Sixteen patients with various head and neck tumors (laryngeal papilloma, lymphangioma, malignant melanoma, others) were treated by CO₂ laser. A lymphanigioma of the tongue, seen in a child, was well cured; the patient was able to take food orally immediately after surgery. Because of easy surgical manipulation, little bleeding and less chanse of the tumor cell dissemination, laser surgery seemed to be the most beneficial tool for treatment of malignant melanoma. The patients with malignant melanoma, who underwent laser surgery, did not complain of pain, and no recurrent signs were observed for one year follow-up. Bone necrosis occurred in a case of hard palate tumor. However there was no life threatening complication in laser surgery.

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Since 1980, CO₂ laser surgery was used to eradicate eight tongue cancers of T1 and three of T2. All the lesions showed superficial expansion on the mobile part of the tongue. Their diameters were less than 2.5 cm. These tumors were excised at least 1.5 cm away from the lesions. The surface of the resected area was carefully vaporized by additional spot beams. In all 11 patients, only one has required further operation to control the local recurrence. The post-treatment articulatory and swallowing functions were not disturbed.

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41 cases of tongue cancer were treated by means of CO₂ laser in laser clinic of Kobe university from March 1979 to December 1984. It is composed of Tis 3 cases, T₁ 10 cases, T₂ 9 cases, T₃ 3 cases, recurrent 11 cases and palliative 5 cases. Tumor was cut off with safety margin by deforcused beam. The wound could by left open without bleeding. All cases except 6 were treated by only laser. 6 cases were combined with radio therapy. The survival rate of 25 fresh cases was 62.3% by kaplan-meier method. All cases of T₃ were recurred. We could get good result by CO₂ laser for tongue cancer within T₂ cases

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A 1%DMBA-acetone solution was applied to the tongue of male hamsters, 6-8 weeks old, and the lingual carcinoma were produced on an average in 15 weeks. These tumors were cut at its basal part with Nd-YAG laser (laser), and the carcinoma were reduced. As the control, the carcinomas were similary reduced with scissors. And then the hamsters were observed in local and general condition until they died. Ther was a case which lived for a long period by complete disappearance of carcinoma in the group with laser. But most of the carcinomas recurred within one month, and hamsters died. For the survival, evident differences were not noted between the group with laser and control.

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A carbon dioxide laser surgery was applied for treatments of various laryngeal diseases including cancer. The application of the laser surgery to treating cancer was classified into the following three groups: 1. removal of tumor with laser alone, 2. reduction of tumor with laser and the postoperative irradiation, 3. removal of the residual tumors after irradiation. No major complications or operative morbidity occured. Moreover, the postoperative phonatory function was examined in ten cases with glottic canceer. They retained sufficient phonatory function for their social activities.

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Since a serious hemorrhage sometimes occurs during the surgery of the nasopharynx, the maneuvers must be performed with great care. Laser enables us to operate with more security.

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We treated 36 oral benign diseases with CO₂ Laser during May 1979 and April 1985. 31 of these 36 cases were treated by radical therapy, and 4 cases were done by palliative therapy. The other 1 case was treated by cutting the gingiva after the osteomyelitis of the mandible was treated. In 27 of the 31 cases (87.1%) it was found that the diseases had disappeared. In 2 of these cases it was not found that the diseases had disappeared. The prognosis of the other 2 cases are unknown. The advantage of the CO₂ Laser surgery is that the hemorrhage is little and it is easy to see the operation field. Further in most cases, there is no need to cover the wound so the operation time is short. From our experience we believe that CO₂ Laser surgery is one of the useful methods for the benign diseases of the oral cavity.

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The CO₂ laser surgery has been used to treat allergic rhinitis. We used the new hand piece developed by us for vaporized with certainty, and obtained some results of subjective and objective improvement. The subjects had perennial antigens and showed no improvement after conservative treatment. 77% of the patients obtained exellent results, who were seen at regular intervals up to 12 months after the surgery. No complication and easy technique are the benefits of this method. We consider the laser surgery using the new hand piece developed by us to be one of the most valuable treatment for allergic rhinitis.

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Chronic maxillary sinusitis is one of the common disease in the rhinological field. Recently, severe cases of chronic sinusitis have decreased during the past decade but cases requiring surgical treatment are still frequently encountered. So, we have developed Nd-YAG Laser antrostomy using a flexible fiberscope for maxillary sinusitis. Nd-YAG Laser antrostomy were carried out in 76 cases during the years 1983 to 1985. The results were that 57 cases or 75% of the patients were markedly improved, 17 cases or 22.4% of the patients showed moderatly improved while only 2 cases or 2.6% of the patients showed no improvement. This new operation has been designed which produced minimal surgical injury, and takes into consideraton the physiological anatomy of nose and paranasal sinuses.

