diode lasers in medicine - amt medicals€¦ · hemorrhoids, fistula, polips and condyloma. the...
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DIODE LASERS IN MEDICINE
MEDICAL APPLICATIONS
5 wavelengths with different radiation power for wide range of
applications:
Microsurgery
Proctology
Vascular (EVLT)
Physiotherapy
ENT
Aesthetic & Plastic Surgery
Podiatry
- CONVENIENCE
Dedicated workstation - perfect convenience for
operation
Small size of the laser and handy grip - easy
transportation, enhance portability
Transportation case – protection during transport
MICROSURGERY
Contact Microsurgery – excision of warts, fibromas, yellow tufts.
Accessories for Microsurgery
Handpiece and tips
Optical fiber 320µm
or 400µm diameter
Safety glasses
DIODE LASERS IN COLOPROCTOLOGY
In proctology lasers are used commonly for the precise excision or vaporization of the
hemorrhoids, fistula, polips and condyloma.
The result of the laser surgery is less discomfort, less medication, and faster healing. A
hospital stay is generally not required. The laser is inherently therapeutic, sealing off
nerves and tiny blood vessels. By sealing superficial nerve endings patients have a
minimum of postoperative discomfort. With the closing of tiny blood vessels, the
proctologist is able to operate in a controlled and bloodless environment.
Laser can be use alone or in combination with other modalities.
Wavelengths: 980nm, 1470nmnm
PROCTOLOGY
• Under LA/GA, laser energy is delivered by conical fiber directly to hemorrhoidal
nodes and they will obliterate from inside and this will help to preserve mucosa
and sphincter structure to an extremely high precision. Laser energy is used to
close off the blood supply nourishing the abnormal growth. The laser energy
induces destruction of the venous epithelium and simultaneous obliteration of the
hemorrhoidal pile by a shrinkage effect.
• Advantage if using laser compare to conventional surgery, fibrotic reconstruction
generates new connective tissue, which ensures that the mucosa adheres to the
underlying tissue. This also prevents the occurrence or recurrence of a prolapsed.
Surgical procedure can be executed in only a few minutes.
Laser treatment of hemorrhoids
• Under LA/GA, laser Energy is delivered, via radial fiber, into the anal fistula
tract and is used to thermally ablate and close off the abnormal pathway.
The laser energy induces destruction of the fistula epithelium and
simultaneous obliteration of the remaining fistula tract by a shrinkage
effect. The epithelialized tissue is being destroyed in a controlled way and
the fistula tract collapses to a very high degree. This also supports and
accelerates the healing process.
• Advantage if using diode laser using radial fibre compare to conventional
surgery is, it give good control to operator, also allows use in convoluted
tract, no excision or splitting Independent on the length of the tract.
Surgical procedure can be executed in only a few minutes.
Laser treatment of
Anal Fistula & Pilonidal Sinus
Main Feature Laser Surgical Procedure
Anaesthesia LA GA
Patient Hospital Stay Day care 3-7 Days
Pain (Post-operative) Low High
Recovery Time 3 Days 10 Days
Recurrence Low High
Complication Low High
TREATMENT OF PILES AND FISTULA
– LASER VS CONVENTIONAL SURGICAL METHODS
Main Feature Surgical Procedure Non-Surgical
Treatments Option Procedure vary as per disease Laser
Anesthesia High Dose Can be done under LA
Patient Hospital Stay More than 24 Hours 2-3 Hours
Invasivness Suture required No suture required
Cost Low High
Pain (Post-ops) High Low
Recovery Time High Back to work within 2-3 hours
Reoccurrence Very High Low
Complication Very High Low
TREATMENT OF PILES AND FISTULA
– LASER VS CONVENTIONAL SURGICAL METHODS
ADVANTAGES IN PILES, FISTULA TREATMENT
High success rate
Low recurrence rate – the comparative rate is much lower than the traditional methods.
Quick treatment – Take less than an hour. Saves tremendous time for you and your patient.
Minimal invasion – just a nick in the skin, so no scar or stitches.
Minimal blood loss. Minimal pain. Less traumatic.
Instant Relief from accompanying symptoms - Since no surgery and extremely less harm to neighboring
tissues, so recovery is fast. Even less pain, bruising and numbness.
OPD procedure performed with Local anesthesia – It’s safer than General anesthesia. There’s nohospitalization, ambulatory.
Quick Recovery - no downtime. Minimal post operative pain. Your patient can walk away post operation
and can quickly regain his normal activity
Greater Surgical Precision.
Reduced Risk of infection.
ACCESSORIES FOR PROCOTOLGY
Slim Radial Fiber for Fistula (400μm fiber
core, 3m long, standard SMA 905
connector with knurl nut, disposable)
Proctology handpiece
Proctology cannula
Proctology Fiber for Hemmorhoids (600μm
fiber core, 3m long, standard SMA 905
connector with knurl nut, disposable)
DIODE LASERS IN PHLEBOLOGY
PHLEBOLOGYTHE NEW ‘GOLD STANDARD’ TREATMENT FOR VARICOSE VEINS
• EndoVenous Laser Treatment (EVLT) was developed in
Europe and the United States in the latter part of the
1990’s as an alternative to traditional ligation and
stripping surgery for treating the underlying cause of
varicose veins. It has a number of major benefits.
