Transcanalicular Laser-Assisted Dacryocystorhinostomy

Advances in endoscopic and fiberoptic technology have led to the development of innovative, minimally invasive approaches for lacrimal surgery. Lacrimal endoscopy, endocanalicular drilling, trephination, electrocauterization, and endocanalicular laser-assisted dacryocystorhinostomy (ELADCR) are techniques being used to treat nasolacrimal duct obstruction. In the endocanalicular laser-assisted DCR, a laser fiberoptic probe (Fig. 40.1) is inserted in the punctum and advanced along the canaliculus to the nasolacrimal sac. Once in the sac, the laser is used to make the osteotomy between the sac and middle meatus. Advantages of the ELADCR approach include avoidance of an external scar, improved hemostasis, limited intranasal instrumentation and tissue dissection, decreased operative time, and presumably faster recovery. A variety of lasers have been used in this method, including the argon laser, the holmium (HO):YAG laser, the potassium titanyl phosphate (KTP):YAG laser, the neodymium (Nd):YAG laser, the erbium (Er):YAG laser, and more recently, the diode laser. The diode laser, with a 600-micron fiberoptic probe, is a portable, semiconductor contact laser of 810 nm wavelength that achieves efficient tissue dissection and instant vaporization. The laser coagulates blood vessels with minimal damage to adjacent structures, giving surgeons an alternative method for DCR surgery.