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Laser Surgery

What is Laser Surgery and how can we benefit from it.

Laser stands for (Light Amplification by Stimulated emission of Radiation). Laser surgery is a field dealing with performing surgical procedures thru laser Energy. Laser surgery is surgery using a laser to cut tissue instead of a scalpel. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft tissue laser surgery, in which the laser beam vaporizes soft tissue with high water content. Laser resurfacing is a technique in which molecular bonds of a material are dissolved by a laser. Laser has come a long way when in 1960 it was described as a solution looking for a problem. Laser allows precise denaturation or loss of function of a tissue. It needs to be remembered that Laser is not radiation in any form .It is is only concentrated light in wavelength which gives off its energy in a very controlled form. Laserisation leads to denaturation, coagulation and uncoupling of protein bonds that make up integrity of a tissue. As such it it is different from common cauterisation which causes charring of the tissue, although the difference is seen only at microscopic level. Laser proctology is a field dealing in laser application of Piles, Fistula and pilonidal Sinus. Conventional surgeries for these conditions were a legacy of dawn of surgery in 1930,s and have not changed since. Laser applications for the above conditions leads to a bloodless, painless procedure with no complications. The recovery is amazingly fast with most patients able to join work in couple of days. In expert hands the procedures have a almost no recurrence rate.

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Laser Treatments in Surgery are only couple of years old. We have been a pioneer in mastering this exciting and emerging field. We are trained in use of Nd Yag, Excimer, Co2, Diode and Argon lasers. We are also pioneered in the field of Laser proctology and have probably the largest series in this field. Our patients are a lot happy and typically say thanks within 2 weeks of the laser treatments. Due to his extensive experience in this field we are able to offer one sitting Laser treatment in all Surgical treatments. We have propagated the safe use of lasers in medicine & are also member of British Medical Laser Association which stands for a controlled and scientific use of lasers in medicine. Orchid Center for Laser Surgery is the only center offering all available surgical laser options under one roof.

Treatments

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A hemangioma of infancy is a benign tumour, usually a self-involuting tumor, (swelling or growth) of the endothelial cells that line blood vessels and is characterised by increased number of normal or abnormal vessels filled with blood. It usually appears during the first weeks of life and generally resolves by age 10. In more severe case hemangioma may have permanency, if not treated by a physician. Laser surgery is the mostproactive way of removal in cases where patients are older than 10 years of age. In infancy, it is the mostcommon tumor. Hemangiomas affecting the musculoskeletal system are more accurately termed vascular malformations." These are present from birth and do not involute spontaneously

Procedure The anaesthesia required is local or general depending on the site. The procedure is carried percutanously with a needle under sonography and Doppler control. The lesion is localized and laser fibre is passed thru the needle. The lesion is laserised under direct vision. The relief from symptoms is evident within 48 hrs but may take longer in larger lesions.

Laser For Allergic Rhinitis Stuffiness of nose is a common problem affecting patients visiting an ENT Surgeon.
Stuffiness of nose is caused by 2 basic mechanisms

1. DNS or Deviation of Nasal Symptom.
The nasal septum is the bone and cartilage in the nose that separates the nasal cavity into the two nostrils. The cartilage is called the quadrangular cartilage and the bones comprising the septum include the maxillary crest, vomer and the perpendicular plate of the ethmoid. Normally, the septum lies centrally, and thus the nasal passages are symmetrical. A deviated septum is an abnormal condition in which the top of the cartilaginous ridge leans to the left or the right, causing obstruction of the affected nasal passage. The condition can result in poor drainage of the sinuses. Patients can also complain of difficulty breathing easily, or of sleeping disorders such as snoring or sleep apnea.
It is common for nasal septa to depart from the exact centerline; the septum is only considered deviated if the shift is substantial or is adversely affecting the patient. Many people with a deviation are unaware they have it until some pain is produced. But by itself a deviated septum can go undetected for years and thus be without any need for correction.

2. Hypertrophied Nasal Turbinates
Chronic nasal obstruction, or a stuffy nose, is often caused by enlargement of the inferior nasal turbinates. The nasal turbinates---small, shelf-like structures composed of thin bone and covered by mucous membranes (mucosa) ---protrude into the nasal airway and help to warm, humidify and cleanse air as it is inhaled, before it reaches the lungs.
Chronic enlargement (hypertrophy) of the turbinates and the accompanying symptom of nasal obstruction affect people throughout the day, as well as during sleep. A chronic stuffy nose can impair normal breathing, forcing patients to breathe through the mouth and often affecting their daily activities.
Enlarged turbinates and nasal congestion can also contribute to headaches and sleep disorders such as snoring and obstructive sleep apnea, as the nasal airway is the normal breathing route during sleep. Chronic turbinate hypertrophy is often unresponsive to medical treatment such as nasal sprays; thus surgical treatment is required.
Chronic turbinate hypertrophy and nasal obstruction are commonly associated with rhinitis, the inflammation of the mucous membranes of the nose. When the mucosa becomes inflamed, the blood vessels inside the membrane swell and expand, causing the turbinates to become enlarged and obstruct the flow of air through the nose.
According to several large population surveys, approximately 20% of the population suffer from some type of chronic rhinitis.
How Can laser Help me? Laser therapy can reduce the size of these enlarged turbinates without surgery. This leads to the patient having relief of his symptoms. The procedure is a short abd can be done on OPD basis. Most cases of Allergic Rhinitis have a combination of above 2 conditions. Laser can be advised as a first therapy in cases where the DNS is is not a very prominent symptom. However Laser therapy is of limited use in cases Of prominent Deviated Nasal Septum. Therefore it is necessary to have a proper diagnosis of your symptoms.

