Lasers are based on the principle of light amplification by empowering atoms to store and emit light in a coherent form. Through their effect on tissues, lasers reduce hemorrhage allowing the surgeon to work in a clear field with precise removal of the tissues. Irradiation of the soft tissues by lasers produces thermal effects on the surrounding healthy tissues which can make histopathological examination difficult. Hence this study was done to find a correlation between adjustable parameters of CO2 laser and the extent of collateral thermal damage in the excised vocal cord lesions on histopathological examination and diagnosis. In this study, we enrolled 80 patients who were divided into 4 groups with different combinations of laser power and mode, used during transoral laser micro laryngeal surgery for the excision of vocal cord lesions and subsequent histopathological analysis to objectively measure the extent of thermal damage zone and subjectively assess histo-morphological effects of thermal damage in terms of grade of carbonization. The extent of the thermal damage zone is directly related to the power of the laser, but the mode of the laser had no relation with the thermal damage zone in our study. On subjective histo-morphological examination of excised lesions showed that both power and mode of laser have significant effects on tissue morphology. Continuous mode causes a significantly higher grade of carbonization as compared to the superpulsed mode of the laser. However, in our study it was seen that charring in no way affected the diagnosis in any of the biopsies examined whatever the power or mode of the laser used. The depth and width of the tissue thermal damage zone are mainly dependent upon the laser parameters (power and mode). Although considering the limitations of this study carried out in terms of sample size, it would be pertinent to mention here that further studies with larger cohorts need to be done to authenticate these results.

OBJECTIVE: Climate change has serious consequences for our wellbeing. Healthcare systems themselves contribute significantly to our total carbon footprint, of which emissions from surgical practice are a major component. The primary sources of emissions identified are anaesthetic gases, disposal of single-use equipment, energy usage, and travel to and from clinical areas. We sought to quantify the waste generated by laser surgery which, to our knowledge, has not been previously reported.
METHODS: The carbon footprint of two laser centres operating within the United Kingdom were measured. The internationally recognised Greenhouse Gas Protocol was used as a guiding framework to classify sources of waste and conversion factors issued by the UK government were used to quantify emissions.
RESULTS: The total carbon footprints per day at each unit were 299.181 carbon dioxide equivalents (kgCo2eq) and 121.512 kgCO2eq, respectively. We found the carbon footprint of individual laser treatments to be approximately 15 kgCO2eq per procedure. The biggest overall contributor to the carbon footprint was found to be the emissions generated from staff, patient and visitor travel. This was followed by electricity usage, and indirect emissions from physical waste and laundry.
CONCLUSIONS: The carbon footprint of laser procedures was considerably less than the average surgical operation in the UK. This initial study measures the carbon footprint of a laser center in a clinical setting and allows us to identify where improvements can be made to eventually achieve a net carbon zero health care system.

Laser surgery, a minimally invasive procedure for the definitive approach to pilonidal disease (PD), has been frequently studied in recent years. This study aims to describe a new pilonidotomy method using minimal laser energy and evaluate its initial results. This is a retrospective multicenter study. We included 47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\" between 2019 and 2023 in four centers in Brazil. Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed. The median age was 27; 61.7% were men, and 38.3% were women. The median BMI was 25.7. Smoking was evident in 14.9%, and diabetes in 2.1%. The average duration of the disease was 3 years. Most operations (36%) were performed on stage R disease. The median hospitalization time was 6 h, and the median healing time was 15 days. The average energy used in procedures was 433 J. The median postoperative pain was 2. Secretion occurred in 14% on the 60th day. Complications (cellulitis) occurred in 4% of cases. The median time to return to work was 7 days. The average following time was 12 months; recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective. MELPi shows promising initial results: low pain, low complication rates, and a fast activity return. It is a good option in recidivate cases and can be done more than once if necessary.

