Diode Laser in Aesthetic and Regenerative Gynecology
Ksenija Selih Martinec (Slovania)
It was in 1917 when Einstein proposed the process that makes laser possible. He theorized that electrons could be stimulated to emit light of a particular wavelength. But it took almost 40 years to make this genius idea true. 13.11.1957 acronym LASER (light amplification by stimulation of Radiation) by Gordon Gould was used for the first time. In May 1960 Theodore H. Maiman constructed the first laser. Charles J. Campbell was the first to use laser in human patient, ruby laser to destroy a retinal tumor. In 1973 CO2 laser was first applied in gynecology for treating cervical neoplasia by Dr. Kaplan from Israel.
In September 2011 Adrian Gaspar first time published the use of fractional CO2 laser for vaginal rejuvenation . In the same year Fotona introduced Er: YAG laser for minimally invasive treatment of SUI, GSM, and relaxed vagina. In 2012 pixelated CO2 laser entered the field. After this there was expansion of using both CO2 and Er: YAG laser in the field of functional gynecology.
But great minds never stops. Dr. Ziv Karni, an industrial pioneer in the field of laser and energy technologies introduced Diode laser
in the field of functional and regenerative gynecology
In functional and regenerative gynecology
we are treating soft tissue so the main chromophore we want to reach is water. There are three types of laser used in this field: Er: YAG CO2 and Diode 1470, all three are absorbed in water but each with different absorption coefficient and different penetration
depths. The erbium
laser wavelength coincides with the strongest absorption peak of the water molecule, thus resulting in very high absorption in virtually all biological tissues . CO2 laser is 15 times less absorbed in water that Er: YAG and diode 1470 much less. So Diode 1470 laser has the deepest penetration
depth. Er: YAG and CO2 laser are ablative
lasers, diode is nonablative. Ablation is not needed. Manufacturers resolved this by very long pulses in Er: YAG, CO2 partly resolved this by pixelating laser beam.
and CO2 have high absorption in tissue, deep heating is done by conduction (slow and inefficient). Diode laser
penetrates deep and heat by electromagnetic radiation (quick and efficient).
With these physics characteristics, Diode 1470 emerged in the field of gynecology, proctology, EVLA-endovenous Laser Ablation, Laser Liposuction
, ENT, and more.
For intravaginal treatments the wavelength is brought by 600 micron Radial Emission fiber and 5 mm Glass tube. It emits energy in a 360 degree pattern. Because the wavelength is transmitted by electromagnetic radiation, the contact with mucosa is not needed, so a very thin handpiece is used that is suitable also for very narrow vagina. The thin handpiece is inserted into vaginal canal and inside it the probe is moving. This helps to homogenously affect the vaginal wall and eliminates need to move the handpiece what results in painless treatment. The Diode 1470 wavelength combined with the controlled radial emission of the handpiece has a bio modulating effect that stimulates neocollagenesis
and regenerates the epithelium and the connective tissue.
Mechanism of action: A diode laser
emits an infrared light that penetrates the deep penetration and deep heating in the tissue. The treatment is non-ablative
. The result is toned tissue and a thickening of the vaginal mucosa. The solid state 1470 nm vaginal laser working with sub necrotic temperatures aims to influence collagen
remodelling restoring the natural composition of a pelvic floor
Treatment protocol: 3 sittings 3 months apart, repeat one sitting every second year. No anesthesia
Treatment outcome: Improvement in sexual function, dyspareunia
, bladder function, vaginal sensation and lubrication.
Adverse effects: Mild warmth at vaginal introitus. No significant side effects reported.
Main indications are: GSM—genitourinary syndrome of menopause
, SUI—stress urinary incontinence, recurrent vaginal infections
rehabilitation, VVS—vulvar vestibular syndrome, and FSD—female sexual dysfunction.
Diode 1470 is used also for treating: Asherman, polyps, myomas, dismorphic uterus and T shape uterus, septum, isthmocele, retained conception products.
Gaspar A, Addamo G, Brandi H. Vaginal fractional CO2 laser: a minimally invasive option for vaginal rejuvenation. AJCS. 2011;28 (3). https://doi.org/10.1177/074880681102800309. First Published September 1, 2011
Fistonić I, Štefica FG, Fistonić N. Minimally invasive laser procedure for early stages of stress urinary incontinence (SUI). J Laser Health Acad. 2012 (2012). ISSN 1855-9913.
Diaci J, Filipic C, Perhavec T, Lukac M. Influence of water absorption shift on ablation speed of Er:YAG and Er,Cr:YSGG dental lasers. J Laser Health Acad. 2012 (1); 67–74