Contact laser microsurgery.

Abstract

INTRODUCTION: Lasers are commonly understood as instruments that produce a freestanding light beam that can cut or vaporize tissue. In contrast, a contact laser is an instrument where the laser beam resides entirely within a coated sapphire crystal probe tip. The authors describe the use of the contact laser for a variety of intraspinal procedures. METHOD: The probe is mounted on a curved handpiece and can be used in the same way as any microsurgical instrument. The laser energy is delivered only at the probe tip and only on contact of the tip with tissue. Different probe sizes and shapes allow for sharp cutting or tissue vaporization with minimal tissue penetration. FINDINGS: We have used this laser in 95 operations for dysraphic conditions, and intradural (both intra- and extramedullary) spinal tumors. It was easy to use for the microsurgically trained neurosurgeon. It is safer than a freestanding, noncontact, laser beam. To lyse scar tissue, evaporate lipomatous tissue, perform a precise myelotomy, and dissect, cut and debulk firm and fibrous intradural spinal lesions this instrument is superior to microscissors, suction, or the ultrasonic aspirator. INTERPRETATION: The contact laser is a useful microsurgical instrument for use in neurosurgery. It combines the advantages of lasers with those of microinstruments and avoids most shortcomings of both.