Laser Ablation in Gynecology
Laser ablation is type of endometrial ablation (sometimes misspelled as “oblation” or “ablasion”, also called uterine ablation and uterus ablation), which is a surgical technique to stop heavy bleeding during the period.
Normal loss of blood during the period is around 25 ml, and anything above 80 ml is too large. Besides anemia and the problems it can bring you, losing so much blood may make your life unbearable. Many women describe this not as having a period but as downright hemorrhaging. It is difficult to live when you cannot sleep, cannot move because of blood, cannot go to work for several days or even for a whole week. It is exactly in this situation when you say “I can’t live like this anymore, doctor, do anything, just save me now!” Next thing you know, you’re discussing all kinds of surgery, all up to hysterectomy. If you’re lucky, and fall into one of the groups of patients described below, you can settle for “smaller” surgery such as endometrial ablation.
Laser ablation is a good alternative to other types of ablation of the uterus. Laser stands short for Light Amplification by Stimulated Emission of Radiation. It has been discovered in the middle of the twentieth century and has quickly found its way to the various fields of medicine.
Lasers produce a hot, precisely focused beam of light, which can remove or vaporize tissue and control bleeding. They are so focused that are somethimes called the “scalpels of light”. They can cut and destroy tissues, shrink tumours or lesions, and seal (cauterize) blood vessels to prevent excessive bleeding.
Applications of Lasers In Medicine
One of the first applications of lasers in medicine was in
|ophthalmology (treating eye problems), followed by many uses in dermatology (skin problems, esthetic surgery). Lasers are also used in
gastroenterology (disorders of the stomach and intestines),
gynecology , since 1989,
oncology (cancer treatment),
orthopedics (disorders of bones, joints, muscles, ligaments, and tendons),
otolaryngology (ears, nose, and throat; snoring),
pulmonary care (for the respiratory system),
urology (the urinary tract and of the male reproductive system),
Types of Lasers
There are three types of lasers used today in gynecology:
|Carbon dioxide (CO2) laser. It cuts or vaporizes tissues while minimizing the bleeding. Used for surgery.|
|Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser. Can penetrate the tissues more deeply than other lasers, so blod clots quickly. The surgeon can see and work with the parts of the body for which an open surgery would be needed without the laser.|
|Argon laser. Used for eye surgery, for treatments of superficial skin disorders, and for photodynamic therapy (PDT) to shrink or dissolve tumors by means of light-sensitive dyes.|
Lasers in Gynecology
In gynecology, lasers are most frequently used for
|Regulation of heavy bleeding (click here for general introduction to endometrial ablation)|
|Cancerous or non-cancerous tumors that cannot be removed or destroyed|
|Ectopic pregnancy (development of a fertilized egg outside the uterus)|
Laser Ablation in Gynecology
One of the well-known methods for endometrial ablation now is laser ablation. It was first performed by Dr. Goldrath in 1979 using a Nd:YAG laser.
Often the patient will have both the myoma and heavy bleeding, and both can be treated with this laser. The Nd:YAG laser will better serve the surgeon for fibroids, however, it can be used for ablation as well in spite of its small field of focus. It would take an hour to ablate a small uterus with this type of laser, and can come very expensive in hospital costs. The results of laser ablation are comparable to those of other devices, say roller electrode.
Whether through laser ablation or through roller-ball ablation, the 95% of patients can control their bleeding and the uterine size is reduced to 50%. The final effect, the state of amenorrhea, will depend both on the technique used and on the size of uterus. 60% of women with preoperative uterine cavity less than 7 cm and only 30% of women with uterine cavity less than 10 to 15 cm reach the goal, i.e. enter the state of amenorrhea.
All in all, the Nd:YAG and bipolar needles for fibroids result in the same-day surgery, avoidance of hysterectomy, and elimination of bleeding.
Just as with any other surgical procedure, you should first ask why the physician chose that method for you and what are his or hers experiences with the procedure, the rate of failure or success etc. Be an informed patient and stick to your views until the doctor wins you over.
Problems with Laser Ablation
The person guiding the laser must be thoroughly trained for the procedure. Even if the procedure is done in the doctor’s office, the precautions taken must be the same as for an inpatient procedure. All the personnel should be trained and all the necessary equipment should be near and ready.
One wrong move and the laser will cut anything it touches. In the first years of using lasers in gynecology, there were two deaths from gas embolism. Both occured when the laser was activated while in contact with endometrial tissue. A gaseous embolism occured, and in those two cases, that led to death through irreversible cardiac arrest. Thefore, oxygen and other drugs must be at hand if the need arises for cardiopulmonary resuscitation (CPR). An emergency transportation to a hospital or a similar acute care unit must be provided whenever laser surgery is performed in a non-hospital setting.
What Can Happen After Laser Ablation
Laser or non-laser, the general rules still apply. You can leave the hospital or office when your vital signs have stabilized. If you were sedated, you should not leave until you know who you are and where you are. You should leave home accompanied by a responsible adult; it is best not to drive while going home.
There will be pain so you will probably get some analgesic drugs (pain relievers). Other possible risks are:
the wound becoming infected, and
piercing — a perforation of an organ or tissue.
For other pre- and post-op procedures have a look at the general page for endometrial ablation on this site.