What Is Laser Surgery?

Laser surgery is a family of medical procedures in which focused beams of laser light replace or supplement conventional scalpels and instruments to cut, ablate, coagulate, or vaporize tissue with high spatial precision. A surgical laser delivers energy at a specific wavelength that is selectively absorbed by the target tissue, allowing the surgeon to act on a defined region while limiting thermal or mechanical damage to surrounding structures. The technique entered clinical practice following the development of the continuous-wave CO2 laser in the 1960s and has since expanded into nearly every surgical discipline. A detailed review of laser applications across medical specialties is available in a PMC-hosted survey of laser surgery techniques.

The choice of laser depends on the optical properties of the target. Wavelength determines which chromophore absorbs the energy: the CO2 laser at 10,600 nm is strongly absorbed by water and is effective for vaporizing soft tissue; the Nd:YAG laser at 1,064 nm penetrates deeper and favors coagulation; the argon laser at 488 to 514.5 nm targets hemoglobin and melanin. Femtosecond pulsed lasers deliver ultrashort bursts that photoionize tissue through multiphoton absorption rather than thermal heating, enabling sub-micrometer precision with negligible collateral injury.

Ophthalmic and Refractive Procedures

Ophthalmology was among the first specialties to adopt laser surgery at scale. Photocoagulation with argon lasers has been a standard treatment for diabetic retinopathy and retinal tears since the 1970s. LASIK (laser-assisted in situ keratomileusis) uses an excimer laser operating at 193 nm to ablate stromal tissue and reshape the cornea, correcting myopia, hyperopia, and astigmatism with micrometer-level accuracy. Femtosecond lasers have further refined the procedure by creating precise corneal flaps and fragmenting the crystalline lens during cataract surgery. These ophthalmic applications are discussed in depth in published reviews of ophthalmic laser science on IEEE Xplore.

Oncology and Minimally Invasive Procedures

Lasers provide tumor surgeons with tools for ablation and photodynamic therapy across a wide range of organ systems. CO2 lasers are used in laryngeal and head-and-neck oncology to resect tumors through endoscopes with minimal blood loss, preserving surrounding structures that conventional electrosurgery would damage. Laser interstitial thermal therapy (LITT), guided by real-time MRI, delivers Nd:YAG or diode laser energy through thin fibers inserted directly into brain tumors or epileptic foci, destroying tissue at temperatures of 50 to 90 degrees Celsius without open craniotomy. In urology, holmium:YAG lasers at 2,100 nm fragment kidney and biliary stones with high efficiency and are used for endoscopic ablation of bladder and prostate tissue.

Dermatology and Tissue Remodeling

Dermatology accounts for a large share of clinical laser use. Pulsed dye lasers at 585 to 595 nm selectively destroy blood vessels responsible for port-wine stains and vascular lesions through selective photothermolysis, a principle introduced by Anderson and Parrish in 1983. Fractional CO2 and Er:YAG lasers resurface skin by creating arrays of microscopic ablation columns that stimulate collagen remodeling without removing the entire epidermis, reducing recovery time compared to full-field ablation. Q-switched Nd:YAG and picosecond lasers fragment tattoo ink particles into sizes small enough for macrophage clearance. The photophysics underlying these procedures are covered in the PMC article on laser applications in surgery.

Applications

Laser surgery has applications across a broad range of medical disciplines, including:

• Ophthalmology: corneal reshaping, retinal photocoagulation, and cataract surgery
• Oncology: endoscopic tumor ablation in the larynx, bladder, and gastrointestinal tract
• Urology: lithotripsy for kidney and biliary stones
• Neurosurgery: MRI-guided thermal ablation of brain tumors and epileptic lesions
• Dermatology: vascular lesion treatment, skin resurfacing, and tattoo removal
• Cardiovascular surgery: pulmonary vein isolation for atrial fibrillation