Future of Lasers in Gynecology

Introduction:

The use of lasers in gynecology was introduced around 40 years ago. The carbon dioxide (CO2) laser was the first laser to be developed by Patel and his colleagues in the year 1964. Even though laser utilization gained huge popularity in 1980, it was clinically approved only in 1994 after being used as a random trial in the treatment of pelvic pain related to endometriosis (a disorder in which tissue similar to the inner lining of the uterus grows outside the uterus causing severe pain). However, with the advent of laparoscopy in gynecology, lasers faced a progressive decline. But in recent years with technological improvements lasers are being used in the field of gynecology.

What Is Laser?

Laser stands for Light Amplification by Stimulated Emission of Radiation. Medical lasers are devices that use accurately focused light beams to remove or treat tissues. Even though laser

treatment has risks similar to open surgeries, the recovery time following a laser surgery is much lesser than the recovery time after open surgery. Ordinary lights may spread in all directions and have many wavelengths. On the other hand, a laser is very high-intensity light focused in a thin beam and has a specific wavelength. Lasers are used extensively for accurate surgical procedures as they can focus precisely on tiny areas.

What Are the Uses of Lasers in Surgical Procedures?

Due to their efficiency lasers are used in many surgical procedures. They are as follows:

• Refractive Eye Surgery:

Lasers are used in the correction or improvement of vision by reshaping the cornea as in LASIK (laser assisted in situ keratomileusis) or PRK (photorefractive keratectomy) eye surgery.

• Cosmetic Surgery:

Lasers are being used to remove scars, stretch marks, wrinkles, spider veins, body hair, or birthmarks.

• Dental Procedures:

Lasers are being used in endodontic procedures, gum surgeries, tooth whitening, and oral surgery.

• General Surgery:

In the field of general surgery, lasers are used in breast surgery, cataract removal, plastic surgery, tumor removal, kidney stone removal, and many other surgical procedures.

What Is the Role of Lasers in Gynecology?

Lasers are used to treat many gynecological conditions. They are as follows:

• Genital warts (a sexually transmitted infection characterized by the appearance of small growths in and around the genital area).

• Abnormal uterine bleeding.

• Endometriosis (a painful condition in which cells similar to the inner lining of the uterus grow outside the uterus).

• Cysts.

• Precancerous conditions of the cervix.

• Fibroid tumors (a noncancerous growth of the uterus).

• Urinary incontinence (inability to control urine leakage).

• Ectopic pregnancy (a condition in which a fertilized egg grows outside the uterus).

What Are the Benefits of Lasers in Gynecology?

The benefits of lasers in the field of gynecology are as follows:

• Reduced bleeding during the procedure.

• Promotes rapid healing.

• Microscopic precision.

• Limited tissue damage.

• Minimal scar formation.

What Are the Commonly Used Lasers in Gynecology?

The commonly used lasers in gynecological surgeries are as follows:

• Carbon Dioxide (CO2) Laser:

Laparoscopy is a surgical procedure that uses a thin tube called a laparoscope which is inserted into the abdomen (stomach) through an incision to assess the problems in the reproductive system or abdomen of a woman. Colonoscopy is a procedure in which a long tube called a colonoscope is inserted into the rectum to examine the abnormalities inside the large intestine. Carbon dioxide laser is used in combination with laparoscopy or colonoscopy during the procedures. The areas of usage of carbon dioxide lasers are as follows:

• Excision (removal) of a vaginal septum (partition of tissue dividing the vagina into two halves and interfering with sexual function, menstruation, and childbirth).

• Excision of an imperforate hymen (a thin membrane covering the opening of the vagina causing blockage).

• Condylomata (a skin tumor near the genital organs or anus) in pregnant women.

• Excision of hypertrophied labia minora (the inner layer of the protective tissue of the female genital being larger than the outer layer).

• Vaginal polyps (overgrowing cells in the uterus lining).

• Endometriosis.

• Human papillomavirus infections.

• Erbium-Doped Yttrium Aluminum Garnet (ER: Yag) Laser:Er: YAG laser is used in the following treatment areas. They are:

  • Pelvic organ prolapses.

  • Vaginal laxity (vaginal looseness characterized by loss of sensation in the vagina).

  • Vaginal atrophy (drying and thinning of the inner vaginal layer).

  • Exposure of Er: Yag laser to the vagina causes absorption of laser beams by the outer layers of the vagina leading to increased temperature. The energy is passed on to the deeper layers of the tissues which affect the collagen of the soft tissues below the skin. This results in the remodeling of the vaginal collagen and helps in repairing and restoring pelvic floor function.

• Neodymium-Doped Yttrium Aluminium Garnet (ND: Yag) Laser:The areas of treatment of Nd: YAG laser are as follows:

  • Chronic menorrhagia is treated using Nd: YAG laser either vaginally (through hysteroscope) or intra abdominal (through laparoscope).

  • Intrauterine lesions like uterine fibroids.

  • Lesions of the lower genital tract like abnormal cell growth.

• Potassium-Titanyl-Phosphate (KTP) Laser:

KTP lasers are used in treating benign peritoneal mesothelioma (non-cancerous tumors arising from the abdominal wall lining). This condition causes difficulties like pelvic or abdominal pain, difficulty in passing urine, and constipation. Laparoscopy with KTP laser has shown successful results in relieving the symptoms of patients with benign peritoneal mesothelioma.

• Argon Laser:

Argon laser is very useful in treating endometriosis. The unwanted endometrial tissue is removed using an argon laser combined with laparoscopy. Most of the patients experience complete or partial relief from pelvic pain. Hence argon laser is considered one of the most effective and safest methods of treating mild to moderate endometriosis.

• Diode Laser:

Diode lasers play an important role in the treatment of infertility and severe endometriosis. Generally, women with Y-shaped or T-shaped dysmorphic uterus suffer the problem of infertility. Women face recurrent pregnancy loss or implantation failure due to the abnormally narrow uterine cavity. Diode laser-accompanied hysteroscopic metroplasty surgery enhances the chances of reproduction in a Y-shaped or T-shaped dysmorphic uterus.

What Is the Future of Lasers in Gynecology?

The recent advancements seen in the use of lasers in gynecology pave the way for the future of laser treatments. The recent advancements are as follows:

• Lasers have shown successful results in the treatment of vulvovaginal disorders. Vulvovaginal disorders are the conditions that affect a woman’s vagina or external genitalia (vulva). These disorders can vary from mild yeast infections to serious conditions like gynecologic cancer.

• Most women after menopause face a decline in their estrogen levels. Decreased estrogen levels lead to painful and uncomfortable symptoms of vaginal atrophy like thinning and drying of the vaginal walls. Carbon-dioxide lasers have shown great efficiency in stimulating the collagen regeneration of the vaginal tissue leading to increased elasticity and moisture in the affected area.

• Laser usage is also being researched for procedures like a robotic myomectomy (a robotic-assisted minimally invasive surgery to remove uterine fibroids).

Conclusion:

Lasers in gynecology have increased the scope of minimally invasive surgical procedures. The usage of lasers in gynecology had been limited in the past years due to their low availability and high cost. However technological advancements and cost reduction can make laser treatment a