European Journal of Cardiovascular Medicine

Background on Ganglion Cysts

Ganglion cysts are benign lumps or swells surrounding hand or wrist tendons or joints. The wrist is the most common place, but the ankles and feet can also develop them [1]. These cysts contain viscous, sticky jelly like fluid such as synovial fluid around joints and tendons. Round or oval pimples frequently appear as cysts, and their size may be altered. Sometimes they disappear and resurface later [2]. Owing to connective tissue deterioration, ganglion cysts form and fill with synovial fluid. Ganglion cysts are thought to form when synovial fluid escapes from a joint due to a tendon sheath or joint capsule defect, although the exact cause is unknown. This type of defect can arise after trauma or repetitive strain or without a clear cause. Most ganglion cysts are innocuous, but they can impinge on nearby nerves, causing discomfort, mobility restrictions, and other symptoms. Some individuals seek treatment to correct deformities caused by cysts [3]. Numbness, tingling, and weakness are common signs of nerve compression by cysts.

Current Treatment Options

Ganglion cyst therapy depends on cyst size, symptoms, and patient preferences. Open surgery, sclerotherapy, laser ablation, and nonsurgical techniques are common treatments.

The first step in treating asymptomatic ganglion cysts is observation. When the cyst is not painful or bothersome, doctors may recommend "watchful waiting" because many cysts fade away on their own. The best course of treatment involves monitoring the size or symptom changes of the cyst [4]. Aspirating the cyst with a needle is a common nonsurgical method. This involves syringe-removing the cyst's sticky, mucinous fluid. Viscous fluid requires a wide-bore needle, such as an 18-gauge blood transfusion needle, to drain properly [5].

Although quick and easy, aspiration has limits. An estimated 50% of aspirated ganglion cysts return. Aspiration just removes fluid, not the problem—like a broken tendon sheath or joint capsule—which is why this happens again. Ganglionectomy may be considered if other, less intrusive treatments fail or if the cyst is uncomfortable or affects function [6]. The cyst and a tiny section of the joint capsule or tendon sheath are removed to reduce the risk of recurrence. Although less invasive and slower to recover from than aspiration, this approach has a lower recurrence rate. Surgery can cause wound infection, scarring, stiffness, and nerve or blood artery damage. However, cyst recurrence, which is reduced following surgery, is nevertheless possible. Sometimes, the surgical scar hurts as much as the cyst does [7].

A sclerosing chemical, known as scleotherapy, is injected into cysts for noninvasive treatment. This drug induces inflammation, damage to the lining of the cyst, and fibrosis to shrink the cyst. Common sclerosants include ethanol, polidocanol, and sodium tetradecyl sulfate.

Sclerotherapy is becoming more popular as patients seek less intrusive alternatives to surgery [8]. An outpatient treatment with a short recovery time is one of its numerous benefits. Although smaller than aspiration, the recurrence rate might be high. Success rates range from 60% to 90%, depending on the sclerosant and method used [9]. Sclerotherapy and aspiration are among the less invasive techniques being studied. The arthroscopic or endoscopic method for ganglion cyst excision allows surgeons to make smaller incisions and reduce the recovery time. These surgical methods are still developing and scarce compared with standard methods.

Introduction of Diode Laser Therapy

Recently, introduced laser ablation is a minimally invasive treatment for ganglion cysts that avoids surgery or has recurred after aspiration. Diode lasers are intriguing alternatives to conventional lasers because of their pinpoint accuracy and efficacy in treating soft tissues. Lasers heat and destroy cyst linings in cyst cavities [10]. Diode lasers are widely employed because they can penetrate soft tissues with a concentrated beam. This approach reduces and prevents the formation of cysts by coagulating tissue at the location of the cyst.

Rationale for Using Diode Laser Ablation

Diode laser therapy is best because of its controlled and accurate energy and low degree of tissue damage. Instead of being cut through the skin and soft tissues, laser ablation permits access to the cyst with a smaller incision or the same needle used for aspiration. This reduces scarring and surgery recovery time. Laser ablation may be appropriate if the cyst returns after aspiration or sclerotherapy. The likelihood of recurrence is substantially lower than that with aspiration alone when a diode laser is used to coagulate and heal the joint capsule or tendon sheath defect. Since it reduces inflammation and bleeding, the diode laser may appeal to individuals who prefer less invasive procedures.