EVLT (Endovenous Laser Treatment) is a procedure leading to occlusion of varicose veins. It involvesputting a fiber optic into a saphenous vein through a catheter. Then the laser is turned on and slowlywithdrawed from the vein. Thanks to light-tissue interaction mainly thermal effects occur, the tissue isheated and the walls of the vein shrink, because of alteration of endothelium and contraction ofcollagen.
EVLT – the procedure
EVLT – the procedure
There are two possibilities of performing the treatment: with pulsed and continuous-wave laser operation.
• Using the pulsed operation also the fiber is withdrawedstep by step.
• A better choice is to use continuous-wave laser and towithdraw the fiber also continuously, what provides morehomogenous illumination of the vein, less tissue damagedoutside the vein and better results. The therapy is just abeginning of the occlusion process. After the treatmentthe veins are shrinking for several days or weeks. That’swhy in the long-period observation very good results areobtained.
Comparison of Varicose Veins Treatment –
Laser vs Surgical Procedure
Main Feature Laser Surgical Procedure
Anaesthesia LA GA
Patient Hospital Stay 1 Day 3-5 Days
Pain (Post-operative) Low High
Recovery Time 3 Days 10 Days
Relapse Risk Low High
Complication Low High
Comparison of Varicose Veins Treatment –
Laser vs Non Surgical Procedures
Main Feature Laser Surgical Procedure
Treatments Through Laser (Pin Hole surgery) RF machine (Pin Hole surgery)
Collateral damage Least Very High
Area of treatment 1 cm energy is delivered 7 cm energy is delivered
Treatment of Perforators Yes No
Portability of machine Very Much – (2.5kg) Less – (ranges from 15kg and above)
Technology/Concept Latest Old
Relapse Risk Least High
Complication Least High
Why we choose 1470nm wavelengths?
1470nm vs 980nm
For 980nm the absorption coefficient is higher forhemoglobin than water.
Unlike 980 nm radiation EVLT which needs appropriatepower of 10- 12 watt for a treatment, 1470 nm radiationneeds only 5-8 watt. This low energy level significantlyminimizes adverse effects.
Laser
wavelength
Depth of penetration
in water
Depth of penetration
in hemoglobin
980nm 2cm 0,5 cm
1064nm 7cm 1cm
1320nm 0,6cm -
1470nm 0,03cm -
Why we choose 1470nm wavelengths?
1470nm
The vein structure is mostly water and 1470nm laser iswater specific laser, targeting water as the chromophore toabsorb the laser energy.
Optimal depth of penetration in water (0,03cm), resultingin an optimal vein ablation. The laser energy ispreferentially absorbed in the intracellular water of thevein wall and in the water content of blood.
The irreversible photo-thermal process induced by thelaser energy results in a complete occlusion of the treatedvein.
No risk of damage to surrounding tissues. Less depth ofpenetration adds a safety element.
Benefits of EVLT
MinimallyInvasive
• Reduced risks associated with the technique and reduced complication rates
Easy to learn
• Simplifies the training required and also means that high success rates will be quickly achieved
Quick to perform
• Means more patients can be treated and it also makes good use of resources
No scars
• As well as giving excellent clinical results EVLT is also excellent cosmetically with only a tiny skin mark as the access point
Localanaesthe
-tic
• EVLT can be done under purely local anaesthetic givingreduced risks and making it ideal for patients who would bea poor surgical risk. It also has rapid recovery times and nooperating theatre is needed
Before After
Benefits of EVLT
Day caseprocedure
• With local anaesthetic EVLT is a true ‘walk-in walk-out’ day case procedure
Rapidrecovery
time
• This is especially accepted by patients who are self employed as they can return to work one or two days after treatment.
Reducedpost
operativepain
• The levels of pain will be lower than usual after surgery and if any pain relief is needed it will just be OTC non-aspirin analgesics
Few
complica-
tions
•This will benefit the patient, the clinician and the medical facility. Varicose vein surgery is the No.1 cause of medical litigation in vascular surgery and EVLT should reduce this
Benefits of EVLT
Use of Laser
• Especially in the private sector the use of a laser for a procedure will attract patients.
Wide rangeof applica-
tions
• As well as treating the Greater (Long) Saphenous veinEVLT can also be used for the Lesser (Short) SaphenousVein and other large truncal varicosities. It can besuitable for up to ~ 80% of varicose vein patients.
No surgery at the groin
• If surgery is required round the groin at a later date therewill be no scar tissue. In addition EVLT can be helpful intreating some patients who have recurrent diseasefollowing previous surgery.
