Comparison of the Efficacy of Laser and Hybrid Seton Methods in the Treatment of Perianal Fistula.

OBJECTIVE: To compare the efficacy and postoperative complications of laser and hybrid seton methods in the treatment of perianal fistula (PF). STUDY DESIGN: A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkiye, from January 2021 to April 2022. METHODOLOGY: A total of 76 patients, with 46 in the hybrid seton group and 30 in the laser group, were included in the study. Perianal fistula classification was based on preoperative magnetic resonance imaging. The Likert satisfaction scale was assessed for patient satisfaction and the Cleveland Clinic Florida Faecal Incontinence (CCF-FI) scoring system was used for incontinence. Treatment outcome was determined based on success rate and postoperative faecal incontinence. RESULTS: The mean age of the patients was 43 ± 13 years and 59 (78%) of them were male. Forty-seven (62%) patients had simple fistula. Acute and late complications were significantly higher in the hybrid seton group than in the laser group (p <0.001). According to the Likert satisfaction scale, the rate of unsatisfied patients was significantly higher in the laser group than in the hybrid seton group (p = 0.02). According to the CCF-FI scoring system, incontinence was significantly higher in the hybrid seton group than in the laser group (p = 0.01). Treatment failure was higher in the laser group (p = 0.03). CONCLUSION: The laser method has lower intraoperative / postoperative complications, but higher treatment failure and lower patient satisfaction compared to the hybrid seton method. KEY WORDS: Anal fistula, Fecal incontinence, Laser therapy, Outcome, Loose seton method.

Predictors of Postoperative Urinary Incontinence After Holmium Laser Enucleation of the Prostate (HoLEP) for Surgeons Early in Their Experience.

OBJECTIVES: To evaluate factors impacting continence recovery following holmium laser enucleation of the prostate (HoLEP) for surgeons early in their HoLEP experience. METHODS: Predefined factors were evaluated from a prospectively maintained database for their impact on the recovery of continence after HoLEP. Both surgeons had performed fewer than 150 HoLEPs as attending physicians. Inclusion criteria were subjects with at least 6 months of incontinence data or documented recovery of continence. One or fewer pads per day was defined as continence. Statistical analyses were performed using R and Prism and included Spearman correlations, linear modeling, and Mantel-Cox log-rank testing as appropriate. RESULTS: From December 2020 to May 2023, 152 subjects met inclusion criteria with a median age of 70 (range: 51-93). The median case number was 56 (1-146). Within the study period, 144/152 (94.7%) recovered continence at a median of 1.6 months postoperatively. Linear modeling demonstrated that younger age (p = 0.01) and shorter enucleation time (p = 0.001) predicted recovery. Enucleation time less than 100 min predicted earlier continence recovery based on Mantel-Cox testing (p = 0.0004). CONCLUSIONS: During the surgeons' HoLEP learning curve, age, and enucleation time were predictive of the recovery of continence. Enucleation time under 100 min predicted a faster rate of continence recovery. The relationship between enucleation time and continence recovery may be demonstrative of case difficulty or may be a result of pressure on the external urethral sphincter during enucleation. These findings further our understanding of HoLEP outcomes early in a surgeon's learning curve.

[Fully recognizing selective laser trabeculoplasty].

Selective laser trabeculoplasty (SLT), as one of the main methods for the treatment of open-angle glaucoma, has again aroused wide concern in recent years. Although SLT has a clear effect on reducing intraocular pressure, its role needs to be fully recognized. In order to provide guidance for the clinical SLT practice, this article summarizes and discusses the current status of SLT treatment for glaucoma, its therapeutic effects on primary open-angle glaucoma, ocular hypertension, and other types of glaucoma, surgical details, and application prospects.

Survival, Surgical, and functional outcomes of transoral laser microsurgery for cT1-T3 supraglottic laryngeal Cancers: A systematic review.

