ABOUT CO2 LASER IN BREAST CANCER SURGERY

The properties of the CO2 laser make it particularly useful to the surgeon in the treatment of breast carcinoma. Its energy is well dispersed by the water present in cells therefore dissecting tissue and removing neoplastic processes by vaporization. It seals small blood vessels and lymphatics (fig. 1). As a further benefit the infrared heat sterilizes the operative field. These attributes allow the CO2 laser to function well as a dissecting tool in the surgical treatment of breast disease. In a personal series using the CO2 laser in over 2000 cases of surgery of the breast for primary breast carcinoma including biopsies (fig. 2), segmentectomies with lymph node dissection (fig. 3), and modified mastectomies, the results have been very encouraging.

In conventional surgery there is always the risk that you can seed the wound or inadvertently transfer cells to healthy tissue by the scalpel. The lasers' intense heat destroys the cancer cells and reduces this risk. In addition, when a tumor is excised and the margin is involved on frozen section further excision of the tumor bed is performed either with conventional or laser surgery.

Margins on the frozen section occasionally (5-7%) appear to be free of tumor but there is still involvement on permanent section analysis. Dissection by laser would offer a greater margin safety in the process of excising the tumor (fig. 4).

There are multiple factors that contribute to local breast tumor recurrence. However, in animal studies, using the CO2 laser as a means of dissection, local breast tumor recurrence rates have been significantly reduced (fig. 4). The laser cauterizes as it dissects leaving a clean dry surface that enables the surgeon to focus on fine details frequently facilitating removal of tumor. This factor also decreases blood loss and lymphatic drainage.

Dramatically the value of the CO2 laser becomes even more apparent during the post-operative period. Following major surgery on the breast, drainage is significantly reduced. Drains are usually removed within 24-48 hours. All patients requiring little to no pain medication. Discharge without drains in all patients, has been within 1 day following laser surgery. There have been no complications and no incidences of arm swelling or dysfunction. This lack of need of medication, nursing care and prolonged hospitalization enables the patient to return to normal activity within a short period of time.

In summary the advantages of laser surgery in cancer treatment are as follows:

•  Dry surgical field allows precision detection under magnification

•  Precision removal of cancer cells- maximum normal tissue preservation

•  Total kill in comparison with chemobiological- radiotherapy

•  Repeatable (in contrast with radiotherapy)

•  Minimal trauma surgery, minimal immunodeficiency and minimal postoperative edema (minimal post-operative pain, rapid healing)

•  No mechanical effect to dislodge cancer cells

•  Sealing of lymph vessels- diminished lymphatic metastasis

•  Ability to sterilize the surgical field of tumor cells, bacteria and viruses

•  Ease of delivery through endoscopes, fiberoptics and sapphire tips

•  Hemostatic effect, diminished need for transfusion

Since the days of Aristotle there has been little change in the basic tools of the surgeon i.e., the knife, scissors and the saw. We now have the benefit of modern technology in the form of the laser.

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