Update Course Rewind: CO2 Laser Use Cases 2024

Global Cast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello Pediatric surgery family. I'm Lizzy Lee from Cincinnati Children's Hospital Medical Center. In this video series, we'll be recapping the sessions and sharing the key highlights from our 12th annual update course in pediatric surgery, which was held in August 2024. This year, we introduced a new approach to classify practice changing ideas at our update course. Presentations now fall into three categories: green circles for established practices, blue squares for promising newer practices, and black diamonds for early adopter practices only. Today, we will talk about the CO2 laser for pediatric surgery with Dr. Carlos Colunga, pediatric surgeon from Mexico. This topic falls into the black diamond unproven category. A three-year-old male with chronic balanoposthitis and recurrent infections not responsive to medical treatment presented with phimosis with painful urination reported. About 38% of the audience would use electrocautery, and 50% would use scalpel, with a small portion using CO2 laser. It has a potential to outperform conventional circumcisions and other surgeries, I'll use circumcision as a proof of concept. It can give you faster operative time, reduced pain, lower rates of of scarring and an amazing cosmesis. This meta analysis and systematic review included seven studies. Results showed that laser assisted circumcision is definitely a safe and strong option. This is the thing. We hear about the use of CO2 lasers for surgery. We think, oh, this is new, but this has been reported since 1970. It's just not well researched in pediatric surgery. And what exactly is the CO2 laser and the Yag laser? CO2 is carbon dioxide, and Yag stands for yttrium aluminum garnet and uses this crystal to produce a high energy beam of light. The way it works is the laser emits infrared light. It is highly absorbed by water in biological tissues. Depending on the nanometer wavelength that you change, it absorbs differently. We're using it in the spectrum of 920 to 1,400, which is really well absorbed by water. It's very effective for precise cutting and ablation and reduces blood loss. We have great reduced pain and edema and shorter operative time. The disadvantage is that it has a big learning curve. You need ocular protection and you need specialized training. It is quite expensive. Initially, it has a high cost barrier, but the evidence shows that this high cost is justified because CO2 lasers diminish operating time and lower complications. Which type of tissue is most suitable for laser surgery, especially at these wavelength? 65% of the audience answered mucosa. Yes, mucosa tissue is, of course, filled with mucus, which which is 95% water. So it reacts really well to the laser. Where in the body can we use this? Mucosa is present in a wide range of body surface areas. Let's explore some common use cases for CO2 laser. We've used it for circumcision, 56 patients. We use the slip technique with the dorsal slit. We use cyanoacrylate adhesive and we've only had a 3% complication rate. They only had two partial wound dehiscences that were managed conservatively. Just look at the scarring profile. It's amazing. Low pain profile. We only use ibuprofen. Our surgical time is around 10 minutes and amazing esthetically results. This research paper from 2016 shows that combining a CO2 laser and cyanoacrylate adhesive decreased the operating time significantly and decreased bleeding complications. We've used it for frenulectomy, 47 patients, low pain profile, no suture required. Other conditions that they've used the CO2 laser for include perianal fistulas in four patients, fistulotomy and pilonidal cysts in 12 patients. We do laser ablation and there's a sinus tract, we also ablated, lower labia fusion and condylomatosis, great for ablation. Here's another paper from 2022 showing that laser is very effective in treating benign anal conditions, especially hemorrhoids. In summary, CO2 laser is a strong evidence-based option with promising outcomes. It reduces bleeding, has a lower pain profile and has a shorter operating time. The barriers for adopting the use of CO2 lasers are the high initial equipment costs, the need for specialized training, and the lack of availability. Global Cast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.