1. haemostasis
   • seals blood vessels while cutting any tissue
   • no need to distend with high pressure fluids to stop bleeding - less swelling
   • no need for repetitive diathermy to burn tissues to stop bleeding
   • no need for drainage tubes to drain blood post-operatively (one cause of pain)
2. one probe does the work of many instruments
   • no need to keep changing instuments through the skin wounds
   • less damage to the portal tissues
   • less likelihood of breaking instruments
   • shorter operating & anaesthetic times as ergonomically more efficient
3. small diameter instrument 2mm.
   • therefore less scuffing to adjacent joint surfaces
   • less damage to surrounding tissues which may be stretched to admit actions of conventional instruments eg. basket forceps
   • better access as fits into very small spaces with gentle curve

   (see comparison with conventional instruments above)

4. chondroplasty
   • photo stimulation - some early studies have recognised early ingrowth of healing tissues
5. fibre optic cable
   • very easy to manipulate as flexible
   • sensitive to the surgeon - better feel and so may be more delicate
   • works very well in an aqueous medium ie. in a joint with arthroscopy
6. very powerful now
   • bone sculpting, cartilage contouring now possible
   • therefore training and accreditation of the surgeon most important - in Australia all surgeons who use this should have laser credentialling.
7. Cost saving
   • once a hospital has a laser the ongoing costs are less than conventional equipment ie. less dispoable "single use" expensive equipment
   • reusable hand pieces (~cost of 1 blade/case) - not adding a lot more expense!

Especially for the patient:

1. "less subjective pain; less apparent bleeding and swelling"
   • The surgeon does not need to pump in fluid under pressure to stop the bleeding - this normally causes marked swelling and distention of tissues which is a cause of pain after the traditional arthroscopic surgical operations.
   • tourniquets are not needed and they cause pain because of the period of ischaemia and the pressure beneath
   • no drainage tubes which cause pain with movements
2. reduces surgical time
   • so less problems from the anaesthetic ie. nausea and drowsiness
   • patient gets over the operation more quickly
   • less compliocations from the anaesthetic- important if previous medical problems
3. no charring therefore less irritation and inflammation
4. Safety considerations
   • surface ablation 0.4mm per pulse
   • surrounding tissue effect <1mm. and this seals the blood vessels
   • if beam doesnt come into contact with tissue within 4 mm. a harmless bubble forms as completely absorbed by the fluid- little likely damage to other tissues besides the one being targeted
5. Precise surgery
   • minimal damage/spread other tissues
   • allows better sparing of adjacent tissues - meniscus, labrum
   • safe - danger zone only 3-4mm in water
   • very precise cutter, ablator,coagulator

Local experience with Lasers in Orthopaedics

Initial experience using the Laser for Arthroscopic Subacromial Decompressions on patients with Impingement Syndrome when compared to those treated with conventional mechanical instruments revealed in a study of 34 patients:

1. Patients perceived less pain - scores approx.50%in hospital and 33% at 3 & 6 week followup
2. less analgesia needed in hospital
3. shorter operating time - 20%shorter operating (anaesthetic) time
4. less fluid and swelling
5. quicker return to work - returned to work in half the time (av.2.6 weeks)
6. Cost reductions in patient care