Auto-simultaneous laser treatment and Ohshiro's classification of laser treatment

Abstract

When the laser was first applied in medicine and surgery in the late 1960's and early 1970's, early adopters reported better wound healing and less postoperative pain with laser procedures compared with the same procedure performed with the cold scalpel or with electrothermy, and multiple surgical effects such as incision, vaporization and hemocoagulation could be achieved with the same laser beam. There was thus an added beneficial component which was associated only with laser surgery. This was first recognized as the '?-effect', was then classified by the author as simultaneous laser therapy, but is now more accurately classified by the author as part of the auto-simultaneous aspect of laser treatment. Indeed, with the dramatic increase of the applications of the laser in surgery and medicine over the last 2 decades there has been a parallel increase in the need for a standardized classification of laser treatment. Some classifications have been machine-based, and thus inaccurate because at appropriate parameters, a 'low-power laser' can produce a surgical effect and a 'high power laser', a therapeutic one . A more accurate classification based on the tissue reaction is presented, developed by the author. In addition to this, the author has devised a graphical representation of laser surgical and therapeutic beams whereby the laser type, parameters, penetration depth, and tissue reaction can all be shown in a single illustration, which the author has termed the 'Laser Apple', due to the typical pattern generated when a laser beam is incident on tissue. Laser/tissue reactions fall into three broad groups. If the photoreaction in the tissue is irreversible, then it is classified as high-reactive level laser treatment (HLLT). If some irreversible damage occurs together with reversible photodamage, as in tissue welding, the author refers to this as mid-reactive level laser treatment (MLLT). If the level of reaction in the target tissue is lower than the cells' survival threshold, then this is low reactive-level laser therapy (LLLT). All three of these classifications can occur simultaneously in the one target, and fall under the umbrella of laser treatment (LT). LT is further subdivided into three main types: mono-type LT (Mo-LT, treatment with a single laser system; multi-type LT (Mu-LT, treatment with multiple laser systems); and concomitant LT (Cc-LT), laser treatment in combination, each of which is further subdivided by tissue reaction to give an accurate, treatment-based categorization of laser treatment. When this effect-based classification is combined with and illustrated by the appropriate laser apple pattern, an accurate and simple method of classifying laser/tissue reactions by the reaction, rather than by the laser used to produce the reaction, is achieved. Examples will be given to illustrate the author's new approach to this important concept.