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This study compares local tumor recurrence after low energy CO2 laser wound sterilization with recurrence after scalpel, laser or electrocautery excision. Wound histologic changes were studied to understand the mechanism of the interaction between the laser and wound. Single implants of R3230AC mammary tumor were grown to an average diameter of 24 millimeters in the mammary ridge of 80 female fisher 344 rats. Rats were anesthesized with pentobarbital and randomized into groups, each with similar tumor size: scalpel (S), laser (L), laser with wound sterilization (LV), scalpel with sterilization (SV) and electrocautery (E). All surgical procedures were performed by the same surgeon with the same technique, with the exception of the instruments used. Tow rats from each group were sacrificed immediately and the wounds examined histologically. The Sharplan 1100 CO2 laser was used with a 125 millimeter hand piece in focus and in continuous wave for groups L and LV. Sterilization in groups LV and SV was performed with 5 millimeter spot size by heating the site gently without causing blanching of tissue. Excision in group E was performed with coagulating current from a monopolar cautery (Valley Lab). Rats were examined periodically for 30 days and those dying during this period were excluded from analysis. The incidence of wound recurrence was eight of 12 in group S; five of eight, L; four of 13, E; three of 12, LV, and two of nine, SV (p less than 0 .05). Histologic changes in the wound demonstrated viable tumor in all groups, with fewer areas present in groups E, SV and LV. Local thermal effects and the noncontact nature of the CO2 laser make it an effective adjunct in reducing local tumor recurrence by enhancing the cytoreductive capability of surgical procedures.
To read the full-text of this research, you can request a copy directly from the authors.
... The presence or absence of local recurrence and metastases after primary tumour excision is an important indicator of surgical treatment efficiency. Tumouricidal effects of laser treatment in oncologic surgery were the subject of several experiments.11,13,14,33 It was assumed that the tumour excision with closure of blood and lymphatic vessels and complete destruction of tumour cells in the path of the laser beam may improve prognosis after surgery.13,14,33 ...
... Tumouricidal effects of laser treatment in oncologic surgery were the subject of several experiments.11,13,14,33 It was assumed that the tumour excision with closure of blood and lymphatic vessels and complete destruction of tumour cells in the path of the laser beam may improve prognosis after surgery.13,14,33 Significantly lower local recurrence rate or the delay of its development after CO 2 laser tumour excision, compared with scalpel surgery, was demonstrated in several experiments performed on rats with implanted adenocarcinoma cells (R323OAC).11,14,33 ...
... It was assumed that the tumour excision with closure of blood and lymphatic vessels and complete destruction of tumour cells in the path of the laser beam may improve prognosis after surgery.13,14,33 Significantly lower local recurrence rate or the delay of its development after CO 2 laser tumour excision, compared with scalpel surgery, was demonstrated in several experiments performed on rats with implanted adenocarcinoma cells (R323OAC).11,14,33 Similarly, experiments performed on mouse tumour models showed a lower local recurrence rate after laser excision and a significantly longer time period between tumour excision and local recurrence development compared with scalpel surgery.12,13 ...
The important goal of modern research in the field of surgical oncology is the quest for a tool that could improve the outcomes of tumour excision.
The aim of this study was to compare the usefulness of the CO2 laser with flexible hollow waveguide and scalpel in mammary tumour excision.
Materials & methods:
A total of 112 female BALB/c mice with implanted orthotopically 4T1-luc2-tdTomato tumour cells were included in the research. Tumours were excised in 48 mice using the CO2 laser and in 48 through scalpel surgery. The control group consisted of 16 untreated mice. The evaluation of surgical outcome was obtained by in vivo bioluminescence and fluorescence imaging and post-mortem histopathological examination.
There were no significant differences between recurrence rates, metastases and survival time in groups excised with the scalpel and CO2 laser.
The CO2 laser has similar efficacy compared with conventional scalpel excision for local recurrence rates, incidence of distant metastases and survival time and can be safely applied in oncological surgery.
... As the CO 2 laser is a non-contact application, it also greatly reduces the chance of seeding tumour cells when compared to non-laser surgical excision (Lanzafame et al. 1986;Holt and Mann 2002). A reduction in local tumour recurrence as well as fewer metastases and longer survival rates have been observed in several studies using rodent models to compare excision of tumours with a CO 2 laser to non-laser surgical methods (Tuchmann et al. 1986;Lanzafame et al. 1988). ...
