Lasers are commonly used for all kinds of surgeries. However, lasers are not the main surgical tool for surgery-sinus. In some pathologies, the laser is very helpful and a perfect choice, whereas it may produce edema and trauma in other cases.
While using the laser, doctor should consider a number of factors, including expected results, safety, instrumentation and pathology type. An array of lasers is available for surgery-sinus. The most commonly used lasers are carbon dioxide, holmium:yttrium aluminum garnet, neodymium:yttrium aluminum garnet and potassium titanyl phosphate lasers.
A carbon dioxide (CO2) laser is cumbersome equipment due to its stiff articulating arm. Precision, hemostasis, surgical access and handpiece quality of the laser are poor.
If a holmium:yttrium aluminum garnet (Ho: YAG) laser is used with water medium, the laser minimizes charring and thermal reaction. If used with air medium, surgery becomes difficult due to tiny explosions.
The neodymium:yttrium aluminum garnet (Nd: YAG) laser is ideal for ostiomeatal and turbinate dysfunction surgery. However, the laser is difficult to use. Its well-defined thermal reaction leads to edema of the tissue. Handpiece quality of Nd: YAG, Ho: YAG and CO2 lasers are poor. Absorbing chromophobe, absorption length, power range and wavelength vary from laser to laser.
A potassium titanyl phosphate (KTP/532) laser has a flexible handpiece. Fibers of the laser facilitate access to the spaces and recesses of the sinuses. Since this efficient laser is easy to use, it is an ideal choice for the surgery of the vascular tissues, including paranasal sinus mucosa. The laser is also suitable for turbinate dysfunction. Precision, hemostasis, surgical access and handpiece quality of the laser are excellent.
Safety Precautions
The laser operator and the surgeon should be familiar with the laser. They should be well versed in instrumentation, fiber management, energy dosage and safety aspects of the laser. During surgery, communication between the operator and surgeon should be frequent and consistent to ensure the status (on/off) of the laser, exposure time and wattage. This communication will reduce chances of errors.
Information about the laser wavelength and eye protection for doctors should be mentioned on the door of the room where laser surgery is in progress. For patients’ safety, eye protection is necessary. Goggles are used if local anesthesia or monitored sedation is given. Moistened eye pads are used if general anesthesia is administered. An eye safety filter is placed between the camera and endoscope while aligning the laser with the endoscope before using within the sinuses.