Review of Existing Literature on Laser Therapy for Ganglion Cysts

Although preliminary trials have shown promising outcomes, laser ganglion cyst treatment research is still lacking. A 2019 Journal of Hand Surgery study reported that diode laser therapy healed ganglion cysts 92% of the time, with a recurrence rate of less than 10%. A 2018 Indian Journal of Orthopedics study reported that diode laser treatment was 88% effective in reducing cyst size and preventing recurrence [11]. Multiple studies have reported the same results when treating ganglion cysts with Nd and CO2 lasers [12,13]. Although further research is needed to develop standards and refine laser settings, diode laser ablation appears to treat ganglion cysts safely and effectively with less invasive treatments. Diode laser therapy is a promising new ganglion cyst treatment. Its minimal invasiveness, high success rate, and low recurrence appeal to patients, especially those with a history of cyst recurrence. As more research examines laser treatment for soft tissue problems, diode laser ablation is expected to become increasingly common

Study Design

In this case series, 100 wrist ganglion cyst patients were treated with aspiration and diode laser ablation. This minimally invasive procedure was chosen because it could reduce recurrence with an outpatient procedure. The study tracked this method's success, recurrence, and issues throughout 6–12 months. Patients with ganglion cyst symptoms met the inclusion and exclusion criteria for the case series. A sterile environment was used, and the outcomes were properly recorded.

Patient selection criteria

Inclusion criteria:

• Patients aged 18–65 years.
• The patient was diagnosed with symptomatic ganglion cysts on the wrist (confirmed by physical examination and, in some cases, ultrasound).
• Patients with pain, discomfort, or limited mobility due to the cyst.
• Those who consented to undergo aspiration and diode laser ablation.

Exclusion criteria:

• Patients with infected or inflamed ganglion cysts.
• Individuals with recurrent cysts previously treated by other means (e.g., surgery or multiple aspirations).
• Pregnant or breastfeeding women.
• Patients with a history of bleeding disorders or those receiving anticoagulation therapy.

Procedure Description

Supine wrist flexion exacerbated the ganglion cyst. After the cyst becomes visible, laser aspiration and treatment are easier.

Figure 1 Flexing the wrist to make the cyst prominent.

Local anesthesia was administered by injecting 1–2 mL of xylocaine (lidocaine) into the cyst's skin after sterilization. This reduced the degree of patient agony during surgery.

Figure 2 Infiltration under local anesthesia.

A large 18-gauge blood transfusion needle was then inserted into the cyst cavity. The cyst's mucinous contents were aspirated to drain the cavity. To introduce the diode laser fiber, suction must shrink the cyst.

Figure 3Insertion of the 18-gauge needle for aspiration.

The cyst cavity received the diode laser fiber through the same needle held in place. Activating the fiber provided precise laser energy to ablate the cyst walls. Considering the size, structure, wall thickness, and contents of the cyst, the diode laser was set at 5–8 watts for 60–90 seconds.

 Figure 4 Insertion of the diode laser fiber.

Laser settings

• Power: 5–8 W
• Duration: 60–90 seconds
• Wavelength: 810–980 nm
•  

Laser radiation dissolves the cyst wall, disintegrating it and reducing the risk of recurrence.

After diode laser treatment, the needle and laser fiber were carefully removed, and an ice pack was applied for 30 s to reduce inflammation and pain during this step. The wrist was wrapped in a compression bandage following the ice pack to prevent fluid reaccumulation. This gently pressed the treated area. After treatment, patients were instructed to keep the bandage on for two or three days, rest their wrists for one week, and keep all follow-up visits.

Follow-up and Monitoring

After surgery, patients were monitored for infection, nerve pain, and cyst recurrence. Follow-up appointments were scheduled after one week, one month, and three months of treatment to assess healing and detect cyst recurrence. During follow-up appointments, patients discussed pain, movement restrictions, and discomfort. Five of the 100 patients experienced cyst recurrence and required the same procedure. Failure occurs if the cysts return within 6–12 months. The five patients who experienced recurrence followed the same treatment strategy and never experienced cyst reformation again.

