Diode Laser in Gynecologic Laparoscopic Surgery

Keywords:diode laser ,Diode laser in gynecologic laparoscopic surgery

High-power diode laser applications in laparoscopic surgery in China in recent years, the application of progressive development. Now in our hospital under local anesthesia in the laparoscopic application of diode laser in treatment of gynecological diseases, the fact sheets are as follows.

1.       Materials and methods

1)      Clinical data: from September 2005 to February 2007, in a television imaging applied under Diomed 60 diode laser and laparoscopic (West Germany Wolf produced) in treatment of 120 cases of gynecological diseases. Patients aged 23 to 45 years old, unmarried 3 cases, married in 117 cases, of which 61 cases of infertility.

2)      Surgical methods: a comprehensive local anesthesia after laparoscopic insert a special catheter diode laser optical fiber (diameter 600μm), this catheter in the surgical laparoscopic. Continue to introduce optical fiber until the TV to see the exposed fiber laparoscopic about 1cm. Diode 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 ~ 15 W. Endometriotic lesions, such as burning or coagulation to stop bleeding, use the power of 5 ~ 10 W, a distance of the probe and organizations 2 ~ 4mm, the role of time of 2 ~ 4 seconds.

  

Surgical operation is as follows: (1) ovarian endometriotic cyst (the cyst), or ovarian cystectomy: line cyst puncture and aspiration washed clean, with its semi-conductor laser-cut surface of the ovarian cyst, the cyst stripping out, the diode laser cut the pedicle, residual cyst wall and bleeding punishable by diode laser or electrocoagulation cautery;

(2) resection of ovarian cysts: cyst puncture and red smoke, with its diode laser (or plus bipolar coagulation) piecewise cut ovarian ligament and ovarian mesentery until free ovary;      

(3) the highest ovarian cystectomy: 6 W diode laser with the surface of the cyst after vascular solidified into a line and carefully cut the line this article before the leaves broad ligament peritoneum, Most of the cyst, after stripping, out of intracystic fluid, reverse grip cyst, complete removal;

(4) pelvic adhesions dissection: Exposure adhesion site, a certain tension, away from the organ, to diode laser contact adhesive tape, by segment of separating adhesions. The ablation lesions of endometriosis, tubal ostomy, subserosal myomectomy, tubal pregnancy, polycystic ovarian drilling operation and the specific operative conservative surgery, by reference to literature methods. Surgical resection specimen sent to pathology. All operations until the pelvic lactate Ringer's solution injection, metronidazole, and gentamicin reserved. After 4-2 hours and discharged. Patients were followed up 6 to 23 months, followed up rate was 97.5%. No intraoperative or postoperative complications occurred.

2.       Result

A total of 120 cases of diseases 126. Types of operation and its effects are as follows: (1) 73 cases of endometriosis, associated with cysts in 34 patients (46.6%), cyst diameter of 4 ~12cm. In which cysts completely enuclearion 29 cases (85.3%), part of the strip 5 patients is no different bit cysts were only laser cauterizing 39 cases of pelvic endometriotic lesions. 73 cases of infertility in the merger, 35 cases of pregnancy after 19 patients (54.3%). 34 cases of cysts after pelvic examination and B-by followed up, cysts disappeared in 25 cases, seven cases of smaller cysts, efficiency of 94.1%. There are 73 cases of dysmenorrhea and other painful symptoms of 54 patients (74.0%), postoperative pain and complete remission in 37 cases, reduce the 13 cases, efficiency of 92.6%. (2) 20 cases of ovarian cysts (diameter 4 ~ 12 cm), in which the highest ovarian cyst, 9 cases of ovarian dermoid cysts, 5 cases of simple ovarian cysts in 3 cases, mucinous cystadenoma, 3 cases were satisfied with the strip or the removal of ovarian cysts, and removed no recurrence after operation were followed up. (3), polycystic ovary 7 cases, the merger is not sterile in 6 cases, After 1 month and 4 months pregnant in 1 case, basal body temperature to restore two-phase in 2 cases. (4) chronic pelvic inflammatory disease 22 cases, of which 10 cases of hydrosalpinx combined, 20 cases of infertility. The success of tubal colostomy in 10 cases, 2 cases of pregnancy, three cases of postoperative angiography, or pass liquid show tubal patency, 11 patients had pain and relieve symptoms in 8 cases. (5) two cases of unruptured tubal pregnancy and uterine subserosal fibroids in 2 cases, surgery goes well, have all been recovered.