AIMS: To compare the duration of anaesthesia, surgery, and postoperative hospitalisation, the proportion of tumours excised with complete histologic margins and immediate postoperative surgical site complications in dogs undergoing removal of cutaneous or subcutaneous soft tissue sarcomas (STS) by either carbon dioxide (CO2) laser or non-laser surgical excision methods.
METHODS: Medical records of dogs that underwent surgical excision of cutaneous and subcutaneous STS at the University of Missouri between December 2004 and May 2018 were evaluated. The study population consisted of client-owned dogs that underwent CO2 laser (n=4) or non-laser (n=20) excision of a single STS. Data recorded included: signalment, duration of anaesthesia, surgery and postoperative hospitalisation, tumour characteristics, completeness of histologic margins, postoperative complications, adjunctive therapy, and other procedures at the time of surgery.
RESULTS:. There was no evidence of a difference in mean age, body weight or tumour size between groups. Similarly there was no evidence of a difference in the duration of anaesthesia or surgery, or in the proportion of dogs whose STS were removed with complete histologic margins between dogs whose STS was removed using laser or non-laser surgical excision methods. However, the duration of postoperative hospitalisation trended towards being longer for the laser excision group (p =0.061).
CONCLUSIONS: These data provide preliminary evidence that excision of cutaneous or subcutaneous STS with CO2 surgical laser is comparable to non-laser methods for the measured outcomes.
... The CO2 laser is a very precise soft tissue cutter which causes minimal thermal damage to the surrounding tissue and less spreading of tumour cells than surgical instruments. It is therefore used in human and veterinary oncology (Lanzafame and others 1988, Palmer 1989). A success rate of 60 to 80 per cent has been reported when the laser is used both to cut and evaporate the sarcoids (Diehl and others 1987, Vingerhoets and others 1988, Carstanjen and others 1997). ...
Ninety-five horses with sarcoids were subjected to three types of treatment: surgical excision (conventional or carbon dioxide laser), cryotherapy or local BCG vaccination. The type of treatment was selected on the basis of the size, location and clinical appearance of the tumours. The choice between conventional and laser excision was empirical. A successful outcome was obtained in 11 of 14 (79 per cent) of the horses treated by cryosurgery, 18 of 27 (67 per cent) treated by BCG vaccination, 18 of 22 (82 per cent) treated by conventional excision, and 20 of 28 (71 per cent) treated with a carbon dioxide laser. For both excision methods, rigorous measures were taken to avoid autoinoculation and to ensure a wide margin of normal skin. The probability of local recurrence after excision was significantly higher for large sarcoids and sarcoids which had previously failed to respond to treatment. In 10 of the 31 horses with remaining sarcoids, some or all of the untreated sarcoids were observed to regress spontaneously.
... Thus, the low-intensity laser irradiation (LILI) has anti-inflammatory, immunocorrective and analgesic effects as well as promotes wound healing and helps to restore a balance between the components of the nervous system. There are published reports that say that the emission of low-intensity lasers does not affect the frequency of spontaneously induced mutagenesis, and laser therapy is not a contraindication for patients with premalignant lesions . Long-term studies on the effects of LILI on malignant tumors demonstrated a direct inhibitory effect of laser radiation on the tumor cells . ...
The results of the effective use of magnetic laser therapy in the treatment and rehabilitation of cancer patients were presented. The effect of magnetic-laser therapy in the treatment of radiation-induced reactions in the patients with head and neck cancer and in the patients with breast cancer was analyzed. High efficiency of lymphedema and lymphorrhea treatment in the postoperative period in the patients with breast cancer was proved. The results of rehabilitation of the patients with gastric cancer after surgical treatment were presented. These data indicate a high effectiveness of different physical methods of treatment and rehabilitation of cancer patients.
... During the 3-month post surgical observation period we noticed local recurrence only in two cases. Lanzafame et al.  demonstrated fewer recurrences after CO 2 laser tumor removal compared to conventional scalpel excision. The probable cause of this difference is the sealing of small blood vessels and lymph vessels by the CO 2 laser which prevents tumor cells spreading . ...
Tumors of the skin and subcutaneous tissue are the largest group of canine neoplasms. Total excision is still the most effective method for treatment of these skin tumors. For its universal properties the carbon dioxide (CO2) laser appears to be an excellent surgical instrument in veterinary surgery. Laser techniques are alternatives to traditional methods for the surgical management of tumors. The aim of this study was to compare various types of laser techniques in skin oncologic surgery: excision, ablation and mixed technique and to suggest which technique of CO2 laser procedure is the most useful in particular case of tumors in dogs.
