Instrumentation for urologic laser surgery

Carbon dioxide, neodymium:yttrium-aluminum-garnet, ruby, and argon lasers are the only commercially available lasers with wavelengths suitable for laser surgery. Consequently, researchers have attempted to make the tool fit the clinical need. A pediatric #6 bronchoscope was fitted to a carbon dioxide laser endoscopic coupler to form a modified cystoscopic laser delivery system. This instrument was able to vaporize small condylomata of the distal male urethra. However, the restricted visibility of this crude adaptation represents an inferior solution compared with the endless possibilities of sophisticated fiberoptic technology. Future prospects in infrared optical fiber technology portend a breakthrough for transurethral carbon dioxide laser surgery. Adapting the Nd:YAG laser for urologic surgery is attractive because it can be easily incorporated into conventional cystoscopes. The argon laser's capacity to absorb blood and traverse water suggests future importance for transurethral surgery. Investigation is needed to develop a surgical laser adaptable to both open and transurethral urologic surgery.