By Kazuhiko Atsumi (auth.), Stephen N. Joffe M.D., F.A.C.S., F.R.C.S., Yanao Oguro M.D. (eds.)
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Additional info for Advances in Nd:YAG Laser Surgery
By selecting the appropriate probe and laser power, not only can the user determine the precise spot size and power density, but he can also control the shape and volume of thermal effect. 2). A conventional, noncontact YAG laser delivery system emits a diverging beam of gradually increasing size and diminishing power density. Approximately 30 to 40% of the beam energy can be lost to backscatter, and a portion of the rest is expended on nontargeted healthy tissue due to inaccurate focusing and beam scattering.
This means that if a physician or hospital does not plan to use the laser for purposes other than the treatment of bleeding, it is unlikely to be costeffective, unless the volume of cases to be treated is at least one per week. However, the Nd:YAG laser has other applications in GI, such as recanalization of obstructing carcinomas of the esophagus, stomach, and colon, as well as treatment of polyps and other tumors. In 1986, more than 500 medical centers worldwide, about 300 of which are in the United States, are using lasers to treat gastrointestinal disease.
The SLT Rounded Probe®, on the other hand, delivers approximately the same power density as an 80-W non contact Y AG beam using only 15 W of power, and produces true vaporization with minimal subsurface effects yet with sufficient coagulation to limit bleeding. Vaporization takes place only when the probe is in direct contact with the tissue. There are many advan- tages to the true vaporization delivered by the SLT Rounded Probe®. For endoscopic esophageal cancer removal, for example, the conventional noncontact technique involves coagulating to some depth below the surface, causing necrosis, waiting 48-72 hours for the blanched layer to slough off, and then repeating the process as necessary until the tumor has been removed.