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The Evaluation of Laser Application in Surgery: A Review Article

Ensieh khalkhal, Majid Rezaei-Tavirani, Mohammad Reza Zali, Zahra Akbari




There are several types of surgeries which use lasers in the operating room. Surgeons use lasers in general surgery or surgical specialties to cut, coagulate, and remove tissue. In modern medicine, the application of laser therapy is an attractive subject due to its minimal invasive effect. Today lasers are widely used in the treatment and diagnosis of many diseases such as various cancers, lithotripsy, ophthalmology, as well as dermatology and beauty procedures. Depending on the type of lasers, the wavelength and the delivery system, most lasers have replaced conventional surgical instruments for better wound healing results. Over time, by using many different tools and devices, new lasers have been created; as a result, they are used in a wide range of medical special cases. In this review, laser applications in surgery and its beneficial effects compared to previous surgeries with the aim of providing appropriate therapeutic and non-invasive solutions with minimal side effects after surgery are investigated.


Hunter JG, Bowers JH, Burt RW, Sullivan JJ, Stevens SL, Dixon JA. Lasers in endoscopic gastrointestinal surgery. Am J Surg. 1984;148(6):736-41. doi: 10.1016/0002-9610(84)90427-6.

Wilkinson JM, Cozine EW, Khan AR, Kahn AR. Refractive Eye Surgery: Helping Patients Make Informed Decisions About LASIK. Am Fam Physician. 2017;95(10):637-44.

Adams DH. Holmium: YAG laser and pulsed dye laser: a cost comparison. Lasers Surg Med. 1997;21(1):29-31. doi: 10.1002/(sici)1096-9101(1997)21:1<29::aid-lsm5>3.0.co;2-#.

Halldórsson TH, Rother W, Langerholc J, Frank FJ. Theoretical and experimental investigations prove Nd: YAG laser treatment to be safe. Lasers Surg Med. 1981;1(3):253-62. doi: 10.1002/lsm.1900010309.

Omi T, Numano K. The role of the CO2 laser and fractional CO2 laser in dermatology. Laser Ther. 2014;23(1):49-60. doi: 10.5978/islsm.14-RE-01.

Fried NM, Irby PB. Advances in laser technology and fibre-optic delivery systems in lithotripsy. Nat Rev Urol. 2018;15(9):563-73. doi: 10.1038/s41585-018-0035-8.

Parker S. Verifiable CPD paper: Introduction, history of lasers and laser light production. Br Dent J. 2007;202(1):21-31. doi: 10.1038/bdj.2006.113.

Muguruma N, Okamoto K, Kimura T, Kishi K, Okahisa T, Okamura S, et al. Endoscopic ablation therapy for gastrointestinal superficial neoplasia. Dig Endosc. 2012;24(3):139-49. doi: 10.1111/j.1443-1661.2011.01227.x.

Ikeda N, Usuda J, Kato H, Ishizumi T, Ichinose S, Otani K, et al. New aspects of photodynamic therapy for central type early stage lung cancer. Lasers Surg Med. 2011;43(7):749-54. doi: 10.1002/lsm.21091.

Thomsen S. Pathologic analysis of photothermal and photomechanical effects of laser–tissue interactions. Photochem Photobiol. 1991;53(6):825-35. doi: 10.1111/j.1751-1097.1991.tb09897.x.

Mroz P, Yaroslavsky A, Kharkwal GB, Hamblin MR. Cell death pathways in photodynamic therapy of cancer. Cancers (Basel). 2011;3(2):2516-39. doi: 10.3390/cancers3022516.

Abrahamse H, Hamblin MR. New photosensitizers for photodynamic therapy. Biochem J. 2016;473(4):347-64. doi: 10.1042/BJ20150942.

Chen WR, Adams RL, Heaton S, Dickey DT, Bartels KE, Nordquist RE. Chromophore-enhanced laser-tumor tissue photothermal interaction using an 808-nm diode laser. Cancer lett. 1995;88(1):15-9. doi: 10.1016/0304-3835(94)03609-m.

