In gynecological laser surgery the CO₂ and thulium lasers are successfully used for the treatment of many female genital tract diseases with applications in colposcopy (SmartXide² and MultiPulse PRO), laparoscopy (SmartXide² and MultiPulse Tm+1470) and hysteroscopy (MultiPulse Tm +1470), obtaining many advantages against more traditional techniques or open surgery.
These procedures reduce surgical invasiveness and duration, morbidity, damage to surrounding tissue and ensure more rapid healing of patients with lower incidence of complications.
In gynecology, laser surgery is recommended for the treatment of warts (condylomata acuminata) in the anogenital area and dysplasia of the vulva, vagina and cervix (colposcopy) or for intra-uterine and endometrial pathologies (treated with hysteroscopy or laparoscopy, depending on the lesion). In some cases, outpatient procedures with local anaesthesia may be involved with significant cost savings compared to the corresponding procedures in the operating room.
Learn more about how CO₂ laser microsurgery for gynecology can guarantee the best performance in the operating room.
Used in medicine for over 30 years, a CO₂ laser coupled with a colposcope has become an indispensable tool for the ablation or excision of numerous lesions of the lower genital tract, especially when it is necessary to minimize tissue removal.
Conservative treatments, depending on the lesion to be treated, can involve destructive techniques (CO₂ laser ablation or vaporization) that do not allow to keep a specimen of the histological examination, as well as excision techniques that instead make it possible.
Among the main applications in colposcopy, the treatment of dysplasia and warts of vulva, vagina, perineum and perianal area should certainly be mentioned.
In oncological gynecology, the CO₂ laser is the ideal technology for treating cervical intraepithelial neoplasia (CIN) by vaporization or excisional cone biopsy – in place of the scalpel. The chances of complications with laser cones are very low. Moreover, the histological sample obtained with this method is without artefacts and therefore perfect for examination.
The main features that make it the procedure of choice for CIN include:
• Microscopic accuracy (ability to select the level of ablation with sub-millimetre precision).
• High clinical effectiveness.
• Outpatient methodology or Day Surgery (reduction in health care costs).
• Clean surgical field, without bleeding.
• Minimal damage to healthy tissue surrounding the lesion.
• Rapid healing with minimal scarring, even for the treatment of large lesions.
• Reduced incidence of complications.
The most common treatments with CO₂ laser in colposcopy also include treatment of vulva intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VAIN) for which the use of lasers is an excellent treatment option compared to other surgical treatments.
SmartXide² laser can be coupled with an operative laparoscope for intra-abdominal surgical treatments. The advantage of CO₂ laser in gynecological laparoscopy is the minimal lateral thermal damage and complete control of action depth. The operator can constantly monitor the penetration depth during surgery. This makes the use of the SmartXide² system especially suitable for laparoscopic surgery on critical areas such as those adjacent to the intestine, ureter and bladder.
Also the MultiPulse Tm+1470 laser system, with a special fiber set, is used in laparoscopic surgery. This laser, conveyed by flexible fibers, enables tactile contact with the organ to be treated which for some users facilitates dexterity during surgery.
Both lasers have proven to be particularly effective in the treatment of numerous pathological conditions including:
The areas affected by endometriosis can be vaporized or removed by the SmartXide² or MultiPulse Tm+1470 laser. The CO₂ laser, however, remains the one most commonly used and is the most suitable procedure for endometriosis treatment from phase I to IV (classification of the American Fertility Society – AFS ). The main reason is its high safety margin due to precise penetration depth control coupled with the minimal thermal damage to healthy tissue. These characteristics make it particularly suitable for operations in sensitive areas such as those adjacent to the ureter and intestine.
Pelvic adhesion disease can result from previous infections or after-effects of surgery. Both CO₂ and thulium + raman 1470 laser systems are good choices for adhesiolysis. In particular, they are ideal tools for the lysis of vascular adhesions, because they are able to perform excision and coagulation simultaneously, limiting the trauma of peripheral tissue.
• Uterine fibroids and ovarian fibroids
For the removal of myomas (uterine fibroids) and ovarian fibroids, the CO₂ and thulium + raman 1470 lasers outdo the scalpel and standard electrosurgery procedures in terms of improved hemostasis, decreased tissue trauma and lower incidence of adhesion formation.
MultiPulse Tm+1470 is the laser system that Asclepion Laser Technologies offers for hysteroscopy: equipped with a flexible fiber that can be passed easily through the hysteroscope, it is recommended for the majority of endouterine surgical procedures.
The most common treatments that can be performed with MultiPulse Tm+1470 include the removal of fibroids and polyps, resection of uterine septum, lysis of intrauterine adhesions and endometrial ablation.
Compared to the abdominal surgery approach, the main advantages of operative hysteroscopy lie in the operation execution speed, limited blood loss, absence of abdominal and uterine scars, minimal morbidity, absence of reduction in intra-uterine volume and finally lower health care costs.
Colposcopy: cervical, vaginal, vulvar and anal acuminate condylomas | cysts and abscesses of Bartolin’s glands | cysts of the mucosa | various degrees CIN up to invasive or initial-stage carcinomas (IA1) | Fornix and cupola pathologies (VAIN, vaginal endometriosis, condylomatosis) | VIN | Bowen’s disease | Queyrat’s erythroplasia | Bowenoid papulosis | leukoplakia (vulvar dystrophy) | polyps | perivulvar and perianal fistulas | precancerous endoanal lesions | dysplasia of lower genital tract
Laparoscopy: endometriosis | adhesions | myomas and uterine fibroids | ovarian fibromas
Operations of: salpingostomy | fimbrioplasty | fallopian tube microsurgery | oophorectomy | ovariectomy | ovarian drilling (for ovarian polycystosis) | metroplasty | ablation of the uterosacral ligaments | hysterectomy | sacrocolpopexy | sacrocervicopexy | sacrouteropexy (for genital prolapse)
Hysteroscopy: myomas | polyps | uterine malformations ( septate uterus, uterine synechiae and adhesions)
Treatment of Endometriosis Performed with CO₂ Laser
[Courtesy of M. Rosati, M.D. Director of the Operating Unit of Gynaecology and Obstetrics Spirito Santo Hospital – Pescara, Italy]
MultiPulse Tm+1470 is the only system that combines a 1,940 nm Thulium laser with a 1,470 nm raman laser (maximum power 120 W + 30 W), designed to deliver the best performance in the operating room.
The SmartXide² system with CO₂ and diode laser sources is one of the most versatile and cutting-edge solutions available in the surgery market. It is suitable for precision microsurgery in ENT, gynecology, neurosurgery and general surgery.
MultiPulse PRO is the CO₂ laser surgery system used for ENT microsurgery, general surgery and colposcopic gynecological surgery. Suitable for all photoablation treatments, it facilitates the work of surgeon thanks to the synergy of advanced technologies.