donna@gigaalaser.com
ABSTRACT
In order to investigate the role of diode laser in gynecologic laparoscopic surgery, from september, 2005 to March, 2006 a series of 36 cases of gynecologic diseases were treated laparoscopically with diode laser under local anesthesia. All the operations were achieved with safety and success. There were no complications. The principle of diode laser were discussed. In comparison with Nd∶YAG laser, diode laser has the advantages of effectiveness, safety and easy to perform.
Key words Laparoscopic surgery, Diode laser, Gynecologic diseases
High-power semiconductor laser is the first 90 years by the British scientists have successfully developed a new generation of lasers. It is in principle to make laser technology revolutionized the mutation, in the practical application is effective and efficient, use wide, low consumption, easy operation, small size, long life, maintenance-free, and many other advantages to the clinician with a to the good news, especially in laparoscopic surgery has its obvious advantages, European and American countries have more extensive use of such lasers, in our country is gradually entering clinical use. This will be our hospital under local anesthesia in the laparoscopic application of semiconductor laser (hereinafter referred to as laser) surgical treatment of gynecological diseases a preliminary report.
Materials and methods
Beijing Union Medical College Hospital Obstetrics and Gynecology and Laser Center in September 2005 to March 2006, in a television under the application of semiconductor laser imaging and its accessories with the laparoscopic treatment of 36 patients with gynecological diseases.
1 General Information: Age 23 ~ 45 years old, are married. Of which 23 cases of infertility.
2 Anesthesia Methods: a comprehensive local anesthesia, or intravenous injection of pethidine, phenergan, parallel with hydrochloric acid Dihydroetorphine 20μg sedation analgesics. Skin incision under local anesthesia with procaine. Pelvic internal organs with 0.5% tetracaine 20 ml (100 mg) Penbu for topical anesthesia. Surgical area was added, and 1:16 10000 procaine adrenaline for infiltration anesthesia.
3 Surgical methods: conventional laparoscopic insertion through a special catheter inserted to connect the flexible optical-fiber laser (diameter 600μm), this catheter in the surgical laparoscopic. Continue to introduce optical fiber until the TV to see the exposed fiber laparoscopic about 1 ~ 1.5 cm, activate the laser, you can use. Laser in continuous mode, by the surgeon with the foot switch control. Such as organizations or separation of adhesions vaporization, using contact-type, power 8 ~ 13 W; such as the burning endometriotic lesions or coagulation to stop bleeding, using quasi-contact, power 7 ~ 10 The use of quasi-contact optical fiber can be by adjusting the power, the role of distance and time to control, so that for therapeutic purposes. The distance between the probe and organizations in general for 2 ~ 4 mm, the role of time of 2 ~ 4 seconds. According to different conditions for the second abdominal incision (diameter 0.5 ~ 1 cm), enter the required surgical instruments.
(1)Ovarian chocolate cyst and other benign ovarian cystectomy: cyst puncture and aspiration washed clean, with its laser-cut surface of the ovarian tissue, stripping out the cyst, residual cyst wall and bleeding punishable by laser or electrocoagulation cautery, incision without suture.
(2) Resection of ovarian cysts: cyst puncture and red smoke after the cyst pull to bring to the middle of the laser to cut off the sections of ovarian ligament and ovarian mesentery until the free ovary.
(3)Crown ovarian cystectomy: cyst surface with a laser into a line of vascular coagulation, after carefully cut the line before the leaves broad ligament peritoneum, stripped most of the cyst, cystic fluid extracted, reverse grip cyst, complete out.
(4) Endometriosis ablation lesions: Note anatomic site, quasi-contact laser burning of ectopic lesions, so pale.
(5) Pelvic adhesions dissection: Exposure adhesion site, a certain tension, away from the organ, laser contact adhesive tape, paragraph by paragraph cut, separate adhesion.
(6) Oviduct ostomy: In the tubal end of the enlarged area of stagnant water in order to Laser "10"-shaped incision, release of liquid, and then a low-power laser cauterizing the serosal surface umbrella side to make it contraction valgus, and bleeding.
(7)Subserosal myomectomy: paragraph by paragraph, along the fibroid at the base of
laser cut pulp muscle, clamping fibroids Niuchu, laser to stop bleeding wounds.
(8) Polycystic ovarian drilling technique: The laser irradiation optical fiber insertion hole of ovarian follicles: Every hole diameter of 3 ~ 4 mm, the depth of 4 ~ 6 mm, number of holes depending on size of the ovaries, after punching the release of follicular fluid, ovary, compared with surgery before the relaxation narrowing.
