This document outlines laser safety protocols and procedures. It discusses primary tissue sites at risk of laser damage, appropriate laser eye protection, smoke evacuation procedures, training requirements for laser operators, restricting laser access, and taking precautions to protect patient eyes. References on laser safety standards and efficacy of laser lithotripsy in ureteroscopy are also provided.

1.  Under supervision of Dr Hussein abd Eldayem
 Alaa Hatem
 MD candidate

6.  Primary sites may be
• Eye
• Skin
 Laser beam damage may be
• Thermal
• Acoustic
• photochemical

7. 1. Plume and noxious fumes must be evacuated
through the filter device/smoke evacuation system that
is used according to manufacturers written instructions.
2. High-filtration surgical masks for laser use must be
worn during procedures that produce
plume.

8.  1. Laser-safe eye protection with appropriate wavelength
and optical density must be worn by all health care workers
in the room.
 2. Patients’ eyes must be protected by either moistened
eye pads (CO2 laser), or by goggles specific to laser
wavelength.
 3. Appropriate laser-protective eyewear should be available
near the posted warning sign(s).
 4. All viewing windows in the laser room should provide
adequate protection specific to the laser wavelength.

9.  1. Laser Education Programs should be designed to meet
individuals’ needs and should include operational training,
access to literature and publications, and periodic
continuing education.
 2. Personnel should be required to demonstrate
appropriate skill levels before assuming responsibility for
operating laser equipment.(mode ,setting)
 3. On all procedures that include use of the laser, one
person shall be assigned to function as the laser safety
person. This person may not have any other responsibilities
while the laser is in use.

10.  4. The laser safety operator is responsible for:
 a. laser safety protocol.
 b. performing laser preoperative equipment check
 c. operating the laser control panel
 d. completing the laser documents

11.  5. The laser must be test-fired prior to arrival of the
patient in the Operating Room, as recommended by
the manufacturer.
 6. The laser beam should never be directed at any
person, except when used on the patient.

12.  7. Dull, ebonized, or nonreflective anodized
instruments should be used near the laser site.
 8. The surgeon will assume the responsibility for
selecting mode of operation, wattage and the
appropriate lens for each procedure.

13.  9. To prevent accidental discharge of the laser beam
into tissue to be lased, the operating surgeon should
have only the laser foot pedal to operate. No other
foot pedals should be available to the surgeon.
 10. To prevent accidental discharge of the laser, the
laser will be placed in stand-by when not in
use. (communication)
 11. Access to lasers and keys must be restricted.

14.  1. Only surgeons who have laser privileges granted by
the hospital Credentials Committee are permitted to
perform laser surgery.
 2. A list of physicians who have been granted privileges
must be maintained and available within the
department.

15.  Precautions must be taken to protect patient’s eyes from
inadvertent laser Include protective goggles,glasses, eye
pads and corneal shields.
 Surgical personnel who will be working routinely in a laser
system environment should undergo a health assessment
examination with a focus on ocular performance and
dermatological risks.

17. Primary tissue at risk
of damage
Wavelength range
Cornea or lens (302-315
nm)
180 nm - 400 nm
Ultraviolet
Retina
400 nm - 1.4 µm
Visible Near Infra-red
Cornea or lens (1.4 – 3.0
µm)
1.4 µm - 1 mm
Medium & Far Infra-red

20. This standard pertains to the safe use of lasers and laser
systems that operate at wavelengths
between 180 nm and 1000 µm.

21.  a) LSO
 b) Laser users
 c) Laser operators
 d) Technical support staff
 e) Nurses

22. Conclusion: The results demonstrated that FURS in
combination with holmium laser lithotripsy represented a
favorable less-invasive alternative with high SFR and
acceptable complication rates.

23.  Results: For all 5 ureteroscopes the angle of deflection
was most impaired by a 365 μm laser fiber probe and
least impaired by a 2.2Fr nitinol basket. Among all 5
ureteroscopes irrigation flow rate was most impaired
with a 3.0Fr basket and least impaired with 200 μm
laser fiber.

25. Rationale
• Lasers can offer patients a wonderful range of
treatment options, from standard of care to
experimental innovation.
• It must be remembered that every new system
demands risk assessment and revision of facility
safety policies and procedures.
• continuing professional education and training,
and respect for the technology, can we establish
the foundation for a truly effective laser safety
program.

26.  References: AORN Perioperative Standards and Recommended
Practices 2012.ECRI; CMS REF: S&C -07-11
 ANSI Z136.3-2018. outlines laser classification.
 Safety and Efficacy of Flexible Ureteroscopy in Combination with
Holmium Laser Lithotripsy;Urol Int 2017;98:418-424
 The Journal of Urology Volume 173, Issue 6, June 2005, Pages
2017-2021
 Articles from Laser Therapy are provided here courtesy of Japan
Medical Laser Laboratory
2011;20(2):95106.doi:[10.5978/islsm.20.95PMC3799025