New instrumentation and technique for laparoscopic carbon dioxide laser operations: a preliminary report

Laparoscopic surgery, the accepted procedure for several indications, still has some limitations, mainly due to the risk of uncontrollable bleeding and damage to the surrounding tissues that may result from the procedure. With the advent of the surgical carbon dioxide laser apparatus and its advantage in producing a bloodless incision, the authors have modified their approach toward laparoscopic surgery. A variety of special straight laser channels for introduction into the abdominal cavity have been developed; use of these channels requires special care to protect surrounding tissues from damage during the procedure. A Sharplan laser delivery system comprising an articulated arm was used, and the operative area visualized and controlled by single- and double-puncture laparoscope systems. The techniques were first applied in rabbits and, after several improvements, used in humans for various indications. The laser laparoscope can be particularly useful in the treatment of endometriosis and lysis of pelvic adhesions.