Surgery instruments like a safety scalpel must be kept in proper shape as they are vital towards carrying out an operation properly in USA. Surgical instruments are designed to ensure that the surgeons can complete surgeries in an effective and safe manner using safety scalpels and other tools. Surgeries are mainly held to modify or remove any kind of body tissues. Surgical instruments also come in a variety of types designed to do separate things. They are categorized based on their usage. Also they are sometimes categorized according to the materials they are made of.
Disposable and non disposable surgical scalpels:
The scalpel is one of the most common surgical instruments, and recently safety scalpels in USA are the most used of them. These are used for incisions or thin cuts on the flesh to reach the inner organs. The retractors are used used to keep the cuts open so that the surgeons can reach in and go through with the operation. Forceps are another popular surgical instrument which is used for picking and holding tissues. When it comes to cutting tissues scissors are also used but these scissors are not the same as the household ones. These are much more precise and effective. All these instruments are made from hardened and tampered steel. After considering their composition they are labelled as reusable or not. There are also other surgical instruments which are made for just one time usage. These are destroyed after usage like the disposable surgical needles. Disposable surgical scalpels are always sterilized the moment they are purchased in home and hospital departmental stores in USA. These disposable tools are generally made from runner or plastic materials. Protective surgical gloves, twin bone nasal catheter, nasal oxygen catheter, oxygen mask, suction catheter, and trachea’s tony tubes are few examples of these types of instruments.
Laser Surgery as a Scalpel
Laser surgery is surgery that uses a laser (instead of a scalpel) to cut tissue. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft-tissue laser surgery, in which the laser beam vaporizes soft tissue with high water content. Laser resurfacing is a technique in which covalent bonds of a material are dissolved by a laser, a technique invented by aesthetic plastic surgeon Thomas L Roberts, III using CO2 lasers in the 1990s. The CO2 (carbon dioxide) laser remains the gold standard for the soft tissue surgery because of the ease of simultaneous photo-thermal ablation and coagulation (and small blood capillary hemostasis).
Laser surgery is commonly used on the eye. Techniques used include LASIK, which is used to correct near and far-sightedness in vision, and photorefractive keratectomy, a procedure which permanently reshapes the cornea using an excimer laser to remove a small amount of tissue. Types of surgical lasers include carbon dioxide, argon, Nd:YAG laser, and Potassium titanyl phosphate.
- Photochemical effect: clinically referred to as photodynamic therapy. Photosensitizer (photophrin II) is administered which is taken up by the tumor tissue and later irradiated by laser light resulting in highly toxic substances with resultant necrosis of the tumor. Photodynamic therapy is used in palliation of oesophagial and bronchial carcinoma and ablation of mucosal cancers of Gastrointestinal tract and urinary bladder.
- Photoablative effect: Used in eye surgeries like band keratoplast, and endartectomy of peripheral blood vessels.
- Photothermal effect: this property is used for endoscopic control of bleeding e.g. Bleeding peptic ulcers, oesophagial varices
- Photomechanical effect: used in intraluminal lithotripsy
A range of lasers such as erbium, dye, and CO2 are used to treat various skin conditions including scars, vascular and pigmented lesions, and for photorejuvenation.
Various types of laser surgery are used to treat refractive error:
Lasers are also used to treat non-refractive conditions, such as:
Laser endarterectomy is a technique in which an entire atheromatous plaque in the artery is excised. Laser recanalization of blocked arteries. other applications include laser assisted angioplasties and laser assisted vascular anastomosis.
Lasers are used to treat several disorders in foot and ankle surgery. They are used to remove benign and malignant tumors, treat bunions, debride ulcers and burns, excise epidermal nevi, blue rubber bleb nevi, and keloids, and the removal of hypertrophic scars and tattoos.
A carbon dioxide laser (CO2) is used in surgery to treat onychocryptosis (ingrown nails), onychauxis (club nails), onychogryposis (rams horn nail), and onychomycosis (fungus nail).
- Peritoneum-Laser is used for adhesiolysis.
- Peptic ulcer disease and oesophageal varices - Laser photoablation is done.
- Coagulation of vascular malformations of stomach, duodenum and colon.
- Lasers can be effectively used to treat early gastric cancers provided they are less than 4 cm and without lymph node involvement. Lasers are also used in treating oral submucous fibrosis.
