JenaSurgical designs and sells microscope-assisted laser devices for general surgery and precision microsurgery. It creates the latest generation workstations used in gynecology, urology, oncology and otolaryngology for surgical teams around the world.
The continuous progress in surgical lasers with fiber optics, combined with the widespread use of miniaturized endoscopic instruments able to go where a hand or scalpel could never reach, makes laser surgery the best support for the urologist and for the development of endourology.
Especially holmium and thulium lasers offer advanced performance with a lower intraoperative bleeding risk and shorter hospital stays and catheterization of patients,making endoscopic procedures safer and less invasive than traditional surgical techniques and open surgery.
Endosurgical laser treatments for BPH
BPH (Benign Prostatic Hyperplasia) – The laser has been used since the 80s for the treatment of BPH: after several evolutions of laser sources and surgical techniques, today the holmium laser and the more recent latest generation thulium laser, are the most advanced technology and high performance tools for endoscopic prostatectomy procedures.
In the beginning the pulsed Ho:YAG laser,with its wavelength of 2100 nm (well absorbed by the water contained in tissues), was usedfor the vaporization of the prostate, through HoLAP (Holmium Laser Ablation of the Prostate), an ablation procedure that is easy to learn but does not produce great results especially for large prostates. Subsequently HoLEP (Holmium Laser Enucleation of the Prostate) was developed: an enucleation technique that, with the help of the morcellator, enables treatment of BPH, regardless of the size of the adenomas.In recent years, a new laser source has gained popularity after holmium: the thulium laser.The arrival of the second generation of1.9µm Tm:YAG laser, combined with a 1470nm diode, helped further spread the use of ThuLEP (Thulium Laser Enucleation of the Prostate).
The MultiPulse HoPLUS and MultiPulse Tm +1470 systems by JenaSurgical represent the latest technology available today to urologists for transurethral operations, enabling them to operate on a prostate of any size for a precise adenoma removal at the surgical capsule level. These devices are excellent, minimally invasive, effective and safe alternatives to traditional TURP and open prostatectomy. The prostate enucleation e with Ho:YAG or Tm:YAG+1470 diode laser is less prone to recurrences or complications (such as TUR syndrome or bleeding during and after surgery) and involves shorter periods of catheterization and hospitalization. Thanks to their excellent hemostatic effect, they are recommended in the case of surgery on cardiopathic patients or those with coagulation problems (e.g. under those being treated with anticoagulants). Moreover, the use of the morcellator, unlike other procedures, allows for histopathological analysis to be performed on excised tissue in all cases.
Endoscopic Lithotripsy and Treatments for Stones in the Urinary System
Even for the surgical treatment of urinary tract stones, the development of holmium lasers has offered safer and minimally invasive alternatives compared to traditional lithotripsy techniques.
Due to this, the JenaSurgical product range includes holmium systems with fiber sets specially developed for laser endoscopic lithotripsy such as MultiPulse Ho (35W) and MultiPulse HoPLUS (140W), which support urological surgery for the treatment of a wider range of diseases.
The various lithotripsy techniques are used from time to time according to the shape, size, chemical composition and the anatomical location of the stone to be treated. The patient’s symptoms and condition such as the presence of stenosis of the urinary tract are two other important criteria for choosing the procedure. The major advantages of using a Ho:YAG laser source like the one supplied with MultiPulse Ho and MultiPulse HoPLUS consist of high efficiency for all types of stones and the low percentage of migration and retrograde propulsion of fragments treated.
If ureteroscopy (URS) is suitable for the surgical treatment of different types of ureteral stones, RIRS (Retrograde Intra-Renal Surgery) can be considered as the evolution of URS which, using latest generation endoscopes, also treats many kidney stones. Using a flexible ureterorenoscope with active and passive deflection, it is possible to reach the kidney cavity backwards.
Neither of these procedures requires incisions: a ureteroscope or a ureterorenoscope is directly inserted through the urethra into the bladder, ureter and then, when necessary, in the kidney channels. The laser light is delivered via a flexible fiber optic inserted in the endoscope until it enters in direct contact with the stone. Here the energy emitted by holmium can bring about the pulverization or fragmentation. In the first case, the residue is subsequently expelled spontaneously with urination; in the second case, the fragments are collected and removed using special probes called “stone baskets”.
