[Types of medical lasers].

The knowledge about different types of lasers and their potential use in medicine is presented. A very rapid development of laser technology in the world imposes a need for up-to-date information about the characteristics of different laser instruments. Without this kind of information it would be difficult to keep in touch with the latest developments in the world's technology. Different types of lasers have different indication range in the medical practice. An inquiry into the fundamental principles of lasers physics is an important prerequisite for successful application of this technology in medicine. Laser as a surgical knife has shown certain advantages over scalpel, electrocautery and cryosurgery, as the laser surgery is a noncontact method, bloodless, precise, with better visualization, minimal postoperative edema, painless healing, without complications. Although laser cannot entirely replace conventional surgical instruments, it is still the instrument of choice for treatment of numerous pathological conditions. The carbon dioxide laser is a highly precise, bloodless light scalpel used for incising and excising tissues and sealing small blood vessels. The infrared beam at 10,600 nm wavelength is absorbed by water and tissue destruction is due to the instantaneous vaporization at relatively low temperature of 100 degrees C. The beam seals blood vessels of up to 0.5 mm in diameter and if the beam is defocused, larger vessels may be controlled. The beam also seals lymphatics, possibly reducing the spread of tumour cells by this route, and seals nerve endings: there is no incidence of neuroma formation. Carbon dioxide laser has shown a great efficiency in otorhinolaryngology, in maxillo-facial surgery and plastic surgery, in urology and gynecology. Provides true "no touch" surgery, and is used increasingly in neurosurgery for the precise atraumatic removal of tissue and for creation of precise lesions for the control of pain. The carbon dioxide laser beam cannot, at present, be transmitted via a flexible fibre, although a number of fibres are being investigated. Delivery of laser energy to microscope, colposcope or handpiece is via an articulated arm which is a hollow tube with mirrors at the articulations. The argon laser produces blue-green coherent light at a number of wavelengts but 80% of the energy is at wavelengths of 488 and 514 nm. This laser was first used in ophtalmology to treat diabetic retinopathy through, and without damage to, the clear anterior parts of the eye. The argon laser is used for blood vessel coagulation but can be used to perform slow, thermal tissue destruction at higher power levels. Argon laser is most commonly used in ophthalmology for otological micro-surgery, particularly in the treatment of otosclerosis and tympanosclerosis. Very good results have been achieved in the argon laser treatment of gastrointestinal bleeding ulcers, vascular lesions and polyps. Dermatology is another field where argon laser has shown great efficiency: hemangyomas, telangiectasias, tattoos, small benign and malignant tumours are amenable to argon laser treatment. In neurosurgery it is used to control both normal and abnormal blood vessels but at present much work on treatment of arteriovenous malformations and aneurysms is experimental. Both the argon laser energy can be transmitted via flexible fibre optic delivery system which can then be attached to an operating microscope, slit lamp, endoscope delivery fibre or handpiece. The Neodymium-YAG laser is used both for tissue destruction with good haemostasis and for the control of normal and abnormal blood vessels. This laser produces infrared coherent light at 1060 nm wavelength, which is deeply absorbed in the tissues without colour or tissue specificity. Neodymium-YAG laser is mostly used in tracheobronchial, gastrointestinal and urologic pathology in the treatment of stenoses, granulomas, benign tumours, and for reduction of malignant tumours. (ABSTRACT TRUN