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Lasers blaze new paths

Powerful beams cut across most medical specialties

BY SUSAN JENKS
FLORIDA TODAY

A high-powered laser bathes the operating room in an eerie green glow, as Melbourne urologist Dr. Peter Zabinski uses it to vaporize tissue in a patient's enlarged prostate.

On the video monitor, a shower of sparks flashes across the screen, as the "green-light" laser pares off more of the gland's tissue, leaving behind barely a hint of blood in its wake.

Zabinski, who performed the surgery recently at Holmes Regional Medical Center, said this type of laser -- designed specifically for the prostate -- is the best one developed so far for treating benign prostatic hyperplasia, a common condition many men get as they age, which can cause severe urinary problems.

"With other lasers, the tissue has to die, and the body has to reabsorb it," a process that takes a week to 30 days, he said. "With this, what you see is what you get. It vaporizes tissue as you go."

That difference translates into fewer, if any, hospital days; an immediate relief to often-painful symptoms; and fewer side effects, such as severe burning afterward, where men feel as if they are "urinating glass," according to Zabinski.

It also illustrates how far laser technology has come since its early uses more than 40 years ago. Today, laser-based technology reaches across most medical specialties where lasers vaporize tissues; disrupt chemical bonds; or seal damaged or leaking blood vessels.

Those who use these "scalpels of light" -- as they are sometimes called -- say they not only can shrink the prostate more quickly than drugs or traditional surgery, but they can break apart kidney stones, destroy small tumors, remove polyps on delicate vocal cords and access areas of the body other technologies can't go.

In the cosmetic arena, laser energy helps smooth out wrinkles, blots out unsightly spider veins, excises moles and warts, and reshapes the eye through immensely popular LASIK procedures to correct and improve vision.

"Most of the laser's uses are still for skin and eye conditions -- both cosmetic and clinical," said Dr. Roy Geronemus, a New York dermatologist and the president-elect of the American Society for Laser Medicine and Surgery, which met in Orlando earlier this month.

"I've worked with the laser for the past 22 years," he said. "The biggest change has been in our ability to do selective injuries of a particular target. The 'specificity' is better and so is our targeting."

As in cancer therapies, this pinpoint accuracy means less injury to neighboring healthy tissues and better results for patients, he said.

Many options
While Zabinski used a green-light laser, there are at least 100 other lasers out there, each used for different procedures, according to Geronemus. Wave length and pulse time determine a laser's properties, including the color of light it emits and what, ultimately, it can do.

"What I tell my patients is lasers are simply a special form of light energy," said Dr. Ross Clevens, a facial plastic surgeon with offices in Melbourne and on Merritt Island. "Each laser is tuned to a different color and to a different target tissue."

To remove spider veins in the face, for example, Clevens said, he would use a diode laser, specifically tuned to red, so, as the laser light moves over the skin, it is absorbed only by the red veins -- leaving adjacent tissues unharmed.

Similarly, to do skin resurfacing, he said, he would use a laser only absorbed by water because skin has a higher concentration of water than underlying tissues. "Despite the public perception," he stressed, "one laser does not fit all."

Like Geronemus, Clevens cited the ability to home in on specific tissues, without penetrating or harming others, as laser's major advance in recent years. But the technology is expensive to purchase and maintain, he said, with each laser running between $50,000 to $100,000, or more.

Sometimes, while that cost may be passed on to consumers, many cosmetic procedures, such as laser hair removal, are "quite affordable," Clevens said -- "costing hundreds, not thousands, of dollars."