BACKGROUND: This review aimed to investigate the surgical, functional, and oncological outcomes of transoral laser microsurgery supraglottic laryngectomy (TOLM-SGL) for cT1-T3 laryngeal cancers. METHODS: PubMed, Scopus, and Cochrane Library were searched by two independent investigators for studies investigating the surgical, functional, and oncological outcomes of TOLM-SGL using the PRISMA statements. A bias analysis was carried out with MINORS. RESULTS: Twenty-four studies were included (937 patients), including 206 (25.9 %) cT1, 467 (58.7 %) cT2, and 123 (15.4 %) cT3 cases. Most patients were cN0 (63.9 %). The mean hospital stay of TOLM was 10.1 days. Aspiration (5.5 %), and bleeding (5.3 %) were the most prevalent complications. The laryngeal preservation rate was 93.7 %. Temporary tracheotomy was performed in 18.0 % of patients, with a mean time of decannulation of 6.8 days. A feeding tube was placed in 59.9 % of patients. The oral diet restarted after 6.4 days. Definitive gastrostomy was necessary in 2.4 % of cases. The 5-year OS and DFS were 70.1 % and 82.0 %, respectively. Distant metastasis, local, and regional recurrence occurred in 4.6 %, 11.6 %, and 5.1 % of patients. There was an important heterogeneity between studies for inclusion criteria, patient profiles, TOLM indications, and details of surgical, functional, and oncological outcomes. CONCLUSION: TOLM supraglottic laryngectomy is a safe, and effective procedure associated with adequate functional, surgical, and oncological outcomes. Future studies are needed to define the place of TOLM in advanced LSCC; the role and timing of concomitant bilateral neck dissection, the indications of tracheotomy and feeding tube.

Comparing thulium fiber versus high power holmium laser in bilateral same sitting retrograde intrarenal surgery for kidney stones: Results from a multicenter study.

PURPOSE: Traditionally, bilateral urolithiasis treatment involved staged interventions due to safety concerns. Recent studies have shown that same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) is effective, with acceptable complication rates. However, there's no clear data on the optimum laser for the procedure. This study aimed to assess outcomes of SSB-RIRS comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser in a multicenter real-world practice. MATERIALS AND METHODS: Retrospective analysis was conducted on patients undergoing SSB-RIRS from January 2015 to June 2022 across 21 centers worldwide. Three months perioperative and postoperative outcomes were recorded, focusing on complications and stone-free rates (SFR). RESULTS: A total of 733 patients were included, with 415 in group 1 (Ho:YAG) and 318 in group 2 (TFL). Both groups have similar demographic and stone characteristics. Group 1 had more incidence of symptomatic pain or hematuria (26.5% vs. 10.4%). Operation and lasing times were comparable. The use of baskets was higher in group 1 (47.2% vs. 18.9%, p<0.001). Postoperative complications and length of hospital stay were similar. Group 2 had a higher overall SFR. Multivariate regression analysis indicated that age, presence of stone at the lower pole, and stone diameter were associated with lower odds of being stone-free bilaterally, while TFL was associated with higher odds. CONCLUSIONS: Our study shows that urologists use both lasers equally for SSB-RIRS. Reintervention rates are low, safety profiles are comparable, and single-stage bilateral SFR may be better in certain cases. Bilateral lower pole and large-volume stones have higher chances of residual fragments.

[Comparative assessment of the state of the cornea after YAG-laser interventions on anterior segment structures]. / Sravnitel'naya otsenka sostoyaniya rogovitsy posle YAG-lazernykh vmeshatel'stv na strukturakh perednego segmenta glaza.

YAG-laser interventions are associated with the risk of complications, including in the cornea. PURPOSE: This study evaluates the condition of the cornea after laser discission (LD) of secondary cataracts (SC) and laser iridectomy (LI) using corneal confocal microscopy (CCM). MATERIAL AND METHODS: Group 1 included patients with the diagnosis "Pseudophakia, secondary cataract", they underwent LD of SC. Patients of group 1 were divided into 2 subgroups depending on the initial state of the cornea: group 1A included patients with unaltered corneas; group 1B - with changes in the corneas. Group 2 included patients diagnosed with angle-closure glaucoma (ACG) or suspected ACG, they underwent LI. CCM was performed on the Heidelberg HRT-III system. Laser treatment was performed using the Nd:YAG-laser LPULSA SYL-9000, λ=1.064 µm. RESULTS: Immediately after treatment, subgroup 1A exhibited singular hyperreflective deposits and negligible endothelial cell loss (ECL). After 1 month, CMM findings revealed no changes in this subgroup. In subgroup 1B, a post-LD reduction in endothelial cell density led to increased polymegathism, decreased pleomorphism, heightened endothelial cell nucleus reflectivity, and moderate hyperreflective deposits after 1 month. In the second group, significant hyperreflective deposits of various sizes, increased nucleus reflectivity, and notable endothelial cell density reduction were observed immediately and 1 month after LI. CONCLUSION: The results of this study show that the possibility of developing corneal complications after photo destructive laser interventions is to a certain extent related to the initial state of the cornea. The risk of developing corneal damage increases with decreasing distance between the cornea and the irradiated structure. An increase in the level of laser radiation energy and its total values also contributes to damage to the cornea, which is possible with dense secondary cataracts and thick irises.

