Background: A noncancerous, fluid-filled ganglion cyst can occur inside or outside the wrist. Many conditions cause wrist pain. Traditional treatment involves intrusive suction and long recovery times following surgical excision, which increase the risk of recurrence. Laser ablation and sclerotherapy are minimally invasive alternatives to surgery. This study tests a new procedure that combines suction with diode laser ablation to improve results and reduce adverse effects. Objective: The primary objective of this study was to evaluate the efficacy, recurrence rate, and safety profile of diode laser ablation combined with aspiration in the treatment of wrist ganglion cysts. The secondary objectives include comparing this method to traditional treatments, such as aspiration alone and surgical excision, and assessing patient recovery and satisfaction postprocedure. Methods: A hundred patients with wrist ganglion cysts were studied in this case series. Patient selection was based on cyst size, location, and symptom severity, while exclusion criteria included prior wrist surgery or associated hand disorders. After local anesthesia with xylocaine, the 18-gauge needle aspirated the cyst contents from each patient. A diode laser fiber was injected into the cyst cavity with the same needle, and laser ablation was performed with suitable power and time. Postprocedure instructions, ice packs, and compression bandages were given to the patient. At follow-up sessions 1, 3, and 6 months after surgery, the doctors checked for issues and recurrence. Results: The original procedure eliminated ganglion cysts in 95% of patients. The same method effectively retreated all five patients who relapsed within three months, ensuring 100% success. Only 3% of patients experienced localized skin irritation or edema, whereas 15% experienced transient pain. Other issues were minor. Nerve damage, infections, and chronic pain did not develop. Most patients are thrived because of the rapid recovery time and lack of scars. Conclusion: This study demonstrated that diode laser ablation combined with aspiration is a promising alternative to traditional ganglion cyst treatments. The procedure is minimally invasive, highly effective, and associated with few complications. These findings suggest that diode laser therapy could be considered a viable first-line treatment for symptomatic ganglion cysts, but further research is needed to confirm its long-term efficacy and broader applicability.
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:
Exclusion criteria:
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.
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