Revolutionizing Surgery

Working from UC Irvine’s Beckman Laser Institute and Medical Center (BLIMC), Dr. J. Stuart Nelson hopes to transform the way lasers are used in surgery with his contribution to the center’s Dynamic Cooling Device (DCD).

Nelson is interested in removing port-wine stain birthmarks from young infants using laser technologies that destroy the abnormal blood vessels beneath the skin that caused the birthmarks, without injuring the superficial layer of  skin.

Typically, surgical lasers use yellow light, which has a high wavelength, to heat up the blood vessels very quickly and destroy them. Unfortunately, this same light is absorbed by the skin pigment, known as melanin, on the skin’s surface layer and injure it as well. In essence, it replaces one mark with another.

The BLIMC creates a unique environment that brings together researchers from a variety of disciplines, including engineers, physicists, doctors and biologists, to address various contemporary surgical and medical issues. Dr. Nelson was able to put a team together and work with them to find a solution.

“It wouldn’t have happened if we didn’t have this environment, with a concentration of doctors and basic scientists that get together to solve a problem,” said Michael W. Berns, Ph.D., the founder, president and CEO of the BLIMC.

Dr. Nelson, and his BLIMC colleagues, postdoctoral researcher Thomas Milner and visiting Norwegian engineer Lars Svaasand, tried applying ice cubes, chilled air, cold water and even cooled plates to the skin surface in order to cool it. These techniques not only cooled the surface of the skin, but also constricted the blood vessels underneath, defeating the intrinsic purpose of the procedure.

“What we had to develop, was to get something onto the skin surface, in perfect thermal contact, very quickly and then get it off of the skin surface so that you only cooled that superficial layer of the skin, the melanin,” explained Dr. Nelson.

A breakthrough finally came in 1992 while Dr. Nelson was watching a baseball game. Observing trainers spraying ethyl chloride on injured players inspired Dr. Nelson to invent the Dynamic Cooling Device. Within weeks, his team had a prototype ready and was testing it on their own arms to see if it worked.

“We have the scars to prove it,” Dr. Nelson stated as he lifted his sleeve and revealed a number of white spots. “Where we did the sights without the cooling, we got burned.”

Because the cryogen spray cooling device uses liquid with a low boiling point, it quickly cools and then evaporates off the skin surface so that the lasers can destroy the targeted subsurface blood vessels without injuring the superficial layer of the skin. In other words, the skin surface is cooled, and thus protected long enough to allow the subsurface blood vessels to be destroyed by the high frequency laser. And all this happens within a fraction of a second!

“It’s actually a very simple idea, which is why I think it works so well. It’s an easy idea, it’s simple to incorporate, and it works,” stated Dr. Nelson.

Solving his initial problem, the DCD now allows the cooling liquid and laser to work side by side. Incorporating this technique into their laser devices, laser manufacturers allow for a spray timer to be set so that the amount of spray per second can be adjusted.  For those with more melanin, or darker skin types, more spray is used, while less is needed for those with lighter skin types. Catering to the needs of each patient, this device has transformed the way lasers have been used since.

Soon after their breakthrough, Dr. Nelson and his team quickly realized the potential of their device for many other laser applications. Patented in September of 1998, the Dynamic Cooling Device is now used for hair removal, removal of scars, treatment of acne, skin photo-rejuvenation and wrinkle removal.

Generating over $40 million in royalties to UCI, the DCD was among the 10 top-earning inventions in the entire UC system in 2001 and 2010, and it ranked second and third in 2005 and 2006, respectively. With the 16 percent that it receives, the BLIMC has not only been able to fund new research projects with this sum but has also earned a name for itself in the intellectual community.

“Patients come here from all over to get birthmarks treated with the laser and the dynamic cooling system that Dr. Nelson developed,” stated Berns..

Thanks to the DCD, laser procedures are now more efficient, less painful and safer for patients, according to Dr. Nelson.

Because of this device, children like Tiffany Chancheya, who had a port-wine stain that covered almost half of her face and affected her vision, are able to grow up without carrying around unwanted and disfiguring birthmarks. After only eight treatments, Tiffany’s birthmark was completely removed, allowing her to move past her disfiguration.