Efficiency of HoLEP in patients with detrusor underactivity and renal dysfunction secondary to BPO.

PURPOSE: The purpose of this study was to assess the bladder and renal functional outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic obstruction (BPO) complicated by detrusor underactivity (DU) and secondary renal dysfunction. METHODS: Thirty-one patients were included in this prospective study. Eligible patients had urinary retention, a bladder outlet obstruction index (BOOI) greater than 40, a bladder contractility index (BCI) less than 100, abnormal renal function at the initial diagnosis (serum creatinine > 132 µmol/L) and a renal pelvis anteroposterior diameter (PRAPD) > 1.5 cm bilaterally. All patients underwent HoLEP in a routine manner and were evaluated preoperatively and at 1, 3 and 6 months after surgery. The baseline characteristics of the patients, perioperative data, postoperative outcomes and complications were assessed. RESULTS: Significant improvement was observed in the international prostate symptom score (IPSS), quality of life (QoL) score, maximal urinary flow rate (Qmax), post-void residual volume (PVR), Scr and RPAPD at the 6-month follow-up. Bladder wall thickness (BWT) exhibited a decreasing trend but did not significantly differ from the preoperative values. No grade 3 or higher adverse events occurred, and grade 3 and lower complications were treated conservatively. Three patients required reinsertion of indwelling catheters, and they were able to void spontaneously after two weeks of catheterisation training and medication treatment. CONCLUSION: HoLEP is an effective treatment for men with BPO accompanied by DU and consequent renal function impairment. Patients are able to regain spontaneous voiding. Both bladder and renal functions were preserved and improved.

Hydrodissection and femtosecond laser assisted surgery in posterior polar cataract.

PURPOSE: To present our clinical experience using femtosecond laser-assisted cataract surgery (FLACS) and cortical cleavage hydrodissection in eyes with posterior polar cataract. METHODS: Medical records of consecutive10 eyes of 6 patients with clinical diagnosis of posterior polar cataract (PPC), were retrospectively reviewed. All surgeries were done by using femtosecond laser-assisted cataract surgery. In all cases careful hydrodissection was done to separate the lens material from the posterior capsule. RESULTS: There were 3 males and 3 females, ages 39-73 years (average 52.5 years), two of them were implanted with toric lenses. In all eyes hydrodissection was successfully performed and the lens material was separated from the lens capsule. The posterior capsule remained intact during nucleus removal in all cases. In one eye the posterior capsule broke during cortical cleaning and the tear was converted to posterior capsulorhexis (PCCC). No postoperative complications were recorded during follow-up in all eyes. CONCLUSIONS: Hydrodissection can be safely performed in combination (but not exclusively) with FLACS, in eyes with posterior polar cataract with no evidence of a preexisting posterior capsule rent. Hydrodissection is regarded by most surgeons as contraindicated in these eyes however apparently it is more gentile to the capsule than any other surgical maneuver and allows clean and efficient separation of the lens material from the thinned posterior capsule. Femtosecond laser capsulotomy and lens fragmentation is effective and may further assist surgery by pneumo-separation of the lens material. Anterior chamber maintainer may further aid to the stability of the chamber and safety of surgery.

The ideal range of laser hair removal for microtia patients undergoing two-stage ear reconstruction.

