The future of lasers in gynecology

There were many claims of extraordinary possibilities for laser surgery by the early gynecologic laser surgeons. They promised that by using the laser there would be increased speed of the operation, decreased blood loss, decreased infection rates, decreased thermal damage and finally increased clinical results. Despite this `hype,' our clinical experience over the last decade has demonstrated in a large part that the clinical results using the laser are equivalent to those using either sharp scalpel or electrocautery. It appears that the skill of the surgeon is a far more important variable than the type of instrument used by the surgeon. As a result, since 1990, the laser has begun to fall out of favor with gynecologists and, more recently, general surgeons. The gynecologic surgeon of the 1990s is now exploring the use of intra-abdominal endoscopically delivered sutures and staples as well as electrocautery. Considering the increased expense associated with lasers, it is likely that a gynecologic surgeon will continue to explore non-laser options in the future. With planning and cooperation and consultation between clinicians, basic scientists and industry, lasers may ultimately play an even more significant role than they have in the 1980s.