Physical and surgical principles governing expertise with the carbon dioxide laser

There is widespread misconception that the unique physical properties of the carbon dioxide (CO2) laser essentially guarantee favorable results. In reality, the margin between excellence and mediocrity is very narrow. Unless sophisticated strategies are employed to restrict lateral heat conduction during photovaporization, the laser will produce the same kind of conduction burn as a hot cautery. This article examines the rationale for the use of the CO2 laser and provides an overview of six physical and six surgical principles governing expertise with the CO2 laser in the lower genital tract.