Endometriosis: papel del láser de CO2 en el abordaje quirúrgico / Endometriosis: CO2 laser in surgical treatment

El tratamiento quirúrgico de elección del endometrioma es la quistectomía clásica o decapsulación. No obstante, hay suficiente evidencia científica donde se demuestra que esta técnica se asocia a una reducción de la reserva ovárica, ya sea por la exéresis de tejido ovárico sano durante el procedimiento o por el daño térmico realizado durante el control de la hemostasia. Por este motivo, se han descrito nuevas aproximaciones quirúrgicas para paliar este efecto negativo sobre la reserva ovárica. El uso del láser CO2 en ginecología se conoce desde la década de los 80, y la vaporización de la cápsula del endometrioma mediante este láser es una técnica simple, sencilla de usar, fácilmente reproducible y técnicamente accesible. Aunque inicialmente se pensó que la tasa de recurrencia con esta técnica era superior, varios estudios demuestran lo contrario. Asimismo, el daño sobre la reserva ovárica es menor comparado con la decapsulación, en términos de mejor recuento folicular y nivel de hormona antimülleriana. Aunque las tasas de gestación espontánea y por técnicas de reproducción asistida son similares, en los casos de reproducción asistida las pacientes tratadas con vaporización láser CO2 presentan un mayor recuento folicular y nivel de hormona antimülleriana comparadas con las pacientes tratadas con decapsulación. A día de hoy, el tratamiento del endometrioma sigue siendo motivo de discusión. No obstante, los estudios revisados a continuación favorecen las técnicas ablativas en términos de preservar mejor la reserva ovárica sin mayor riesgo de recurrencia.(AU)

The surgical treatment of choice for endometrioma is cystectomy or endometrioma decapsulation. However, there is sufficient scientific evidence showing that this technique is associated with a decrease in ovarian reserve, either due to the removal of healthy ovarian tissue during the procedure or due to thermal damage performed during the control of haemostasis. For this reason, new surgical approaches have been described to alleviate this negative effect on ovarian reserve. The use of the CO2 laser in gynecology has been known since the 1980s, and vaporization of the endometrioma capsule using this laser is a simple, easy-to-use, easily reproducible, and technically accessible technique. Although it was initially thought that the recurrence rate with this technique was higher, several studies show the opposite. Likewise, the damage to the ovarian reserve is less compared to decapsulation, in terms of better follicular count and antimullerian hormone level. Although the rates of spontaneous pregnancy and assisted reproductive techniques are similar, in assisted reproductive techniques patients treated with CO2 laser vaporization have a higher follicular count and antimullerian hormone level compared to patients treated with decapsulation. To this day, the treatment of endometrioma continues to be a matter of discussion. However, the studies reviewed below favor ablative techniques in terms of better preserving ovarian reserve without increased risk of recurrence.(AU)

Tratamiento simultáneo secuencial con ultrasonidos focalizados de alta intensidad, láser de CO2 fraccionado y plasma rico en plaquetas para rejuvenecimiento facial en fototipos altos / Sequential simultaneous treatment with high-intensity focused ultrasound, fractional CO2 laser and platelet-rich plasma for facial rejuvenation in dark phototypes

Introducción y objetivo: La combinación de técnicas mínimamente invasivas es muy frecuente para tratar el envejecimiento de la piel. El objetivo de este ensayo es evaluar un protocolo de tratamiento intensivo para rejuvenecimiento facial en una sesión única, combinada y secuencial, empleando ultrasonidos focalizados de alta intensidad (HIFU), láser de CO2 fraccionado y plasma rico en plaquetas (PRP) autólogo. Material y método: Ensayo piloto para evaluar la eficacia y seguridad del tratamiento combinado en una muestra seleccionada de 15 pacientes (fototipos III-V) con signos evidentes de envejecimiento facial. La eficacia fue evaluada de forma enmascarada por 2 expertos independientes mediante comparación de fotografías antes del tratamiento y 3 meses después. Las variables analizadas (grado de dolor, laxitud, rejuvenecimiento global y satisfacción) se cuantificaron mediante escalas ordinales cuantitativas o cualitativas. La seguridad se evaluó mediante anotaciones de seguimiento en las historias clínicas. Resultados: Obtuvimos mejorías significativas en la reducción de la laxitud en los tercios superior, medio e inferior de la cara (p=0.026, p=0.011, p=0.003). En la escala de mejoría estética global, según los evaluadores expertos, 14 participantes (93%) se consideraron “mejorados” o “muy mejorados”. Todos los pacientes reconocieron algún tipo de mejoría, 9 indicaron estar “muy satisfechos”, 3 “satisfechos” y 3 “moderadamente satisfechos”. El tratamiento fue doloroso, pero suficientemente tolerado por la mayoría de pacientes. No aparecieron efectos adversos inesperados ni complicaciones importantes, con buena recuperación postoperatoria. En general los pacientes se reincorporaron a sus actividades laborales 10 días después del tratamiento. Conclusiones: El perfil de eficacia/seguridad del método ensayado ha sido muy favorable en la serie investigada. (AU)

