We have used the CO2 laser as a surgical tool for over a decade. Our experiences with surgical lasers from five different manufacturers and their use from nose to bronchi indicate following deficiences and needs:
The readout of the power meter is only indirectly related to beam power at the delivery site. Feedback instrumentation needs to be developed to indicate the energy actually delivered to the tissues. The “laser on” indicator is usually not visible to the surgeon.
Current articulated have inertia, are not truly axial, and are easily misaligned. We need a flexible conductor system with minimal energy absorption.
Of the types of aiming lights available the helium-neon laser is inadequate since the image is diffused by the tissue and is not adjustable. The other type is a spot of light projected into the eyepiece and aligned with the image of the burn. This aiming light needs a brightness control as it is often bright or dim.
The spot size of the CO2 laser at a focal length of 400 mm should be viariable in diameter from about 5 - 3.0 mm.
For oral, pharyngeal and laryngeal surgery we need a nonflammable, air tight, and flexible intratracheal tube with a built-in cuff and filling tube buried in the wall.
The bronchoscopic coupler should be smaller lighter. One should be able to change quickly from bronchoscopic coupler to micromanipulator or to a hand held device. Also needed is a precise, visually controlled, strong aspirator. Its use should not require detachment of the bronchoscopic coupler from the bronchoscope.
Increased safety in instrumentation and procedures for its use are vitally needed.