Carbon dioxide laser laparoscopy performed with a flexible fiber in humans

A flexible carbon dioxide laser fiber delivery system was used in conjunction with the laparoscope to treat 12 women. The 77 by 2 mm hollow fiber could subtend an arc of 90 degrees without significant loss of power or unfavorably affecting the delivery mode. As many as 20 W of power was transmitted through the fiber; however, carbon dioxide gas flow rates as high as 2000 cc/min reduced power by approximately 25%. Replaceable tips preserved fiber integrity to the extent that a single fiber could be reused repeatedly and gas sterilized without jeopardizing laser transmission. Of the 12 cases, endometriotic implants were vaporized in eight women, adhesiolysis was performed in four women, endometrial cysts were drained in two women, and vaporization of myomata was accomplished in two patients. The fiber was also used as a manipulating instrument and could be internally bent with a grasping forceps to better site the laser beam on a lesion. No complications related to the use of the carbon dioxide laser fiber were observed. The safety aspects of carbon dioxide laser fiber technology are not inconsiderable and could provide laser laparoscopy with an extra margin of security.