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Anterior capsulotomy was performed by Nd-YAG laser as the pretreatment of cataract surgery in 35 cases. The linear increase of intraocular pressure after capsulotomy was observed in all 20 cases examined.
Nine of them showed values over 30mmHg. However, even in these cases significant complications such as corneal edema and the increase of vitreous pressure were not observed. Nd-YAG laser technique enabled precise anterior capsulotomy and resulted in marked decrease of after cataract compared with the can-opener method, and seems widely applicable to the pretreatment of cataract surgery.

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We developed a needle type probe consisted of fiberoptics to transmit CO2 laser effectively and intra- and extraocular photocoagulation with CO2 laser were performed successfully. In the experimental intraocular photocoagulation, the approach was similar to the pars plana vitrectomy. The retina was coagulated by almost touching the to it. And retinal vein was occluded by coagulation which may be applicable to treat neovascularization of various fundus disease. The extraocular coagulation is as effective as cryocautery with minimum scleral damage. Because of its several merits, it is already in many cases and useful results have been obtained as retinal detachment surgery.

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The authors have already reported that perforation or restenosis might occur when the irradiation to normal dog's trachea was applied on a half circle of more than 4 rings in the direction of major axis with 40w×3 seconds until the mucosa turned to white. In this series, a comparative study of irradiation to a half circle and a whole circle of tracheal ring is discussed. Irradiation was applied on less than three rings in the direction of major axis and totally 24 places for 13 dogs were subjected. The average dose was 1,350 joules per cm². Irradiation was performed to the submucosal layer in 19 places out of 24, however the deformity of the cartilage ring was observed in one place out of 6 (17%) with a whole circle irradiation and 4 places out of 18 (22%) with a half circle irradiation. The tracheal lumen was not deformed in 11 places which were irradiated on less than two rings in the direction of major axis with under 1,600 joules per cm², wheather it would be irradiated to a whole circle or a half circle.

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Contact irradiation of Nd-YAG laser was applied to bovine liver and its clinical application under endoscopic therapy of gastrointestinal lesions by a new-ceramic probe, which is superior to quartz fiber in its heat resistance,hardness, and mechanical strength,was studied. The laser was applied to bovine liver at variable contact pressure of the probe. The relationship between pressure and the size of tissue coagulation was studied. The result was that the higher pressure raised, the larger the size of tissue coagulation became. The use of distilled water for the protection of the probe was also studied and concluded that adhesion of coagulated tissue could be prevented by allowing an outflow of distilled water and the abdominal distension relieved in the clinical treatment.

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For the purpose of medical treatment of small liver cancer which is not indicated for surgical treatment, a fundamental experiment was carried out in the rat liver, comparing the effect of contact and interstitial irradiation of YAG laser. The results were as follows; 1. In both methods of irradiation,the degenerated area was histologically discriminated with three layers of carbonization, necrobiosis and necrosis. 2. In both irradiations, the degenerated area expanded according to the increase of irradiation energy. 3. The interstitial irradiation with a longtime output of low power resulted in producing more extensive degenerated area with less hemorrage.

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To Improve some drawbacks of micro-prismatic lateral probe, we developed tip-prismatic lateral probe for laser radiation therapy. Newly prismatic lateral probe has such superiority as higher endurability and transmission. With combination of a forward looking or a sidelooking endoscope, lateral radiation characteristics enjoys its bigger advantages than conventional these of forward beaming probe.
Clinical applications of esophageal varices, stomach cancer and duodenal pappila were successfully performed.

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35 cases that showed stenosis of upper G. I. tract have been treated with laser irradiation by endoscopy. Post therapeutic evaluation were classified in 3 groups. Sufficient; normal meal can be taken. Effective; soft meal can be taken. Insufficient; only liquid meal can be taken. 7 cases were benign stricture such as post operative stomal stenosis, all cases got sufficient or effective result. 28 cases were malignant stenosis caused by advanced canser. 7 of them got sufficient, 10 got effective, others were insufficient. Endoscopic laser therapy is very usaful as primary induction for malignant stenosis, And other method such as chemotherapy, radiation should be followed.

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Laser angioplasty was performed on 2 cases with stenoses of iliac and femoral arteries. Vascular endoscopy was done in order to assess the degree of vaporization of stenosis of the arteries before and after laser irradiation. Laser angioplasty was restricted only to open up the central portion of stenoses, and angioplasty was supplemented by balloon dilatation. The results of combined use of laser irradiation and balloon dilatation were satisfactory, and the claudication in two patients was completely cured. It is believed to be, to our knowledge, the first in Japan that both laser angioplasty and percutaneous transfemoral arterial endoscopy with photographs were successfully carried out.

