The safe removal of water spray dispersed laser plume is not covered by ANSI Z136.3 Standard for Safe Use of Lasers in Health Care (2018 Edition)
June 3, 2020
When selecting a surgical laser, one of the most important factors to consider is the ergonomics of its delivery system, as this choice greatly affects the practice, surgeon, and patient.
The return on investment for the LightScalpel flexible fiber surgical CO2 laser is fast and great because of its versatility for virtually all types of soft-tissue medical and dental laser treatment, along with the lower cost and highly-praised longevity.
Competitor’s articulated arm CO2 lasers are more expensive and make medical and dental treatments far less ergonomic. Also, competitor lasers have limited applications and require a longer time for return on investment.
Articulated Arm CO2 laser technology emerged in the 1970s in the absence of flexible fiber technologies. Articulated arm lasers deliver the laser beam to the tissue through a complex four-elbow – seven-mirror articulated arm requiring a high-precision factory assembly of expensive and tight-tolerance machined parts. A lens in the base of the handpiece focuses the laser beam 2-3 cm from the exit aperture of the laser handpiece. The articulated arm MUST have a visible aiming beam – the only visible indicator of where the CO2 laser beam is; the articulated arm is unusable without the aiming beam!
The articulated arm laser handpiece has a bulky feel unlike a scalpel or a pen – it is cumbersome and is limited in its reach and accessibility in regard to soft tissue surgery.
Flexible fiber waveguide surgical CO2 lasers were developed in the 1990s by LightScalpel’s predecessor, the Luxar Corporation. The LightScalpel novel fiber design has greatly improved the distal end beam quality over older generation Luxar flexible fibers. This improved design allows for unprecedented focusability and versatility with LightScalpel’s surgical handpieces, previously unattainable with neither articulated arm lasers nor with older generation Luxar lasers.
The laser beam exits the LightScalpel laser system through either a pen-sized handpiece, focused by interchangeable laser tips, or through a slender tipless handpiece. Both the focusing tips and tipless handpiece focus the beam 1 – 3 mm away from the handpiece, so both are held very close to the tissue. No aiming beam is needed or desired for medical or dental laser treatment with the LightScalpel pen-like handpiece – in the hand of a clinician, it feels and behaves very similar to a scalpel.
The thin, flexible fiber and its pen-like handpieces are exceptionally comfortable and easy for the surgeon to use during medical or dental laser treatments. Due to the flexibility of the fiber, the laser can be conveniently positioned with the handpiece suspended over a mayo stand for ready access. The convenience of the flexible-fiber enables the surgeon to access hard-to-reach sites.
Thus Dr. Stuart Coleton, DDS, Diplomate of both the American Board of Periodontology and the American Board of Oral Medicine, pointed out the advantage of the flexible fiber over the articulated arm lasers in his August 2011 interview for the Laser Surgery News:
With my flexible waveguide and my contra-angle tip, there’s no place in the mouth I can’t reach! Every area of the mouth is accessible, and that’s a fantastic advantage.
The bulky articulated arm delivery system with its restricted movement significantly limits laser positioning and doesn’t always allow suspension of the handpiece over a mayo stand for ready access. The overall weight and bulk of the articulated arm system may cause fatigue to the surgeon’s arm and hand, and potentially negatively affect the outcome of the medical or dental laser treatment.
LightScalpel soft tissue CO2 laser treatment improves surgical field visibility through reduced bleeding. Another contributing factor is the strong airflow from the narrow beam exit aperture (area approx. 0.5 mm2). The airflow is important because it prevents smoke-like vaporized tissue from obscuring the surgical site. Since the flexible fiber laser’s handpiece is held only 1-3 mm away from the tissue, this airflow is sufficient for maintaining good visibility.
In contrast, the articulated arm’s handpiece is held 2 – 3 cm away from the tissue, which is 10 times farther than the distance to tissue for the flexible fiber CO2 laser. In addition, the beam exit aperture of the articulated arm laser is large (area approx. 100 mm2). The large distance and size make the air-purge in articulated arm lasers ineffective and result in reduced visibility of the surgical field.
The flexible fiber CO2 laser handpiece is held very close to the tissue, i.e. it is aimed at a distance of 1 – 3 mm, allowing the surgeon to gain maximum stability by resting the hand holding the handpiece on the patient during the medical or dental laser treatment. Such positioning means that flexible fiber CO2 lasers are well suited for a wide variety of procedures including high precision ones. Articulated arm delivery handpieces are held 2 – 3 cm from the tissue; this results in lower precision and necessitates a visible aiming beam which is inaccurate (greatly exceeds the diameter of the laser beam) and obscures the surgical site visibility. Articulated arm lasers are suitable for simple skin incisions and gross dissection, but are ineffective for higher precision cosmetic, medical or dental laser treatments.
LightScalpel flexible fiber CO2 lasers can be used with multiple sizes of focusing tips and tipless nozzles that can be quickly and easily changed during medical or dental laser treatment: 0.25, 0.4, 0.8, and 1.4 mm. This variety of spot sizes enables the surgeon to choose the size that is most appropriate for the procedure and type of target soft tissue. Articulated arm lasers offer one fixed focal spot size, usually 0.2 – 0.25 mm.
Cutting and removing tissue requires maximum power density. However, hemostasis and wound contraction are achieved with lower power density. Flexible fiber CO2 laser focusing tips with a focal length of 1 – 3 mm produce a laser beam with wide angles of convergence and divergence. This enables the surgeon to adjust power density by just moving the handpiece away from the tissue. The focusing lens used in articulated arm laser handpieces has a fixed, 50 – 100 mm focal length. The angles of convergence and divergence of their laser beam are very narrow; therefore, it is only possible to defocus the beam by holding the handpiece far from the tissue.
Flexible fiber CO2 laser focusing tips have a wide-angle of divergence, which, along with rapid defocusing of the beam, means that the danger zone for eye injury is relatively short. The nominal hazard zone is far longer for articulated arm lasers because, due to the narrow-angle of divergence of their focusing lens system, the laser beam maintains high power density for a great distance.
Articulated arm lasers require a visible aiming beam since the surgeon must hold the handpiece away from the tissue for the laser beam to focus – the visible aiming beam is the only visible indicator of where the focused CO2 laser beam will hit the target. Even the slightest misalignment between the aiming beam and CO2 beam results in great collateral damage, causing the laser beam to hit unintended areas around the target.
Flexible fiber CO2 lasers have a special external calibration feature, which allows the clinician to accurately verify whether the selected power setting is actually exiting the delivery system. In articulated arm lasers, however, the energy entering the delivery system is monitored by an internal power meter, but there is no way to verify the energy exiting the system is attenuated within the aging delivery system.
Fine print instructions in articulated arm laser user manuals call for annual calibrations of the beam delivery; these can only be done by a visiting field service engineer, at the expense of the articulated arm laser owner. However, flexible fiber CO2 laser owners can perform calibrations daily for ultimate accuracy and precision, all due to distal end calibration built into flexible fiber CO2 lasers – at no cost to the owner.
The use of flexible fiber CO2 lasers, with their pen-shaped light handpieces, is intuitive due to their scalpel-like feel. Clinicians who perform medical or dental laser treatment in hard-to-reach areas particularly value the ease of access provided by the flexible fiber surgical CO2 laser. The short learning curve, along with the ease of use, explains the growing popularity of flexible fiber CO2 lasers.
Articulated arm lasers are more expensive and far less ergonomic; they have limited applications and require longer time for return on investment.
The return on investment for the flexible fiber surgical CO2 laser is fast and substantial because of its versatility for virtually all types of soft-tissue surgeries, lower cost of ownership and longevity.