Percutaneous nephrolithotomy (PCNL) is the procedure most often used for larger kidney stones or for those of harder consistency. Under general anesthesia, a small incision is made on the patient side at the level of the kidney, for the direct passage of a nephroscope that brings the laser in direct contact with the kidney stone for fragmentation. When the operation is completed, a special inner catheter (double- J stent) is inserted, to function as a link between the kidney and the bladder to allow the outflow of urine, thus avoiding the occurrence of colic.
The development of more effective and long-lasting treatments for urethral stricture, using minimally invasive and safe procedures, continues to be an important research area. These fibrotic strictures of the urethra, resulting from spongiofibrosis originating from different causes such as inflammation or trauma, can now be quickly and effectively treated with thulium or holmium laser urethrotomy using MultiPulse Ho, MultiPulse HoPLUS or MultiPulse Tm+1470. The use of the laser is suitable for short urethral strictures as well as for more significant strictures or for the treatment of urethral atresia. The laser performs the ablation of the damaged tissue with a clean cut, free of bleeding and without penetrating too deeply. This reduces the risk of lateral thermal damage, complications, recurrences or the formation of post-surgery fibrosis, resulting in complete restoration of normal urinary flow.
The laser is an excellent surgical instrument widely used in surgical oncology. In urology, both the Ho:YAG and the Tm:YAG lasers can be used for the excision of tumors of the urethra, bladder, ureter and kidneys. The use of wavelengths that are transmitted through fiber optics allows the work to be performed easily endoscopically. By suitably adjusting the parameters, precise control of both the cutting and ablation is achieved. In particular, the MultiPulse Tm+1470 system allows for quick work with an excellent hemostatic effect (it can be adjusted simply using a pedal according to need, by appropriately mixing the two wavelengths 1940 nm and 1470 nm) and extremely reduced thermal damage to the surrounding tissue.
Prostate enucleation & ablation (i.e. BPH treatment) with HoLEP, HoLAP and ThuLEP procedures | transurethral and percutaneous lithotripsy | urethrotomy (urethral strictures) | excision of urethra, bladder, ureter and kidneys, tumors | partial nephrectomy in open, laparoscopic and robotic surgery
The use of lasers in ENT surgery is common practice today. Thanks to the evolution of laser sources, the surgical otolaryngology approach has been revolutionized by the ability to perform minimally invasive, highly precise surgery, suitable for a wide range of treatments for diseases of ear/nose/throat.
The most used source is the CO₂ laser, particularly appreciated for the high degree of precision in cutting combined with an excellent coagulation effect.
SmartXide² and SmartXide HS, the CO₂ laser systems by JenaSurgical, represent a turning point towards surgery that is easier, faster, safer and more effective. Technological developments and the ongoing scientific research carried out in laboratories at Jena and in specialized centers worldwide, took the SmartXide² beyond ordinary use, with a decisive impact on laser technology for ENT.
The SmartXide² system further enhances the well-known advantages of CO₂ laser surgery. Its innovative RF CO₂ laser source, featuring exclusive PSD® (Pulse Shape Design) technology, generates pulses (U-Pulse) specifically designed for surgical applications, operating in total synergy with the HiScan Surgical scanning system.
The energy density achieved with a small focused spot combined with high peak power and ultra-pulsed emission mode provides advanced performance in photoablation, especially using the EasySpot Hybrid micromanipulator and the surgical microscope.
The surgeon can simply control the main operative functions without having to look away from the microscope, thanks to the micromanipulator’s joystick. This allows for perfect control of cutting depth, shape and size of ablation figures.
The main advantages of CO₂ laser surgery (with particular reference to the transoral laser microsurgery):
- Minimally invasive surgery
- Possibilityof operating onelderlyand /or debilitated patientsand/or withpacemaker
- Shorter hospitalization (cut in healthcare costs)
- Results of surgical oncology equal to or even better than those of traditional surgery
These laser systems are excellent surgical instruments, characterized by remarkable hemostasis ability and reduced lateral thermal damage.
