The flexibility of the laser scalpel in the hands of a skilled neurosurgeon makes possible the safe removal of tumors.

The use of laser light for some microsurgical procedures isn't new. What is new, however, is the use of handheld CO2 laser scalpels for the safe removal of life-threatening tumors with minimal blood loss and minimal retraction to the brain or spine (and associated nerves).

For example, Dr. Narayan Sundaresan, a NYC neurosurgeon, whose mother was shot in the head when he was a boy, recently operated on a patient with a metastatic brain tumor in her temporal lobe. He performed the surgery at Lenox Hill Hospital using a BeamPath CO2 laser by Cambridge, MA-based OmniGuide (omni-guide.com). The laser allows the surgeon to preserve tissue around the tumor. Further, because it provides a "no-touch" procedure, it is at times safer than using alternative techniques, such as radiosurgery systems like the CyberKnife (accuracy.com) and Gamma Knife (elekta.com) systems. Sundaresan reports that the patient has returned home without any complications and will be spending the holidays with her family.

What is most appealing about the CO2 laser scalpel technology from a surgeon’s perspective, says Sundaresan, "is that the light beam is highly focused and it is possible to deliver the laser through a small handheld device using a flexible tube."

Sundaresan says the laser scalpel technology allows him to perform, in addition to the removal of tumors, other procedures that he otherwise wouldn’t be able to perform, such as dense or fibrous meningioma, acoustic tumors, and small spinal tumors.

Tabletop sophistication: material is key
Sundaresan is one of approximately 3,800 surgeons currently using the BeamPath technology and the Lennox Hill procedure referred to earlier is one of the 36,000 BeamPath procedures performed since it was introduced in 2006.

The laser's operating wavelength is 10.6µm and is delivered through a hollow core flexible fiber. Since the absorption depth of CO2 laser energy is shallow, damage to underlying or surrounding tissue can be minimized.

The ability to bend CO2 laser energy through a flexible fiber enables beam delivery to many locations throughout the body while providing increased control through a handheld instrument. Until such a glass material was developed in the late 1990s by a team of MIT scientists, the application of laser light in surgical procedures was limited. To achieve the material breakthrough, semiconductors and insulators had to be layered at submicron accuracy within a hollow fiber, something that was never before achieved, according to a July 2009 Science Times article, which also reports that the MIT team established for the first time a solid-state,  "omnidirectional" mirror inside a fiber. These breakthroughs led to the founding of OmniGuide.