Seguridad, consejos y límites para el uso del láser en la cirugía retrógrada intrarrenal / Laser safety, warnings, and limits in retrograde intrarenal surgery

Objetivo Analizar la información actual sobre la seguridad del láser en la cirugía retrógrada intrarrenal (CRIR), centrándonos en las dos principales tecnologías láser que utilizamos en urología, el láser de holmio:itrio-aluminio-granate (Ho:YAG) y el láser de fibra de tulio (TFL). Métodos Revisión narrativa de los artículos más relevantes publicados en las bases de datos Medline y Scopus sobre este tema. Resultados Los láseres TFL y Ho:YAG con ajustes similares (0,2 J/40 Hz) tienen un aumento de temperatura promedio por volumen similar y la tasa de calentamiento promedio aumenta proporcionalmente a la potencia del láser, especialmente cuando se utilizan frecuencias altas. Datos preclínicos recientes que comparan ambas tecnologías láser con diferentes ajustes del láser coinciden en que cuando la energía suministrada aumenta a expensas de frecuencias más altas, el daño térmico también aumenta. Las frecuencias más altas, a pesar del aumento de temperatura en el medio de irrigación, pueden causar lesiones térmicas accidentales por láser. Conclusiones El uso de ajustes de baja frecuencia y una irrigación adecuada es fundamental para evitar lesiones térmicas en la litotricia endoscópica con láser (LEL). Además, se recomienda el uso de gafas de seguridad láser en la LEL con Ho:YAG y TFL. (AU)

Objective To analyze the current information about laser safety in retrograde intrarenal surgery (RIRS), focusing on the two main laser technologies that we use in urology, the holmium:yttrium-aluminum-garnet (Ho:YAG) laser, and the thulium fiber laser (TFL). Methods Narrative overview of the most relevant articles published in Medline and Scopus databases about this subject. Results TFL and Ho:YAG laser at similar settings (0.2 J/40 Hz) have similar volume-averaged temperature increase and the average heating rate increase proportionally to laser power, especially when high frequencies are used. Recent preclinical data, comparing both laser technologies at different laser settings, agreed that when the delivered energy increases in expenses of higher frequencies, the thermal damage increases too. Higher frequencies, despite of the rise of temperature in the irrigation medium, can cause accidental thermal lasering lesions. Conclusions The use of low frequency settings and a proper irrigation is critical to avoid thermal injury in endoscopic laser lithotripsy (ELL). In addition, the use of laser safety eyeglasses is recommended in Ho:YAG and TFL ELL. (AU)

Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society.

Acronyms and abbreviations are frequently used in otorhinolaryngology and other medical specialties. CO2 laser-assisted transoral surgery of the pharynx, the larynx and the upper airway is a family of commonly performed surgical procedures termed transoral laser microsurgery (TLM). The abbreviation TLM can be confusing because of alternative modes of delivery. Classification and definition of the different types of procedures, performed transorally or transnasally, are proposed by the Working Committee for Nomenclature of the European Laryngological Society, emphasizing the type of laser used and the way this laser is transmitted. What is usually called TLM, would more clearly be defined as CO2 laser transoral microsurgery or CO2 TOLMS or CO2 laser transoral surgery only (with a handpiece) would be defined as CO2 TOLS. KTP transnasal flexible laser surgery would be KTP TNFLS. Transoral use of the flexible CO2 wave-guide with a handpiece would be a CO2 TOFLS. One can argue that these clarifications are not necessary and that the abbreviation TLM for transoral laser microsurgery is more than sufficient. But this is not the case. Laser surgery, office-based laser surgery and microsurgery are frequently and erroneously interchanged for one another. These classifications allow for a clear understanding of what was performed and what the results meant.

Laser skin treatment in non-Caucasian patients.

The demand for facial rejuvenation and cosmetic procedures is rising among all ethnicities and skin types. The authors present a review of lasers and how to select a laser based on skin type and the treatment goals of laser resurfacing: skin laxity, dyschromia, hair removal, keloid, and hypertrophic scarring. In addition, they discuss preprocedural and postprocedural considerations, potential complications, and their management to maximize patient outcomes and minimize risk.

Medical devices; general and plastic surgery devices; classification of the low level laser system for aesthetic use. Final rule.

