by
Sean Ruck, Contributing Editor | March 28, 2014
From the March 2014 issue of HealthCare Business News magazine
However, Wong cautions that not all greenlights are created equal and the learning curve is relative — greenlight isn’t easy to learn, it’s just easier to learn than holmium. “People overestimate the ease of use,” he says. “People who are not so proficient won’t have optimal results,” he says.
Another drawback is the cost per procedure. The holmium laser is an end-fire laser with the tip of the fiber is burned away as it’s used, allowing the possibility for it to be used for more than one procedure (with proper sterilization). The greenlight is a side-firing laser, so it’s created as a single-use fiber.
Greenlight fibers cost an average of anywhere from $800 to $1,300 per fiber.
Manufacturers saw that cost as an opportunity. If they were able to develop a fiber that could be sterilized after a procedure and used again, it could attract customers holding onto TURP or could bring over greenlight users . . . enter the Thulium:YAG laser. “The wavelength is similar to that of the holmium laser,” says Wong. “The claim, but with limited data, is that it will vaporize prostate tissue. It’s somewhere between greenlight and holmium with a reusable fiber.”
The laser is manufactured by the Italian company, Quanta System. Wong is keeping an eye on data as it becomes available, but for now he still believes greenlight is his best option. For other disciplines utilizing lasers for surgery the choice isn’t as clear.
“We have only recently started to see requests for pricing information on thulium lasers which indicates providers are starting to take an interest,” says Katie Regan, clinical publishing analyst at MD Buyline.
The rising interest around thulium laser systems may also be the reason greenlight laser prices are falling, says Regan. “A thulium laser comes in around $140,000, not including the fibers which range from $350 to $620.”
Neurosurgery’s reawakening
The history of laser use for neurosurgery runs a parallel course to urology’s. Initial forays into the field in the ‘80s didn’t provide results that would support adoption of the technology for spinal surgery.
“Compared to options already in use, the financial investment as well as the time investment for education didn’t make it a valid option,” says Dr. Raymond Lanzafame, CME director for the American Society for Laser Medicine and Surgery.
In 1986, doctors Daniel Choy and Peter Wolf Ascher pioneered a method of treating herniated discs using lasers. The method, percutaneous laser disc decompression, works by using imaging equipment to insert and guide a laser probe into the lumbar or cervical disc that needs treatment. The laser then ablates a portion of the annulis, or center-portion of the disc. “The mechanics of it is that the removal of a small volume of material actually relieves a huge amount of pressure, eliminating the bulging of the disc,” says Lanzafame.