The study was performed on 38 privately-owned dogs with total number of 40 skin tumors of different type removed by various CO2 laser operation techniques from 2010-2013. The treatment effect was based on the surgical wound evaluation, the relative time of healing and possible local recurrence of the tumor after 3 months post surgery. Local recurrence was observed in two cases. The study showed that in 30 cases time needed for complete resection of lesions was less than 10 minutes. Time of healing was longer than 12 days in 6 cases (42.8%) with tumor excision and in 14 cases (87.5%) where excision with ablation technique was performed.
The advantages of the CO2 laser surgery were better hemostasis, precision of working, non-contact dissection, less instruments at the site of operation and minimum traumatization of the surrounding tissues.
... CO 2 laser use results in a reduction and delay in the inflammatory response.  This particular laser is capable of inducing heat shock proteins by a mechanism similar to that observed in modification of wound healing and scar formation in laser-assisted-scar-healing (LASH) in humans. 26,27 Similarly, phototherapy at 660 nm is known to reduce inflammation. ...
Red light phototherapy is known to stimulate cell proliferation in wound healing. This study investigated whether low-level light therapy (LLLT) would promote tumor growth when pre-existing malignancy is present.
LLLT has been increasingly used for numerous conditions, but its use in cancer patients, including the treatment of lymphedema or various unrelated comorbidities, has been withheld by practitioners because of the fear that LLLT might result in initiation or promotion of metastatic lesions or new primary tumors. There has been little scientific study of oncologic outcomes after use of LLLT in cancer patients.
A standard SKH mouse nonmelanoma UV-induced skin cancer model was used after visible squamous cell carcinomas were present, to study the effects of LLLT on tumor growth. The red light group (n=8) received automated full body 670 nm LLLT delivered twice a day at 5 J/cm(2) using an LED source. The control group (n=8) was handled similarly, but did not receive LLLT. Measurements on 330 tumors were conducted for 37 consecutive days, while the animals received daily LLLT.
Daily tumor measurements demonstrated no measurable effect of LLLT on tumor growth.
This experiment suggests that LLLT at these parameters may be safe even when malignant lesions are present. Further studies on the effects of photoirradiation on neoplasms are warranted.
... Although the causes of port-site metastases remain uncertain, many investigators have suggested preventive strategies. These include port-site protection 80,81 , the use of prophylactic tumoricidal agents 2,12,82-84 , wound 'sterilization' 85 and gasless laparoscopy 66 . ...
Application of laparoscopy to the resection of malignancy has been followed by a literature describing cases of metastatic involvement at laparoscopic port sites. These include patients who underwent surgery for early stage carcinoma and instances following laparoscopic procedures during which tumours were not dissected.
Recently published clinical and experimental studies, and case reports related to this problem are reviewed; their relevance is discussed.
Experimental studies incorporating bench top and large animal models have confirmed that tumour cells may be redistributed to port sites during laparoscopic surgery either directly from contaminated instruments or indirectly via the insufflation gas. Small animal models suggest that the incidence of wound metastasis is increased following conventional laparoscopic surgery, and that it may be decreased by gasless laparoscopy or helium insufflation. This evidence suggests that the development of port-site metastases depends not only on the physical redistribution of tumour cells but also on the specific insufflation gas used, possibly because of influences on local metabolic or immune factors acting at the wound site.
Further research in this area is urgent. Until the issue is better understood, patients undergoing laparoscopic surgery for malignancy should be entered into clinical trials.