Although the technologies for auricular reconstruction in microtia have improved, issues such as low hairlines or excessive hair growth can still pose aesthetic problems for the reconstructed ear. Laser depilation has been reported as a solution for hair problems. However, few studies have discussed the appropriate region for hair removal. A retrospective analysis was performed on 276 patients with unilateral microtia who underwent the Nagata two-stage ear reconstruction. The gender ratio of male to female was 2.5 (198 males/78 females). Intense pulsed light depilation was used to remove hair. To determine the proper hair removal area, we measured the extent of hair removal. Before the first stage, the average vertical distance between the upper point (after localization) and hairline was 3.42 ± 4.75 mm (-10-20 mm). After the first stage, the average vertical distance between the upper point of the reconstructed ear and the hairline was 1.27 ± 2.41 mm (-10-15 mm). By using chi-square test to assess differences in hair removal success rates among various regions, we aimed to identify the suitable depilation region. Before the first stage, a depilation vertical distance ≥ 10 mm led to a 92.1% success rate. After the first stage surgery, among the patients needing additional hair removal, a vertical depilation distance ≥ 4 mm resulted in an 81.3% success rate. Based on our observation, we suggested that a depilation region of ≥ 10 mm (before the first surgery) or ≥ 4 mm (after the first surgery) would be the ideal range for laser hair removal.

Treatment of Acne Vulgaris-Associated Post-Inflammatory Dyschromia With Combination of Non-Ablative Laser Therapy and Topical Antioxidants.

Acne can cause disfiguring sequelae, such as scarring, post-inflammatory erythema (PIE), and post-inflammatory hyperpigmentation (PIH). These post-inflammatory dyschromias pose a significant psychological burden on patients. This burden disproportionately affects skin of color (SOC) patients and can be the most distressing aspect of acne in SOC patients with skin types IV to VI. Multiple non-ablative lasers are used in the treatment of acne-related PIE and PIH. Combination therapies have shown promise in conditions such as rosacea, acne, and post-inflammatory dyschromia. Addressing both the inflammatory and scarring components of acne is key. Given the role of oxidation in the inflammatory cascade, including antioxidants could be an efficacious adjuvant with non-ablative lasers. This is a single-site, randomized, controlled clinical study of 25 subjects with skin types I to VI with facial PIE and/or PIH from acne. The primary objective was to investigate the clinical efficacy of non-ablative laser therapy followed by the topical application of Silymarin/Salicylic Acid/L-Ascorbic Acid/Ferulic Acid (SSAF) or control in the improvement in oily skin patients with facial PIE and PIH due to acne lesions. There was a statistically significant decrease in PIH and intralesional melanin in patients treated with a combination SSAF and non-ablative laser therapy. Improvement of both PIE and PIH was augmented in combination with SSAF and laser-treated patients compared with the laser-only group, with a concomitant increase in collagen density. This was even more strikingly marked in the SOC subjects, potentially providing an energy-based device (EBD)-based therapy in this population. Limitations of this study include small sample size and length of post-treatment follow-up. J Drugs Dermatol. 2024;23(9):769-773. doi:10.36849/JDD.8309.

INDIVIDUAL ARTICLE: Real-World Patient Cases Using Triple Lipid-Containing Cream for Cutaneous Healing Post Laser or Microneedling Radiofrequency Treatment.

Lipids play an essential role in skin barrier health. With age, there is a natural reduction of physiological lipids such as fatty acids, ceramides, and cholesterol. The triple lipid restore cream is a moisturizer that contains an optimized lipid ratio for aging skin. The cream contains a 2:4:2 ratio of ceramides, cholesterol, and fatty acids that have been shown to best support aging skin. The triple lipid restore cream has been used in combination with energy-based procedures, to provide patients with comprehensive integrated skincare regimens. With limited clinical data and guidelines available in regenerative medicine, real-world cases serve as an invaluable guide for patients and dermatologists in navigating rejuvenation treatment plans. J Drugs Dermatol. 2024;23:9(Suppl 1):s3-14.

Investigating the efficacy of Endolift laser and Nanofat as a combination therapy for horizontal neck lines compared to Nanofat autologous alone.

