The evolution of Laser in Laryngology

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Abstract presented at the meeting British Society for the History of ENT

Held December 4th 2014

In the Toynbee McKenzie Room, at the Royal Society of Medicine, London
The evolution of Laser in Laryngology

Asil Tahir

Technological breakthroughs in physics are often adapted and incorporated into the ever growing field of otolaryngology. When first discovered ‘The Incredible Laser’ had promised to be ‘science’s new ‘Aladdin’s lamp’, although it was commonly joked to be ‘a solution looking for a problem[1].’
Albert Einstein propelled the theoretical foundation for the development of this landmark invention in 1916 when he proposed that photons could stimulate emission of identical photons from excited atoms[1].
Post world war II research into laser technology benefitted greatly from corporate and government investments into technological progress during the cold war era. This coupled with the growth in numbers of physicists and engineers and growth in the economy created the foundations for the invention of the ruby laser in 1960 by Theodore Maiman[2].
It was not until 1964, when Patel invented the first CO2 laser, did it gain immediate popularity and rapidly developed as an important surgical tool in laryngology[3, 4][5]. The carbon dioxide laser was the first to be used on the larynx due to its ideal tissue properties for surgery; water absorbs the 10,600 nm wavelength really well, its high focus limits soft tissue penetration and minimises collateral thermal damage whilst providing good haemostasis [6]. It was initially experimented on cadaveric larynx and dogs[7] and only became medically effective with the development of coupling of the microscope and the development of the micromanipulators by Bredemeier to deliver precise energy to the larynx[8]. The first use of laser in patients was in 1975 by Strong (Boston, USA) who used the CO2 laser to successfully treat 11 patients with early T1 laryngeal Cancer[9]. In 1978 Vaughan when on to use the laser to resect supraglottic tumours[10]. However most early laryngeal cancers continued to be treated with radiotherapy or open partial laryngectomy. A decade later, building on the early work of Strong & Vaughan, Steiner in Germany developed new endoscopes, instruments and new techniques to handle the larynx and improve oncologic effectiveness[11, 12].
There are many different lasers available now to use for otolaryngologists with extended applications and variable wavelengths such as CO2, Nd:YAG, argon, KTP and argon dye. The considerable amount of research that continues to develop the use of laser in otolaryngology inevitably means further advancements in its clinical application.

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