Laser Therapy, Assisting
Using the highly focused and intense energy of a laser beam, the surgeon can treat various skin lesions. Laser therapy has several advantages. As a surgical instrument, the laser offers precise control. It spares normal tissue, speeds healing, and deters infection by sterilizing the operative site. The laser beam also leaves a nearly bloodless operative field because it seals tiny blood vessels as it vaporizes tissue.
Laser therapy can be performed on an outpatient basis. The lasers used most commonly to treat skin lesions are vascular, pigment, and carbon dioxide (CO2) lasers. (See Understanding types of laser therapy.)
In general, laser surgery is safe, although bleeding and scarring can result. One pronounced hazard, to the patient and treatment staff alike, is eye damage or other injury caused by unintended laser beam reflection. For this reason, anyone in the surgical suite, including the patient, must wear special goggles to filter laser light, and the surgeon must use special
nonreflective instruments. Access to the room must be strictly controlled, and all windows must be covered.
nonreflective instruments. Access to the room must be strictly controlled, and all windows must be covered.
Equipment
Laser ▪ filtration face masks ▪ protective eyewear (approved by the laser safety officer [LSO])1 ▪ laser vacuum ▪ extra vacuum filters ▪ surgical drape ▪ prescribed cleaning solution ▪ sterile gauze ▪ nonadherent dressings ▪ surgical tape ▪ cotton-tipped applicators ▪ nonreflective surgical instruments ▪ gown ▪ sterile gloves.
Preparation of Equipment
Perform hand hygiene 2,3,4 and gather the equipment. Prepare the tray. It should include a local anesthetic, as ordered, and dry and wet gauze. The gauze will be used to control bleeding, protect healthy tissue, and abrade and remove any eschar, which would otherwise inhibit laser absorption. Prepare nonreflective surgical instruments as needed.
Cover all the windows and door windows in the treatment room to prevent the laser from being seen through the windows, creating a potential for exposure.1
Fire is a significant hazard during laser use. Make sure that water, saline, and a fire extinguisher are readily available for use during the procedure.1
Understanding Types of Laser Therapy
Laser therapy is now an essential tool for treating many types of skin lesions. The number of lasers used in dermatology continues to grow, and each type is used for specific conditions.
The term laser is an acronym for Light Amplification by the Stimulated Emission of Radiation. When directed toward the skin, most of this light energy is absorbed by chromophores, substances that absorb specific wavelengths of light. This is the basis of selective photothermolysis, which has revolutionized cutaneous laser surgery. Melanin is the target chromophore in pigmented lesions, and oxyhemoglobin within microvessels is the target chromophore in vascular lesions.
Each type of laser has a different use.
Lasers for Vascular Lesions
The laser most commonly used for vascular lesions is the pulsed dye laser (PDL). Other lasers used to treat vascular lesions include the copper vapor, argon, argon-pumped tunable dye, potassium-titanyl-phosphate (KTP), krypton, and neodymium:yttrium-aluminum-garnet (Nd:YAG). Vascular lesions appropriate for laser therapy include port-wine stains, hemangiomas, venous lake, rosacea, telangiectasia, and Kaposi’s sarcoma.
Lasers for Pigmented Lesions
Lasers that effectively treat tattoos and dermal and epidermal pigmented lesions include Q-switched ruby, Q-switched Nd:YAG, Q-switched alexandrite, and PDL. Pigmented lesions appropriate for laser treatment include tattoos, nevi of Ota, melasma, solar lentigo, café au lait spots, Becker’s nevi, and epidermal nevi.
Lasers for Hair Removal
Lasers used to eliminate unwanted hair include ruby, alexandrite, and Nd:YAG. Laser treatment is only effective in removing dark-colored hair; it doesn’t effectively remove blonde, red, white, or gray hair.
Implementation
Make sure the doctor has obtained informed consent and that it’s documented in the patient’s medical record.5,6
Conduct a preprocedure verification to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient identifiers.7
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