BACKGROUND: The emergence of horizontal neck wrinkles is increasingly becoming a focal point for both cosmetic professionals and clients. Various treatment approaches must be considered to address this issue effectively, owing to its diverse underlying causes. The study explores the potential of utilizing the Endolift laser in conjunction with nanofat injection as a viable treatment option. METHODS: Twenty patients with horizontal neck wrinkles involved in the study. Ten patients underwent treatment with a combination of Endolift laser and nanofat injection and 10 patients treated with nanofat injection alone. The participants were monitored for 6 months post-treatment. Biometric measurements were utilized to assess outcomes, including changes in volume, depth, and area of the wrinkles, skin elasticity, as well as the diameter and density of the epidermis and dermis in the treated area. Skin improvement was evaluated by two independent dermatologists, who compared before and after photos in a blinded manner. Patient satisfaction levels were also documented. RESULTS: The Visioface analysis showed a notable decrease in neck wrinkle depth and area in both groups. However, the group receiving the combination treatment of Endolift laser and nanofat exhibited a significantly greater improvement compared to the group treated with nanofat alone. Skin ultrasonography results demonstrated an increase in thickness and density of the dermis and epidermis in both groups. Particularly, the group treated with Endolift laser-nanofat displayed significant enhancements in dermis and epidermis density and thickness when contrasted with the nanofat-only group. Analysis with Cutometer revealed a marked enhancement in skin elasticity in the Endolift-nanofat treated group in comparison to the nanofat-only treated group. Furthermore, in the Endolift-nanofat treated group, a substantial majority (90%) of patients exhibited improvement. Patient evaluations highlighted significant distinctions between the two groups, with 95% of patients in the Endolift-nanofat treated group demonstrating enhancement. CONCLUSION: Both methods notably enhance horizontal neck wrinkles; nevertheless, the combination of endolift laser and nanofat seems to be more efficient for treating horizontal neck wrinkles.

Functional outcomes following external beam radiation therapy for patients with prior holmium laser enucleation of the prostate.

INTRODUCTION/BACKGROUND: Holmium laser enucleation of the prostate (HoLEP) is an increasingly popular size-independent technique of treating male voiding dysfunction due to benign prostatic hypertrophy. Some patients after HoLEP may develop clinically significant prostate cancer and opt for definitive treatment with external beam radiation therapy (EBRT). Little is known about the safety of EBRT after HoLEP and how it may functionally impact voiding after HoLEP has altered the anatomy of the prostate. Our study aimed to assess patient-reported voiding outcomes following EBRT after HoLEP with a focus on incontinence related patient outcomes. METHODS/MATERIALS: This study was conducted with approval from our hospital's institutional review board. Patients that underwent HoLEP followed by EBRT were identified and data were collected in a retrospective nature from a single surgeon HoLEP cohort over the past 4 years (2019-2023). Patient demographics, disease and radiation therapy characteristics, radiation therapy, and baseline voiding symptoms were recorded. Current functional voiding outcomes were also collected via phone-call or portal communication in a cross-sectional manner with questions pertaining to type of incontinence, IPSS quality of life score, and administration of the Michigan incontinence symptom index (M-ISI). Adverse events encountered during follow-up were recorded. RESULTS: 24 patients were identified who received RT for prostate cancer after HoLEP with an average age of 73.6 (± 5.3). One third of patients reported no incontinence whatsoever after radiation and of those who experienced incontinence, the majority felt that it was not worsened after radiation. Median IPSS QoL score following radiation was 1 (range 0-6), median M-ISI Severity Score was 4 out of a maximum of 32, and median M-ISI bother score was 0 out of a maximum of 8. One patient developed a bladder neck contracture (BNC) approximately 1 year following his radiation therapy (approximately 18 months after HoLEP) causing bothersome incontinence and LUTS. CONCLUSIONS: In our cohort most patients who received RT after HoLEP reported a high urinary-symptom related quality of life and a low rate of urinary incontinence. One patient who received SBRT suffered a BNC which is a known adverse event with RT but given our small sample size it remains unclear if the risk is higher in patients receiving RT after HoLEP. Larger studies should focus on examining the rate of bladder neck contracture in patients receiving RT after HoLEP, particularly focusing on whether the degree of dose fractionation may impact their development.

Results of CO2 laser surgery in laryngeal papillomatosis.