A tonsillectomy is a surgical procedure in which the tonsils are removed. Sometimes the adenoids are removed at the same time.
Reasons for tonsillectomy
Tonsillectomy may be indicated when the patient:
Experiences frequent bouts of acute tonsillitis. The number requiring tonsillectomy varies with the severity of the episodes. One case, even severe, is generally not enough for most surgeons to decide tonsillectomy is necessary.
Has chronic tonsillitis, consisting of persistent, moderate-to-severe throat pain.
Has multiple bouts of peritonsillar abscess.
Has sleep apnea (stopping or obstructing breathing at night due to enlarged tonsils or adenoids)
Has difficulty eating or swallowing due to enlarged tonsils (very unusual reason for tonsillectomy)
Produces tonsilloliths in the back of their mouth.
Has abnormally large tonsils with crypts (Craters or impacts in the tonsils)
Post Surgery for Tonsils many patients experience pain in throat for 2-3 weeks and children are especially distressed during this period. Bleeding during mealtimes is a troublesome complication. The patient can have infection post surgery when the bleeding may be excessive and life threatning. Immunity in throat is altered after tonsillectomy. The patients have increased incidence of Granular pharyngitis.
How does Laser tonsilloplasty help?
Laser application to tonsils destroys the tonsillar tissue and microorganisms from inside.
The patient consequently experiences very little pain post laser. After the treatment is performed, scarring occurs within the tonsil causing it to decrease in size over a period of several weeks.
There is no need for ice creams post laser.
Since the tonsillar tissue is only shrunk and not removed the immunity in throat is preserved and incidence of pharyngitis is very low.
There is no bleeding during treatment and in fact it is recommended in bleeding disorders.
Post laser tonsilloplasty there is more than 50% reduction in size of tonsils along with reduction in inflammation and swelling. This patient had total pain relief of tonsillitis within 48hrs after treatment.

Laser Circumcision Circumcision is always associated with extreme pain and discomfort in children and adults. In children circumcision is done for a condition of Phimosis where the top skin narrows and there is a problem in passing urine.
In adults inability to retract the prepuce or foreskin is a problem for which circumcison is performed. Normal surgery has the following problems:

Pain for 3 weeks
Dressing for 4 weeks
Inability to join work for 2 weeks
Chordee or bending of penis after erection.

Laser circumcision is a bloodless and quick procedure which does not have any stitches post laser. There is no pain after surgery and patient can go back to normal activity in 2 days.

Endo Venous Laser Therapy for Varicose veins
EVLT® uses targeted laser energy to close the vein shut and helps in making you look and feel better fast. The benefits of the procedure are relief from heaviness in the legs, in addition to an overall wellness of being. You will have the confidence to show off your legs, regardless of the weather or season.
EVLT for Venous Ulcers
The EVLT® procedure is a minimally invasive laser procedure in treating varicose veins without scarring. The laser energy minimizes the vein walls, shrinking them and closing the faulty vein so that the blood cannot flow through it. This eliminates the bulging of the vein at its source. After the treatment, the blood in the faulty veins will be diverted to the many normal veins in the leg.
The procedure takes about 45 minutes with local anesthetic and is done on an outpatient procedure basis.
Less than 1 percent of patients develop deep vein thrombosis (DVT) from the laser ablation. Numbness has been known to occur in a small number of cases and on rare occasions can be permanent.
Before and After Edovenous Laser Treatment and Ambulatory Phlebectomy The procedure leaves no visible scarring, there is minimal postoperative pain, and a quick recovery period gains immediate relief from symptoms. Walking immediately after the procedure is encouraged. Minor soreness and bruising can be treated with over-the-counter, non-aspirin pain relievers as needed. It is well documented that EVLT® has a 98% initial success rate with excellent long-term results.
There are no risks from the laser treatment but just as a precaution against accidental firing of laser energy outside the body, you will be given a pair of special glasses to protect your eyes.

EVLT Frequently Asked Questions (FAQ's)
What is Endovenous laser treatment (EVLT)?
EVLT is a procedure performed in an office/clinic, requires no incisions and no hospital stay is required. After local anesthesia is administered, a laser fiber is inserted through a small needle hole in the skin into the vein that runs along the inner thigh. The laser is then slowly heated and the vein collapses around it. The collapsed vein soon shrinks and disappears. This technique rapidly treats the large varicose veins in the thigh and takes less than 30 mins to perform. Patients can resume all their normal activities soon after the procedure.