Some of the latest generation of CO2 lasers incorporate features that alter the wave form. The present study was undertaken to evaluate the relative zone of coagulation in acute laser wounds created in continuous-wave (CW), chop-wave (CPW), and super pulse wave (SPW) modes. The damage from single-point impact sites and incisions was compared in a guinea pig model. Animals were anesthetized with pentobarbital, and wounds were created with a 125-mm handpiece in focus (0.2-mm spot size) on dorsal and flank skin sites with the Sharplan 743 and 1100 CO2 lasers (Sharplan, Ltd., Allendale, NJ). Point impacts of CW and CPW were compared at power levels of 5, 10, 25, 40, 60, and 80 W at time durations of 0.05, 0.1, 0.2, and 0.5 seconds. Incisions of 3.0 cm were created at 25 W in CW, CPW, and SPW modes. Histologic sections stained with hematoxylin and eosin and Van Giesen elastin stains were evaluated by a single observer (R.J.L.). Zones of coagulation for the point-impact study varied from 79 to 257 +/- 66 (SD) micron in width with no significant differences between any of the wounds. Greater thermal damage (coagulation) occurred as the time interval increased. The zones of coagulation in the incision study were 309 +/- 83 (SD) micron for CW, 238 +/- 51 (SD) micron for SPW1 (743), 260 +/- 79 (SD) micron for CPW, and 194 +/- 56 (SD) micron for SPW2 (1100). These results are significant to the P less than 0.01 level.(ABSTRACT TRUNCATED AT 250 WORDS)
Only 18 cases of recurrence at the sites of cannula insertion after laparoscopy have been reported in the literature, ten of them in the past year. The period between laparoscopic surgery and presentation of wound metastasis varies widely, from 7 days to 10 months; the lesions are typically hard, craggy and painful. The most likely mechanism is direct implantation of viable exfoliated tumour cells but three aspects specific to laparoscopy may also be important. First, there may be increased exfoliation of tumour cells following manipulation by laparoscopic instruments of an unsuspected malignancy. Second, there may be repeated close contact between tumour-laden instruments and the port. Third, the passage of resected tissue through a small incision may coat the wound with potentially malignant cells.
In order to assess the therapeutic potential of CO2 laser in breast cancer, a randomized study was performed. One hundred and thirty-nine women were randomly assigned to laser
or conventional technique (scalpel and electrocautery) groups. Age, clinical tumour stage and pre- or post-menopausal state
were set up as criteria of randomization. A radical mastectomy with axillary lymph node dissection was performed in our patients.
Statistical analysis showed no difference between the two therapy groups regarding blood loss, post-operative drainage, operating
time and hospital stay. All patients were examined on a regular basis—median follow-up time was 5.5 years. Recurrence was
equal in both groups (four in each group). Kaplan-Meier evaluation of survival demonstrated no difference between the groups.
Evaluation of prognostic factors by the proportional hazards regression model demonstrated an increased risk for the advanced
clinical tumour stage (relative risk 2.37,p=0.05) and for patients who did not receive hormone therapy (relative risk 4.85,p=0.0001). The mode of surgical therapy did not affect prognosis. An interaction between treatment and clinical stage was found
(ratio of relative risks, 5.87,p=0.01). Thus a differential effect of laser treatment on survival depending on tumour size could be demonstrated. According
to our study CO2 laser treatment does not in general offer significant advantage over conventional technique. However, due to the study design,
our findings are preliminary; definite results have to be awaited. The therapeutic potential of laser in breast conserving
surgery remains to be investigated.
This study compares the incidence of local tumor recurrence following primary excision with the CO2 laser, Nd:YAG laser (contact), Argon Beam Coagulator, or electrocautery. One hundred eight Fisher 344 rats with R3230AC mammary tumors (1.6 +/- 0.04 [SD] cm diameter) were used. All animals were randomized into groups of similar tumor size. In groups C and CS, excision was performed with a Sharplan 1060 CO2 laser (TEMoo, 25 W, continuous wave [CW], 0.2-mm spot size). Wounds in group CS were "sterilized" (0.5-mm spot size, 25 W, CW) by gently heating the wound without causing blanching or charring. In group N, a 0.4-mm contact Laser Blade and a Cooper 8000 Nd:YAG laser at 20 W CW was used. In groups SA1 and SA2, tumors were excised with the scalpel, and hemostasis and wound "sterilization" were accomplished with the Bard System 6000 Argon Beam Coagulator (ABC) at 40 W and 4 liters/min argon gas flow in SA1 and 12 liters/min in SA2. In group E, excision was accomplished at 40 W blend mode, 10 W spray mode. In group EA, excision was accomplished at 60 W cutting current, and hemostasis was achieved with the ABC. The animals were examined for evidence of recurrence for 34 days postoperatively. Mortalities were excluded from analysis. The incidence of recurrence was 11/14 (79%) in C, 6/16 (38%) in CS, 10/14 (71%) in SA1, 6/13 (46%) in SA2, 6/15 (40%) in N, 7/10 (70%) in EA, and 3/15 (20%) in E. Group E is statistically different (P less than .01) from groups EA, C, and SA1. Group C was different (P less than .01) from groups E, CS, and N. These results demonstrate an inverse relationship between tumor recurrence and local thermal effects at the surgical site. The ABC did not increase tumor recurrence. Contact YAG surgery was similar to CO2 laser excision and "sterilization." An attempt to study the influence of gas flow and pressure on local tumor recurrence and metastases should be made.
