Laser-mode electrosurgery

Abstract

The major requirements for safe and expeditious surgical dissection of a malignant process include (1) wide exposure, (2) meticulous hemostasis, (3) thorough knowledge of the anatomy of the region involved, and (4) a well-conceived plan for complete removal without tumor spillage. Oftentimes, in reoperative surgery the local accumulation of fibrous tissues obscures the normal anatomy. Destruction of the adhesive process is necessary for successful initiation of the cancer resection. In surgery for advanced malignancy, dissection through malignant tissue is unavoidable. Tumor spillage must be avoided as cancer is transected. This chapter describes a new technique for surgical dissection, laser mode electrosurgery. This technique electroevaporates scar tissue, fibrous adhesions, and fat, thus separating adherent structures one from another and rapidly defining the normal anatomy. It destroys tumor as it is transected so that peritoneal seeding is avoided. Any extraneous tissues that would otherwise obscure the surgeon’s full view of the structures involved are resected. This simplifies subsequent dissections and any other surgical procedures required at a later time. This maneuver is referred to as contouring.