of choice for BLOODLESS SURGERYas well as for treat-
ing vascular disorders of the skin such as birth-
marks.
Because the intense light the laser gen-
erates can burn the RETINAand cause
permanent blindness, people undergo-
ing laser surgery as well as the surgeon
and other members of the surgical team
must wear EYE protection when the
laser is in use.Laser surgery has the same risks as conven-
tional surgery for bleeding and infection, and car-
ries additional risk for BURNSand related damage.
A laser can permanently discolor the skin, particu-
larly the skin of people of color (notably African
Americans, Asian Americans, and Hispanic Ameri-
cans). Lasers may also cause burns of the skin.
Though laser surgery makes many operations eas-
ier and more comfortable, it is important to
choose a surgeon who is qualified to perform laser
surgery and to fully understand the potential ben-
efits and risks of laser surgery compared to con-
ventional surgery.
See also LASER SKIN RESURFACING; MINIMALLY INVA-
SIVE SURGERY; OPEN SURGERY; PHOTOTHERAPEUTIC KERA-
TECTOMY(PTK); REFRACTIVE SURGERY; SURGERY BENEFIT
AND RISK ASSESSMENT; TATTOOS.minimally invasive surgery Any OPERATION in
which the surgeon uses an endoscope and special-
ized instruments to enter the body through small
incisions, called ports. An endoscope is a lighted,
flexible tube with a tiny camera at the tip that
sends visual images of the operative site to a mon-
itor similar to a television screen. The endoscope is
specialized for the procedure, such as a laparo-
scope for operations within the abdominal cavity.
The surgeon watches the images on the screen
rather than seeing the operative site directly. Min-
imally invasive surgery is in contrast to OPEN SUR-
GERY, in which the surgeon makes an incision
large enough to allow direct access to the opera-
tive site. Surgeons must receive specific training in
the minimally invasive procedures they perform,
which require special equipment and instruments.
Surgeons sometimes combine minimally invasive
procedures with LASER SURGERY, assisted open sur-
gery, or other operative techniques.266 Surgery
TYPES OF SURGICAL LASERSLaser Type Characteristics Surgical Application
argon gas shallow penetration dermatologic procedures
moderately hot refractive surgery (vision correction)
only pigmented tissues and fluids absorb the coagulate bleeding BLOODvessels
lightwaves
carbon dioxide (CO 2 ) shallow penetration instead of scalpel for incisions
very hot vaporize tissue (including tumors)
only pigmented fluids absorb the lightwaves dermatologic procedures such as SKIN
resurfacing
neodymium:yttrium-
aluminum garnet (Nd:YAG) deep penetration fiberoptic transfer to locations within the body
moderately hot vaporize or shrink tumors
all fluids in the body absorb the lightwaves remove pigmented lesions
remove tattoos
pulsed dye shallow penetration port wine stain and other vascular birthmarks
moderately hot
tunable wavelength