Excerpt from Carbon Dioxide Laser Surgery of the Lower Genital Tract

Synonyms, Key Words, and Related Terms: light amplification by stimulated emission of radiation, LASER, CO₂ laser, endometriosis ablation, lysis of pelvic adhesions, cervical intraepithelial neoplasia, CIN, vaginal intraepithelial neoplasia, VAIN, vulvar intraepithelial neoplasia, VIN, human papillomavirus, HPV, carcinoma in situ, CIS, vaginal condyloma, vulvar condyloma

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With the development of light amplification by stimulated emission of radiation (LASER) for medical use in early 1970 (Anderson, 1982), the carbon dioxide (CO₂) laser was adapted to the laparoscope and colposcope, which opened a new era of laser treatment for patients with gynecologic diseases. The CO₂ laser was used via laparoscope for conditions such as endometriosis ablation and lysis of pelvic adhesions. Through the colposcope, the CO₂ laser was used for vaporization or conization of cervical intraepithelial neoplasia (CIN) (Carter, 1978; Dorsey, 1980; Baggish, 1980; Masterson, 1981; Bellina, 1981; Beneder, 1981; Burke, 1982; Anderson, 1982; Baggish, 1982; Fallani 2003) or vaporization of vaginal intraepithelial neoplasia (VAIN) (Stafl, 1977; Townsend, 1982; Jobson, 1991) and vulvar intraepithelial neoplasia (VIN) (Baggish, 1981; Leuchter, 1984; Sideri, 1999).

These lesions primarily result from previous human papillomavirus (HPV) infection (see Human Papillomavirus). Reportedly, laser treatment is more advantageous than cryotherapy (Townsend, 1981; Townsend, 1983) or cold knife conization (Larsson, 1982).

In recent years, the use of laser for CIN has been gradually replaced by the loop electrical excision procedure (LEEP) for biopsy or conization. A randomized study compared 3 different techniques for cervical conization with cold knife, laser, or LEEP for its recurrence rate and complications during subsequent pregnancy. No statistical differences among the methods were found (Mathevet, 2003). The use of laser treatment for vaginal and vulvar diseases remains one of the best treatment methods (Penna, 2002).

For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education article Cervical Cancer.

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