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An introduction to laser endosurgery

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Abstract

In recent decades, advances in minimally invasive surgery and surgical lasers have facilitated interventions in anatomical locations that were previously inaccessible. This chapter details laser physics, types of laser, laser–tissue interactions, laser safety and uses of laser endosurgery.

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Figures

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16.1 a = Atoms resting in a ground state of energy. b = When bombarded with electrons (electricity), atoms move from a ground state of energy. c = When excited, atoms drop from the singlet state to the metastable state of energy. This change in state results in the loss of energy in the form of a photon. d = If a photon collides with a metastable atom as it is dropping to the ground state (which invariably happens), energy is lost in the form of a photon. = Photon.
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16.2 Coefficient of absorption of light. CO₂ = carbon dioxide; Er = erbium; H₂O = water; Hb = haemoglobin; HbO₂ = oxyhaemoglobin; NIR = near infrared.
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16.3 Tissue interaction with non-contact fibres. (a) Light emitted at 810–900 nm is highly absorbed by haemoglobin and melanin, and generates high temperatures at the tissue surface. This results in rapid vaporization with underlying coagulation of up to 3 mm. (b) The effects of high power (left) and low power (right) on the surrounding tissue. (Courtesy of Diomed Ltd)
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16.4 Laser ablation of a nasopharyngeal sialocoele. (a) Sialocoele. (b) Laser fibre in contact with the sialocoele. (c) Introduction of a probe to aspirate saliva from the opened sialocoele. (d) Final result of ablation. (Courtesy of D. De Lorenzi)
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16.5 Rostral aberrant turbinate.
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16.6 Caudal aberrant turbinate.
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16.7 Laser-assisted turbinectomy. (a) Rostral aberrant turbinate. (b) Vaporization of the turbinate. (c) Final result of the turbinectomy. (Courtesy of D. L. Casas)
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16.8 Laryngeal mass.
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16.9 (a) Tracheal chondroma. (b) Ablation of the tracheal chondroma using a Ho:YAG laser.
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16.10 Rostral nasal carcinoma.
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16.11 Turbinectomy to remove a nasal mass. (a) Laser fibre in contact with the mass. (b) Effect of firing the laser on the tissue. (c) Devascularization of the tissue following laser firing. (d) Appearance of the surgical site on completion of the turbinectomy.
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16.12 Nasopharyngeal mass.
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16.13 Ablation of a nasopharyngeal mass. (a) Rostral view of a nasopharyngeal tumour. (b) Effect of firing the laser on the tissue. Note that rostral access is required for this procedure. (c) Appearance of the surgical site on completion of the ablation.
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16.14 Retroflexed laser endoscopy for ablation of a nasopharyngeal mass.
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16.15 Nasopharyngeal stenosis. (a) View of nasopharyngeal stenosis from the nasal cavity. (b) View of nasopharyngeal stenosis during retroflexed endoscopy.
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16.16 Nasal aspergillosis. (a) plaque. (b) Partial laser turbinectomy around the plaque. (c) Use of a catheter to fill the nasal cavity with clotrimazole cream.
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16.17 Intraoperative images of a calcium oxalate urolith (a) before and (b) during laser lithotripsy. (c) Following the procedure, the fragments were removed with a stone basket and by voiding urohydropulsion.
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16.20 (a) Preoperative and (b) intraoperative images of laser ablation of bilateral intramural ectopic ureters in a bitch. A catheter is placed in the lumen of the left ectopic ureter to shield the outer wall while the wall shared between the urethra and ureter is ablated cranially until the ureter opens in the urinary bladder.
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16.22 Stenotic distal ureteral orifice (arrowed) at the vesicourethral junction in a male dog.
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16.23 Laser ablation of a congenital retained paramesonephric remnant bridging the dorsal and ventral vestibulovaginal junction.

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