Background and objective: The combination of minimally invasive techniques is very common to treat aging skin. The objective of this trial is to evaluate an intensive treatment protocol for facial rejuvenation, in a single, combined and sequential session, using high intensity focused ultrasound (HIFU), fractional CO2 laser and autologous platelet rich plasma (PRP). Methods: Pilot trial to evaluate the efficacy and safety of the combined treatment in a selected sample of 15 patients (phototypes III-V) with evident signs of facial aging. Efficacy was assessed blinded by 2 independent experts by comparing photographs before treatment and 3 months later. The variables analyzed (degree of pain, laxity, global rejuvenation and satisfaction) were quantified using ordinal quantitative or qualitative scales. Safety is assessed by follow-up notes in medical records. Results: Significant improvements in laxity reduction were achieved in the upper, middle, and lower thirds of the face (p=0.026, p=0.011, p=0.003). On the scale of global aesthetic improvement, according to the expert evaluators, 14 participants (93%) consider themselves "improved" or "very improved". All patients recognized some kind of improvement, 9 indicated being "very satisfied", 3 "satisfied" and 3 "moderately satisfied". The treatment was painful, but sufficiently tolerated by the majority of patients. There were no unexpected side effects or major complications, with good postoperative recovery. In general, the patients returned to their work activities 10 days after treatment. Conclusions: The efficacy/safety profile of the tested method has been very favorable in the series investigated. (AU)

A histological evaluation of the surgical margins from human oral fibrous-epithelial lesions excised with CO2 laser, Diode laser, Er:YAG laser, Nd: YAG laser, electrosurgical scalpel and cold scalpel

Background: We aim to evaluate the presence of histological artefacts in the surgical margins of human oral fibro-epithelial hyperplasias excised with lasers of different wavelengths, and also electrosurgical scalpel and cold scalpel. Moreover, we aim to determine if some of these instruments could impair the normal histological diagnosis of these lesions. Material and Methods: We included 130 consecutive surgical samples of 80 females and 50 males (mean age of 53.82±16.55) with a histological diagnosis of an oral benign fibrous-epithelial hyperplasias. The samples were categorized into 6 groups according to the type of instrument used: CO2 laser group, diode laser group, Er:YAG laser group, Nd:YAG laser group, electrosurgical scalpel group and cold scalpel group. Histological instrument-induced changes were microscopic evaluated and related with clinical and pathological variables. Results: The instrument with highest tissue damage extension (TDE) was the electrosurgical scalpel (1002.2μm±434.92), followed by diode laser (913.73 μm±322.45), Nd:YAG (899.83μm±327.75), CO2 laser (538.37μm±170.50), Er:YAG laser (166.47μm±123.85), and at last with fewer alterations the cold scalpel group (2.36μm±7.27) (P < 0.001). The most regular incision was observed in CO2 laser group, followed by Er:YAG laser, Nd:YAG laser, electrosurgical scalpel and diode laser group with the less regular incision using cold scalpel as comparison (P < 0.001). A correlation was found between the incision score and TDE (P < 0.001). Regarding histological diagnosis, no case showed any limitation of diagnosis related with the use of any instrument evaluated. Conclusions: Our results suggest that lasers can be used for the excision of oral benign fibrous-epithelial hyperplasias, without hispathological diagnosis limitations, as long as the physical properties of each laser are known and respected. Er:YAG laser have shown to be a laser with few tissue damage extension and with good incision regularity, been a possible instrument of choice for the surgical removal of these lesions