Loeffler JS, Barker FG, Chapman PH. Role of radiosurgery in the management of central nervous system metastases. Cancer Chemother Pharmacol. 1999;43(1):S11-S4. doi: 10.1007/s002800051092.

Mondschein J, Kahn E, Chakravarthy A, Cmelak A, Sosman J, Thompson R, et al. Stereotactic Radiosurgery Plus Whole Brain Radiation Therapy vs. Stereotactic Radiosurgery Alone in the Treatment of Brain Metastases from Malignant Melanoma. Int J Radiat Oncol Biol Phys. 2010;78(3):S262-S3.

Bown SG. Phototherapy in tumors. World J Surg. 1983;7(6):700-9. doi: 10.1007/bf01655209.

Sugiyama K, Sakai T, Fujishima I, Ryu H, Uemura K, Yokoyama T. Stereotactic interstitial laser-hyperthermia using Nd-YAG laser. Stereotact Funct Neurosurg. 1990;54(1-8):501-5. doi: 10.1159/000100263.

Medvid R, Ruiz A, Komotar RJ, Jagid J, Ivan M, Quencer R, et al. Current applications of MRI-guided laser interstitial thermal therapy in the treatment of brain neoplasms and epilepsy: a radiologic and neurosurgical overview. AJNR Am J Neuroradiol. 2015;36(11):1998-2006. doi: 10.3174/ajnr.A4362.

Patel P, Patel NV, Danish SF. Intracranial MR-guided laser-induced thermal therapy: single-center experience with the Visualase thermal therapy system. J Neurosurg. 2016;125(4):853-60. doi: 10.3171/2015.7.JNS15244.

Mohammadi AM, Schroeder JL. Laser interstitial thermal therapy in treatment of brain tumors–the NeuroBlate System. Expert Rev Med Devices. 2014;11(2):109-19. doi: 10.1586/17434440.2014.882225.

Jethwa PR, Barrese JC, Gowda A, Shetty A, Danish SF. Magnetic resonance thermometry-guided laser-induced thermal therapy for intracranial neoplasms: initial experience. Neurosurgery. 2012;71(1):133-45. doi: 10.1227/NEU.0b013e31826101d4.

Carpentier A, McNichols RJ, Stafford RJ, Guichard JP, Reizine D, Delaloge S, et al. Laser thermal therapy: Real‐time MRI‐guided and computer‐controlled procedures for metastatic brain tumors. Lasers Surg Med. 2011;43(10):943-50. doi: 10.1002/lsm.21138.

Schulze P, Vitzthum H, Goldammer A, Schneider J, Schober R. Laser-induced thermotherapy of neoplastic lesions in the brain–underlying tissue alterations, MRI-monitoring and clinical applicability. Acta Neurochir (Wien). 2004;146(8):803-12.doi: 10.1007/s00701-004-0293-5.

Hawasli AH, Ray WZ, Murphy RK, Dacey Jr RG, Leuthardt EC. Magnetic resonance imaging-guided focused laser interstitial thermal therapy for subinsular metastatic adenocarcinoma: technical case report. Neurosurgery. 2011;70(2):332-7. doi: 10.1227/NEU.0b013e318232fc90.

Willie JT, Laxpati NG, Drane DL, Gowda A, Appin C, Hao C, et al. Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery. 2014;74(6):569-85. doi: 10.1227/NEU.0000000000000343.

Torres-Reveron J, Tomasiewicz HC, Shetty A, Amankulor NM, Chiang VL. Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery. J Neurooncol. 2013;113(3):495-503. doi: 10.1007/s11060-013-1142-2.

Rahmathulla G, Recinos PF, Valerio JE, Chao S, Barnett GH. Laser interstitial thermal therapy for focal cerebral radiation necrosis: a case report and literature review. Stereotact Funct Neurosurg. 2012;90(3):192-200. doi: 10.1159/000338251.

