Other Lasers in Aesthetic and Regenerative Gynecology

Abstract

Pelvic floor dysfunction results in numerous pathologies which impact quality of patient’s life. In spite of many therapeutic approaches to stress urinary incontinence and sexual dysfunction in women, there is still need for efficacious, safe and minimally invasive therapy. Recently developed, novel non-surgical laser therapy with SMOOTH Er-YAG laser appeared as an anwer a few years ago, declaring to have the features of safety, efficacy and minimal invasiveness. Today this photothermal laser therapy is accepted as a promising method for the treatment of mild to moderate female stress urinary incontinence and vaginal relaxation syndrome and fast developing as an answer to some other female health problems as well.

 The therapy shows promising results in the reduction of uncontrolled leakage of urine. Laser therapy with the SMOOTH Er - YAG laser promotes collagen remodeling and tightening of collagen fibers. Laser phototherapy affects the metabolic processes of collagen, accelerates its formation and, hence, the tightening of the vaginal wall, which also improves sexual sensation. The result of the laser treatment is better support to the urethra and bladder neck, so we expect fewer problems with uncontrolled leakage of urine.

 Problems with the loss of optimal vaginal structure after child birth and with advancing age are connected to impaired sensations during sexual intercourse. By some reports, approximately 40% women report dissatisfaction concerning their ability to achieve sexual gratification due to vaginal relaxation, which interferes with the intensity of contact during sexual intercourse. Laser treatment also enhances flexibility and contraction of the vaginal wall, so we can expect better feeling and more satisfaction when having sexual intercourse.

 This treatment protocol is promising to become minimally invasive solution of choice for many women suffering from vaginal relaxation syndrome and stress urinary incontinence.

 The therapy proved to be well tolerated by patients and safe – there were no adverse effects noted till date. Beside due to its noninvasivenes, one of the main advantages of laser therapy over surgery is that the treatment could be applied ambulatory. This novelty in the treatment presents significantly reduced costs that offer us the possibility to treat a wider population of incontinent women with minimally invasive and better tolerated procedure.

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 [1]. 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 [5]. 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.

Since Erbium 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 tissue [6].

Treatment protocol: 3 sittings 3 months apart, repeat one sitting every second year. No anesthesia required.

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 , Post-partum 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.

Bibliography

• 1. 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

• 2. 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.

• 3. 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