Lasers and Fiber Optics Enable Microsurgery and Keyhole Surgery

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Lasers and Fiber Optics Enable Microsurgery and Keyhole Surgery

Photograph

By: Robert J. Herko

Date: 2000

Source: YAG Laser Laparoscopic Surgery. Getty Images. 2000.

About the Photographer: Robert J. Herko is a professional photographer who works with many large commercial, state government, and corporate clients. He utilizes thirty-five millimeter, medium, and large format photography equipment, as well as digital cameras and software to accomplish assignments. He has written several books on the techniques and practice of (commercial) photography.

INTRODUCTION

Prior to the last quarter of the twentieth century, virtually all surgical procedures were open, meaning that they involved an incision in the vicinity of the surgical site. Major surgeries, such as cholecystectomy (removal of the gall bladder), hysterectomy (removal of the uterus, with or without oophorectomy, or removal of the ovaries), organ transplants, or orthopedic procedures typically necessitated an incision that was a minimum of several inches long, often along with the use of muscle paralyzing agents in order to split the necessary muscle layers. The risk of infection was considerable, because of the exposed surface area for the duration of the procedure, postoperative pain was often debilitating, hospital stays were lengthy, and recovery was a several-week to several-month process. In addition, surgeries, because of their extensiveness, were lengthy procedures, increasing the risk and trauma to the patient by requiring prolonged periods of anesthesia.

With the evolution of the surgical microscope, as well as the adaptation of jeweler's tools for use in the operative setting, it became possible to perform microsurgery. Pioneered in the mid-1960s in California, microsurgery offered the opportunity to perform surgery on minute or fragile structures, such as blood vessels. In its early stages, it was often used to reattach partially (or completely) severed digits, toes, and, eventually, limbs. From precision and technically intricate surgery, it was a relatively short technological and evolutionary step to laparoscopic microsurgery, in which small incisions (typically less than one centimeter in length) are made in the skin, fine instruments, surgical microscopes and camera equipment are utilized to perform invasive surgery through the use of several small incisions (for tools and viewing equipment), dramatically reducing surgical risk, vastly shortening surgical procedure time, and significantly minimizing postoperative complications, recovery time, and hospital stays. Laparoscopic surgery, also called keyhole surgery, also enables the use of sedation and local anesthesia in place of general anesthesia in many cases. There has been considerable research on the safety and efficacy of keyhole surgery, and one of many the interesting findings from a German study has concerned post-surgical immune system function. The German team discovered that patients who had undergone keyhole surgery, when compared with patients who had the same procedures performed using traditional open methods, had a more intact general immune system after the procedure. In other words, although there is always a systemic inflammatory response to any invasive procedure, there was less trauma to the overall immune system subsequent to the less invasive laparoscopic procedure. This suggests that the rate of infection among patients with laparoscopic procedures is likely to be less than for those with open surgical procedures.

Toward the end of the twentieth century, the construction and development of various types of lasers progressed to the point where they began to be used in the medical and surgical realm, where they have represented a significant technological advancement of the use of electrosurgical techniques.

PRIMARY SOURCE

LASERS AND FIBER OPTICS ENABLE MICROSURGERY AND KEYHOLE SURGERY

See primary source image.

SIGNIFICANCE

Laser surgery essentially involves the use of a focused beam of moving light energy in a manner akin to the use of an electronic scalpel or a cautery. The light energy heats the targeted tissue, and can cause it to vaporize. It is used to ablate or remove lesions, tumors, scars, and other types of masses, as well as to shrink or seal blood vessels. When used as a surgical scalpel, it cauterizes while it ablates, minimizing bleeding in most instances. Currently, there are several types of medical and surgical lasers being employed, each of which performs different types of functions. One of the most striking characteristics and distinct advantages of the use of the laser in surgery is precision. It is able to target a specific type or area of tissue, and leave the surrounding structures undisturbed. As a result, it is very useful in sealing blood vessels, removing small lesions and tissue structures and leaving intact surgical margins (cleanly removing all of the desired tissue)—thereby preventing the spread of tumors by leaving stray cells behind which can seed. Lasers are also used to ablate nerve endings in order to eliminate sources of chronic pain, to provide palliative relief in patients who are chronically or terminally ill, or to diminish postoperative pain. Lasers, particularly the argon type, are commonly used to correct vision defects (in place of corrective lenses or the now passé radial keratotomy procedure). In addition, surgical lasers are used for the removal of unwanted body hair and to make cosmetic improvements in appearance (plastic or cosmetic surgery). Lasers are now used to vaporize benign and malignant lesions, skin growths, fibroid tumors, gallstones, endometrial cysts (endometriosis), and kidney stones. Lasers are now being used to treat dysfunctions of virtually every organ system, as well as to perform complicated bone and muscle (orthopedic) surgeries.

In the field of neurosurgery, the newest technological advance involves completely non-invasive surgery, through utilization of the gamma knife stereotactic radiosurgical procedure. Quite often, brain lesions and lesions of the central nervous system are either not amenable to surgery by virtue of their location, or their invasive surgical removal poses a risk that outweighs any potential benefit. The gammaknife is created by the precise intersection of 201 (high dose) gamma rays, causing the targeted lesion to dissipate and eventually dissolve. It is a single exposure radiation procedure.