No disponible

Tumors of the oral cavity: CO2 laser management

Background: Cancer of the oral cavity combined with oropharyngeal cancer is the sixth leading cause of death for cancer worldwide. Surgery remains the standard treatment for this disease in early clinical and locally advanced stages. Numerous studies have shown that laser management is useful for premalignant lesions in the oral cavity; however, there is no conclusive evidence that its use is appropriate in cancer of the oral cavity and that results are comparable with traditional surgery. The objective of this study is to determine cancer control after wide local resection with CO2 laser for oral malignant neoplasms. Material and Methods: Retrospective study in patients with tumors of the oral cavity who were considered for surgical resection with CO2 laser from January 2006-December 2015. Demographic data, treatment modalities, histopathological diagnosis and clinical stage variables were obtained. All resections were done with the use of the microspot. Patients with cancer of the tongue were not included because a specific protocol for these patients does exist in our institution. Results: There were twenty patients, 10 male and 10 female with a average age of 58 years (range: 20-92 years). Mean age was 53.5 years for females and 63 years for males. Twelve (60%) patients are alive and disease free and four (20%) were lost free of disease. Conclusions: CO2 laser is an acceptable surgical method for the management of small lesions in the oral cavity. We cannot rule out that small lesions of the oral cavity with positive neck could be managed in this manner, adding treatment to the neck, producing an adequate local regional control. However, this hypothesis requires additional studies

No disponible

Outcome of CO2 laser vaporization for oral potentially malignant disorders treatment

Background: Oral cancer is a public health issue worldwide. Oral potentially malignant disorders (OMPDs) are lesions of the oral mucosa that are predisposed to malignant transformation. The mainstay of OMPDs treatment around the world is now the carbon dioxide (CO2 ) laser but the reported recurrence and malignant transformation rates vary widely in the literature. We aimed to estimate the recurrence and the malignant transformation rates of OPMDs treated with CO2 laser at the University Hospital of Bordeaux, in France, from 2010 to 2014, and to identify associated factors with recurrence or malignant transformation. Study design: We conducted a retrospective study in patients with a minimum follow-up of 12 months. Collected variables included characteristics of the patients (gender, age, alcohol and tobacco consumption, previous diagnosis of graft-versus-host disease, previous treatments for OPMD or for upper aerodigestive tract cancers and human immunodeficiency virus infection), characteristics of the lesions (form, colour, size, location, degree of dysplasia), laser treatment outcome (complications, recurrence, malignant transformation). Results: Twenty-five patients were included. Mean follow-up was 28.9 months. Recurrence was observed in 11 patients (44%). Annual recurrence rate was 18.3% and annual malignant transformation rate was 1.7%. Hyperplasia without dysplasia was the only factor found to be statistically associated with recurrence. Conclusions: Our results suggest that OMPDs treated by CO2 laser vaporization have high recurrence rates, particularly those presenting hyperplasia. A standardized definition of recurrence would be necessary for inter-study comparisons. Long-term follow-up is recommended in order to detect and treat squamous cell carcinoma in its early stages (AU)

No disponible

Vaporización con láser tulio de alta potencia: eficacia y seguridad a medio plazo / Mid-term safety and efficacy of high power thulium laser vaporization

