LASERS IN GYNECOLOGY Gynecology refers to the surgical specialty dealing with the health of female reproductive system (uterus,

vagina or ovaries) The main conditions dealt with by a gynecologist are. (i) Cancer and Pre-cancerous diseases of the reproductive organs including ovaries, fallopian tubes, uterus etc (ii) Incontinence of time. (iii) Amenorrhea (Absent menstrual periods) (i) Dysmenorrhea (painful menstrual periods) (ii) Infertility (iii) Menorrhagia (Heavy menstrual periods)

Common operations don by a Gynecologist: Some of the more common operations that gynecologists perform include. Hysterectomy (Removal of the uterus) Oophorectomy (Removal of the ovaries) Hysterectomy o cesarean Tubal ligation.

Lasers used Gynecologists all over the world are becoming increasingly aware of the potential applications of laser in both conventional surgeries and newer endoscopic and microsurgical procedures. The most useful lasers in gynecology are the CO2, Nd: YAG, and the Argon and KTP lasers. CO2 lasers in Gynecology Co2 is most commonly used by gynecology for colposcopic procedure and during lapartomy (to investigate the level of progression of malignant disease). This layer is safe with minimal depth of thermal injury. But various limitations include less coagulating power and it is a non-contact laser. It cannot be transmitted down in an optical fibre. So it cannot be used for operative hysteroscopy.

During laparoscopy , it necessitates the use of a direct or indirect laser coupler or a special laser laparascope. Recently waveguide delivery systems have been introduced for this Nd: YAG Laser in Gynecology: This laser is the primary endoscopic instrument. Nd is the active medium used for lasing action while YAG is a solid with good crystalline strength. It is used for deep coagulation. This laser can be used through the bare fibre or in association with a variety of contact sapphire tips which increases it precision. For using this laser in the infrared spectrum, a He-Ne beam for aiming is needed.

Argon and KTP laser The properties of the Argon and the KTP (Potassium titany/ Phosphate)lasers are like Nd: YAG and they can be used similarly. However, these lasers are best used as colour selective photocoagultors.

BRAIN SURGERY Surgery is the primary treatment for brain tumours that can be removed without causing severe damage. Many benign (harmless) tumours are treated only by surgery. Most malignant (dangerous, cancerous) tumours, however required treatment in addition to surgery such as radiation therapy or chemotherapy. Goals of Surgical treatment for brain tumours These goals are multiple in number and it may include one or more of following. (i) (ii) (iii) (iv) (v) Conform diagnosis by obtaining tissue that is examined under a microscope. Remove all or as much to the tumour as possible. Reduce symptoms and improve quality of life y relieving intracranial pressure caused by the cancer. Provide access for implantation of internal chemotherapy or radiation. Provide access for delivering intro-surgical treatments including laser surgery.

Surgical techniques Many different surgical techniques are utilized in the treatment of brain tumours. The technique utilized for a particular patient depends on the type of tumour and its location as well as the preference of the surgeon. The surgical techniques most commonly employ in the treatment of brain tumours include. 1. 2. 3. 4. 5. Stereotatic surgery. Embolization Endoscopy laser surgery. Photodynamic laser surgery.

Stereotactic surgery The use of computers to create a three dimensional image is called sterotaxy. The purpose of this technique is to provide precise information about the location of the tumour and its position relative to man structures in the brain. Stereotaxy can be used by the surgeon to map out the surgical procedure before hand. Embolization Embolization is used to reduce the amount of blood supply to a tumour by blocking the flow of blood in selected arteries. This procedure is conducted prior to surgery.

Endoscopy: Endoscopes are long, narrow flexible lighted tubes that are inserted into the surgical area. They provide the surgeon with light and visual axes. Preoperative scans helps determine the location of tumours and enable the surgeon to plan surgery using relatively small openings. Surgery The aim of laser surgery is to direct the laser beams at the cancer and destroy it with heat. Since light beams cannot penetrate bone, the laser can be used only during surgery. Lasers also perform the function of a scalpel (surgical knife). Lasers are capable of immense heat and power when focussed at close range.

Lasers destroy tumour cells by vapourising them. Sterostactic or computer assisted techniques are used to direct the laser beam. Lasers are chiefly used in the treatment of tumours that have invaded the skull base or deep within the brain since they cannot be removed by suction or with tumours that break apart easily. Photodynamic laser Surgery A laser is also used in photodynamic therapy, Photodynamic therapy combines a drug that increases a tissues sensitivity to light and laser surgery. Prior to surgery, the photosensitizing drug is injected into a vein or artery. It travels through the blood system to the tumour, accumulating in the cells of the tumour. The patient is taken to surgery for removal of tumour. During the operation, the treated tumour cells appear fluorescent. The physician aims a laser at the tumour cells activating the drug. The activated drug then kills the tumour cells.

Disadvantages Tumours cells cannot seen by the surgeon (i.e) not visible to the surgery or not sensitive to the drug cannot be treated by this method. This is a local form of therapy because some parts of the tumour might not be exposed to the light. Because of he danger of swelting, tumours nears the brain stem cannot be treated with this technique.