1 00:00:00,000 --> 00:00:08,000 Global Cast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. 2 00:00:08,000 --> 00:00:14,000 Hello, Pediatric Surgery family. I'm Lizzie Lee from Cincinnati Children's Hospital Medical Center. 3 00:00:14,000 --> 00:00:24,000 In this video series, we'll be recapping the sessions and sharing the key highlights from our 12th annual update course in Pediatric Surgery, which was held in August 2024. 4 00:00:24,000 --> 00:00:29,000 This year, we introduced a new approach to classify practice-changing ideas at our update course. 5 00:00:29,000 --> 00:00:40,000 Presentations now fall into three categories. Green circles for established practices, blue squares for promising newer practices, and black diamonds for early adopter practices only. 6 00:00:40,000 --> 00:00:47,000 Today, we will talk about the CO2 laser for pediatric surgery with Dr. Carlos Coluva, pediatric surgeon from Mexico. 7 00:00:47,000 --> 00:00:51,000 This topic falls into the Black Diamond unproven category. 8 00:00:51,000 --> 00:01:00,000 A three-year-old male with chronic melanoprostitis, recurrent infections not responsive to medical treatment, and has a type of fomosis with painful urination report. 9 00:01:00,000 --> 00:01:07,000 About 38% of the audience would use electric artery and 50% would use scalpel, with a small portion using CO2 laser. 10 00:01:07,000 --> 00:01:14,000 It has the potential to outperform conventional circumcisions and other surgeries. I'll use circumcision as a proof of concept. 11 00:01:14,000 --> 00:01:21,000 It can give you faster operative time, reduced pain, lower rates of scaring, and amazing cosmetic. 12 00:01:21,000 --> 00:01:25,000 This meta-analysis and systematic review included seven studies. 13 00:01:25,000 --> 00:01:30,000 Results showed that laser-assisted circumcision is definitely a safe and strong option. 14 00:01:30,000 --> 00:01:37,000 This is the thing. We hear about the use of CO2 lasers for surgery. We think, oh, this is new. But this has been reported since 1970. 15 00:01:37,000 --> 00:01:40,000 It's just not well researched in pediatric surgery. 16 00:01:40,000 --> 00:01:44,000 And what exactly is a CO2 laser and a YAG laser? 17 00:01:44,000 --> 00:01:52,000 CO2 is carbon dioxide, and YAG stands for yttrium aluminum garnet and uses this crystal to produce a high-energy beam of light. 18 00:01:52,000 --> 00:01:58,000 The way it works is the laser emits infrared light. It is highly absorbed by water and biological tissues. 19 00:01:58,000 --> 00:02:02,000 Depending on the nanometer wavelength that you change, it absorbs differently. 20 00:02:02,000 --> 00:02:09,000 We're using it in the spectrum of 920 to 1400, which is really well absorbed by water. 21 00:02:09,000 --> 00:02:13,000 It's very effective for precise cutting and ablation and reduces blood loss. 22 00:02:13,000 --> 00:02:18,000 We have great reduced pain and edema and shorter operative time. 23 00:02:18,000 --> 00:02:21,000 The disadvantage is that it has a big learning curve. 24 00:02:21,000 --> 00:02:25,000 You need ocular protection and you need specialized training. It is quite expensive. 25 00:02:25,000 --> 00:02:35,000 Initially, it has a high-cost barrier, but the evidence shows that this high cost is justified because CO2 lasers diminish operating time and lower complications. 26 00:02:35,000 --> 00:02:40,000 Which type of tissue is most suitable for laser surgery, especially at this wavelength? 27 00:02:40,000 --> 00:02:43,000 65% of the audience answered mucosa. 28 00:02:43,000 --> 00:02:53,000 Yes, mucosa tissue is, of course, filled with mucous, which is 95% water. So it reacts really well to the laser. 29 00:02:53,000 --> 00:02:59,000 Where in the body can we use this? Mucosa is present in a wide range of body surface areas. 30 00:02:59,000 --> 00:03:02,000 Let's explore some common use cases for CO2 laser. 31 00:03:02,000 --> 00:03:08,000 We used it for circumcision, 56 patients. We used the sleep technique with the dorsal slit. 32 00:03:08,000 --> 00:03:13,000 We used cianulocridate adhesive and we've only had a 3% complication rate. 33 00:03:13,000 --> 00:03:17,000 They only had two partial wound dehistances that were managed conservatively. 34 00:03:17,000 --> 00:03:23,000 Just look at the scarring profile. It's amazing. Low pain profile. We only use ibuprofen. 35 00:03:23,000 --> 00:03:28,000 Our surgical time is around 10 minutes and amazing aesthetically results. 36 00:03:28,000 --> 00:03:34,000 This research paper from 2016 shows that combining a CO2 laser and cianuacrylate adhesive 37 00:03:34,000 --> 00:03:39,000 decreased the operating time significantly and decreased bleeding complications. 38 00:03:39,000 --> 00:03:44,000 We've used it for phrenolectomy, 47 patients, low pain profile, no suture required. 39 00:03:44,000 --> 00:03:49,000 Other conditions that they've used the CO2 laser for include perianal fistulas in four patients, 40 00:03:49,000 --> 00:03:53,000 fistulotomy and pilonidal cysts in 12 patients. 41 00:03:53,000 --> 00:04:01,000 We do laser ablation and there's a sinus tract we also ablated. Lower labia fission and condylomatosis, great for ablation. 42 00:04:01,000 --> 00:04:09,000 Here's another paper from 2022 showing that laser is very effective in treating benign anal conditions, especially hemorrhoids. 43 00:04:09,000 --> 00:04:14,000 In summary, CO2 laser is a strong evidence-based option with promising outcomes. 44 00:04:14,000 --> 00:04:19,000 It reduces bleeding, has a lower pain profile and has a shorter operating time. 45 00:04:19,000 --> 00:04:24,000 The barriers for adopting the use of CO2 lasers are the high initial equipment costs, 46 00:04:24,000 --> 00:04:29,000 the need for specialized training and the lack of availability. 47 00:04:29,000 --> 00:04:50,000 GlobalCastMD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.