UNASSIGNED: Recurrent respiratory papillomatosis (RRP) is a benign, rare disease caused by Human Papilloma Virus (HPV) that can be divided into juvenile and adult forms. The course of the disease is variable, but is usually more aggressive in the juvenile form. The standard surgical treatment is represented by CO2 laser resection, although photoangiolytic lasers represent a valid alternative. Adjuvant therapies have been proposed for disease control in case of frequent surgical resections or spreading into the lower airways. In recent years, the development of immunotherapy led to the use of bevacizumab either intratumorally or intravenously, but the most promising therapeutic development is represented by HPV vaccination. This paper aims to present a narrative review of the literature and the experience of three different University Centres in the treatment of RRP.
UNASSIGNED: A retrospective analysis of the clinical charts of all patients affected by laryngeal papillomatosis and treated in three different University Centres between 2002 and 2022 was performed. The following parameters were collected: sex, age at first evaluation, sites of larynx involved, HPV type, type of first surgical treatment, presence and number of recurrences, surgical treatment of recurrences, adjuvant therapies, side effects and status at last follow-up.
UNASSIGNED: Seventy-eight patients were available for evaluation. Of these, 88% had adult onset RRP (Ao-RRP) and 12% juvenile onset RRP (Jo-RRP). The glottis was the most frequently involved subsite; all patients were submitted to surgical resection with CO2 laser under general anaesthesia. Recurrences appeared in 79% of the patients, the patients who did not recur were all adults. The mean number of recurrences was 9 (range 1-110). Recurrences were more frequent in children (M = 20; range 2-110) than adults (M = 5; range 1-21). Thirty-two (52%) of the 62 patients who recurred were re-treated with CO2 laser under general anaesthesia, while office-based treatment with a photoangiolytic laser was preferred in the remaining 30 (48%) patients. Adjuvant treatments were applied in 26 patients. The analysis of the course of the disease showed that in the 9 patients with Jo-RRP, 6 (67%) were free of lesions at the last follow-up, while the other 3 (33%) had papillomas. Of the 69 patients with Ao-RRP, 53 (77%) were alive and free of disease at the last visit, 14 (21%) were alive with disease, 1 (1%) was lost at follow-up and 1 (1%) died for other disease. Severe side effects were not observed except for 2 patients, who developed posterior glottic stenosis.
UNASSIGNED: Our results confirmed the literature review. RRP is a potentially aggressive disease, especially in juvenile onset. Surgical resection is still first-line treatment, but in case of multiple recurrences the use of adjuvant therapies must be taken into consideration.
La papillomatosi laringea ricorrente: strategie terapeutiche multimodali. Revisione della letteratura e analisi retrospettiva multicentrica.
UNASSIGNED: La papillomatosi recidivante delle vie respiratorie è una rara patologia benigna causata dal Papilloma virus umano (HPV) e può essere suddivisa in una forma giovanile ed una dell’adulto. Il decorso della malattia è variabile, di solito più aggressivo nella forma giovanile. Il trattamento chirurgico standard è rappresentato dalla resezione con laser CO2, anche se i laser fotoangiolitici possono rappresentare una valida alternativa. L’utilizzo di terapie adiuvanti è stato proposto per il controllo della malattia nei casi che richiedono trattamenti chirurgici frequenti o che tendono a diffondere nelle vie respiratorie inferiore. L’alfa-interferon è stato uno dei primi farmaci ad essere utilizzati, seguito dal cidofovir. Negli ultimi anni, lo sviluppo dell’immunoterapia ha condotto all’utilizzo del bevacizumab sia per somministrazione intralesionale o sistemica, ma lo sviluppo terapeutico più promettente è rappresentato dalla vaccinazione anti HPV. Lo scopo di questo lavoro è di presentare una revisione della letteratura e l’esperienza di tre differenti Centri Universitari nel trattamento della papillomatosi recidivante delle vie respiratorie.
UNASSIGNED: È stata condotta un’analisi retrospettiva sulle cartelle cliniche dei pazienti affetti da papillomatosi laringea e trattati in tre differenti Centri Universitari tra il 2002 e il 2022. Sono stati analizzati i seguenti parametri: sesso, età alla prima visita, siti laringei coinvolti, sierotipi di HPV, tipologia del primo trattamento chirurgico, presenza e numero di recidive, trattamento chirurgico delle recidive, terapie adiuvanti, effetti collaterali e status all’ultimo follow-up.
UNASSIGNED: Settantotto pazienti sono stati selezionati per lo studio. Di questi, l’88% presentava papillomatosi dell’adulto (Ao-RRP) e il 12% una forma giovanile (Jo-RRP). La glottide è risultata la sottosede più coinvolta; tutti i pazienti sono stati sottoposti a chirurgia con laser CO2 in anestesia generale. Recidive sono state osservate nel 79% dei pazienti, i pazienti che non hanno mostrato recidive erano tutti adulti. Il numero medio di recidive è stato di 9 (range 1-110). Le recidive sono risultate più frequenti nei bambini (M = 20; range 2-110); rispetto agli adulti (M = 5; range 1-21). Il 52% dei 62 pazienti con recidiva è stato ritrattato con laser CO2 laser in anestesia generale, mentre nell’altro 48% dei pazienti è stata scelta una procedura ambulatoriale con un laser fotoangiolitico. Terapie adiuvanti sono state impiegate in 26 pazienti. L’analisi del decorso della malattia ha rivelato che nei 9 pazienti con papillomatosi giovanile, 6 (67%) erano liberi da malattia all’ultimo follow-up, mentre gli altri 3 (33%) avevano ancora papillomi. Dei 69 pazienti con papillomatosi dell’adulto, 53 (77%) erano liberi da malattia all’ultima visita; 14 (21%) presentavano ancora papillomi; 1 (1%) è stato perso al follow-up e 1 (1%) è morto per altra malattia. Effetti collaterali severi sono stati riscontrati solo in 2 pazienti che hanno sviluppato una stenosi glottica posteriore.
UNASSIGNED: I risultati hanno confermato quelli della revisione della letteratura. La papillomatosi respiratoria ricorrente è una malattia potenzialmente aggressiva, specie nell’insorgenza giovanile. La resezione chirurgica è ancora il trattamento di prima linea, ma in caso di multiple recidive è necessario prendere in considerazione l’uso di terapie adiuvanti.