The Food and Drug Administration (FDA) is classifying the low level laser system for aesthetic use into class II (special controls). The special control(s) that will apply to the device is entitled ``Class II Special Controls Guidance Document: Low Level Laser System for Aesthetic Use.'' The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. Elsewhere in this issue of the Federal Register, FDA is announcing the availability of a guidance document that will serve as the special control for this device type.

[Lasers: principles, characteristics and tissue interactions]. / Lasers: principes, caractéristiques et interaction tissulaire.

Since their appearance in 1960, lasers have been considered useful light sources for medical applications. Laser light is monochromatic, the bundle is parallel and can be directed and focussed, as a result of which very high energy densities can be achieved. Several applications in dentistry have been investigated over the past decades. This article describes the physics behind lasers, the characteristics of the laser beam and overviews the laser wavelengths currently used in dentistry. The different interactions between the laser beam and the target are explained.

Urologic laser types and instrumentation / Tipos de láser en urología e instrumentos

Though the primary role of lasers in urology has always been in the treatment of urolithiasis, there are several other indications for their use. There are many different types of lasers currently available, each with unique properties conducive to treating certain disorders. As such, it is critical that today's urologist understands each laser's characteristics in order to optimize patient selection and treatment. The lasers which are primarily used in urologic applications include the carbon dioxide (CO2) laser; the Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG); the Potassium Titanyl Phosphate (KTP) laser and the Holmium:YAG (Ho:YAG) laser. This review focuses on the unique characteristics of each of these lasers as well as the instrumentation needed utilize and deploy these tools in the urinary tract (AU)

Aunque el uso primario de láser en urología ha sido siempre el tratamiento de la litiasis, hay otras indicaciones para su utilización. Existen muchos tipos diferentes de láseres actualmente disponibles, cada uno de ellos con unas propiedades únicas que les permiten tratar ciertas enfermedades. Es crítico que el urólogo actual entienda las características de cada láser para optimizar la selección del paciente y el tratamiento. Los láseres utilizados primariamente en aplicaciones urológicas incluyen el láser de dióxido de carbono (CO2); el de Neodinio:Ytrio-Aluminio-granate (Nd:YAG); el láser de potasio titanilo y fosfato (KTP), y el de Holmio:YAG (Ho:YAG). Esta revisión está enfocada a las características únicas de cada uno de estos láseres, así como al instrumental necesario para utilizarlos en el aparato urinario (AU)

[The usefulness of laser in the treatment of urethral stenosis]. / Utilidad del láser en el tratamiento de las estenosis uretrales.

INTRODUCTION: Optical urethrotomy was introduced by Sachse in 1973 and it has a registered long-term recurrence rate of 75-80%. This stimulated the search for new therapies with less recurrences. Several types of laser were tried: Nd:YAG, KTP, Argon, Ho:YAG, diode,... Since the end of the '70s various types of laser are being used for the treatment of ureteral stenosis. OBJECTIVES: To describe the usefulness of the laser energy in the treatment of ureteral stenosis, mainly recurrent stenosis and to analyze the current experience with various types of laser (diode, nd:yag, holmium, argon,...) METHODS: We performed the systematic review of the bibliography, based on a medline search, and a detailed analysis of the selected articles. CONCLUSIONS: 1) The use of laser in the treatment of urethral stenosis is on the a valid, effective, and safe alternative option to optical urethrotomy, at least in the mid term; nevertheless, it has not demonstrated to date being better than that. 2) The election of treatment is surgeon dependent and, and no single technique has demonstrated to be clearly better than the others. 3) Prospective long-term studies with larger numbers of patients and longer follow-up are necessary. 4) Laser technology is extensive and it is not available in all centers.

Comparison of adverse events of laser and light-assisted hair removal systems in skin types IV-VI.

Photoepilation, utilizing lasers and noncoherent light sources, is designed to irradiate as much of the follicular unit as possible, with melanin as the target chromophore. Wavelength absorption should generate energy sufficient to heat and destroy the hair follicle, while preserving the surrounding tissue. When performing photoepilation on African-American skin (Fitzpatrick skin types IV-VI) a greater risk of potential epidermal adverse events, such as dyspigmentation, blistering, crusting, edema, and subsequent scarring, is possible. To reduce epidermal melanin absorption of energy longer wavelengths are considered safer for use on Fitzpatrick skin types IV to VI. This article reviews and compares the reported incidences of adverse events in African-American skin, utilizing lasers and noncoherent light sources for assisted hair removal.