This study examines whether primary laser excision results in augmentation of the systemic host anti-tumor response to tumor rechallenge. Single R3230AC mammary tumor implants, (0.5 x 0.5 x 1.0 mm), were grown in 112 female Fisher 344 rats. The animals were randomized. Group S tumors were excised by scalpel. Group E was excised with a Surgistat electrocautery (Valley Labs, Boulder, CO). Group CS was excised with a Sharplan 1100 CO2 laser (Sharplan, Allendale, NJ) at 25 watts (W) continuous wave (CW) (0.2 mm spot size) and the wound was "sterilized" with a 5-mm spot size by gently heating the tissue without blanching. Group K was excised with a KTP/532 laser (Laserscope, San Jose, CA) at 17 W CW using a 400 microns fiber. Group Y was excised with a Sharplan 2100 Nd:YAG laser set at 15W CW using a 0.2 mm clear sapphire tip. A second tumor implant, (0.5 x 0.5 x 1.0 mm), was placed at a remote site 14 days postoperatively. An unoperated control group was implanted. Secondary tumor volumes were measured for 36 days and the mean tumor volumes (MTV) were statistically compared. The MTV in groups CS, K, Y, and E was less than control (P less than 0.01). The MTV in groups CS, K, Y, and E was less than group S, although this was not statistically different. Lasers and cautery appear to increase the host response against subsequent tumor challenge. This study corroborates earlier studies of other modalities. Further studies to determine whether this host sensitization is an immune response and to elucidate the mechanisms of this effect are warranted.
Procedures most commonly performed in aquatic animals include dermal mass excisions or ablations, abscess debridement, laser‐assisted amputations, and other dermal incisions. In sea turtles, the CO2 laser is used to assist in flipper amputations, enucleations, and esophagostomies, and is most commonly used for excision of fibropapilloma (FP), a debilitating infectious neoplastic disease that affects sea turtles of all species, but most commonly juvenile green sea turtles (Chelonia mydas). Although the tumors are locally aggressive and benign, the disease is often fatal due to physical debilitations created by their presence. The tumors block vision, prevent appropriate feeding and foraging behaviors, limit swimming and diving abilities and predator evasion, cause increased entanglement risk, and cause overall immunosuppression leading to other secondary illnesses. Many FP tumors, particularly larger tumors, are highly vascular. Intraoperative hemostasis is essential for patient safety, decreased postoperative morbidity, and surgeon visualization. The bloodless surgical field provided by the use of a CO2 laser enables the surgeon to more accurately follow clean surgical margins around the tumor and navigate tissue planes more precisely. Another benefit of CO2 laser surgery over conventional scalpel is the prevention of surgical site contamination and infection through vaporization of infectious agents and neoplastic cells at the surgical site. Furthermore, since FP surgeries typically involve multiple excisions, the contactless incision of the laser prevents accidental bacterial and neoplastic contamination of consecutive surgical sites. The local thermal effects combined with decreased tissue manipulation have been shown to decrease the chances of tumor seeding and recurrence. Based upon the surgeon's comfort and skill level, CO2 lasers have a wide variety of practicalities for soft tissue surgeries in aquatic species.
Lasers and light source technologies have been applied to a wide variety of open and laparoscopic procedures in general surgery and other disciplines.
The ability to produce highly precise and controllable effects on tissues, and the potential to facilitate complex dissection make these devices a welcome addition to the armamentarium of the surgeon.
Each laser wavelength has a characteristic effect on tissue and it is the combination of the laser tissue interaction and the selection of the appropriate delivery systems and laser parameters that determine the ultimate effects of laser use during surgery.
This chapter will review the array of laser technologies available for both open and laparoscopic surgical use and will discuss the relative merits and disadvantages of each.
Lasers and light source technologies can be applied to a wide variety of open and laparoscopic surgeries, as well as other procedures encountered by general surgeons and other medical professionals. The ability to produce highly precise and controllable effects on tissues, and the potential to facilitate complex dissection make these devices a welcome addition to the armamentarium of the surgeon, who is skilled in their use. Each laser wavelength has a characteristic effect on tissue. The combination of the laser tissue interaction, the selection of the appropriate delivery systems and laser parameters determines the ultimate effects of laser use on the conduct and outcomes of surgery. This chapter reviews the array of laser technologies available for operative surgical and therapeutic use and discusses the relative merits and disadvantages of each.