Lumenis Smart CO2 Laser Solutions for Minimally Invasive Gynecological Surgery

Smart CO2 Solutions for Laparoscopic Gynecological SurgeryWhen it comes to delicate laparoscopic surgeries, optimal thermal control and precision are required for smart tissue management. With unique pulsed and continuous power mode settings, you have optimal control over cutting, ablation, or adequate hemostasis with the least amount of disturbance to adjacent tissue. A clearly visible aiming beam helps you target only the tissue of interest.Lumenis provides the opportunity to choose either fiber or freebeam delivery of precision CO2 laser energy depending on your preference.

For freebeam delivery, the SurgiTouch™ scanner and operating system has become an industry benchmark for precision in CO2 laser surgery, assuring reproducible tissue-effects that can be perfectly tailored to patient anatomy. Beam alignment units connect to commonly available operating laparoscopes. For fiber delivery, advanced CO2 fiber technology used either in robotic surgery or with specially designed GYN Laparoscopic handpieces, feature consistent, high energy transmission and a fiber tip that can be renewed during a procedure. This helps assure predicable results, fast procedure times, and cost effective procedures.

Two handpieces are designed to facilitate surgeon technique preference, through a trocar cannula or the suction irrigator, for optimal maneuverability and access to the most difficult to reach disease.

During surgery, the unique, high-precision characteristics of the CO2 laser translate to:

Greater safety • Depth of cutting and tissue ablation is controllable

and predictable• Superficial effect with bare minimum of thermal damage• Reduced risk of complications, such as strictures

and adhesions

Higher precision • Low thermal impact (compared with electrocautery) for

minimal tissue disturbance• Excellent tissue visualization of surgical plane for

precision ablation, excision, and incisions

Endometriosis: 1, 2, 3, 4

CO2 laser laparoscopic endometriosis surgery has been shown to be associated with:• Less pain• Limited thermal damage• Low perioperative morbidity (e.g. blood loss, bladder

and bowel injury)• Significant improvements in quality of life• High fertility rates• Low recurrent disease rates

Adhesions: 5

• Precise, yet hemostatic lysis of adhesions• Minimal thermal damage allows avoidance of injury to

neighboring structures

Myomas: 6, 7

• Precision allows removal of pathological tissue, while operating in well-defined surgical planes

• Faster tissue healing is reflected by low rates of adhesion formation

Benefits of CO2 Laser in Minimally Invasive Gynecology

Clinical Applications of CO2 Energy in Gynecological Surgery

Quality Beam PerformanceGreater power with less beam divergence allows for maximal precision

320µ

400µ

485µ

570µ

1153µ

1570µ

Spotdiameter

Spotdiameter

0mm

1mm

2mm

3mm

10mm

15mm

295µ

349µ

404µ

458µ

839µ

1111µ

Other*

Lumenis

This information relates only to fiber energy delivery.* Other fiber manufacturer’s reported beam divergence numbers

How is CO2 Laser Energy Delivered to the Abdominal Cavity?

Free Beam Fiber

Required accessoryMicroSlad, ColpoSlad,Nezhat AdapterBeam Align Units

Robotic Drop in GuideCO2 fiber with GYN LAP handpieces

Power delivery modes Continuous Wave, SuperPulse, Pulser

Aiming beam 5 mW red diode laser, 635 nm, adjustable intensity

Properties • Confocal with optics• No additional hand required to

utilize energy source• For operation with common

colposcopes or laparoscopes depending on application

• Operated through a side-port (may be inserted through the suction irrigator)

• May be more intuitive for surgeons previously using electrocautery

• May reach places which are not under direct line of sight

Other Energy Sources Used in Minimally Invasive Laparoscopic Surgery8

Energy Source Applied on External/Serosal Surface

Bipolar Cautery

MonopolarCautery

UltrasonicScalpel

CO2 Laser

Inju

ry to

Muc

osal

Surfa

ce o

f: Ureter 5/6 5/6 4/6 0/6

Bladder 2/3 1/3 0/3 0/3

Rectum 2/3 3/3 1/3 0/3

CO2 Laser Energy as Compared with Other Energy Sources

Traditionally, minimally invasive laparoscopic surgery has been performed with alternative energy sources such as electocautery, harmonic scalpel, or even other laser wavelengths. However, electrocautery-based treatment of such disorders poses a tremendous surgical challenge. In many cases pathology is located in close proximity to important intra-abdominal structures such as the bowel, ureters, urinary bladder and major blood vessels for which thermal damage to non-target tissue should be avoided.