Patient Demographics

Symptomatic wrist ganglion cysts were found in 100 research participants. The patients' age, sex, and occupation varied. Twenty somethings and thirty somethings dominated the patient population. See the demographic summary table below.

The patients were mostly 26–35 years old, with 55% males. Most wrist ganglion cysts (80%) are dorsal. As 40% of the workforce, manual laborers constitute the largest occupational category due to their repetitive wrist strain. This work pattern suggests a link between wrist ganglion cysts and rigorous exercise.

Success rate

The first aspiration and diode laser ablation operation eliminated 95 of 100 ganglion cysts. The 95% success rate suggests that this combination treatment controls wrist ganglion cysts.

A remarkable 95% of patients had their ganglion cysts completely removed without further treatment. These findings indicate that diode laser ablation and suction reduce the cyst size and prevent early recurrence.

Recurrence rate

Five of the 100 treated individuals developed ganglion cyst recurrence within three months. The same aspiration and diode laser ablation methods were used for all the treatments. After retreatment, all five patients whose cysts were cleared achieved 100% success.

The initial recurrence rate for minimally invasive methods such as aspiration and laser ablation is 5%. However, diode laser ablation removed the cysts when repeated, confirming its efficacy. The second treatment appeared to resolve any cystic tissue remaining from the first treatment.

Complications

Diode laser ablation has few side effects in most cases. The most common negative effect was slight injection site discomfort in 15% of the participants. Edema or localized skin irritation near the treatment site occurred in three people (3%), although cautious treatment with cold packs and anti-inflammatory drugs resolved it. No one became sick, experienced nerve damage or chronic pain, or needed to see the doctor again.

This operation had few consequences, mostly slight soreness. This pain was well managed postop. Diode laser ablation does not cause infection or nerve damage, making it a safe, minimally invasive ganglion cyst treatment. Patients seeking a low-risk alternative to surgery may prefer this therapy because it is localized and causes minimal tissue damage, which may explain its low complication rate.

Figure 5 Postlaser ice pack application.

Comparison with traditional treatments

The latest ganglion cyst therapies include surgery, sclerotherapy, and lasers. Another common choice is aspiration. Traditional aspiration alone is less invasive. However, research reports 40%–70% recurrence rates. This is because aspiration cannot reach the cyst wall or stalk, which releases fluid. Surgical excision has a lower recurrence incidence (10–20%) but is more invasive, takes longer to recuperate, and can cause infection, scarring, and nerve damage. Surgery is an effective but not necessarily ideal treatment. Some patients prefer noninvasive, low-downtime techniques. Diode laser ablation is a promising alternative. According to this study, diode laser ablation and cyst aspiration can achieve surgical excision results without surgery. With five recurrences successfully treated, our 100-patient case series had a 95% success rate. This method reduces recurrence rates and speeds recovery, making it a good option for aspiration alone for outpatient therapy with minimal disruption.

Role of a Diode Laser in Ganglion Treatment

Ganglion cyst therapy using diode lasers is an example of how technology can improve patient results. Diode laser ablation uses photothermal effects. The cyst shrinks and collapses once the laser fiber enters the cyst cavity, heats and coagulates the cyst wall. Since fibrosis is produced, recurrence and fluid reaccumulation are less likely [14]. Diode lasers penetrate tissue precisely, reducing the danger of nerve injury and adjacent structural damage. A major benefit of diode laser treatment is its noninvasiveness. The laser method requires only a needle puncture and less downtime than does open surgical excision, which requires incisions and longer recovery. Most patients in this study had mild postoperative pain that could be treated conservatively. The procedure is safe because it does not cause nerve damage or infection. Owing to the laser's ability to seal the cyst wall during ablation, recurrence rates may be lower than those associated with suction alone. The aesthetic outcome is another benefit of laser ablation. Despite its effectiveness, surgical excision often causes scarring, especially on the wrist. For many patients, scarring is a major issue; however, laser treatment greatly reduces this risk.