How does Endovenous laser ablation work?
The energy source from the laser irritates the vein walls, causes them to shrink and slowly disappear. The vein can no longer carry any blood through it. Because these veins are superficial, they are not important for transfer of blood to the heart.

Is loss of this vein a problem?
No. The saphenous vein which is destroyed is not healthy in the first place and of no use. Because the vein is engorged and thrombosed, removal has no affect on the body. The deep veins, however, are not touched by the laser as they continue to carry blood away from the legs.

What are the alternatives to this treatment?
Surgery has been the traditional treatment for varicose veins, and is moderately painful and has a slightly longer recovery period. Surgery requires the use of anesthesia, leaves a scar and a few incisions. Sclerotherapy is not used to treat large varicose veins. Sclerotherapy for the saphenous vein has a high recurrence rate frequently requiring multiple treatments Other alternatives include ultrasound-guided mini sclerotherapy to destroy small branched veins and radio frequency electrosurgery.. Radiofrequency electrosurgery is similar to EVLT and is more of a physician choice and availability. So far the results are good and patients are satisfied

How is EVLT performed?
The vein is identified just above the knee and the entire leg area is cleaned with an anti septic ointment. The entire procedure is performed with ultrasound visualization of the vein. A small amount of local anesthetic is applied and a needle is place in the vein. Through this vein is inserted a small laser probe. The probe is then identified with Ultrasound to verify its position and then the laser is slowly heated with low energy. The laser energy damages the vein walls causing it to shrink and eventually leading to closure of the vein. The vein becomes fibrosed and does not carry any blood in it The procedure is painless and takes about 30-45 minutes. Once the vein is burnt, the probe is removed and a small dressing is applied. A compression bandage is applied and worn for 1 week. The patient is usually discharged home in an hour.

What is Recovery after EVLT?
The procedure leaves no scars, is associated with minimal postoperative pain, a rapid recovery period and provides almost immediate relief from symptoms. Minor soreness and bruising can be treated with over-the-counter, pain medication. After the procedure, all patients are encouraged to walk and resume their normal activities. A follow up appointment is made with the doctor in 1-2 weeks.

Is destroying the saphenous vein harmful?
No. Generally the saphenous vein is only destroyed when it is thick and thrombosed. The vein in this state is almost useless and non- functioning and there is no harm in removing it. However, a normally functioning saphenous vein with no leaky valves should not be treated. A normal saphenous vein should always be preserved because it may be required in the future for open heart surgery.

Risks and Potential Complications
As with any invasive procedure, there are potential complications. These rare complications include:
there may be mild numbness around the thigh area
there may be a pulling sensation which may last a week
Phlebitis (redness and tenderness of the skin is quite common but is mild in nature and easily treated with over the counter pain medications. Most cases of phlebitis resolve in 3-7 days.
Deep venous thrombosis. This is a very rare complications following Endovenous Laser Ablation. The best way to prevent this rare complication is to wear compression bandage or compression stocking and to walk right after the procedure.
Infection at an incision site is a rare occurrence and usually resolves on its own.
Bruising is a common feature after the procedure. The bruising is mild and resolves in a week.
Failure of the procedure does occur and may be related to the inability to place the probe in the vein. This does happen rarely. Other causes of failure are the inability of the laser to destroy the vein. The majority of technical failures are related to inexperience of the physician with the procedure.

Is the laser harmful to the eyes?
No. One is usually given a pair of special glasses to protect the eyes. There are no other harmful effects from the laser

How successful is EVLT?
All data indicate that EVLT is a safe and effective procedure. The procedure does not involve any incisions and is relatively painless and has minimal complications.

What are disadvantages of EVLT?
The technique does not treat spider veins nor does it treat veins in the lower leg. Today, with an increased emphasis of preserving the veins for future use for either coronary artery bypass or some vascular procedure, EVLT completely destroys the vein and makes it unusable for future use.

Laser Ablation of piles. This procedure entails ablation of veins causing piles. All types of degreees of piles can be handled with an average procedure time of 8 mins. Old patients and anaemic patients can be handled under local anesthesia. Most patients are able to walk home after 6 hrs. The follow-ups are are minimal with an average of 1 follow-up /per patient after 5 days which is optional in most cases. There is no danger of narrowing of Anal ring or loosing of control over passage of motions. We have performed over 4000 cases of Laser Piles with no recurrence in last 6 years. Laser Ablation of fistula. Straight single fistula are handled by this method wherein the Fistula tract is laserised from below the surface of skin leaving no extra external wound. Since there is no cutting of anal ring , there is no danger of loosing control over motions. This procedure is a boon for high fistula –in-ano cases wherin the complication rate is very high after conventional surgery. Laser Ablation of Pilonidal Sinus Pilonidal sinus surgeries are among the most frustrating post operative recoveries for patients. The pilonidal sinus surgery recovery extends to 2 months. Contrast this with laser where the procedure is a 5 minute procedure and can be performed under local anesthesia with no extra wound and no dressings required post procedure. The sinus itself closes down in 3 weeks. PIlonidal sinus Post laser healed

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