In addition to the CO₂ source, recognized as the gold standard for ENT applications also the diode lasers (SmartXide² and QuadroStarPRO) and the thulium laser (MultiPulse Tm+1470) from the Jena Surgical product range are used in ENT, primarily in middle ear surgery, in endonasal surgery andin oral surgery.
Finally, thanks to the photomechanical action, the Ho:YAG (MultiPulse Ho PLUS and MultiPulse Ho) lasers are used in ENT applications for the treatment of salivary stones (sialolithiasis).
In many cases, endoscopic laser lithotripsy is a viable minimally invasive alternative to transoral scialectomy or external sialoadenectomy procedures when too large salivary stones cannot be entirely removed from the ducts.
Transoral Laryngeal Microsurgery: cordectomies and cordotomies | polyps and laryngeal papillomas (including diffuse papillomatosis) | cordal nodules | benign neoformations | Reinke’s edema | laryngocele | hyperkeratosis laryngitis | scar tissue | granulomas | congenital web | leukoplachia and erythroplasia | primary laryngeal tumors | surgery after unsuccessful radiotherapy | paralysis in adduction of the vocal chords | laryngotracheal stenosis | laryngeal amyloidosis
Middle Ear Surgery: stapedotomies and myringotomies.
Oral Surgery: leukoplachias | erythroplasias | papillomas | hemangiomas | tumors (e.g. glossectomy) | Zenker’s diverticulum | choanal atresia | LAUP (Laser Assisted Uvulo Palatoplasty) | tonsillotomy & tonsillectomy | sialolithiasis (salivary stones)
Nasal, Endonasal & Endoscopic Sinus Surgery:turbinate reduction (for hyperplasia of turbinates) | septoplasty | removal of nasal obstructions (e.g. stenosis), recurrent polyposis nasi & sinuum, synechiae | rhinophyma | cheloids and hypertrophic scars
Tracheobronchial Tree:stenosis, nodules, polyps, tumors
Head & Neck:resection of tumors in sub-facial and neck areas
In gynecological laser surgery the CO₂ and thulium sources are successfully used for the treatment of many female genital tract diseases with applications in colposcopy (SmartXide² and SmartXide HS), laparoscopy (SmartXide² and Multipulse Tm+1470) and hysteroscopy (MultiPulse Tm +1470), obtaining many advantages over more traditional techniques or open surgery.
These procedures reduce surgical invasiveness and duration, morbidity, damage to surrounding tissue and ensure more rapid healing of patients with lower incidence of complications.
In gynecology, laser surgery is recommended for the treatment of warts (condylomata acuminata) in the anogenital area and dysplasia of the vulva, vagina and cervix (colposcopy) or for intra-uterine and endometrial pathologies (treated with hysteroscopy or laparoscopy, depending on the lesion). In some cases, outpatient procedures with local anaesthesia may be involved with significant cost savings compared to the corresponding procedures in the operating room.
General Surgery & Oncology
In the General Surgery and Oncology fields, laser systems are precious allies for surgeons in many procedures, from routine operations such as gallstone lithotripsy and breast surgery through to the more complex procedures of resection of liver, pancreas, intestine and lung tumors.
The most advanced technology provides surgeons with a vast range of sources and wavelengths for cutting, cauterizing, vaporizing or removing tissue both in endoscopic and open surgeries.
Each wavelength has its own specific effect on biological tissue. The combination of laser-tissue interaction, the transmission system that can be used and the laser operation parameters determines the overall final effect of the laser system during surgery.
In the hands of a specialized and correctly-trained surgeon, the use of lasers in the theater makes it possible to:
- cut or remove diseased tissue without damaging the adjacent healthy tissues
- reduce or destroy tumors and lesions
- cauterize (seal) blood vessels to reduce blood loss
- block nerve terminals to reduce post-surgical pain and discomfort
- reduce the risk of incision infection
- seal lymph vessels to minimize swelling and prevent malignant cell diffusion
- minimize the size of the area involved by the surgery
- obtain faster wound healing
Liver, pancreas, intestine and lung tumors resection in open & endoscopic surgery | breast surgery (e.g. mastectomy and mammoplasty) | cysts | decubitus ulcers | wound debridement | common bile duct stones