CO2 Laser Surgery

What are the advantage of CO2 lasersurgery

Laser surgery has precision, haemostatic capacities and minimal tissue damage

The physics of CO2 laser surgery and of electrosurgery are depicted on the right.
The minimal tissue damage and the haemostatic capacity of the laser will probably result in less adhaesions if used well.
The main indications of CO2 laser surgery are excision and/or vaporisation of superficial pelvic endometriosis. For deep endometriosis the major advantage is that surgery takes 1 to 1.5 hours less.
CO2 laser however is not suited for dissection surgery : this means that the surgeon should be skillen in both laser and in electrosurgery.

Bikini -incisions

The first trocar is put in the umbilicus except when severe adhesions are expected. )

The secondary trocars : only with CO2 laser surgery 2 additional trocars are sufficient for interventions as superficial endometriosis and fertility surgery. These in addition can be placed very low. For electrosurgery we always need 3 trocars gebruikt te worden placed slightly higher.

Disadvantages ?

The cost of the laser and the necessary other devices such as a high flow insufflator (only the Thermoflator is suited for this surgery.) are the major disadvantages
Another problem is that the surgeon needs additional training first in open surgery, then in laparoscopic surgery and then in laser surgery.

Conclusions : Lasersurgery and Electro surgery are complementary with specific indications

Laser is better for superficial and deep endometriosis

Electo surgery is better for dissection ie lymfadenectomy, pelvic floor surgery, ureter dissection and bowel surgery.

For deep endometriosis we thus need both since the Co2 laser will shorten surgery by 1 to 2 hours .

If laser surgery is better for endometriosis, why is it not used systematically ?

1. Few gynaecologist have the training for both electrosurgery and laser surgery.
2. The necessary equipment is not always available . This is not surprising when few surgeons can use it