Laser technologies in rhinosurgery

M.A. Ryabova, M.Yu. Ulupov, N.A. Shumilova, E.K. Tikhomirova

Pavlov First Saint Petersburg State Medical University, Saint Petersburg

Aim: to develop an algorithm for selecting the laser radiation wavelength, parameters and methods of exposure in rhinosurgery.

Patients and Methods: 250 surgeries performed using semiconductor lasers with wavelengths of 0.81 µm, 0.98 µm and 1.47 µm were analyzed: 52 cases — laser coagulation of inferior nasal turbinates, 21 cases — incision of nasal synechiae, 10 cases — coagulation of blood vessels in the nasal cavity, 175 cases — nasal polypectomy. The parameters of laser exposure were selected on the basis of previous experimental studies on biological effects of laser radiation with wavelengths of 0.81, 0.98 and 1.47 µm on various types of tissue.

Results: upon nasal polypectomy, the predominance of laser contact exposure with the wavelength of 1.47 µm over lasers radiation of the hemoglobin absorption spectrum was found due to less pronounced thermal damage to the surrounding tissues and more significant hemostatic properties. Incision of nasal synechiae with the laser radiation of the water absorption spectrum demonstrated more pronounced hemostatic properties and led to the formation of less significant reactive postoperative inflammatory events, including in patients with dystrophic changes in the nasal mucosa. Nasal tamponade was not required in any case; the re-epithelization period of the mucous membrane was from 2 to 4 weeks. Upon laser coagulation of inferior nasal turbinates with wavelengths of 0.81, 0.98 and 1.47 µm, the postoperative period was mild in all patients; intense nosebleed was observed in one patient receiving anticoagulants due to incorrect selection of laser exposure parameters. Laser coagulation of blood vessels in the nasal septum was effective when exposed on the capillary network. The method of stopping nosebleed from vessels of more than 1 mm in diameter using a laser did not have the necessary hemostatic properties.

Conclusion: velocity, power of laser exposure and the total amount of transmitted energy are crucial parameters in rhinosurgery. The mode of laser radiation exposure should be selected taking into account the localization of the irradiated zone in the nasal cavity, the presence of target chromophores for the spectrum of the laser radiation device.

Keywords: laser surgery, polyps, vasomotor rhinitis, synechiae.

For citation: Ryabova M.A., Ulupov M.Yu., Shumilova N.A., Tikhomirova E.K. Laser technologies in rhinosurgery. RMJ. 2020;5:38–42.