these devices.

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Laparoscopic myomectomy was performed in 33 patients. The indication for laparoscopy were pelvic mass and/or infertility. Nd: YAG laser was used for the uterine incision. Myometrium and serosa were sutured, Myomas were removed through the10mm trocar puncture site, the suprapubic puncture site or the cu1-de sac after flag-mentation of large myomas. Fifty one myomas were removed laparoscopically. No complication was observed. In selected cases, laparoscopic myomectomy appeares to be a safe technique with the advantages of laparoscopic surgery.

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Many problems had to be solved for utilizing lasers to the treatment of the liver carcinoma in minimally invasive laparoscopic surgery. First, we developed the Spherical Laser Coagulation Therapy, which creates a spherical coagulation layer inside the liver. Next, with development of abdominal wall lifting with subcutaneous wiring, it became possible to promptly evacuate a large amount of high temperature gas which is generated during spherical laser coagulation. Such process is impossible in the pneumoperitoneal method. The very fine flexible ultrasound probe, which can freely move along the irregular liver surface to produce clear vision, allowed ultrasonic observation of the wide area of the liver. Along with the development of the Variable Direction Laser Beam Forceps which incorporated the mechanism of bending tip originally developed for the Ojigi Forceps, the new operative methods such as Area Lifting & Sliding Window have been devised. The risk mapping, which applies three dimensional reconstruction method, is a joint project with the Department of Engineering, and is useful for evaluating the safety of the laser insertion therapy.

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The experimental study was conducted to determine the effectiveness of the modified PDT with preceding local injection of w/o/w PHE emulsion combined with YAG-OPO laser irradiation 24 hours after, as a treatment for gastric cancer and lymph node metastases. The aim of the modification was to reduce the photo-hypersensitivity of skin or intraabdominal organs.
We observed the effectiveness of the PDT with local injection of w/o/w PHE emulsion as following. The locally injected PHE emulsion, which is only 1/4 of general dose, successfully maintained the PHE level high in the tumor without increasing its level in the blood or intraabdominal cavity from 1 up to 24 hours after the injection.
We also recognized that another major advantage of the modified PDT, which included YAG-OPO laser irradiation to the tumor at 24 hours after the injection, was its significantly destructive effect on the tumor.
Thus it is concluded that our modified PDT seems to reduce the photo-hypersensitivity and is expected to be an alternative treatment for intraabdominal tumor and lymph node metastases.

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