Fabiano AJ, Alberico RA. Laser-interstitial thermal therapy for refractory cerebral edema from post-radiosurgery metastasis. World Neurosurg. 2014;81(3-4):652.e1-4.

doi: 10.1016/j.wneu.2013.10.034.

Jethwa PR, Lee JH, Assina R, Keller IA, Danish SF. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance–guided laser-induced thermal therapy. J Neurosurg Pediatr. 2011;8(5):468-75. doi: 10.3171/2011.8.PEDS11148.

Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342(5):314-9. doi: 10.1056/NEJM200002033420503.

Liu SY, Yang XL, Chen B, Hou Z, An N, Yang MH, et al. Clinical outcomes and quality of life following surgical treatment for refractory epilepsy: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94(6):e500. doi: 10.1097/MD.0000000000000500.

Mathon B, Ulvin LB, Adam C, Baulac M, Dupont S, Navarro V, et al. Surgical treatment for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Rev Neurol (Paris). 2015;171(3):315-25. doi: 10.1016/j.neurol.2015.01.561.

Helmstaedter C, Van Roost D, Clusmann H, Urbach H, Elger C, Schramm J. Collateral brain damage, a potential source of cognitive impairment after selective surgery for control of mesial temporal lobe epilepsy. J Neurol Neurosurg Psychiatry. 2004;75(2):323-6.

Helmstaedter C, Richter S, Röske S, Oltmanns F, Schramm J, Lehmann TN. Differential effects of temporal pole resection with amygdalohippocampectomy versus selective amygdalohippocampectomy on material‐specific memory in patients with mesial temporal lobe epilepsy. Epilepsia. 2008;49(1):88-97. doi: 10.1111/j.1528-1167.2007.01386.x.

Hoppe C, Witt J-A, Helmstaedter C, Gasser T, Vatter H, Elger CE. Laser interstitial thermotherapy (LiTT) in epilepsy surgery. Seizure. 2017;48:45-52. doi: 10.1016/j.seizure.2017.04.002.

Okada M, Yoshida M, Tsuji Y, Horii H. Clinical application of laser treatment for cardiovascular surgery. Laser Ther. 2011;20(3):217-32. doi: 10.5978/islsm.20.217.

Mirhoseini M, Shelgikar S, Cayton MM. New concepts in revascularization of the myocardium. Ann Thorac Surg. 1988;45(4):415-20. doi: 10.1016/s0003-4975(98)90015-7.

Horvath KA, Cohn LH, Cooley DA, Crew JR, Frazier OH, Griffith BP, et al. Transmyocardial laser revascularization: results of a multicenter trial with transmyocardial laser revascularization used as sole therapy for end-stage coronary artery disease. J Thorac Cardiovasc Surg. 1997;113(4):645-54. doi: 10.1016/S0022-5223(97)70221-6.

Allen KB, Dowling RD, Fudge TL, Schoettle GP, Selinger SL, Gangahar DM, et al. Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med. 1999;341(14):1029-36. doi: 10.1056/NEJM199909303411403.

Wolf-de Jonge I, Beek J, Balm R. 25 years of laser assisted vascular anastomosis (LAVA): what have we learned? Eur J Vasc Endovasc Surg. 2004;27(5):466-76. doi: 10.1016/j.ejvs.2004.02.021.

Quigley MR, Bailes JE, Kwaan HC, Cerullo LJ, Block S. Comparison of myointimal hyperplasia in laser-assisted and suture anastomosed arteries: A preliminary report. J Vasc Surg. 1986;4(3):217-9. doi: 10.1067/mva.1986.avs0040217.

Birch J, Bell PR. Methylene blue soldered microvascular anastomoses in vivo. Eur J Vasc Endovasc Surg. 2002;23(4):325-30. doi: 10.1053/ejvs.2001.1601.

