return to: Laser Surgery Protocols

Note: last updated before 2017

BASICS OF LASER USAGE

What is a laser?

A laser is an electro-optical device that emits organized light in a narrow intense beam.

Light Amplification by the Stimulated Emission of Radiation, or LASER as it is commonly known today, is an acronym whose theoretical basis was theorized by Einstein in 1917 (1). In 1960, Maiman produced the first laser. (2).

Today, lasers are used for a wide variety of purposes including (but not limited to) medical, industrial, consumer electronic and research purposes.

How do lasers work?

The quantum physical basis for lasers involves an understanding of the electron energy levels of an atom. The most stable level for a given electron is the ground state. In the transition between different energy states of the electrons, photons may be either absorbed or emitted.

At a basic level, the production of lasers involves the transitioning of the electrons of an atom between elevated and ground energy states. An electron that has been excited (elevated to a higher energy state), will spontaneously revert to its ground state by emitting a photon of equal energy to the difference in the excited and ground states of the electron. Likewise, atoms in high energy states can be stimulated (by a photon of the appropriate wavelength) to achieve a lower energy state via emission of a photons (light). This is the basis for the production of a laser.

Are all lasers the same?

Lasers differ in the type of wavelength they produce, and as a result, the specific tissue absorptive properties. The exact effect a specific laser will have on a specific tissue will vary based on the wavelength of the laser utilized and the type of tissue being treated. Physicians choose the specific laser utilized for a given procedure based on the tissue being treated (skin, mucosa, vessels, scar, etc) and the desired impact (ablation of tissue, coagulation of tissue, minimal energy transmission, debulking, etc.).

What some of the different types of lasers in Otolaryngology?

Please refer to the individual links on the laser page homepage for further information regarding specific lasers and their use in specific procedures (Laser Surgery Protocols)

Why does a laser need to be used for my treatment?

The properties of medical lasers allow for a variety of benefits. These include, but are not limited to the following benefits:

• Precise treatment of specific areas of disease
• Preservation of normal tissue
• Avoidance of or decreased incidental damage to adjacent structures
• Treatment delivery to areas that are difficult to access (base of tongue, larynx, trachea, middle ear, etc).

Are there risks to using the laser for my treatment?

There are risks inherent to all surgical procedures. The risks for any specific procedure/treatment course will vary based on a number of different factors. The risks of your procedure should be thoroughly discussed with your physician prior to the undergoing any surgical procedure.

CO2 Laser

Wavelength: 10,600 nm; Infrared wavelength (invisible)
Power: 0.1-100 W
Penetration: 0.2-0.3 mm
Absorbtion: tissue with high water content selectively absorbs energy
Otolaryngologic Uses:

• Recurrent Respiratory Papillomatosis Treatment (3) - utilized for ablation of papillomas in the airway. Does not necessarily cure the RRP disease process, but allows for relief of airway obstruction with fine tuned ablation of specific disease areas that may not otherwise be easily addressed due to the limited space and potential for damage to adjacent structures.
• Supraglottic Laryngectomy
• Stapedectomy
• Subglottic hemangioma treatment

-The CO2 laser is not a visible laser.
-A visible helium-neon beam is utilized to aim the CO2 laser. As such, the laser must be test fired to ensure aiming to two beams are aligned and the CO2 laser will be focused on the intended target tissue

Settings:

Neodymium : Yttrium-Aluminum-Garnet (Nd-YAG) Laser

Wavelength: 1064 nm; Infrared wavelength (invisible)
Penetration: 4mm
Absorbtion:

• increased absorption in pigmented tissues and charred debris
• low absorption in high water content tissues

Otolaryngologic Uses:

• Tracheo-bronchial lesions
• Esophageal lesions
• Treatment of vascular lesions

Settings:

Holmium : Yttrium-Aluminum-Garnet (Ho-YAG) Laser

Wavelength: 2,100 nm; Near to mid Infrared wavelength (invisible)
Penetration: 3-5 mm; deeper penetration allows for improved tissue coagulation
Absorbtion:
Otolaryngologic Uses:

• Lithotripsy (via sialendoscopy)
• Tonsillectomy/Adenoidectomy
• Endonasal and sinus surgery
• Laryngeal surgery

Settings: see Sialendoscopy for photo of laser settings (0.3-0.5 Joules; 5 pulses per second)

Potassium-Titanyl-Phosphate (KTP) Laser

Wavelength: 532 nm; visible wavelength
Penetration: 0.9-1 mm
Absorbtion: skin pigmentation and hemoglobin absortion
Otolaryngologic Uses:

• Stapedectomy and middle ear surgery
• Laryngeal/tracheal surgery
• UPPP
• Sinus surgery

Settings: see KTP Laser for the Larynx

(Burns 2007)

Suggested setting for KPT laser for RRP under general anesthesia:

• 5.25-7.5 Joules / pulse
• 15 ms pulse width
• 2 Hz repetition rate
• 0.4 mm fiber

Argon (Ar) Laser

Wavelength: 485-515 nm; Infrared wavelength (invisible)
Penetration: 0.8-1 mm
Absorbtion: absorbed by pigmented tissues and hemoglobin; reflected by tissues white in color
Otolaryngologic Uses:

• treatment of skin lesions
• stapedectomy

Settings:

References

Yan Y, Olszewski AE, Hoffman MR, Zhuang P, Ford CN, Sailey SH, and Jiang JJ: Use of Lasers in Laryngeal Surgery Journal of Voice, vol 24,No.1. pp 102-109

Wang C-T, Huang T-W, Liao L-J, Lo W-C, Lai M-S and Chng P-W: Office-Based Potassium Titanyl Phosphate Laser-Assisted Endoscopic Vocal Polypectomy. Jama Otolarygnol Head Neck Surg/ Vol 139 (No.6), June 2013

Young VN, Mallur PS, Wong AW, Mandal R, Staltari GV, Gartner-Schmidt J, and Rosen CA: Analysis of Potassium Titanyl Phosphate Laser Settings and Voice outcomes int he Treatment of Reinke's Edema  Annals of Otology Rhinology and Larygnolgoy 2015. Vol 124(3) 216-220

Mallur PS, Johns MM, Amin MR, Rosen C Proposed classification system for reporting 532-nm pulsed potassium titanyl phosphate laser treatment effects on vocal fold lesions. Laryngoscop 2014;124(5):11701175

Zeitels SM: Glottic Cancer: A Metamorphosing Disease. Annals of Otology, Rhinology & Laryngology 1-5 DOI:10.1177/0003489415619177

Janda P, Leunig A, Sroka R, Betz C and Rasp G: Preliminary report of endolarygneal and endotracheal laser surgery of juvenile-onset recurrent repoiratory papillomatosis by Nd:YAG laser and a new fiber guidance instrument

Burns JA, Zeitels SM, Akst LM, Broadhurst MS, Hillman RE and Anderson R: 532 nm Pulsed Potassium-Titanyl-Phosphate Laser Treatment of Laryngeal Papillomatosis under General Anesthesia. Laryngoscope 117:1500-1504