More than 7 years ago, we started a new experience in our gynecologic professional life, influenced by the seminal paper by Stefano Salvatore et al.Citation1. They reported the results of a study clearly demonstrating that a treatment with the microablative carbon dioxide (CO2) laser induced a significant improvement of vaginal health in postmenopausal womenCitation1. Since then, more research and data have been reported on the use of vaginal lasers in gynecology together with an increased use of lasers in clinical practice. However, a variety of different machines are available on the market, all listed (by the manufacturer) to be effective and safe. However, often little or no evidence at all supports the claims and statements in the accompanying leaflets. As clinicians, patient safety is our main concern. All lasers are not created equal, and even the same laser wavelength can induce different tissue interactions, depending on the various technologiesCitation2.
The second-generation, innovative vaginal laser is based on a sophisticated technology using the solid-state erbium in yttrium aluminum-garnet crystal (Er:YAG) laser with a wavelength of 2940 nm, and with the SMOOTH™ technology. This SMOOTH™ technology provides a registered sequence of low fluence and longer-shaped erbium pulses, achieving a controlled, deep thermal effect, without ablation. Therefore, the SMOOTH™ mode pulses allow controlled tissue heating, in a safe ambulatory procedure without ablation and carbonization of the tissues. The innovative techniques used in the vaginal erbium laser (VEL)-SMOOTH® procedures can guarantee not only efficacy, but also an intrinsic safety, since the non-ablative laser beam cannot damage the tissues in depth, preventing the risk of accidental lesions of the urethra, bladder or rectum. The VEL-SMOOTH® technology is currently used for the treatment of mild to moderate stress urinary incontinence and atrophy in the genitourinary syndrome of the menopauseCitation2–6. These two conditions are chronic disorders. In our opinion, VEL-SMOOTH® can be considered ideal for long-term management with repeated treatments, since the laser–tissue interaction does not cause lesions or ablations and thus vaginal scarring. Standardization of the technique and fixed protocols are the basis for the VEL-SMOOTH® intrinsic safety. Nevertheless, the training of operators (a gynecologist or at least a dedicated caregiver), along with patient selection and the long-term monitoring of clinical effects are essential. This is why the Vaginal Erbium Laser Academy (VELA) was born 6 years ago: to form a scientific community of Er:YAG SMOOTH laser users. Thanks to unrestricted grants from the Fotona Company (Ljubljana, Slovenia), we were able to organize five annual meetings to present and discuss our results and our research.
The present Supplement of Climacteric includes a selection of the presentations at the Fifth VELA Meeting held in Florence in November 2019. All the papers were peer-reviewed and acceptances and rejections were meant to provide the best data available, avoiding repetitions and subjects not covering the areas of interest of Climacteric, such as data on chronic candidiasis, esthetic applications, or scar treatments. Therefore, this Supplement is unusual as the Proceedings of a meeting because every paper published has been peer-reviewed, making the published data more solid than the usual Congress Proceedings. We wish to thank all the VELA members and presenters for their contribution to the success of the Fifth VELA Meeting and we are sure that their work will find its deserved publication in other, more suitable journals.
Potential conflict of interest
The authors report no potential conflict of interest.
Source of funding
Nil.
References
- Salvatore S, Nappi RE, Zerbinati N, et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: A pilot study. Climacteric 2014;17:363–9
- Tadir Y, Gaspar A, Lev-Sagie A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: Consensus and controversies. Lasers Surg Med 2017;49:137–59
- Gambacciani M, Cervigni M. Erbium laser in gynecology: Aims, aspirations and action points. Climacteric 2015;18(Suppl 1):2–3
- Gambacciani M, Palacios S. Laser therapy for the restoration of vaginal function. Maturitas 2017;99:10–15
- Gambacciani M, Levancini M, Russo E, Vacca L, Simoncini T, Cervigni M. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause. Climacteric 2018;21:148–52
- Blaganje M, Šćepanović D, Žgur L, Verdenik I, Pajk F, Lukanović A. Non-ablative Er:YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2018;224:153–8