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Several years ago, we illuminated resected gastric cancer using argon laser and found a specific strong yellow autofluorescence in the depressive type of early gastric cancer. In this study, we developed a fluorescence-analysing probe to examine the fluorescence spectrum of gastric mucosa via endoscope and detected the fluorescence spectrum of various gastric leseions. The results revealed that the instruments we developed could detect accurately the autofluorescence of the gastric mucosa. But we could not get a strong autofluorescence in the IIc lesion as the results we got in the resected stomach cancer. The possible causes were listed and discussed in this article.

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The purpose of this brief report is to mention the validity of a newly deviced YAG laser probe with 1.8mm in outer diameter on the occasion of endoscopic laser therapy. When the target of laser therapy is located on the gastric body or cardia, J-turn maneuver with fine angulation of the tip of an endoscope is usually satisfactory enough to visualized it. However, introduction of an ordinally laser probe with 2.1 or 2.6mm in outer diameter through the biopsy channel makes the degree of angulation restricted one, thus proper aiming at the target is often not attainable. On the other hand, this new probe allows of free angulation of the tip of an endoscope to the greatest extent, and possibility of proper YAG laser aiming at the target of the upper part of the stomach is certainly raised.

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YAG laser have some problem of far reaching property to tissue and difference of the absorption amount of the laser due to the color of the tissue and the far remote manipulation yield the difficult control of the procedure. So it was difficult to apply it for the cosmetic surgical approaches. However this newly surgical rod enables to use directly to the region itself. This study intend to evaluate the applicability of this newly developed device for the cosmetic surgical approach of benign tumor. The result indicate that the newly developed device has the better operability with less coagulation of the proteineous substances, with better vaporization and with much higher incisional competency in comparison to the conventional type YAG laser device. On the basis of this study, it is suggested that the newly developed surgical rod is very suitable for the cosmetic surgical approach of benign tumor.

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During 1975 and 1985, 6382 cases of nevi caused by melanin disorders were treated. Nevus spilus, pigmented nevus, and Ohta's nevus are examples of melanin anomalies treated at our clinic. The ruby, argon, Nd-Yag, He-Ne, diode and other lasers were applied selectively, either alone or in conjunction with other lasers and traditional forms of therapy such as dry ice. In order to prevent scarring, we tried to achieve reepithelialization within 10 to 20 days. Analyzing the best laser for each type of lesion, we found that the ruby was best for 9 out of 15 types of lesion, dry ice for 3, and CO2 for 2.

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Laser treatment for pigmented nevi is one of the most advantageous clinical application of lasers and lasers have been practically applied to skin nevi. The author has trially applied a few kinds of lasers to gingival pigmentation or pigmented nevi in oral mucosa and the following results were obtained:
Argon laser was proved to be very effective and advantageous in selective depigmentation for mucous deseases of pigmentation without anesthesia. Nd-YAG laser, however, was found not to be effective for depigmentation of these deseases. Recently, the author has tried to apply low power GaAlAs laser of 10-20mW to treatment of pigmented oral mucosas and obtained very interesting results.

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Syringomas usually treated with electrodesiccation or surgicalremoval of skin like a blefaaloplasty in the past. This report descrives a techniqul for precise removal of syringomas using CO₂ laser which lead less reccurrence rate of these tumors.

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There are some problems in maintaining the long-term patency after a conventional anastomosis especially for the small caliber vessels. Low energy CO₂ laser was employed to make vascular anastomosis with a few stay sutures for the purpose of aorto-coronary bypass. Seventy four vascular anastomoses (side-to-side, side-to-end, end-to-end) using 54 mongrel dogs in the femoral arteries and their veins, the carotid arteries and their veins were carefully carried out by CO₂ laser. A-C bypass was also successfully ma.de between the left internal mammary artery and the left anterior descending artery under the beating heart. Outputs of 20~40mW and irradiation times of 6~12sec/mm were optimal conditions for anastomosis of small caliber vessels. Satisfactory intensity and good healing of the anastomotic sites were confirmed by pressure tolerance test or tensile strength test and histological examinations in comparison with the conventional suture method. On the basis of these excellent results of our study a low energy CO₂ laser was applied clinically in 7 patients with anginal pain or chronic renal insufficiency and cardiac failure. All patients are doing well without any complications. In conclusion, this method may be recommended in performing for small caliber vessels such as aortocoronary bypass in the near future.