Irritation fibroma removal: a comparison of two laser wavelengths.

Laser wavelengths are available that offer dentists treatment options for both hard and soft oral tissues. This article discusses the benefits of removing hypertrophic soft tissue by using an all-tissue laser. A clinical case is presented involving the use of both an 810 nm diode laser and a 2,780 nm Er,Cr:YSGG laser to remove two irritation fibromas, both located on the left cheek of the same patient. This unique perspective was ideal for comparing the healing of each wound. The Er,Cr:YSGG appeared to have a less traumatic effect on target tissue and offered improved postoperative healing, faster recovery time, and less trauma than traditional surgical modalities.

Applications of the neodymium:YAG laser in plastic surgery of the face and lacrimal surgery. Wound repair. A review.

The physical and clinical features of a number of laser energy sources presently being used in plastic and endonasal surgery, such as the Nd:YAG, KTP, Ho:YAG, Er:YAG and CO(2) lasers, are emphasized. Particular attention is paid to the Nd:YAG laser and to an Nd:YAG laser-powered quartz laser scalpel.

[Preliminary experiences with the use of the Holmium-YAG laser in the treatment of soft tissues and of cystine calculi in children]. / Premières expériences avec l'utilisation du laser Holmium-YAG dans le traitement des tissus mous et des calculs de cystine chez l'enfant.

INTRODUCTION: Experience of the use of the Holmium: Yttrium-Aluminium-Garnet (Ho:YAG) laser in children has been limited. However, the Ho:YAG laser has been in clinical use in urology for several years but has mainly been used for the treatment of renal stones and benign prostatic hyperplasia. Due to its unique combination of vaporization and coagulation, the Ho:YAG laser allows a precise cutting action. The depth of penetration in water and tissue is limited to < 0.5 mm and therefore provides a safety margin. The Ho:YAG laser can be used in children, as the energy can be delivered via fibers that range from 200 to 1000 mu in diameter. MATERIALS AND METHODS: We used the Ho:YAG laser in 5 children (2-15 years): one child (2 years) with bladder exstrophy had a urethral stricture after bladder neck reconstruction, two children (6 years and 14 years) had ureteropelvic junction (UPJ) stenosis and refused open surgery and two children (5 years and 15 years) suffered from cystine stones (ESWL failed). The urethral stricture was incised in a retrograde fashion. We performed an antegrade incision of the UPJ with the Ho:YAG laser in the 6-year-old child and a retrograde incision in the 14-year-old child. We removed the stones in antegrade fashion in the 5-year-old child and in retrograde fashion in the 15-year-old child. RESULTS: All children now have more than 12 month's follow-up. There were no immediate or late complications. The boy with urethral stricture remained free of recurrence, the boy with UPJ stenosis obtained improved drainage on the excretory renogram and the two children with cystine stones remained stonefree. CONCLUSION: We have shown that the safety and efficacy of the Ho:YAG laser is also reproducible in urologic pathology in children. In addition, due to its vaporizing quality, the Ho:YAG laser is more effective in the treatment of cystine stones and allows minimaly invasive treatment in children.

Laser light: waves of the future.

The use of lasers is becoming more prevalent in the health care arena. Lasers can perform functions from lightening spider veins to correcting nearsightedness. Nurses must become familiar with lasers as 21st century medicine becomes a reality.

Otosclerosis update.

The use of lasers for primary and revision stapes surgery has many applications and potential advantages over mechanical techniques. It should be emphasized, however, that the laser is simply a tool, albeit a sophisticated one, and not a substitute for knowledge, experience, judgment, or ability. A laser will not "make" a good stapes surgeon, any more than a scalpel "makes" a good surgeon. There are limitations as well as benefits to lasers. Excellent results for stapes surgery were obtained for years prior to the advent of lasers, which is testimony to the skill and understanding of nonlaser stapes surgeons.

Lasers play a major role in dermatology.

With new technology constantly being developed, lasers will continue to evolve and become more specialized. Laser treatments are now well known to the general public. To keep abreast of the latest technology, physicians and hospitals have to maintain a continuing educational process. Just as medicine is constantly advancing in other areas of outpatient treatments, the use of these lasers in a hospital or physician's office program will continue to provide the best and most efficient care available to people today.