Women’s Health

Gynecological Lasers for CO2 Colposcopy, Laparoscopy

360° of delicate and precise approach to gynecological health.
The CO2 laser wavelength is the adequate energy for gynecological (GYN) surgery with highly predictable tissue effects and low thermal impact to non-target tissue. CO2 laser has the smallest zone of thermal spread in comparison with all other energy based devices and other wavelengths therefore the unprecedented ability to operate near critical structures and delicate anatomy which are the common characteristics for all GYN and Pelvic anatomical structures.

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Achieve the Master’s Touch

“Of the various lasers available, the Lumenis CO2 laser is the most versatile and is extremely safe, in my experience, because of its limited depth of penetration and minimal lateral thermal damage. This allows for use of the CO2 laser in delicate areas where Electrosurgery would be unsafe, such as the bladder, lateral side wall near the ureter, nerves, major vessels, and bowel serosa”

Dr. Ceana Nezhat, Atlanta, GA

Benefits of CO2 Laser in Minimally Invasive Gynecological Surgery

When it comes to delicate laparoscopic surgeries, optimal thermal control and precision are required for smart tissue management. In many cases pathology is located in close proximity to important intra-abdominal structures such as the bowel, ureters, urinary bladder and major blood vessels for which thermal damage to non-target tissue should be avoided. A comparative study assessing the macro and microscopic characteristics of the most commonly used energy sources applied on the ureter, bladder and bowel in a laparoscopic setting (in-vivo porcine model) showed that COlaser energy was associated with the least deep tissue damage.

Excellent tissue visualization of surgical plane, Minimal disturbance to the tissue and precise management of the disorder are associated with:

  • Maintenance of healthy tissue[1]
  • Increased fertility preservation[2]
  • Slower recurrence disease rates[3,4,5]
  • Low perioperative morbidity (e.g. blood loss, bladder and bowel injury)[6]
  • Low post operational complications such as adhesions[6]
  • Significant reduction of pain symptoms and improvement in quality of life[7,4]

Benefits of CO2 Laser in Colposcopy

A new dimension in the treatment of lower tract disease is advocated with the Lumenis CO2 lasers that offer smart and reproducible tissue management. CO2 laser is a synonym for precision.  Adding scanning capabilities to the field of CO2 laser colposcopy offers comprehensive synergy between adequate visualization and precise tissue management.

The Lumenis advanced laser systems and designated GYN accessories and surgical tools allow for differentiated tissue treatment capabilities, especially targeted to work on and around delicate tissue surfaces, such as the cervix, vulva and lower genital tract.

Excellent tissue visualization of surgical plane, minimal disturbance to the tissue and precise management of the disorder are associated with:

  • Preserving cervical volume and structure[8]
  • Potential for minimized cervical stenosis[9]
  • Potential for minimized cervical incompetence[9]
  • Precise conization with identification of margins[10]
  • Very little scarring[11]

Clinical Indications

Lumenis’ gynecological solutions extend the use of the AcuPulse™ DUO and UltraPulse DUO CO2 laser systems, allowing you to maximize the utilization of the delicate and precise CO2 laser energy to a wide variety of GYN applications. The Lumenis COLasers product line is indicated for laser incision, excision, ablation, and/or vaporization of soft tissue in the pelvic and vaginal anatomies. A partial list of indications and procedures are included:

Laparoscopy

  • Endometriosis
  • Adhesions
  • Myomas/ Fibroids
  • Cysts
  • Hysterectomy

Colposcopy

  • Cervical Intreapithlial Neoplasia (CIN)
  • Conization of the cervix, cervical dysplasia
  • Vulvar Intraepithelial Neoplasia (VIN)
  • Genital & Anal – Benign & Malignant tumors

Gynecological Indications

  • Vulvar cosmetic procedures
  • Lichen planus
  • Lichen sclerosis

Co2 laser fibers

With the introduction of the CO2 laser fibers, it also represents flexibility: A Surgical approach where compliance to flexible endoscopy and robotic surgery is possible and treating precisely on hard to reach anatomy is achievable. For Gynecology, the CO2 laser fiber is a game changer. The ability to treat delicately and in a flexible manner near critical structures is key to obtaining precise and controlled tissue interaction while maintaining the preservation of valuable organs.