Okada M, Yoshida M, Tsuji Y. Clinical experience of endovascular laser intervention in cardiovascular disease. J Clin Laser Med Surg. 1998;16(5):249-54. doi: 10.1089/clm.1998.16.249.

Okada M, Yoshida M, Tsuji Y. Clinical experience of laser angioplasty for the cardiovascular disease. Diagn Ther Endosc. 1995;2(1):11-8. doi: 10.1155/DTE.2.11.

Powell RJ. Endovascular treatment in the superficial femoral artery: Which devices, where? Semin Vasc Surg. 2008;21(4):180-5. doi: 10.1053/j.semvascsurg.2008.11.003.

Bordignon S, Chun KRJ, Gunawardene M, Schulte-Hahn B, Nowak B, Fuernkranz A, et al. Endoscopic ablation systems. Expert Rev Med Devices. 2013;10(2):177-83. doi: 10.1586/erd.12.86.

Metzner A, Wissner E, Lin T, Ouyang F, Kuck KH. Balloon devices for atrial fibrillation therapy. Arrythm Electrophysiol Rev. 2015;4(1):58-61. doi: 10.15420/aer.2015.4.1.58.

Dörschel K, Müller G. The role of laser in cardiac surgery. Thorac Cardiovasc Surg. 1999;47( 3):385-7. doi: 10.1055/s-2007-1013206.

Metzner A, Wissner E, Schoonderwoerd B, Burchard A, Tilz R, Fürnkranz A, et al. The influence of varying energy settings on efficacy and safety of endoscopic pulmonary vein isolation. Heart Rhythm. 2012;9(9):1380-5. doi: 10.1016/j.hrthm.2012.03.059.

Bordignon S, Chun KRJ, Gunawardene M, Urban V, Kulikoglu M, Miehm K, et al. Energy titration strategies with the endoscopic ablation system: lessons from the high-dose vs. low-dose laser ablation study. Europace. 2012;15(5):685-9. doi: 10.1093/europace/eus352.

Dretler SP. Laser lithotripsy: a review of 20 years of research and clinical applications. Laser Surg Med.1988;8(4):341-56. doi: 10.1002/lsm.1900080403.

Chan KF, Joshua Pfefer T, Teichman JM, Welch AJ. A perspective on laser lithotripsy: the fragmentation processes. J Endourol. 2001;15(3):257-73. doi: 10.1089/089277901750161737.

Grasso M, Bagley D, Sullivan K. Pulsed Dye Laser Lithotripsy—Currently Applied to Urologic and Biliary Calculi. J Clin Laser Med Surg. 1991;9(5):355-9. doi: 10.1089/clm.1991.9.355.

Azadgoli B, Baker RY. Laser applications in surgery. Ann Transl Med. 2016;4(23):452. doi: 10.21037/atm.2016.11.51.

Tasca A, Cecchetti W, Zattoni F, Pagano F. Photosensitization of cystine stones to induce laser lithotripsy. J Urol. 1993;149(4):709-12. doi: 10.1016/s0022-5347(17)36189-x.

Rink K, Delacrétaz G, Salathé RP. Fragmentation process of current laser lithotriptors. Lasers Surg Med. 1995;16(2):134-46. doi: 10.1002/lsm.1900160203.

Chan KF, Vassar GJ, Pfefer TJ, Teichman JM, Glickman RD, Weintraub ST, et al. Holmium: YAG laser lithotripsy: a dominant photothermal ablative mechanism with chemical decomposition of urinary calculi. Lasers Surg Med. 1999;25(1):22-37. doi: 10.1002/(sici)1096-9101(1999)25:1<22::aid-lsm4>3.0.co;2-6.

Cimino S, Favilla V, Russo GI, Saita A, Sortino G, Castelli T, et al. Pneumatic lithotripsy versus holmium: YAG laser lithotripsy for the treatment of single ureteral stones: a prospective, single-blinded study. Urol Int. 2014;92(4):468-72. doi: 10.1159/000355828.

