FLEX APPEAL: OmniGuide's approach to laser surgery seeks to add a new level of flexibility to optical scalpels by directing the infrared energy of a high-intensity carbon dioxide laser through a flexible fiber tube lined with reflective material. Image: COURTESY OF OMNIGUIDE
Laser technology has proved to be an invaluable surgical tool, be it to improve eyesight, repair torn retinas, zap kidney stones, or to delicately remove spinal tumors. Still, despite more than four decades of use in the operating room, laser surgery has been limited by the fact that its energy travels in straight lines. This means that a laser works best on areas that can be reached with a straight shot. Maneuvering the beam so that it can reach out-of-the-way areas—without damaging healthy tissue—is sometimes done, using a series of mirrors to guide the laser beam, but this typically dilutes the laser's strength.
An approach to laser surgery on the market for barely more than a year, however, seeks to add a new level of flexibility to optical scalpels by directing the infrared energy of a high-intensity carbon dioxide (CO2) laser through a flexible fiber tube lined with reflective material. This gives the surgeon the ability to snake the laser safely through the body to wherever it is needed without losing any of the beam's strength.
The BeamPath CO2 laser energy system (manufactured by OmniGuide, an optics company in Cambridge, Mass.) marks a significant improvement over optical scalpels used over the past three decades to perform precision microsurgery, says Yair Schindel, OmniGuide's vice president of clinical affairs and business development.
"Going deeper into the body, to places where you couldn't see, was impossible" with the old lasers, delivered through a large articulating arm, he says. "If you couldn't see it, you couldn't get to it."
OmniGuide chose the CO2 laser—produced by exciting carbon dioxide gas within a sealed tube—because it was already commonly used in operating rooms, given its ability to effectively ablate, cut and cauterize tissue. It is the most precise optical scalpel available, Schindel says, adding, other laser-light wavelengths, such as those created using argon or krypton lasers, are not absorbed as quickly by certain human tissues, "so they do more cooking than cutting."
Still, conventional CO2 lasers have difficulty with incisions that must be made at awkward angles. "If you think of a large tumor in the throat, you would have to shoot the laser from [16 inches (40 centimeters)] away, manipulating both the light and the patient to reach the tumor," Schindel says. The alternative: a laryngectomy, a less precise procedure in which all or some the vocal cords are removed. OmniGuide's laser can also be used with a flexible fiber–tipped endoscope. "The surgeon can go through the nose, mouth, ear or other small openings," Schindel says, "and [laser] and view at the same time."