From
StayCurrentMD
Update Course Rewind: CO2 Laser Use Cases 2024
With Dr. Carlos Colunga · hosted by Dr. Lizzy Lee
Chapter 1 of 4 · Fundamentals
Introduction
Introduction and Update Course Classification System
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
CO2 laser for pediatric surgery falls into the black diamond unproven category in the update course classification system.
About 38% of the audience would use electrocautery for circumcision, and 50% would use scalpel, with a small portion using CO2 laser.
CO2 laser can give faster operative time, reduced pain, lower rates of scarring and amazing cosmesis compared to conventional circumcisions.
CO2 laser use for surgery has been reported since 1970 but is not well researched in pediatric surgery.
CO2 laser emits infrared light that is highly absorbed by water in biological tissues, with wavelength spectrum of 920 to 1,400 nanometers being really well absorbed by water.
CO2 laser is effective for precise cutting and ablation and reduces blood loss, with reduced pain and edema and shorter operative time.
Disadvantages of CO2 laser include a big learning curve, need for ocular protection, need for specialized training, and high initial cost.
Mucosa tissue is most suitable for laser surgery at these wavelengths because it is 95% water.
In Dr. Colunga's series of 56 circumcision patients using CO2 laser with slip technique and dorsal slit, there was only a 3% complication rate with two partial wound dehiscences managed conservatively.
For CO2 laser circumcision, surgical time is around 10 minutes with low pain profile requiring only ibuprofen and amazing aesthetic results.
The barriers for adopting CO2 laser use are high initial equipment costs, need for specialized training, and lack of availability.
Dr. Colunga's institution used CO2 laser for frenulectomy in 47 patients with low pain profile and no suture required.
CO2 laser has been used for perianal fistulas in four patients with fistulotomy technique.
CO2 laser has been used for pilonidal cysts in 12 patients with laser ablation technique.
CO2 laser has been used for labial fusion and condylomatosis with ablation technique.
A meta-analysis and systematic review including seven studies showed that laser assisted circumcision is a safe and strong option.
Evidence shows that the high cost of CO2 lasers is justified because they diminish operating time and lower complications.
A 2022 paper shows that laser is very effective in treating benign anal conditions, especially hemorrhoids.
A 2016 research paper shows that combining CO2 laser and cyanoacrylate adhesive decreased operating time significantly and decreased bleeding complications.