Teichman JM. Laser lithotripsy. Curr Opin Urol. 2002;12(4):305-9. doi: 10.1097/00042307-200207000-00008.

Alio J. Refractive surgery today: is there innovation or stagnation? Eye Vis (Lond). 2014;1(1):4. doi: 10.1186/s40662-014-0004-0.

Bressler NM, Beck RW, Ferris FL 3rd. Panretinal photocoagulation for proliferative diabetic retinopathy. N Engl J Med. 2011;365(16):1520-6. doi: 10.1056/NEJMct0908432.

McAlinden C, Moore JE. The change in internal aberrations following myopic corneal laser refractive surgery. Graefes Arch Clin Exp Ophthalmol. 2011;249(5):775-81. doi: 10.1007/s00417-010-1459-x.

McAlinden C, Moore J. Laser-assisted subepithelial keratectomy retreatment surgery. J Cataract Refract Surg. 2011;37(2):358-63. doi: 10.1016/j.jcrs.2010.11.009.

Weiblinger RP. Review of the clinical literature on the use of the Nd: YAG laser for posterior capsulotomy. J Cataract Refract Surg. 1986;12(2):162-70. doi: 10.1016/s0886-3350(86)80034-7.

Donaldson KE, Braga-Mele R, Cabot F, Davidson R, Dhaliwal DK, Hamilton R, et al. Femtosecond laser–assisted cataract surgery. J Cataract Refract Surg. 2013;39(11):1753-63. doi: 10.1016/j.jcrs.2013.09.002.

Berr F, Wiedmann M, Tannapfel A, Halm U, Kohlhaw KR, Schmidt F, et al. Photodynamic therapy for advanced bile duct cancer: evidence for improved palliation and extended survival. Hepatology. 2000;31(2):291-8. doi: 10.1002/hep.510310205.

Lovat LB, Mathou N, Thorpe SM, Gertner D, Sargeant IR, Winslet MC, et al. 7048 Relief of dysphagia with self expanding metal stents is far from perfect. Gastrointest Endosc. 2000;51(4):AB254. doi: 10.1016/S0016-5107(00)14719-4.

Bown SG, Lovat LB. The biology of photodynamic therapy in the gastrointestinal tract. Gastrointest Endosc Clin N Am. 2000;10(3):533-50. doi: 10.1016/S1052-5157(18)30121-1.

Asnaashari M, Zadsirjan S. Application of laser in oral surgery. J Lasers Med Sci. 2014;5(3):97-107.

Majdabadi A, Abazari M. Study of Interaction of Laser with Tissue Using Monte Carlo Method for 1064nm Neodymium-Doped Yttrium Aluminium Garnet (Nd: YAG) Laser. J Lasers Med Sci. 2015;6(1):22-7.

Lukac M, Vizintin Z, Zabkar J, Pirnat S. QCW pulsed Nd: YAG 1064 nm laser lipolysis. Journal of the laser and health academy. 2009;4(1):24-34.

Abdelaal MM, Aboelatta YA. Comparison of blood loss in laser lipolysis vs traditional liposuction. Aesthet Surg J. 2014;34(6):907-12. doi: 10.1177/1090820X14536904.

Wu EC, Wong BJ. Lasers and optical technologies in facial plastic surgery. Arch Facial Plast Surg. 2008;10(6):381-90. doi: 10.1001/archfaci.10.6.381.

Kelly KM, Choi B, McFarlane S, Motosue A, Jung B, Khan MH, et al. Description and analysis of treatments for port-wine stain birthmarks. Arch Facial Plast Surg. 2005;7(5):287-94. doi: 10.1001/archfaci.7.5.287.

Faurschou A, Olesen AB, Leonardi‐Bee J, Haedersdal M. Lasers or light sources for treating port‐wine stains. Cochrane Database Syst Rev. 2011;9(11):CD007152. doi: 10.1002/14651858.CD007152.pub2.

DOI: https://doi.org/10.22037/jlms.v10i4.27719