The evolution of char-free laser surgery - From CW to S.P- From Sharpulse^™ and SwiftLase^™

Commercial CO₂ surgical lasers introduced in the early 70-'s employed continuous-wave (CW) operation only. Following several years of clinical research and applications, it was realized that for some procedures surrounding thermal necrosis was too excessive. The Superpulse (S.P.) mode, adapted from industrial CO₂ laser ceramic scribing techniques, was found to be advantageous and was thus incorporated in surgical systems. Over the years, additional modes such as the Pulser (chopped) mode were adapted. However, only recently a better understanding of CO₂ laser-tissue interactions has led to significant improvements in char-free techniques, especially for nonfocused, tissue surface treatments. These techniques are based on high energy pulse modes such as the Sharpulse^™ as well as innovative beam scanning devices like the SwiftLase^™ and SilkTouch^™. The evolution of these different techniques and their basic physical principles will be discussed, and histologies showing reduced tissue carbonization and thermal necrosis will be presented.