- Palliative laser therapy is given in advanced oesophageal cancers with obstruction of lumen. Recanalisation of the lumen is done which allows the patient to resume soft diet and maintain hydration.
- Ablative laser therapy is used in advanced colorectal cancers to relieve obstruction and to control bleeding.
- Laser surgery used in hemorrhoidectomy, and is a relatively popular and non-invasive method of hemorrhoid removal.
- Laser-assisted liver resections have been done using carbon dioxide and Nd:YAG lasers.
- Ablation of liver tumors can be achieved by selective photovaporization of the tumor.
- Endoscopic laser lithotripsy is a safer modality compared to electrohydraulic lithotripsy.
The CO2 laser is used in oral and dental surgery for virtually all soft-tissue procedures, such as gingivecomies, vestibuloplasties, frenectomies and operculectomies. The CO2 10,600 nm wavelength is safe around implants as it is reflected by titanium, and thus has been gaining popularity in the field of periodontology. The laser may also be effective in treating peri-implantitis.
Laser spine surgery first began seeing clinical use in the 1980s and was primarily used within discectomy to treat lumbar disc disease under the notion that heating a bulging disc vaporized enough tissue to relieve pressure on the nerves and help alleviate pain.
Since that time, laser spine surgery has become one of the most marketed forms of minimally invasive spine surgery, despite the fact that it has never been studied in a controlled clinical trial to determine its effectiveness apart from disc decompression. Evidence-based data surrounding the use of lasers in spine surgery is limited primarily due to the presence of a number of challenging factors including patient selection, operative indications in the type of laser used in the procedure. As a result, the official Blue Cross of Idaho position on laser disc surgery concluded:
"Evidence on decompression of the intervertebral disc using laser energy consists of observational studies. Given the variable natural history of back pain and the possibility of placebo effects with this treatment, observational studies are insufficient to permit conclusions concerning the effect of this technology on health outcomes."
The CO2 laser is also used in gynecology, genitourinary, general and thoracic surgery, otorhinolaryngology, orthopedic, and neurosurgery.
Electrosurgery instead of a Scalpel CutA 40 watt CO2 laser scalpel with applications in ENT, gynecology, dermatology, oral surgery, and podiatry
A laser scalpel is a scalpel for surgery, cutting or ablating living biological tissue by the energy of laser light. The laser scalpel was invented in 1964. In soft tissue laser surgery, a laser beam ablates or vaporizes the soft tissue with high water content. Diode, Nd: and Er:YAG, and CO2 lasers are used most commonly in soft tissue surgery.
CO2 lasers are best for cutting soft tissue because their wavelength is most absorbed by water. The focused CO2 laser beam vaporizes tissue precisely, with little thermal damage to surrounding tissues (thermal coagulation zone is as little as 50 microns). The surgical outcome is thus safe and predictable. The CO2 laser is used in virtually all soft tissue procedures, including face lifts, tumor excision, and surgeries in the oral cavity. CO2 laser surgery is praised for minimized bleeding, less swelling and discomfort, reduced infection risk, and less procedure time, as compared to traditional scalpel surgery. Applications include oral surgery, periodontal surgery, oncological surgery, among many others.
In ophthalmology, excimer lasers are used for changing the shape of the cornea, procedures known as LASIK and LASEK.
Other surgical fields where the use of a laser scalpel is common are circumcision, neurosurgery and vascular surgery.
For research use in cell biology, special laser micro-scalpels can make cuts smaller than a single cell.
Laser lancets, e.g. Lasette or LaserDoc, are used as a less painful alternative for drawing small amounts (up to 100 µl) of capillary blood, e.g. for diabetic glucose tests. An adjustable-power flashlamp or diode pumped pulsed Er:YAG laser is typically used. A 150 mJ pulse (focused to 6 J/mm2) can vaporize a 0.025 mm2 of skin to 0.5 mm depth.
Today diode lasers, Nd:YAG and Er:YAG (and their variants, differing by pumping methods and host crystal type, e.g. Er,Cr:YSGG laser), and CO2 lasers are most commonly used, but possible benefits of using the vastly more expensive free electron lasers are being researched.
- USA stainless steel blade
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