Lamellar keratoplasty is the most effective and safe method of surgical treatment of recurrent pterygium, providing restoration of the corneal frame and optical properties and a high anti-relapse effect due to the barrier properties of the lamellar graft. However, potential postoperative changes in the regularity of the anterior and posterior surfaces of the cornea (especially in case of advanced stage of fibrovascular tissue growth) do not always allow achieving high functional results of treatment. The article presents a clinical case that demonstrates the effectiveness and safety of excimer laser correction of refractive disorders after surgical treatment of pterygium.
Послойная кератопластика является наиболее эффективным и безопасным методом хирургического лечения рецидивирующего птеригиума, обеспечивающим восстановление каркасных и оптических свойств роговицы, а также обусловливающим высокий противорецидивный эффект благодаря барьерным свойствам послойного трансплантата. Однако потенциальные послеоперационные изменения регулярности передней и задней поверхности роговицы (особенно в случае далекозашедшего роста фиброваскулярной ткани) не всегда позволяют достичь высоких функциональных результатов лечения. Представлено клиническое наблюдение, свидетельствующее об эффективности и безопасности выполнения эксимерлазерной коррекции рефракционных нарушений после хирургического лечения птеригиума.

Laryngeal Squamous Cell Carcinoma is one of the most common head and neck cancers, and patients experience dysphonia after treatment with transoral laser microsurgery (TLM) or radiotherapy (RT). This study aimed to investigate the multidimensional assessment of voice, based on objective and subjective evaluation. In this cross-sectional study, a group of 120 patients (mean = 57.59 years, SD = 4.87), including men (n = 116) and women (n = 4) with early laryngeal carcinoma, were divided into two groups; Patients who had undergone TLM (n = 60) or RT (n = 60). The multidimensional assessment of voice was conducted using the acoustic analysis, the dysphonia severity index (DSI), the Persian versions of Consensus Auditory Perceptual Evaluation of Voice, and the voice handicap index (VHI). Results revealed that objective voice assessment only shows differences (P < 0.001) in the DSI between TLM and RT groups, despite there being no significant differences (P = 0.196) in overall severity of voice disorder in comparison between them. Also, there is a significant difference (P < 0.05) based on the Emotional subscale of VHI, between irradiated and TLM-treated patients. This finding showed that TLM-treated patients with early laryngeal carcinoma had severe voice disorder compared to irradiated patients. In addition, radiotherapy has a greater impact on the emotions of patients with early glottic cancer.

Background: Holmium laser enucleation of the prostate (HoLEP) has been used as an effective minimally invasive technique for management of enlarged prostates. We aimed to report the role of HoLEP in prostate cancer (PCa) patients either on active surveillance with bothersome lower urinary tract symptoms (LUTS) or for prostate debulking before radiation therapy and the impact on PCa management plans. Methods: Prospectively maintained database in two institutions was reviewed for patients with localized PCa managed by HoLEP with at least a follow-up of 1 year. We assessed prostate-specific antigen (PSA) trends, effect on international prostate symptom score (IPSS) and further management of PCa. Results: Out of >2000 HoLEP patients, 117 patients with a median follow-up of 30 months were included. Mean (standard deviation) age was 72.3 (±8.3) years with median (interquartile range, IQR) IPPS of 22 (16-28) and median (IQR) PSA at 7.6 (5.3-14.9) ng/mL. Gleason grade group was 1, 2, 3, and 4 in 47 (73.2%), 32 (27.35%), 7 (5.9%), and 4 (3.4%) patients, respectively. Median (IQR) PSA has significantly dropped to 1.3 (0.6-3.1), 1.4 (0.75-2.9), and 1.7 (0.86-2.75) ng/mL at 6-week, 3-month, and 1-year follow-up, respectively (p < 0.001). IPSS scores post-HoLEP obviously improved with mean (IQR) IPSS of 10 (5-13), 7 (3-12), and 3 (2-5) at 6-week, 3-month, and 1-year, respectively (p < 0.001). Eighty-eight (72%) patients stayed on active surveillance, whereas 27 (23%) patients had radiotherapy ± androgen deprivation therapy for persistently high or relapsing PSA. Within 36 intermediate-risk patients, 15 (41.6%) and patients had radiotherapy, whereas 21 (58.3%) patients continued active surveillance. Conclusions: HoLEP is beneficial in debulking large prostate in PCa patients with bothersome LUTS on active surveillance or before radiotherapy. HoLEP reduces the contribution of large adenoma to PSA level, thus reflecting PSA level better and helping reduce overtreatment.

