Laser medicine

Laser medicine is the use of lasers in medical diagnosis, treatments, or therapies, such as laser photodynamic therapy,^[1] photorejuvenation, and laser surgery.

CW rhodamine dye laser emitting near 590 nm, one typically used in early medical laser systems.

Laser radiation being delivered via a fiber for photodynamic therapy to treat cancer.

A 40-watt CO₂ laser with applications in ENT, gynecology, dermatology, oral surgery, and podiatry

The word laser stands for "light amplification by stimulated emission of radiation".^[2]

History

The laser was invented in 1960 by Theodore Maiman,^[3] and its potential uses in medicine were subsequently explored. Lasers benefit from three interesting characteristics: directivity (multiple directional functions), impulse (possibility of operating in very short pulses), and monochromaticity.^[4]

Several medical applications were found for this new instrument. In 1961, just one year after the laser's invention, Dr. Charles J. Campbell successfully used a ruby laser to destroy an angiomatous retinal tumor with a single pulse.^[5] In 1963, Dr. Leon Goldman used the ruby laser to treat pigmented skin cells and reported on his findings.^[6]

The argon-ionized laser (wavelength: 488–514 nm) has since become the preferred laser for the treatment of retinal detachment. The carbon dioxide laser was developed by Kumar Patel and others in the early 1960s and is now a common and versatile tool not only for medicinal purposes but also for welding and drilling, among other uses.^[7]

The possibility of using optical fiber (over a short distance in the operating room) since 1970 has opened many laser applications, in particular endocavitary, thanks to the possibility of introducing the fiber into the channel of an endoscope.

During this time, the argon laser began to be used in gastroenterology and pneumology. Dr. Peter Kiefhaber was the first to "successfully perform endoscopic argon laser photocoagulation for gastrointestinal bleeding in humans". Kiefhaber is also considered a pioneer in using the Nd:YAG laser in medicine, also using it to control gastrointestinal bleeding.^[8]

In 1976, Dr. Hofstetter employed lasers for the first time in urology. The late 1970s saw the rise of photodynamic therapy, thanks to laser dye. (Dougherty, 1972^[9])

Since the early 1980s, applications have particularly developed, and lasers have become indispensable tools in ophthalmology, gastroenterology, and facial and aesthetic surgery.

In 1981, Goldman and Dr. Ellet Drake, along with others, founded the American Society for Laser Medicine and Surgery to mark the specialization of certain branches of medicine thanks to the laser.^[10] In the same year, the Francophone Society of Medical Lasers (in French, Société Francophone des Lasers Médicaux) was founded for the same purpose and was first led by Maurice Bruhat.^[11]

After the end of the 20th century, a number of centers dedicated to laser medicine opened, first in the OCDE, and then more generally since the beginning of the 21st century.

The Lindbergh Operation was a historic surgical operation between surgeons in New York (United States) and doctors and a patient in Strasbourg (France) in 2001. Among other things, they utilized lasers.

Advantages

The laser presents multiple unique advantages that make it very popular among various practitioners.

• Due to its directional precision, a laser precisely cuts and cauterizes tissues without damaging neighboring cells. It's the safest technique and most precise cutting and cauterizing ever practiced in medicine.
• Laboratories use lasers extensively, especially for spectroscopy analysis and more generally for the analysis of biochemical samples. It makes it possible to literally "see" and more quickly determine the composition of a cell or sample on a microscopic scale.
• The electrical intensity of a laser is easily controllable in a safe way for the patient but also variable at will, which gives it a very wide and still partially explored range of uses (in 2021).

Disadvantages

The principal disadvantage is not medical but rather economic: its cost. Although its price has dropped significantly in developed countries since its inception, it remains more expensive than most other common technical means due to materials, the technicality of the equipment necessary for the operation of any laser therapy, and the fact that it requires only certain specific training.

For example, in France (as in other countries with a social security system), dental, endodontal or periodontal laser treatment is classified outside the nomenclature and not reimbursed by social security.

Lasers

Lasers used in medicine include, in principle, any type of laser, but especially the following:

• CO₂ lasers,^[12] used to cut, vaporize, ablate, and photocoagulate soft tissue.^[13]
• diode lasers^[14]
• dye lasers^[1][15]
• excimer lasers
• fiber lasers^[16]
• gas lasers
• free electron lasers
• semiconductor diode lasers^[17]

Applications in medicine

Examples of procedures, practices, devices, and specialties where lasers are utilized include the following:

• angioplasty^[15]
• cancer diagnosis^[17][18]
• cancer treatment^[19]
• dentistry
• cosmetic dermatology such as scar revision, skin resurfacing, laser hair removal, and tattoo removal^[15]
• dermatology,^[15] to treat melanoma
• frenectomy
• gingivectomy
• lithotripsy^[15]
• laser mammography^[20]
• medical imaging^[20]
• microscopy^[21][22]
• ophthalmology (includes Lasik and laser photocoagulation)
• optical coherence tomography^[16]
• optogenetics^[23]
• prostatectomy
• plastic surgery, in laser liposuction,^[24] in the treatment of skin lesions (congenital and acquired), and in scar management (burns and surgical scars)
• surgery,^[16][25] to cut, ablate, and cauterize tissue

