Superficial laser vulvectomy. III. A new surgical technique for appendage-conserving ablation of refractory condylomas and vulvar intraepithelial neoplasia.

Despite the unique properties of the carbon dioxide laser, many surgeons do not know how to exploit the full potential of this sophisticated instrument. Effective laser operation on the vulva depends upon the accuracy of delineation of disease, the use of optimum power densities, and the ability to exercise precise control over depth of ablation. This article describes a surgical technique that capitalizes upon these principles, thereby maximizing the margin between favorable and poor outcomes. Superficial laser vulvectomy is a safe and efficient procedure in the hands of expert physicians, but should not be attempted by those who are less experienced. Indications for this operation and safeguards against surgical misadventure are also discussed.