Recurrent respiratory papillomatosis is medical condition strictly connected with HPV infection of the epithelium of the upper respiratory track. The main treatment of lesions located in larynx or lower pharynx includes microsurgical excision by using CO2 laser. A thorough preoperative assessment of patients is extremely important, which should not only be based on traditional laryngological examination, but also on endoscopy of the larynx and the use of the NBI (narrow band imaging) technique to assess the vascularization of lesions. In patients with recurrent papillomas, neoadjuvant therapy with antiviral agents or agents that inhibit angiogenesis is also often used. Among our group of 31 patients with laryngeal papillomas, 15 people (48%) required repeated surgical intervention and additional antiviral therapy while 10 (33%) people had to undergo the procedure three or more times due to disease recurrence. In this article we will discuss that laryngeal microsurgery with a CO2 laser is an effective method of treating patients with laryngeal papillomatosis and we will present the possibilities of adjuvant therapy.

BCLA CLEAR presbyopia: Management with scleral techniques, lens softening, pharmaceutical and nutritional therapies.

The aging eye undergoes the same progressive crosslinking which occurs throughout the body, resulting in increased rigidity of ocular connective tissues including the lens and the sclera which impact ocular functions. This offers the potential for a scleral treatment that is based on restoring normal biomechanical movements. Laser Scleral Microporation is a laser therapy that evaporates fractional areas of crosslinked tissues in the sclera, reducing ocular rigidity over critical anatomical zones of the accommodation apparatus, restoring the natural dynamic range of focus of the eye. Although controversial and challenged, an alternative theory for presbyopia is Schachar's theory that suggests a reduction in the space between the ciliary processes and the crystalline lens. Widening of this space with expansion bands has been shown to aid near vision in people with presbyopia, a technique that has been used in the past but seems to be obsolete now. The use of drugs has been used in the treatment of presbyopia, either to cause pupil miosis to increase depth of focus, or an alteration in refractive error (to induce myopia in one eye to create monovision). Drugs and laser ablation of the crystalline lens have been used with the aim of softening the hardened lens. Poor nutrition and excess exposure to ultraviolet light have been implicated in the onset of presbyopia. Dietary nutritional supplements, lifestyle changes have also been shown to improve accommodation and the question arises whether these could be harnessed in a treatment for presbyopia as well.

Comparisons of the oncological results of transoral laser surgery and radiotherapy for early stage laryngeal squamous cell cancer: single-center long-term results.

BACKGROUND: In the treatment of early stage laryngeal cancers, surgery (transoral laryngeal surgery (TOLS), open partial laryngeal surgery (OPLS) and radiotherapy (RT) are used. OBJECTIVES: Compare the oncological results of patients with early stage laryngeal squamous cell carcinoma (LSCC) treated with TOLS or RT. DESIGN: Retrospective. SETTINGS: Tertiary training and research hospital. PATIENTS AND METHODS: The participants were divided into patients who underwent TOLS and RT treatment. The groups were compared with each other in terms of local recurrence, regional recurrence, distant metastasis, 3 and 5-year overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and laryngectomy-free survival rates (LFS). MAIN OUTCOME MEASURES: The effects of TOLS and RT treatment on local control, regional control, OS, DFS, DDS and LFS in early stage laryngeal cancers. SAMPLE SIZE: 261. RESULTS: The mean follow-up time was 48 (26) months. There were 186 patients who underwent TOLS and 75 patients who underwent RT treatment. Gender, cigarette/alcohol consumption, tumor localization, anterior commissure involvement, tumor grades, recurrence rates and recurrence localizations of the groups were similar. The 5-year overall, disease specific, disease free and laryngectomy-free survival rates were 85.9%, 88%, 79.4%, 96.3% in the TOLS group and 74.3%, 76.7%, 72.3%, 85.2% in the RT group (P=.034, .065, .269, .060, respectively). CONCLUSIONS: TOLS had equal and good oncological outcomes on OS and DFS compared to RT. Anterior commissure involvement was statistically significant independent prognostic risk factor for DFS in both groups. The 5-year OS rate was greater in the TOLS groups (P=.034). LIMITATIONS: Retrospective, but to the best our knowledge, this is the first study in Turkey with a high patient volume and a long follow-up time.