Advantages of Lasers for Stapes Surgery

Early enthusiasm for lasers in stapes surgery was far from unanimous. In the discussion of Perkin's first presentation, Frances Sooy cited Kaplan's law, "When you give a kid a hammer, everything he sees needs pounding."39 Similarly, the fiberoptic argon laser hand pieces have been described as a gimmick and fad by more than one nationally recognized otologist. One may question whether surgical lasers are little more than technological bravado for an operation considered by many the quintessence of otologic surgery. We believe that surgical lasers offer several worthwhile advantages to the stapes surgeon. The most significant benefit is elimination of mechanical trauma. In our experience, the high-frequency notch occasionally seen after mechanical stapedectomy is avoided with use of the argon laser. The absence of mechanical trauma is particularly important during revision stapes. The small spot size of the CO2, KTP-532, and argon lasers allows precise and controlled removal of both bone and soft tissue in the oval window. Finally, the CO2, KTP-532, and argon lasers all have hemostatic qualities that virtually eliminate bleeding during fenestration of the stapes footplate. In our hands, we believe that these advantages have increased the speed, efficiency, and safety of the small fenestra stapes procedure.

From a practical point of view, the use of a fiberoptic hand piece avoids a cumbersome micromanipulator that must be attached to the microscope and increases the working distance from the surgeon to the operative field. The fiberoptic hand piece may be held similar to a traditional surgical instrument and avoids removal of the surgeon's dominant hand from the operative field to control the joystick on the micromanipulator. By moving the tip of the optical fiber closer or farther from the target, the power density may be changed instantaneously from a high-power density for cutting or vaporization to a low-power density for coagulation. Fiberoptic hand pieces can be used around corners by simple movement of the instrument in the surgeon's hand rather than moving the entire micromanipulator/microscope system to a different visual axis or using micromirrors. Finally, the protective shutter may be left on the microscope at all times, and laser use is accomplished by turning on the system and attaching the fiberoptic hand piece. This avoids time-consuming micromanipulator calibration and testing.

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