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Advanced Laser Technologies Help Improve Safety in the COVID-19 Era


By Nicole Miller, MD, FACS
Associate Professor, Department of Urology, and Fellowship Director for Endourology and Minimally Invasive Surgery, Vanderbilt University Medical Center, Nashville

COVID-19 has drawn many aspects of medicine into a different focus. Now, months after the pandemic made its initial impact on our hospital, we are able to reflect on all the adjustments made, how they’re working and what the future might look like. As a urologist, it’s clear that one particularly beneficial part of my armamentarium is my advanced laser. Surgeons in other fields who have upgraded their laser to the latest-generation technologies and applications have had similar realizations.

HoLEP for enlarged prostate — I perform holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH). Using the second-generation 120 watt holmium laser that optimizes the “MOSES effect” I achieve enhanced hemostasis and therefore have shortened operative time. This has permitted many patients to be discharged the same day. By following an outpatient model, we reduce patients’ exposure in the hospital while lowering costs.

Patients with very large prostates who would have required open or robotic simple prostatectomy and a hospital stay can now have HoLEP, which is indicated for prostates of all sizes. What’s more, HoLEP has an excellent retreatment rate (about 1%, compared to about 17% for TURP1). Even high-risk patients who are most concerned about going to the hospital in today’s environment can get effective treatment, go home the same day, and likely never require additional surgery for BPH.

Airway surgeries — Daniel Fink, MD, is an Assistant Professor of Otolaryngology at the University of Colorado School of Medicine and a surgeon at National Jewish Health in Denver. Dr. Fink, who specializes in voice, swallowing and airway disorders, sees the value of his CO2 laser for improving COVID-19 safety in the OR. “For airway work, it has been very useful to have a CO2 laser system with the ability to switch from a line-of-sight surgical approach where patients are intubated to a fiber-based approach. This dual modality in a single platform is advantageous because versatility allows me to easily pivot without the need for two laser systems on standby, saving the hospital money. Currently, I’ve found that using a flexible bronchoscope and a laser fiber through a laryngeal mask airway, creating a closed system that reduces potential aerosols, minimizes the risk of spreading coronavirus in the OR,” he explains.

Complex laparoscopic pelvic surgeries — “The advanced CO2 laser allows me to be more precise and surgically meticulous when performing complex laparoscopic surgery, such as for severe pelvic endometriosis disease,” says Vadim V. Morozov, MD, FACOG, FACS, a gynecologic surgeon specializing in management of chronic pelvic pain, endometriosis, and minimally invasive gynecologic surgery at MedStar Health in Washington, DC and Maryland. “That high level of control allows me to work faster because I have less chance of injuring sensitive organs. This reduces operative time, which in turn ensures that OR personnel experience less overall exposure to potential pathogens, including coronavirus. The precision helps potentially eliminate intra- and postoperative complications related to the use of energy. Moreover, patients have a quicker recovery and less post-op pain, shortening the time they spend in the recovery room after the surgery.”

The very same advantages of advanced lasers that help lower patients’ potential exposure to the coronavirus also offer clinical advantages that make them wise choices for the future. Used appropriately, they are even helping us reduce aerosol exposure in the OR, a risk we were already working to mitigate before COVID-19. Going forward, we will continue to learn and evolve in ways that best serve our patients while protecting surgeons and staff.

Reference
1. Abedi A, Razzaghi MR, Rahavian A, et al. Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? J Lasers Med Sci. 2020 Spring; 11(2): 197–203.

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