Professional laser technology in gynecology for doctors

Recently, in gynecology, laser technology has attracted increasing application and interest. A large number of laser equipment has appeared, both invasive and non-invasive, which is successfully used by specialists in gynecology. One of the first lasers, which was actively used in gynecology, was a CO2 laser, and given the specificity of its wavelength (10.6 μm), its use was mainly of a surgical nature of the procedures. However, in addition to carrying out intimate plastic procedures, professional laser technologies in gynecology can be used, at least, for the following procedures:

• 1) treatment of urinary incontinence
  2) dispaurenia
  3) treatment of vulvovaginal atrophy
  4) vaginal rejuvenation

For each laser procedure, the parameters necessary for the effective conduct of a particular procedure are used, in addition, a large number of handpieces and laser modules produced by manufacturers can confuse even experienced specialists and make it difficult to choose the optimal laser for gynecology. This article discusses the basic laser technologies and tools used in gynecology, as well as the most significant differences between them.

Which laser to choose for gynecology – CO2 or Er:YAG

Currently, among the majority of techniques used in laser gynecology, it is advisable to distinguish two main ones:

1)Ablative laser action. This technique is based on damage and subsequent regeneration of the mucous membrane through exposure to laser radiation. For this technique, two types of lasers are most often used – CO2 and Er: YAG laser. Despite the similarity of the effects of radiation on tissues (both erbium and CO2 radiation are very strongly absorbed by water and, as a consequence, by the uppermost layers of tissues), there are a very large number of differences between these lasers for using in gynecology:

• Direct optical CO2 radiation (10.6 μm) penetrates the skin 7 times deeper than erbium radiation (2.94 μm), therefore, the likelihood of unpleasant and painful sensations after using a CO2 laser, as well as the likelihood of scarring is much higher than after Er: YAG laser applications. Those some advantages that CO2 has over an erbium laser when working on the surface of the skin layer (the ability to remove more bulky neoplasms, a deeper coagulation effect in the epidermis layers) lead only to an additional risk during gynecological procedures due to the delicacy of the mucous membrane.
• The ability to control the duration of pulses, and, consequently, control the depth of exposure is very different for erbium and CO2 lasers. For erbium laser in gynecology you can choose different pulse durations and, accordingly, fully control the depth of exposure. At minimum pulse durations (from 50 μs), the nature of the effect of laser radiation is in the nature of “cold ablation”, in which the laser radiation penetrates to a depth of 0.03-0.05 mm without thermal heating of the tissues. With an increase in the duration of the Er: YAG laser pulse, the thermal zone in the area of ​​the laser beam near the ablation zone increases due to the heat conduction mechanism in tissues and, finally, with pulse durations exceeding 30-40 ms (depending on the energy flux density), the ablation effect is completely disappears and the main remains the warming mechanism of heat transfer due to thermal conductivity in the tissues. For a CO2 laser, there is no possibility of such adjustment; accordingly, it is much more difficult to control the depth of laser radiation penetration during the procedures.

2) Warming laser action. Among non-ablative laser techniques, laser technologies in gynecology based on neodymium and non-ablative erbium lasers are currently the most widely used. Moreover, neodymium non-ablative methods, as a rule, are more popular, because the use of non-ablative erbium techniques involves the use of laser energy purely for heat transfer due to the heat conduction mechanism, which significantly limits their effectiveness in certain procedures. Neodymium laser techniques also have significant differences among themselves, because have wide differences among themselves, not only in the levels of energy densities and pulse durations, but even in the length of the laser radiation. The main wavelength of the laser radiation of the Nd: YAG laser used in gynecology is 1320 nm. Unlike the more common wavelength of the Nd: YAG laser – 1064 nm, 1320 nm has a penetration depth of 2-2.5 mm, which is optimal for most gynecological procedures, especially for non-ablative anti-aging procedures. Because the penetration depth of a wavelength of 1064nm is already 3-4mm, which is excessive and even unsafe due to the structural features of female body.

Choosing of gynecology laser

The main differences in design and parameters

Despite the relative similarities in the design of most laser instruments for gynecology, there are many fundamental differences between them both in design and in technical characteristics, which plays a crucial role for efficiency and safety during procedures:

1. The materials used and the ability to sterilize laser instruments. Despite the assurances of almost all manufacturers, the main attention when choosing a laser for gynecology should be given to the possibility of sterilizing the instrument. All parts must be securely fixed, disassembled, and, of course, made of reliable and sterilized materials.
2. The presence of special applicators and expanders supplied with the tool. For laser gynecological procedures, the accuracy and accuracy of exposure to laser radiation is important. Accordingly, it is recommended to use only those laser instruments that allow a controlled and accurate treatment of the mucous membrane.
3. The direction of propagation of the laser beam. Most laser manufacturers offer two types of mirrors for the propagation of laser radiation – 90-degree reflective radiation (for processing point areas) and conical (capable of affecting the mucous walls throughout the 360 degree circle.). Given the wide variety of laser procedures in gynecology, it is very important for a gynecologist to be able to quickly and easily change one reflecting mirror to another.

When opening or expanding a business using the purchase of medical laser equipment, any specialist doctor or the head of a medical institution should, if not thoroughly understand it, then, as a minimum, understand the main differences and fundamental features of using certain laser technologies. Because it is the equipment that determines the safety and efficiency of the procedures and, accordingly, the success of your business.