OBJETIVO: La vaporización prostática con láser Tulio (VP-LT) se realiza desde hace 12 años aproximadamente, durante este tiempo los diferentes sistemas láser han ido evolucionado, particularmente los reportes de su uso en alta potencia (150-180W) son aún escasos. En este trabajo presentamos nuestra experiencia en cuanto a su eficacia y seguridad a medio plazo (seguimiento 42 meses). MÉTODOS: Desde Marzo de 2011 a Noviembre de 2013 se recogieron datos de 235 pacientes intervenidos con VP-LT. Las variables incluyen, tamaño prostático, características intraoperatorias, IPSS, Qmax, PSA entre otros. RESULTADOS: La edad media fue 69±9 años. La media del tamaño prostático fue 62±28 ml. Las medias de IPSS y Qmax preoperatorios fueron 18±6 puntos y 7,6±3,5 ml/seg respectivamente. La media del tiempo quirúrgico fue 45,31±16 min. La estancia hospitalaria media fue 24±17 horas y el tiempo medio de sondaje fue 38 horas. Sólo 26,1% sufrieron complicaciones perioperatorias, ninguna mayor de grado III de Clavien. Únicamente 1,7% requirieron reingreso. En el postoperatorio la media del Qmax a los 3 y 24 meses fue 19±6 ml/seg, y 17±8 ml/seg. El IPSS 5±5 puntos. El resultado se considero éxito en 81,3%. Un 15,7% persistió con síntomas obstructivos y 3% con patología funcional de llenado. La tasa de reintervención fue 5%. La única diferencia significativa (p = 0,008) entre resultado exitoso vs. no exitoso fue el tamaño prostático, 60 ml vs. 72 ml respectivamente. La tasa de reintervenciones aumenta significativamente a partir de un tamaño prostático de 70 ml (p = 0,001). CONCLUSIONES: La VP-LT de alta potencia es una alternativa segura, eficaz y eficiente con resultados funcionales subjetivos y objetivos comparables a la técnica "gold standard", ofrece un tiempo de estancia hospitalaria más corto y una menor tasa de complicaciones. Sin embargo su efectividad a mediano plazo disminuye en próstatas mayores de 70 ml aumentando las probabilidades de reintervención

OBJECTIVE: Thulium laser vaporization of the prostate (TL-PVP) has been performed for almost 10 years. However, there are very few studies focused on high power (150 W) applications. Published sources have short follow-up periods, few cases and small prostatic volumes. In this study, we present an analysis of the safety and efficacy of this technique in the medium-term (42 months follow-up) perspective. METHODS: Data from 235 patients that underwent TL-PVP from March 2011 to November 2013 has been collected, including prostatic size, intraoperative variables, IPSS, Qmax, and PSA, among others. RESULTS: Mean age was 69±9 years. Mean prostatic size was 62±28 ml. The average IPSS score and Qmax were 18±16 and 7.6 ± 3.5 ml/s, respectively. Mean hospital stay was 24±17 h. Mean time with urethral catheter was 38 h. Only 26.1% of the patients had perioperative complications but none of the cases was higher than a Clavien III. From this population, no more than 1.7% required readmission. Mean postoperative Qmax after 3 and 24 months was 19±6 ml/s and 17±8 ml/s. IPSS was 5±5 points. A successful outcome was achieved in 81.3% of the patients. Obstructive symptoms persisted in 15.7% of the population and 3% resulted in filling-phase dysfunction. Reoperation rate was 5%.The only statistically significant difference (p = 0.008) between successful and unsuccessful outcomes occurred in prostatic size, where mean values calculated were 59.73 ml and 71.82 ml, respectively. CONCLUSIONS: In this study, high power TL-PVP is a safe and effective alternative with subjective and objective functional results that are comparable to the "gold standard" technique. It also offers a shorter hospital stay and a lower complication rate

Type of surgical treatment and recurrence of oral leukoplakia: A retrospective clinical study

Background: Oral leukoplakia (OL) is the most typical potentially malignant disorder of the oral mucosa. We aimed to evaluate the clinical outcome of oral leukoplakia treated with several types of lasers and with the use of quantic molecular resonance (QMR) lancet, in terms of recurrence rate. Material and Methods: Eighty-seven previously untreated OL (52 occurring in females and 35 in males, mean age of 59.4 ± 13.9 years) were consecutively submitted to surgical treatment at University Hospital of Parma, Italy, and Hospital de Valongo, Portugal, (1999 to 2012). Interventions were subclassified into 5 groups according to the instrument used for the surgical removal of OL (cold blade - 17; Nd:YAG 1064nm laser - 14; Er:YAG 2940nm laser - 33; CO2 10600nm laser - 15; and QMR scalpel - 8). The mean follow-up period after treatment was 21.6 months (range 1-151 months). The outcome of treatment was scored through the same clinical protocol in the two participating units. Statistical analysis were carried by univariate analysis using chi-square test (or Pearson's test when appropriate). Results: Recurrences were observed in 24 cases of OL (27.6%). Malignant transformation occurred in one patient (1.1%) after a period of 35 months. Statistical comparison of the 5 surgical treatment modalities showed no differ ences in clinical outcomes nor in the recurrence rate of OL. However, when Er:YAG laser group was compared with traditional scalpel, a significantly better outcome in cases treated with Er:YAG laser (P = 0.015) was highlighted. Conclusions: Our results suggests that Er:YAG laser could be a promising option for the treatment of OL (AU)