Role of Sclerotherapy

Noninvasive sclerosing agent injections into ganglion cysts produce inflammation, fibrosis, and cyst shrinkage. Common sclerosants include polidocanol, ethanol, and tetradecyl sulfate. Sclerotherapy has 60%–90% success rates; however, recurrence can reach 30%. Several precise sclerotherapy sessions (typically with an ultrasound aid) may be needed to resolve this issue. Sclerotherapy is nonsurgical and similar to diode laser ablation; however, it differs significantly [15]. Lasers ablate cyst walls and produce controlled fibrosis for greater precision. Additionally, diode laser treatment normally requires only one session, but sclerotherapy may require repeated injections. Sclerotherapy may cause skin irritation and injection-site inflammation, which some people may not tolerate. Both procedures can treat ganglion cysts, but diode laser ablation provides better cosmetic results, fewer recurrences, and patient comfort. If laser equipment is unavailable, sclerotherapy can still be performed.

Strengths and Limitations of the Study

Using both suction and diode laser ablation together is a new way to treat ganglion cysts, as shown in this study. The fact that this minimally invasive method works 95% of the time and causes few problems shows that it works. The large sample size of 100 patients in this study is its main strength; it allows researchers to determine how well and safely the process works. The long follow-up time also helps determine how often the problems come back and how long the treatment effects last. However, there are some problems that need to be solved. The first problem is that this study focused on only one center, so the results might not be applicable to all people. A study with more than one center would provide more varied data and improve the study's external validity. Second, it is difficult to directly compare how well diode laser ablation works with other treatment methods because there is no control group of people who are only treated with aspiration or surgical excision. The use of a randomized controlled trial design would help solve this problem in future studies. In addition, even though the success rate was high, the fact that five patients had cysts returned shows that we need to learn more about what causes cysts to come back and how long laser ablation lasts. While this study only followed up with people for a few months, it did not look at longer-term effects such as cysts returning after a few years. In the future, researchers should try to extend the follow-up period to learn more about how well diode laser ablation works in the long run.

Suggestions for Future Research

Other studies should work on fixing the problems listed above because this approach has good results. We need larger, multicenter studies with control groups that do aspiration alone, sclerotherapy, or surgical excision to ensure that the results are correct and to determine how well diode laser ablation works compared with other common methods. It would be easier to draw firmer conclusions about the relative benefits and risks of each treatment method if more randomized controlled studies (RCTs) were included. More studies should also explore how to improve the laser parameters, such as the power settings and ablation duration, so that they are more effective and less likely to occur again. Studies could also look into things that are unique to each patient, such as the size, location, and age of the cyst, that might affect how well or how poorly laser ablation works. Finally, future research could explore whether diode laser ablation is more cost-effective than other treatments are. The equipment for laser therapy may increase the initial costs, but the fact that it may be able to stop recurrences and eliminate the need for multiple treatments may save money in the long run. In conclusion, this study strongly supports the use of diode laser ablation to treat ganglion cysts, highlighting its high success rate, low risk of problems, and benefits over other methods. However, more studies are needed to ensure that these results are true and to improve the method so that it can be used in more clinical settings.

For ganglion cysts, diode laser ablation is better and less invasive than surgery or suction alone. This study included 100 patients and had a 95% success rate. Only 5% of the 100 patients were treated again, and all of them were treated successfully. When aspiration and diode laser ablation are used together, the recovery time, problems after surgery, and chance of recurrence are decreased. Because there are no large cuts or long recovery times, minimally invasive surgery has better cosmetic benefits and fewer side effects. Cyst wall targeting with diode laser ablation helps the wall fall apart and stops the cyst from forming again. This cuts down on fluid buildup, which can occur with aspiration treatment. Patients are safer with the diode laser than with more invasive surgeries because it hurts tissues less. This surgery is safe and successful because it does not cause any major problems, such as infections or nerve damage. Since the study only looked at one center and did not have a control group, it could only compare one type of therapy to another. The short time between follow-ups makes me wonder how well the treatment will work in the long run. To prove that diode laser ablation works and determine how it works against other common treatments, randomized controlled studies with larger patient groups and investigations that involve more than one center are needed. Finally, ganglion cysts can be cured with diode laser ablation and suction. This method works well, has few side effects, and makes patients happy. While this study lays the groundwork for the use of this approach in clinical settings, more research is needed to confirm its long-term benefits and find ways to improve procedures and outcomes.

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