Taking endometriosis surgery to the next level

The Lumenis CO2 lasers provide patients with true added value, determined mostly by the delicate and precise manner the disease is being addressed. In fact, the key success parameter of Lumenis’ CO2 lasers is the clean removal of Endometriosis lesions causing no damage to surrounding healthy tissue. This is the key to less post-operative complications and equally important to the preservation of valuable reproductive organs, compared with traditional surgical techniques.

  • Fast recovery time[12]
  • Low risk of infection[13]
  • Fewer side effects[3]
  • Low disease recurrence rates[3, 4]
  • Immediate improvement in quality of life[7]
endo

Lumenis Women’s Health Devices

Resources
GYN Handpiece brochure
AcuPulse DUO Brochure
FiberLase Brochure
UltraPulse DUO Brochure
Endure Brochure
FiberLase STC Brochure
References

1. Adelman, M. R., Tsai, L. J., Tangchitnob, E. P., & Kahn, B. S. (2013). Laser technology and applications in gynaecology. Journal of Obstetrics and Gynaecology, 33(3), 225–231.

2. Candiani, M., Ottolina, J., Posadzka, E., Ferrari, S., Castellano, L. M., Tandoi, I., Jach, R. (2018). Assessment of ovarian reserve after cystectomy versus “one-step” laser vaporization in the treatment of ovarian endometrioma: a small randomized clinical trial. Human Reproduction.

3. Donnez, J., Lousse, J.-C., Jadoul, P., Donnez, O., & Squifflet, J. (2010). Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery. Fertility and Sterility, 94(1), 28–32.

4. Meuleman, C., D’Hoore, A., Van Cleynenbreugel, B., Beks, N., & D’Hooghe, T. (2009). Outcome after multidisciplinary CO2 laser laparoscopic excision of deep infiltrating colorectal endometriosis. Reproductive BioMedicine Online, 18(2), 282–289.

5. Speck, N. M. de G., Boechat, K. P. R., Santos, G. M. L. dos, & Ribalta, J. C. L. (2016). Treatment of Bartholin gland cyst with CO2laser. Einstein (São Paulo), 14(1), 25–29.

6. Bellina, J. H., Hemmings, R., Voros, J. I., & Ross, L. F. (1984). Carbon dioxide laser and electrosurgical wound study with an animal model: A comparison of tissue damage and healing patterns in peritoneal tissue. American Journal of Obstetrics and Gynecology, 148(3), 327–334.

7. Posadzka, E., Jach, R., Pityński, K., & Jablonski, M. J. (2014). Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electro ablation vs. CO2 laser ablation. Lasers in Medical Science, 30(1), 147–152.

8. Fallani, M. G., Penna, C., Fambrini, M., & Marchionni, M. (2003). Laser CO2 vaporization for high-grade cervical intraepithelial neoplasia: a long-term follow-up series. Gynecologic Oncology, 91(1), 130–133.

9. Favalli G, Lomini M, Schreiber C, Ciravolo G, Junasevic J, Pecorelli S, Bianchi UA. The use of carbon-dioxide laser surgery in the treatment of intraepithelial neoplasia of the uterine cervix, Przegl Lek. 1999;56(1):58-64.

10. Puttemans, P., van Belle, Y., & de Muylder, E. (1986). Carbon dioxide laser vaporization of cervical subclinical papillomaviral infection and intraepithelial neoplasia: short-term effectiveness. European Journal of Obstetrics & Gynecology and Reproductive Biology, 23(3-4), 167–180.

11. Claudia B, Serena T, Noemi A, Giuseppe C, Felice P, Annalisa P. The Repair Process of the Uterine Cervix Subjected to CO2 Laser Vaporization: A Pilot Study. Biomed Sci&Tech Res 8(2)- 2018. BJSTR MS.ID.001622.

12. MILINGOS, S., LOUTRADIS, D., KALLIPOLITIS, G., LIAPI, A., DRAKAKIS, P., ANTSAKLIS, A., & MICHALAS, S. (1999). Comparison of Laparoscopy with Laparotomy for the Treatment of Extensive Endometriosis with Large Endometriomata. Journal of Gynecologic Surgery, 15(3), 131–136.

13. Donnez, J. (1987). CO2 laser laparoscopy in infertile women with endometriosis and women with adnexal adhesions. Fertility and Sterility, 48(3), 390–394.

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