NEW MODALITIES
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What is a laser?
The term LASER stands for Light Amplification by Stimulated Emission of Radiation. Laser light is different from ordinary light. The light from the sun or from a light bulb has many wavelengths and spreads out in all directions. Laser light, on the other hand, has one wavelength and can be focused in a narrow beam. This makes it both powerful and precise. Lasers can be used instead of scalpels for very careful surgical work, such as repairing a damaged retina in the eye or cutting through tissue.
Soon after the first working laser was developed in 1960, researchers began studying its possible uses in medicine. Lasers were first used medically in 1961 to treat a type of skin discoloration and to repair detached retinas.
Types of Lasers
Lasers are named for the liquid, gas, solid, or electronic substance that is used to generate the light. There are many types of lasers that are used in medical settings, and new ones are being tested all the time. So far, 3 kinds have gained wide use in medicine:
Carbon dioxide (CO2): The CO2 laser is mainly a surgical tool. It can cut or vaporize tissue with relatively little bleeding as the light energy changes to heat. This type of laser is used to remove thin layers from the skin's surface without penetrating the deeper layers.
Argon: The argon laser penetrates only a short distance into tissue. It is useful in dermatology and in eye surgery. It is sometimes used during colonoscopies to remove polyps. It can be used along with light-sensitive dyes to treat tumors in a procedure known as photodynamic therapy (PDT).
Neodymium: Yttrium-Aluminum-Garnet (Nd: YAG): Light from this laser can penetrate deeper into tissue than light from other types of lasers, and it can cause blood to clot quickly. Nd: YAG light can be carried through endoscopes to get to hard-to-reach parts of the body, such as the esophagus or colon. It can also travel through optical fibers, which can be bent and placed directly into a tumor to heat it up.
The Nd: YAG is sometimes used with KTP (potassium titanyl phosphate) crystals for some kinds of surgery. Other types of lasers that may be used in cancer care include the holmium YAG, copper vapor, and diode lasers. The erbium: yttrium aluminum garnet (Er: YAG), is being tested for use with bladder tumors, and a diode laser called 805nID is being tested on early stage breast cancers.
Pros and Cons of Laser Use in Medicine
Lasers have some advantages over standard surgical tools:
- Lasers are more precise (cut more finely) than scalpels. Tissue near an incision is not affected since there is little contact with skin or other tissue.
- The heat produced by lasers helps sterilize the surgery site, reducing the risk of infection.
- Since laser heat seals blood vessels, there is less bleeding, swelling, or scarring.
- Less operating time may be needed because the precision of the laser allows for a smaller incision.
- Laser surgery may be less invasive. For example, with fiber optics, laser light can be directed to parts of the body without having to make a large incision.
- More procedures may be done on an outpatient basis, without requiring recovery time in a hospital.
- Healing time is often shortened.
There are disadvantages with laser surgery:
- Fewer surgeons are trained in laser use.
- Laser equipment is expensive and bulky compared to the usual surgical tools, although advances in technology are slowly helping reduce cost and size.
- Strict safety precautions must be observed in the operating room when lasers are used. For example, the entire surgical team and the patient must wear eye protection.
- The effects of some laser treatments may not last long, so they may need to be repeated. Sometimes the laser cannot remove an entire tumor in one treatment, and further treatments may be needed.
X-knife radiosurgery/ radiotherapy
The X-knife system is specially designed to treat brain disorders. It consists of a specialized treatment planning system and certain hardware to be used along with the linear accelerator.
X-knife radiosurgery, also called stereotactic radiosurgery, is a technique that delivers a very high level of radiation dose to brain tumors, both malignant and benign such as meningiomas, arterious malformations (AVM) and secondary metastases. Unlike conventional radiotherapy techniques, it uses very precisely-guided beams of radiation focused to a small volume to treat a tumor, therefore enabling a highly effective treatment that can replace some of the invasive traditional surgical operation. The procedure is completed in one day and the actual treatment time ranges from half hour to two hours, depending on the number of sites to be treated.
The above X-knife system can also be used to accurately give low levels of focused radiation over a series of treatment sessions. This is called stereotactic radiotherapy. It is very useful to treat smaller lesions in the head and neck region, which are adjacent to critical organs such as the brain stems, eyes or optic nerves.
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