TECHNIQUE OF TUMOR DEBULKING IN THE HEAD &NECK USING Nd:YAG LASER

L.S.Handikin,P.Hasan,Pelni &Husada Hospital,Jakarta-Indonesia

Abstract

The goal of tumor treatment is eradiaction of the disease while maintaining the patient"s quality of life.In saome cases with head and neck tumor we have used Nd:YAG laser for tumor debulking.
Tumor was diagnosed clinically and its pathology was verified through biopsy.Squamous cell carcinoma underwent in vivo staining technique to observe dysplasia,ca in situ,pre invasive carcinoma or second focus of malignancy.
Tumor delineation was done with imaging system(contrast CT scanning,MRI).Whenever possible debulking procedures were done endoscopically,to minimize surgical trauma.Imaging control was done to observe the result.We used knife for skin incission only.Nd:YAG laser was used for cutting,coagulating and evaporating purposes.
For illustration,cases of nasal,paranasal,tonsillar,laryngeal and nasopharyngeal tumors treated with Nd:YAG laser were presented.

Keywords:Nd:YAG laser;Head and Neck Tumor;Tumor debulking

WARRIOR OF THE LIGHT

Warrior of the Light is a short notes on accepting failure,embracing life,and rising to your destiny.I just recently find this book handed to me by my daughter,who endorsed it to me hoping me read the book it,and it was what I have done.
May I quote some words of this interesting book:
What is a Warrior of the Light?....".He is someone capable of understanding the miracle of life,of fighting to the last for something he believes in-and of hearing the bells that the waves set ringing on the seabed."...."He had never thought of himself as a Warrior of the Light.....Everyone is capable of these things.And,though no one thinks of himself as a Warrior of the Light,we all are......(prologue)"He realizes that he is acting as a channel for some higher wisdom"(page 13).......-the Universe is going to help Warriors of the Light and hinder the prejudiced.The Earth's energy needs to be renewed.New ideas need space.Body and soul need new challenges.The future has become the present,and every dream-except those dream that involve preconceived ideas-will have a chance to be heard....(page 17)
PAULO COELHO(the author of this book) has inspired millions worldwide,including me,and maybe you too.

START BASICS JUMP TO BIG OPPORTUNITY IN LASER MEDICINE

Dear colleguae,
There is an exclusive world of medical practice:Laser Medicine.
As President of The Indonesian Society for Laser Medicine,(IKLASI)may I invite you to joint our Basic Training Program in Laser Medicine and Surgery.The training will be dated on Sunday,May 20, 2007 Venue:Auditorium Pelni Hospital,AIP II KS Tubun 92-94,Jakarta Barat 11410.Trainers will be scientist- medical doctors-laser expert-experienced laser clinicians.Topics laser basics:introduction to laser medicine,laser physics,laser tissue interaction,laser safety,how to operate laser,laser application in various medical specialties etc.Live demo will also be demonstrated esp.for skin lesions.We welcome you whether you are a general practitioner or specialist physician.Please contact Riza by phone 62-21-5306793 ,HP/SMS :0817-0136600 or fax:62-21-5306907 e-mail:iklasi_pusat@yahoo.com
Regards
IKLASI(Ikatan Kedokteran Laser Inddonesia)
L.S.Handikin MD (President)

New Generation Lasers & Leading Edge Treatments With CANDELA Technology

A laser workshop was taken place in Gerbera Room, Mulia Hotel, Jakarta, Indonesia on February 28, 2007. There were 2 speakers: Taro Kondo, MD (Tokyo Women Medical University) and Aryani Sudharmono, MD (Division of Aesthetic Dermatology, Dept. of Dermatology and Venereal Diseases, Faculty of Medicine, University of Indonesia).

Taro Kondo talked about “Gentle YAG Treatment in Hair Removal ,Vascular Lesions and Skin Rejuvenation” while Aryani Sudharmono presented “V Beam Experiences in Indonesia”. As an addition to the speakers’ presentations, a live demo was presented by Taro Kondo for Gentle YAG and V Beam Perfecta.

Overall, this meeting was a great opportunity both for doctors and investors. The market is growing even greater and faster with the raising demand and better understanding of individual health as well as the interest to beauty and wellness.

Many doctors are interested in Laser Medicine and Surgery. Recent data shows that more than 400 doctors are now registered as members of The Indonesian Society for Laser Medicine. Training and education are most important and highly critical in the competency development programs in laser medicine.

Let me quote some basic principles on the selective photothermolysis as written by Yacov Domankevitz, a senior scientist at Candela Corporation:

Laser treatment of vascular lesions is based on the principle of selective photothermolysis (Parrish and Anderson). By proper selection of laser system parameters, selective heating of vessels within the skin is possible while producing only minimal damage to the overlying epidermis and adjacent dermis.

The basic elements of selective photothermolysis for the treatment of vascular anomalies are:

1. Selective Absorption -- Laser energy should be preferentially absorbed by blood vessels and not by the overlying epidermis and adjacent dermis.

2. Optical Penetration Depth (OPD) -- Laser energy should penetrate sufficiently deep to reach the larger and deeper situated vessels.

3. Energy Deposition -- Laser energy at the vessel site should be sufficient to heat the vessels to the damaging temperature.

4. Damage Confinement -- The exposure time of the laser energy should be less or equal to the thermal relaxation time of the vessels

5. Epidermal Cooling -- Although this is not a basic element of selective

photothermolysis it is an essential element in many laser therapies.

The Role of Laser in Otorhinolaryngology, Head, and Neck Surgery

A visit to HNO –Praxis Dr.med.F.-P.August, ambulante Operationen.Laserchirurgie

This is a report on my trip to Germany last November 2006. I was delighted to visit a country where actually I should be trained in Stuttgart several years ago. Two younger doctors accompanied me, dr. Bestari and dr. Muh.Abdu from Padang (School of Medicine,University of Andalas).

Before our departure, we have finished the in-house training for them in dr.M.Djamil Hospital (please see our pictures at http://www.flickr.com/handikin). We concentrated on the application techniques of diode laser (980 nm in wavelength) in surgical daily practice. So, we were happy to meet Dr.August, a young doctor who is very keen and a skilled master in laser surgery.

We went to Kleinmachnow, a small area outside Postdam, a well-known city not so far from Berlin, attending small group seminars, discussions, sharing experiences and practical observation in the clinic and hospital. The weather was around 5 degree Celsius so we had to put jackets and ”kopiah” around the clock.

Laser technology was so close even for the rural area like this. We hope that Indonesia, which is an archipelago, will be able to conduct this kind of services.

Laser medicine changes medical services into a practical, very easy to do minimal invasive surgery in one day setting. At last, it should be economical for the patients’ pocket and insurance company as well.

Please find our pictures here, they will tell you many things by themselves! If you wish to have further personal contact with me, you can write an e-mail to lshandik@gmail.com