No disponible

Desprendimiento coroideo seroso bilateral tras trabeculoplastia selectiva láser / Bilateral choroidal effusion after selective laser trabeculoplasty

La trabeculoplastia selectiva láser (TSL) es un medio eficaz para tratar el glaucoma de ángulo abierto con una baja tasa de complicaciones. Reportamos el caso de una mujer de 73 años con un glaucoma primario de ángulo abierto no controlado que tras someterse a una trabeculoplastia selectiva láser en ambos ojos desarrolló un desprendimiento coroideo bilateral (AU)

Selective laser trabeculoplasty (SLT) is an effective treatment to treat open-angle glaucoma with a low risk of complications. The case is presented of a 73 year-old woman with uncontrolled primary open-angle glaucoma who underwent selective laser trabeculoplasty in both eyes and developed bilateral choroidal effusion (AU)

Láser de dióxido de carbono fraccionado asociado a corticoide tópico para el tratamiento del prurito en las secuelas cicatriciales del paciente quemado / Fractional carbon dioxide laser associated with topic corticosteroid for the treatment of scar pruritus in burn patients

El prurito en los pacientes quemados supone una secuela frecuente que puede ser incapacitante y difícilmente controlable mediante tratamiento médico. Presentamos el caso de un paciente con prurito grave resistente a tratamiento médico y los resultados tras el tratamiento con láser ablativo y liberación de corticoide local asistida por láser. Se trata de un paciente con quemaduras graves en el 70% de superficie corporal, con prurito refractario a tratamiento médico y lesiones por rascado que precisaron de sedorrelajacion e intubación orotraqueal, y en el que realizamos una sola sesión de tratamiento con láser CO2 fraccionado tras la que se aplicó cura oclusiva con triamcinolona acetonido disuelta en suero (20 mg/ml). La evaluación del resultado se realizó mediante valoración del prurito (escala Burn Itch Questionnaire) y del resultado clínico y estético de la cicatriz (escalas Vancouver Scar Scale y Patient and Observer Scar Assessment Scale). Logramos un buen control del prurito y de las lesiones por rascado sin complicaciones asociadas. La liberación de fármacos asistida por láser fue la base del nuestro tratamiento, en el que el láser ablativo crea canales de comunicación transepidermicos que favorecen la entrada del corticoide a la dermis y el efecto inmediato del mismo. Esta modalidad de tratamiento y este nuevo concepto clínico se presentan como una alternativa terapéutica importante en el tratamiento del prurito refractario en el paciente quemado (AU)

Itch is a frequent sequelae in burns that might be disabling and hardly managed with medical treatment. We present a case of a burn patient with medical refractory pruritus and the result after treatment, consisting of laser assisted corticosteroid delivery. He was a severe burn patient with 70% total body surface area burned, with medical refractory pruritus and secondary skin lesions resulting from scratching, needing of sedation and intubation to control. One session of fractional carbon dioxide laser was performed, covering the treated area with an occlusive dressing soaked in triamcinolone acetonide dissolved with saline (20 mg/ml). Results were evaluated by using Burn Itch Questionnaire to assess the pruritus, and both Vancouver Scar Scale and Patient and Observer Scar Assessment Scale to assess the scar aesthetic result. We were able to control itch and stop scratching skin lesions, without any complication associated to the procedure. Laser assisted drug delivery was the mainstay concept of our patient treatment, where the ablative laser creates transepidermal channels that allow the corticosteroid to reach the dermis, and therefore the immediate effect of the drug. Both, this modality of treatment and new clinical concept are becoming an increasingly important tool for refractory pruritus management in burns (AU)

Hiperpigmentación facial simétrica adquirida / Acquired Symmetric Facial Hyperpigmentation

No disponible

Estapedotomía mediante láser CO2: nuestra experiencia y resultados en régimen de Cirugía Mayor Ambulatoria / CO2 laser stapedotomy: our experience and results in a Day Care Surgery procedure