See also

• Dental laser
• Endovenous laser therapy
• Laser-assisted new attachment procedure
• Laser surgery
• Light therapy
• Low level laser therapy
• Photodynamic therapy
• Photomedicine

References

1. Duarte F. J.; Hillman, L.W. (1990). Dye Laser Principles, with Applications. Boston: Academic Press. ISBN 0-12-222700-X.
2. "What is a Laser?". NASA Space Place.
3. Townes, Charles H. "The first laser". The University of Chicago Press. Retrieved April 24, 2023.
4. "Lasers en médecine".
5. "It Happened Here: The Ruby Laser". NewYork-Presbyterian. 30 March 2017. Retrieved April 24, 2023.
6. Appold, Karen (April 11, 2019). "The history of aesthetic lasers". Dermatology Times. Dermatology Times, April 2019 (Vol. 40, No. 4). 40. Retrieved April 24, 2023.
7. "C. Kumar N. Patel". Invent.org. Retrieved April 25, 2023.
8. Khemasuwan, Danai; Mehta, Atul C.; Wang, Ko-Pen (December 2015). "Past, present, and future of endobronchial laser photoresection". Journal of Thoracic Disease. 7 (4): S380–S388. doi:10.3978/j.issn.2072-1439.2015.12.55. PMC 4700383. PMID 26807285.
9. Serge Mordon (10 October 2013). "Différents effets des lasers médicaux". Techniques de L'ingenieur (in French).
10. "ASLMS History". American Society for Laser Medicine and Surgery. Retrieved April 24, 2023.
11. "About SFPMed". SFPMed. Retrieved April 24, 2023.
12. Polanyi, T.G. (1970). "A CO₂ Laser for Surgical Research". Medical & Biological Engineering. 8 (6): 541–548. doi:10.1007/bf02478228. PMID 5509040. S2CID 40078928.
13. "Soft-Tissue Laser Surgery - CO2 Surgical Laser - LightScalpel". LightScalpel. Retrieved 2016-04-04.
14. Loevschall, Henrik (1994). "Effect of low-level diode laser irradiation of human oral mucosa fibroblasts in vitro". Lasers in Surgery and Medicine. 14 (4): 347–354. doi:10.1002/lsm.1900140407. PMID 8078384. S2CID 11569698.
15. Costela A, Garcia-Moreno I, Gomez C (2016). "Medical Applications of Organic Dye Lasers". In Duarte FJ (ed.). Tunable Laser Applications (3rd ed.). Boca Raton: CRC Press. pp. 293–313. ISBN 9781482261066.
16. Popov S (2016). "Fiber Laser Overview and Medical Applications". In Duarte FJ (ed.). Tunable Laser Applications (3rd ed.). Boca Raton: CRC Press. pp. 263–292. ISBN 9781482261066.
17. Duarte FJ (2016). "Broadly Tunable External-Cavity Semiconductor Lasers". In Duarte FJ (ed.). Tunable Laser Applications (3rd ed.). Boca Raton: CRC Press. pp. 203–241. ISBN 9781482261066.
18. Duarte, Francisco Javier (Sep 28, 1988), Two-laser therapy and diagnosis device, EP0284330A1, retrieved 2016-04-18
19. Goldman L (1990). "Dye Lasers in Medicine". In Duarte FJ; Hillman LM (eds.). Dye Laser Principles. Boston: Academic Press. pp. 419–32. ISBN 0-12-222700-X.
20. Carroll FE (2008). "Pulsed, Tunable, Monochromatic X-rays: Medical and Non-Medical Applications". In Duarte FJ (ed.). Tunable Laser Applications (2nd ed.). Boca Raton: CRC Press. pp. 281–310. ISBN 978-1-4200-6009-6.
21. Orr BJ; Haub J G; He Y; White RT (2016). "Spectroscopic Applications of Pulsed Tunable Optical Parametric Oscillators". In Duarte FJ (ed.). Tunable Laser Applications (3rd ed.). Boca Raton: CRC Press. pp. 17–142. ISBN 9781482261066.
22. Thomas JL, Rudolph W (2008). "Biological Microscopy with Ultrashort Laser Pulses". In Duarte FJ (ed.). Tunable Laser Applications (2nd ed.). Boca Raton: CRC Press. pp. 245–80. ISBN 978-1-4200-6009-6.
23. Penzkofer A; Hegemann P; Kateriya S (2018). "Organic dyes in optogenetics". In Duarte FJ (ed.). Organic Lasers and Organic Photonics. London: Institute of Physics. pp. 13–1 to 13–114. ISBN 978-0-7503-1570-8.
24. Przylipiak AF, Galicka E, Donejko M, Niczyporuk M, Przylipiak J (Oct 2013). "A comparative study of internal laser-assisted and conventional liposuction: a look at the influence of drugs and major surgery on laboratory postoperative values". Drug Design, Development and Therapy. 7: 1195–200. doi:10.2147/DDDT.S50828. PMC 3798112. PMID 24143076.
25. Jelinkova H, ed. (2013). Lasers for Medical Applications: Diagnostics, Therapy, and Surgery. Oxford: Woodhead. ISBN 978-0-85709-237-3.

External links

Media related to Laser medicine at Wikimedia Commons