The Er:YAG endoscopic delivery system described is a clinically viable and cost-effective device for a range of hard and soft tissue wet field applications accessible through rigid or semi-rigid endoscopes. Further improvements in the waveguide may allow access also through fully flexible endoscopes.

New advances in instrumentation have facilitated the development of a second generation carbon dioxide (CO2) laser microspot micromanipulator. The 710 Acuspot has unique advantages over the previous generation of microspots. The compact design is easier to handle and has attachment points for sterile draping. The unit produces a spot size of 250 microns at a 400-mm focal length and 160 microns at 250 mm; the maximum de-focus is 3.2 mm at all focal lengths. An innovative dichroic mirror allows use of the laser unit's own HeNe laser as the aiming beam, eliminating possible aiming error introduced with a virtual image-aiming system. The dichroic mirror also allows better light transmission, resulting in a brighter field of view. As with first generation microspots, the laser beam path is coincident with the microscope optical path, eliminating parallax; this feature has been especially advantageous in pediatric and otologic cases. Having used this unit for 6 months on more than 50 patients, we now consider the use of a microspot to be our delivery system of choice for most microlaryngeal laser surgical applications.

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Endoscopic laser surgery is becoming more common with the development of suitable instruments. A hysteroscope designed for use with a Sharplan CO2 laser is described in detail. The method of application, results of preliminary experience, and possible indications are discussed.