Introducción: El uso del láser en cirugía de la otosclerosis muestra buenos resultados de seguridad y eficacia en la literatura. Mostramos nuestra experiencia en esta cirugía. Métodos: Presentamos un estudio retrospectivo de 5 años (2010 a 2014) comparando la cirugía instrumental con estapedectomía y la estapedotomía láser CO2 , y la evolución del procedimiento a Cirugía Mayor Ambulatoria (CMA). Resultados: Revisamos 50 cirugías (28 estapedectomías instrumentales y 22 estapedotomías láser CO2 ; relación mujeres/hombres 1,17; edad media 44,95; umbral aéreo medio en 0,5 a 4 khz prequirúrgico de 62,02 decibelios (db) y Rinne medio 34,75 db. Los resultados audiométricos obtenidos fueron Rinne de 10 db o menor en el grupo instrumental frente a láser del 78,6 % y 77,3 %, con cierre del Rinne del 67,3 % frente un 74,5 % (p 0,67 y 0,35). Recogimos vértigo como complicación más prevalente y trascendente para la ambulatorización, con 35,7 % frente a 22,7 % (p 0,36). Iniciamos la ambulatorización de la estapedotomía láser con 16 casos de CMA (Grupo 1) frente 34 casos con ingreso (28 instrumentales y 6 láser, Grupo 2), con un índice de ambulatorización del 62,5 y 80 % en 2013 y 2014; tasa de ingresos 16,67 y 20 %, sin reingresos, y una estancia media hospitalaria de 0,2 días en el Grupo 1 frente a la 1,3 en el Grupo 2 (p < 0,001). Conclusiones: A pesar de la baja casuística los resultados son alentadores en seguridad y eficacia de la cirugía láser estapedial, con buena eficiencia para conversión a cirugía sin ingreso (AU)

Introduction: Laser in stapes surgery could improve in security and efficacy in reported studies. We expose our experience. Methods: A 5 years (2010 to 2014) retrospective study to assess instrumental stapedectomy versus CO2 laser stapedotomy in otosclerosis patients and evolution to in day surgery procedure. Results: We review 50 procedures (28 instrumental stapedectomy and 22 CO2 laser stapedotomy), ratio women/men 1,17, mean age 44.95 years, air threshold mean in 0.5 to kHz before surgery of 62.02 decibels (db) and mean of air/bone gap of 34.75 db. The audiologic results were an air/bone gap closure of 10 db or less in stapedectomy group versus laser stapedotomy group of 78.6 % and 77.3 %, with a air/bone gap mean closure of 67,3 % and 74.5 % (p 0.67 and 0.35 respectively). We compile vertigo as the most prevalent and important for day-care surgery possibility, with 35,7 % in first group versus 22.7 % (p 0,36). We reported 16 cases of day care stapedotomy (Group 1) and 34 cases with minimum one day hospitalization (28 instrumental stapedectomy and 6 laser stapedotomy, group 2), with a day-care index of 62,5 % y 80 % in 2013 and 2014 respectively, hospitalization index of 16.67 % and 20 %, without re-hospitalization, and a hospitalization day mean of 0,2 in Group 1 versus 1,3 in Group 2 (p < 0.001). Conclusions: Despite our low casuistry the results are encouraging regarding security and efficacy of laser stapedotomy and efficiency for its convertion to day-care surgery (AU)

Hendidura laríngea: diagnóstico y tratamiento quirúrgico endoscópico. Presentación de 2 casos / Laryngeal cleft: Diagnosis and endoscopic surgical treatment. Report of 2 cases

No disponible

Masa verrucosa en la lengua: papilomatosis oral florida / Verrocous mass on the tongue: Oral florid papillomatosis

No disponible

Láser CO 2 en el tratamiento del rinofima / CO 2 laser for the treatment of rhinophyma

No disponible

Matricectomía ungueal parcial con láser de CO 2 / Partial Nail Matricectomy with Carbon Dioxide Laser

No disponible

Buenos resultados tras tratamiento con láser CO2 de leiomioma en el pezón / Successful Treatment of Leiomyoma of the Nipple With Carbon Dioxide Laser

No disponible