The use of laser technology in obstetrics and gynecology

The Contemporary Ob/Gyn Podcast Series is brought to you by a Candela, a global leader in the aesthetic medical device marketplace. In this podcast, host Scott Kober talks with Dr. Martin Garcia, a board-certified Ob/Gyn based in Jacksonville, Florida. Dr. Garcia discusses his philosophy as an Ob/Gyn, the growing use of energy-based devices in Ob/Gyn practices, and how he has benefitted from the versatility offered by tools like the CO₂RE laser.

Scott: Thank you, and welcome to this podcast. My name is Scott Kober with Contemporary Ob/Gyn and today we’ll be talking about shifting paradigms in the use of energy-based devices in Ob/Gyn practices. 

I'm happy to be joined today by Dr. Martin Garcia, a board-certified Ob/Gyn at North Florida Ob/Gyn in Jacksonville, FL. Dr. Garcia is a speaker and consultant of Candela.

Welcome Dr. Garcia, and thank you for joining me.

Dr. Garcia: Thank you for having me.

Scott: Dr. Garcia, you have frequently been on the cutting edge of advancement in surgical procedures for the treatment of issues such as vaginal prolapse and are professionally certified to perform robotic surgery. Why did you develop these interests, and how have they helped to shape your practice?

Dr. Garcia: I’ve always had an interest in staying on top of advances in surgical procedures. It all started early in my career with ultrasound, when I recognized that the images we were getting weren’t as good as they could have been. Since then, I have always pushed to have the most updated ultrasound machine with the best resolution.

It then continued when I tried to better address my patients who were having bleeding problems and related issues. I served on an advisory board to help develop the first hydrothermal ablation machine that gave Ob/Gyns a noninvasive way of controlling patients’ bleeding without requiring a hysterectomy.

Scott: How would you describe your overall practice philosophy?

Dr. Garcia: My philosophy is to always be on the cutting edge in offering total women’s health solutions. That was shaped way back in my residency, when I learned under Dr. Charles Flowers. He was the president of the American College of Obstetrics and Gynecology at the time and had recently written an influential book entitled, The Female Patient. Dr. Flowers taught all his residents that we should be advocates for comprehensive women’s health care, that we needed to treat the entire female patient holistically, whether it was emotional needs, sexual counseling, help with stress urinary incontinence, trying to make them heart healthy, making sure that their cholesterol levels were OK, and so on. I took teachings to heart and have always practiced with the mindset of trying to care for the entire patient and not just dealing with her gynecological issues.

Scott: When did you begin using energy-based devices such as laser into your practice?

Dr. Garcia: My use of laser started back with laser hair removal. I started having patients asking me about the procedure, so I looked into it and decided it made sense for our practice. I eventually expanded to include ultrasound-energy devices for body sculpting and facial wrinkles. More recently, we have added services using lasers specifically for gynecologic indications.

Scott: When did you begin to use energy-based devices to treat gynecologic-related indications?

Dr. Garcia: I was part of the original IRB study for a radiofrequency device. The initial device indications were for the treatment of vaginal laxity; consequently, majority of patients we saw were younger women who had given birth to 1 or more children and had perhaps developed stress incontinence and urinary urgency in addition to vaginal laxity.

Not long after that, I was among the investigators for the initial IRB study when the CO₂RE laser was being developed. The study also focused on gynecology related indications. Once that trial was over, I’ve continued to use the CO₂RE laser in my everyday practice.

Scott: What gynecologic conditions do you currently treat with the CO₂RE laser?

Dr. Garcia: I current use the CO₂RE laser for the treatment of condyloma acuminate, cervical intraepithelial neoplasia, and removal of both pre-cancerous and benign vulvar lesions. I’ve also used it to treat lichen sclerosus.

Scott: What have you found to be the pros and cons of the CO₂RE laser in treating gynecologic issues? 

Dr. Garcia: The CO₂RE laser is versatile since it coagulates at the same time as it vaporizes tissues, so there is minimal bleeding involved. With the introduction of the surgical handpiece, the device has become easier to use externally on the vulva as well as internally. You no longer have the bulk of the colposcope to maneuver. It’s like having a pen in your hand, which allows you to more accurately target the lesion you are trying to treat. I also found it beneficial in using this laser to safely treat breast cancer survivors who are on aromatase inhibitors.

Scott: What message would you offer to your colleagues who are perhaps skeptical about the incorporation of energy-based devices into your practice? 

Dr. Garcia: One of the major advantages of the laser is that it allows you to perform procedures in your office that would otherwise require use of an OR. It is also extremely versatile technology that can be used not only to treat vulvar lesions and similar removals but also to treat scarring from previous surgical procedures. In my experience, there is also better healing and less pain postoperatively with the laser vs. traditional surgery with cautery and a scalpel. 

Scott: Terrific. I think this has been a valuable discussion regarding the potential adoption of laser technology in Ob/Gyn practices to offer additional value to their patients.