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In addition to an amply documented local anaesthetic effect, lidocaine has been demonstrated to reduce the adhesion of leucocytes to blood vessel walls (1). This observation, together with further experimental (2) and clinical (3) findings, has indicated that an antithrombotic effect is attributable to lidocaine.
The purpose of the present investigation was to study whether topically or intravenously (i. v.) applied amide-type local anaesthetics, e. g. lidocaine and bupivacaine, would influence microvascular thrombosis, and whether they would restitute microcirculation after laser-induced thrombus formation in the hamster cheek pouch. It was further intended to record whether the major lidocaine metabolite, mono-ethyl-glycinexylidide, and tocainide (an antiarrhythmic compound, structurally related to lidocaine but suitable for oral administration) produced microvascular effects similar to that of lidocaine.
The investigation was carried out in fore series: two for the purpose of recording the formation of a thrombus using laser microbeam irradiation subsequent to topical or i. v. application of the local anaesthetic (Series I and II); and the other to study the circulatory restitution effects on topical or i. v. application of the compounds onto already formed thrombi (Series II and IV).

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Nd-YAG laser cannot be observed under usual conditions as it is an invisible beam, but it has been recognized that Nd-YAG laser beams could be seen in color by means of a semiconductor TV camera while cautery of early gastric cancer is being performed under gastrofiberscopic observation using the beams. This laser beam observed with the TV was green. The intensity of the green beam seemed to correlate with the output of the laser. Liver of pig and early gastric cancer were observed and recorded on a VTR during the laser cautery. This system made it possible to identify the irradiation focus of the laser. Furthermore, the risk to the eyes of technicians making the observation is extremely small, indicating that this method is very useful.

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The septate uterus which is induced from congenital müllerian abnormalities, may sometimes result in recurrent abortion, premature labor or infertility. The infertile patient who had a septate uterus, was treated by hysteroscopic metroplasty using YAG laser with laparoscopic guidance under the general anesthesia. There was no significant complications during intraoperative nor postoperative period. Hysteroscopic YAG laser surgery is able to avoid abdominal and uterine wall incision and perform the operation without bleeding compared with transabdominal metroplasty. If the excellent pregnancy rate is recognized, hysteroscopic YAG laser surgery should become the effective operation technique for the septate uterus.

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We have treated mainly gastric cancer, by using new type of endo-probe made by ceramic. As a result, 1) much more correct effect of vaporization for tumor can be achieved than noncontact method of it. 2) Shortening of the treating time and stable effect by definite distance can be obtained. 3) Sufficient effect under low power condition of Nd-YAG laser as 10 to 30W for 1 to 2 sec irradiation can be performed.

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Since Jan. 1980 we have used the Nd: YAG laser non-contact irradiation with the purpose of crushing stones. Up to now destruction of quartz fiber tip was often experienced, when high energy, more than 70 watts, was used. Because of this, a new method using lower power contact irradiation was developed and showed more effectiveness. We investigated the contact irradiation through heat resistent new ceramics attached to the fiber tip and after repeated irradiation we could easily crush the biliary stones. Clinically, good results have been obtained using 10-20W, 1 sec. irradiation.

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The peripheral nerve function is easily impared by carbon dioxide laser irradiation whereas the blood vessel is well preserved because CO₂-laser is absorbed by water and loses its energy. On the basis of this concept, the adequate irradiation of CO₂-laser defocused beam was carried out on the gastric wall from the serosal surface. In the irradiated area, the vagus nerve was destroyed but blood vessels were preserved (CO₂-laser vagotomy). In order to demonstrate the efficacy of this procedure, acid reduction test was performed in 5 dogs after CO₂-laser vagotomy for 6 months. Gastric wall blood vessels were also compared between CO₂-laser and parietal cell vagotomy with making plastic cast. The following conclusions were obtained: 1) Vagotomy effect was well preserved up to 6 months period in the dog. 2) Gastric blood vessel stracture was well preserved in CO₂-laser vagotomy group.

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We have been utilizing YAG Laser in the operations of surgical fields since 1980. The former non-contact type Laser Probe and Scalpel lack in faculty of incision and incision control, moreover, they have had some troubles pertaining to operating time and feelings. For the above reasons, we tried to use a surgical rod new ceramics contact type that has been widely spread of recent. In case of standard radical mastectomy, incision faculty of skin, subcutaneous fat tissue and muscles were good enough. We also observed that lymph node dissection at axillar region were produced much but it was lacking in hemostatic faculty. We tried to use the contact type YAG Laser in recidivative breast cancer and liver resection in addition to this case.

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