(9) Conservative surgery of tubal pregnancy: the Department of membrane in the fallopian tubes into the vasoconstrictor, mesangial longitudinal side with a laser-cut parts of tubal pregnancy, clip out the pregnancy, and blood clots after washing the product of the incision is not sutured. Surgical specimens removed from the abdominal incision, and sent to pathology. All operations until the pelvic injection lactate Ringer's injection, and metronidazole, gentamicin reserved. 4 hours ~ 2 days after discharge.
Results
1 The types of diseases: 36 cases, there are 19 cases of endometriosis (of which 11 cases of ovarian chocolate cyst, cyst diameter of 5 ~ 8 cm), pelvic inflammatory disease, or mass in 7 cases, subserosal uterine fibroids, polycystic ovarian , ovarian mucinous cystadenoma in 2 cases, ovarian cysts crown (diameter 12 cm), simple ovarian cysts, dermoid cysts, tubal pregnancy and 1 case of ampulla.
2 Surgery Type: Enucleation of ovarian chocolate cysts, 11 cases of benign ovariancystectomy in 4 cases, 1 case of ovarian cyst resection, ablation of ectopic foci in 10 cases, 9 cases of dissection of pelvic adhesions, tubal ostomy in 4 cases, Polycystic ovarian drilling operation in 3 cases, 2 cases of uterine myomectomy, tubal pregnancy, conservative surgery and 1 case, a total of 45 cases (some cases at the same time to make two kinds of surgery). A smooth operation, of which there were four cases of intraoperative bleeding more active, quasi-contact laser to stop bleeding quickly after irradiation, no intraoperative or postoperative complications. Long-term effect has yet to be followed up.
Discussions
Semiconductor laser excitation energy from low-current high-power laser diode production, aluminum gallium arsenide diode chip by (GaAlAs) semiconductor material formed, with the traditional laser emission mechanism. The wavelength of 805 nm, easily organize pigment absorption, and vaporization of tissue coagulation are very good results, it is required for low power operation, the Group used the power of not more than 13
Semiconductor laser energy can be bent by the optical fiber transmission to the laser probe, part of the energy absorbed by a special probe for the vaporization organization; another part of the energy from the probe revealed a starting role in coagulation to stop bleeding. Vaporization and coagulation at the same time to avoid bleeding. Little bleeding during surgery in this group in case of bleeding, the laser to stop bleeding effect is good.
Carbide surface contact probe absorption is good, and further increases cutting speed. Organization much better than the cutting microwave or scissors cut after electrocoagulation. Our experience is that when the fiber cutting contact with the organization, gently move forward, fiber and Cutter, rather than buried in the organization in order to make the probe mechanical cutting organizations can avoid breaking the probe. Semiconductor laser a high photoelectric conversion rate, power consumption and produces very little waste heat, it can use normal 220 V power supply, and does not require cooling water device, the machine is compact and easy to carry, saving water and electricity. Laser use, the organization surface temperature can reach 150 ℃, the energy concentration of vaporization solidification speed, the temperature dropped rapidly with the organizational depth to make it in the vaporization at the same time, has a good coagulation function. Because diathermy light, no heat probe in clinical use, there is a sense of security can reduce the depth of the main organs of the lesion (For example ureter, intestinal Qu, blood vessel) injury concerns. The patients are able to achieve the desired burning required depth, no bad damage. Surgical operation, through the catheter can have a good feel; in low-power red laser guided positioning, so that surgical cautery site accurate, very little bleeding during surgery, producing less smoke, so clear vision, one can prevent friendly fire around the organs. As the operation efficiency, speed, less pain, and can therefore be carried out under local anesthesia in the surgical operation. Semiconductor laser surgery indications of wider application of surgery in this group of diseases with endometriosis, five kinds of ovarian cysts, pelvic inflammatory mass with adhesions, uterine fibroids, polycystic ovarian, tubal pregnancy, infertility, etc. commongynecological diseases. 1 case of infertility, bilateral tubal water to 10 W power laser-cut bevel side adhesion, the use of nearly 6 W low-power, quasi-umbrella-side contact with serous burning lap. Organization of contraction, the umbrella side quickly turned outward, and very satisfied with the stoma. Polycystic ovarian drilling technique using interstitial laser therapy, will probe into the increased number of follicles in the laser transition from the vertical conduction 360 ° radial scattering, so that the organization follicle vaporization, coagulation and necrosis of the scope of large, a large number of follicles fluid flow, follicles become smaller, for therapeutic purposes.
donna@gigaalaser.com