A comparative study assessing the macro and microscopic characteristics of the most commonly used energy sources applied on the ureter, bladder and bowel in a laparoscopic setting (in-vivo porcine model) showed that CO2 laser energy was associated with the least deep tissue damage. 8

Monopolar, High-Power (7/10)

Based on Lumenis internal testing.

FiberLase™, SuperPulse, 10W

(Monopolar, High-Power (7/10 FiberLase, Super Pulse, 10W

No morethan 200µm

ThermalDamage

Up to 600µm ThermalDamage

For similar cutting effects, the thermal damage associated with electrocautery or other energy based tools can be substantially higher than that of CO2 Laser.

References:

1. Sutton C, Hill D. Laser laparoscopy in the treatment of endometriosis: A 5-year study. BJOG 1990; 97:181-1852. Meuleman C et al, Clinical outcome after laparoscopic radical excision of endometriosis and laparoscopic segmental bowel resection. Curr Opin Obstet

Gynecol., 2012 Aug;24(4):245-523. Nezhat C et al, Laparoscopic Management of Bowel Endometriosis: Predictors of Severe Disease and Recurrence. JSLS 2011;15:431–4384. Schipper, E, Nezhat C; Video-assisted laparoscopy for the detection and diagnosis of endometriosis: safety, reliability and invasiveness; International Journal

of Women’s Health 2012:4, 383 – 3935. Albee R. Excision of Endometriosis with the Carbon Dioxide Laser; in Surgical Management of Endometriosis, Edited by David Redwine, Publ. Martin Dunitz, 20046. Starks GC. CO2 laser myomectomy in an infertile population. J Reprod Med. 1988;33(2):184-67. McLaughlin DS. Micro-laser myomectomy technique to enhance reproductive potential: a preliminary report. Lasers Surg Med. 1982;2(2):107-27.8. Tulikangas PK, Smith T, Falcone T et al, Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril,

2001;75(4):806-810 9. R. Rox Anderson: Laser-Tissue Interaction; chapter in Cutaneous Laser Surgery: Goldman M, Fitzpatrick R; Mosby 199410. Kathryn M. Van Abel et. al.; Transoral Robotic Surgery Using the Thulium: YAG Laser; Arch Otolaryngol Head Neck Surg/Vol 138 (No.2), Feb 201211. Marc Remacle et. al.; Current State of Scanning Micromanipulator Applications With the Carbon Dioxide Laser; Annals of Otology, Rhinology & Laryngology

117(4): 239-24412. Nezhat C and Nezhat F, Laparoscopic surgery with a new tuned high-energy pulsed CO2 laser. J Gynecol Surg, 1992;8(4):251-25513. Meuleman C et al, Clinical outcome after CO2 laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic

segmental bowel resection and reanastomosis. Hum Reprod 2011;26(9):2336-4314. Meuleman C et al, Clinical Outcome After Radical Excision of Moderate-Severe Endometriosis With or Without Bowel Resection and Reanastomosis: A

Prospective Cohort Study. Ann Surg. 2013 Apr 10. 15. Sutton C, Macdonald R. Laser Laparoscopic Adhesiolysis. J Gynecol Surg. Fall 1990, 6(3): 155-159.

PB-1002670 Rev. A www.surgical.lumenis.com

©2013, the Lumenis Group of Companies. All rights reserved. Lumenis, its logo, FiberLase, GYN LAP-R, GYN LAP-S are trademarks or registered trademarks of the Lumenis Group of Companies. Specifications are subject to change without notice.

GYN LAP-R

GYN LAP-S

FiberLase Robotic Drop-in Guide

What Do Physicians Say?

“When it comes to fertility surgery, we have to work around very delicate tissue and spare as much healthy tissue as possible. Few tools offer precision of the CO2 laser to help me excise only the tissue of interest and perform extremely meticulous dissections. It’s a staple in my practice; I use it in every operative case that I perform.”

Ken Sinervo, M.D., Medical Director of the Center for Endometriosis Care, Atlanta, Georgia, USA.

Beam-Align direct laparoscope coupler