UNASSIGNED: The basis of good vocal outcomes following Transoral Laser Microlaryngeal Cordectomy (TLMC) is the narrow margin that is oncologically accepted for the glottis. Our objective is to evaluate the reliability of frozen section (FS) compared to paraffin section (PS) during TLMC and during laser laryngeal surgery when an incisonal or excisional biopsy is being performed.
UNASSIGNED: Retrospectively, records of 159 sequential patients who underwent CO2 laser laryngeal surgery with intraoperative FS were reviewed along with the final PS. Group A patients were TLMC patients where FS was utilized for free margin confirmation (42 specimens) and Group B patients were those in whom FS was performed for primary diagnosis (122 specimens).
UNASSIGNED: A total of 164 samples were included where specimens submitted for FS were also processed for PS. Concordance was observed in 156 samples, discordance in 8, with 4 cases belonging to each group. FS was reported as false negative in 5 and false positive in 3 cases. In Group A where FS was utilized for free margin confirmation, the sensitivity was found to be 60%, specificity and positive predictive value (PPV) 100%, and negative predictive value (NPV) 88.9%. In Group B where FS was performed for primary diagnosis, the sensitivity was found to be 98.4%, specificity 95.1%, PPV 95.2%, and NPV 98.3%.
UNASSIGNED: A 100% PPV of FS in group A suggests that positive FS margins during TLMC may be safely relied upon in making decisions to upgrade the type of cordectomy being performed. A NPV of 88.9% in group A suggests that despite a clear frozen margin report during TLMC, 11.1% of patients would need further treatment. A PPV of 95.2% in group B suggests that although FS analysis is important for guiding further management, decisions regarding major laryngeal surgery should not be undertaken based solely on FS.

BACKGROUND: The study aims to describe the lingual laser frenotomy perioperative protocol for newborns with ankyloglossia with or without breastfeeding difficulties developed by Odontostomatology and Neonatology and Neonatal Intensive Care Units of the Aldo Moro University of Bari.
METHODS: Authors carried out a prospective observational cohort study. Newborns with ankyloglossia (classified by using both Coryllos\' and Hazelbaker\'s criteria) with or without difficult breastfeeding (according to Infant Breastfeeding Assessment Tool) underwent diode laser frenotomy (800 ± 10 nm; 5 W; continuous wave mode; contact technique; under topical anesthesia) and follow-up visits after seven and thirty days postoperatively. The authors analyzed as main outcomes the perioperative pain intensity measured by the C.R.I.E.S. scale, the occurrence of complications and quality of healing, the quality of breastfeeding, newborn\'s postoperative weight gain, maternal nipple pain, and the presence of lesions as secondary outcomes.
RESULTS: Fifty-six newborns were included in the current study. Intraoperative mean pain intensity was 5.7 ± 0.5 points, resolved within thirty postoperative minutes. Observed complications were mild punctuating bleeding, carbonization of the irradiated site, and transitory restlessness. All wounds were completely healed within the thirtieth postoperative day. During follow-up, a significant breastfeeding improvement was evident with satisfactory newborns\' weight gain and a significant reduction of nipple pain and lesions (p < .05).
CONCLUSIONS: Our lingual laser frenotomy protocol provided significant breastfeeding improvement in the mother-newborn dyads with low intraoperative pain and no significant complications.

UNASSIGNED: Cowden\'s syndrome is a genetic disorder characterized by multiple oral hamartomas and an increased risk of internal malignancy. These mucocutaneous lesions can be physically disfiguring and psychologically distressing. As a result, patients frequently seek treatment for their destruction. Removal of oral hamartomas is often a challenge due to their sensitive location and high risk of recurrence.
UNASSIGNED: To review the clinical use, effectiveness, and safety of a fractional ablative laser to treat multiple oral hamartomas in a patient with Cowden\'s syndrome.
UNASSIGNED: A thorough literature review pertaining to treatment of oral hamartomas and a discussion of an illustrative case showcasing successful lesional destruction with a fractional ablative carbon dioxide (CO2) laser in a 33-year-old man with Cowden\'s syndrome.
UNASSIGNED: Multiple oral hamartomas were effectively removed with fractional CO2 laser vaporization. No infection, scarring, dermatitis, nor lesional recurrence were observed 6 months post-treatment.
UNASSIGNED: Fractional CO2 laser vaporization can be used effectively to treat multiple oral hamartomas associated with Cowden\'s syndrome.