Localanaesthetic
• EVLT can be done under purely local anaesthetic givingreduced risks and making it ideal for patients who wouldbe a poor surgical risk. It also has rapid recovery timesand no operating theatre is needed
EVLT - accessories
With one specially chosen wavelength of 1470nm
Radial optical fiber:
400µm or 600µm
disposable
Bare optical fiber:
400µm or 600µm
disposable or reusable
(up to 10 sterilizations)
Catheter set for radial fibers 6F
( sheath introducer, dilator,
guidewire, puncture needle)
EVLT Catheter (14G, 70cm
or 100cm long, Seldinger
puncture needle 18G –7cm,
Dilator 7F – 10 cm, Guide
wire 0.035’’ - 150cm J-tip)
Lock
Adapter for
EVLT
Catheter
EVLT series - advantages
Lightest Diodelaser
Equipment
• The Lasotronix Smart M 1470 Watt varicose vein diode laser is the lightest diodelaser machine. It weighs just 2.5kg against other 8-10 kg devices which makes iteasy to carry while consulting & enhance your efficiency.
Pre-set Procedures and
Customized Programmes
• Lasotronix Smart M 1470 15 watt diode laser has inbuilt pre-set programs & options for customized program as per your treatment plan.
Large Touch-screen LCD Multilingual
Display
• A large LCD Screen display information about parameter of chosen procedure (power, time of work and energy) so as to help easy monitoring & smooth functioning.
Low Operating
Cost
• Lasotronix Smart M 1470 15 watt diode laser runs on very low operating cost.
Security
• Emergency laser Stop button. Error warning Alert e.g., optic fiber missing, interlock is open etc. helps to pinpoint exact problem.
Patient Data Storage
• Easy to store & retrieve patient database which helps to patient follow up & build case study. Easy to navigate to find patient history. All patient data is stored in USB portable memory –Smart Key. Smart M 1470nm can store up to 1000 patient data
EVLT series - advantages
Wavelengths: 808nm, 1064nm
Set of therapeutic
tips for rehabilitation
High Power Physiotherapy – stimulating the physiological processes at the cellular
receptors combined to the stimulation of the nerve. These processes are possible through
the use of high-power radiation at much wider field of operation than before. It allows
you to carry out treatments with unprecedented speed and depth of penetration in
terms of:
- pain therapy
- treatment of inflammatory
- acceleration of wound healing
- treatment of trigger points
PHYSIOTHERAPY
ENT AND OPHTHALMOLOGY
Dacryocystorhinostomy (DCR) laser surgery is a procedure that aims to eliminate fluid and mucus retention within
the lacrimal sac, and to increase tear drainage for relief of epiphora. In comparison to the classical treatment, the
one performed with SMARTM laser characterizes by a small traumatic, is almost bloodless, does not require sewing
and gives less complications.
Ear Cysts
Accessory auricle
Tumors of the inner
ear
Hemangioma
Myringotomy
Cholesteatoma
Tympanitis
Nose Nasal polyp, rhinitis
Turbinate reduction
Papilloma
Cysts & Mucoceles
Epistaxis
Stenosis & synechia
Sinus surgery
Dacryocystorhinostomy ( DCR )
Throat Uvulopalatoplasty ( LAUP)
Tonsillotomy
Glossectomy
vocal cord polyps
Epiglottectomy
Strictures
Wavelengths: 635nm, 980nm
Contact ENT - fiber in contact with the tissue can be used for cutting, notching, cutting out or
coagulating tissue. This results in the narrow field of coagulation.
Contactless ENT - laser is used contactless for
evaporation and deeper coagulation of the tissue
from 1mm to 3mm:
− Evaporation of the tumors which narrows the
bronchial lights. −
− Treatment of the pathological changes within
the area of vocal cords
ENT AND OPHTHALMOLOGY
Accessories for ENT
Set of handpieces
for ENT
Dermosurgery, 980nm/1470nm
Spider veins, 980nm
Lioplysis, 1470nm
Treatment of diaphoresis, 1470nm
Variable zoom handpiece
(for teleangiectasia, beam
spot diameter regulated:
0.5mm - 3mm)
DERMATOLOGY
Dermosurgery, 980nm/1470nm
Spider veins, 980nm
Lioplysis, 1470nm
Treatment of diaphoresis, 1470nm
DERMATOLOGY
Dermosurgery, 980nm/1470nm
Spider veins, 980nm
Lioplysis, 1470nm
Treatment of diaphoresis,
1470nm
Laser lipolysis is the latest technology in fat reduction,
which uses laser to dissolve fat, the cell membranes
are broken up during this process. The thin fat lysate
is released and it is either resorbed naturally or
extracted manually by suction.
DERMATOLOGY
PODIATRY
Nail fungus – onychomycosis removal by irradiation of an infected nail plate also by
using a special handpiece without the need to remove the nail.
Wavelengths: 1064nm
Procedures under further investigation.
THANK YOU FOR YOUR ATTENTION