3.       Discussion

Diode laser excitation energy from low-current high-power laser diode generated by a diode chip of gallium aluminum arsenic (GaAlAs) diode material, with the traditional laser different mechanisms. The wavelength of 810 nm, for tissue coagulation and vaporization have very good results, it is required for low power operation. The power of this group using the 5 ~ 15 W. Diode 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 sent from the probe has played the role of coagulation to stop bleeding. Vaporization and coagulation at the same time, to avoid bleeding. Very little bleeding during surgery in this group, there are six cases of intraoperative bleeding was once, the laser irradiation to stop bleeding quickly to good effect. Our experience is that cutting fiber contact organizations, fiber and probe gently to move forward, rather than buried in the organization in order to make the probe mechanical cutting organizations can avoid breaking the probe. In our hospital since 1989, in the laparoscopic use of Nd: YAG bare fiber laser (referred to as YAG) has been Shubai Li treatment of gynecological diseases in 2005, after application of the diode laser, based on our experience of clinical practice, the diode laser and YAG in Although close to surgery, but the comparison between the two, the former use has the following advantages: diode laser, electro-optical conversion rate is better, for the YAG 30 times, for power consumption and produces very little waste heat, can use regular 220V power supply, the machine No high-pressure, high fever fragile components, so long service life. The YAG need to install the 380 V power supply and cooling water system to remove heat, so more water and electricity consumption, and easy to damage. Diode laser machine is compact, weighing only 11 kg, easy to carry, the hospital is equipped with a machine used for surgical subjects; while YAG machines bulky and heavy is not easy moving. Diode laser used to organize the surface temperature can reach 150 ℃, the energy concentration of vaporization solidification speed, the temperature dropped rapidly with the depth of the organization, the deepest penetration of heat 2 mm, while the organization of the depths of the temperature is higher than YAG surface temperature, diathermy the most up to 4 mm, and the temperature decreases slowly. Diode laser light due to diathermy, heat a small probe, the clinical use of safe, can reduce the depth of the lesion organ (eg, ureter, intestines, blood vessel) damage. The patients are able to achieve the desired burning required depth, there is no bad damage. Surgical operation, the laser fiber which leads to a special catheter, there is a very good feel, in the low-power red laser guided positioning, so that surgical cautery site accurate, easy to learn. Diode laser surgery operations produce smoke due to less bleeding, less than YAG, intraoperative clear vision, one can prevent friendly fire around the organs. Diode laser in gynecologic abdominal Indications for laparoscopic surgery more extensive and effective satisfaction of endometriosis patients with infertility were pregnancy rate was 54.3%, postoperative pain relief rate was 92.6%, treatment efficiency of ectopic cysts were 94.1%, ovarian cyst after surgery have all been recovered. The reason for the endoscopic treatment of pelvic observation point is good, light, strong, lesions enlarge, using diode laser burning lesions accurately, omissions little tissue reaction to light, can be accurately cut and not cut ovarian cortex broken cyst wall, which will help peeling cysts, the door in the past would have been stripped of ovarian cyst using laser cut to prevent bleeding. Polycystic ovarian laser drilling technique can be used (interstitial laser therapy), so that vaporization of follicular organization, follicular fluid outflow, for therapeutic purposes. In general, amounting to about 20 on each side hole. Diode laser safe and convenient in use, fast, effective, compared with electrocoagulation, which condensate or microwave and other equipment is superior, monopolar electrocoagulation to avoid skin effect due to accidents arising from electrical burns, thermal injury in the scope of its far smaller in bipolar electrocoagulation. However, an active case of intraoperative bleeding, still using bipolar electrocoagulation. This advent of high-power diode lasers for endoscopic surgery, played a larger role in promoting.

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