KLS Martin group MCO25plus User manual

CO2Laser System MCO25plus
Operating Instructions and Technical Description

MCO25plus Operating Instructions
2 V 4.1
Table of Contents
1Product Liability and Warranty ......................................................6
2Safety Instructions......................................................................7
2.1General Provisions ...............................................................................7
2.2Laser Safety........................................................................................9
2.3Explosion and Fire Hazards..................................................................10
2.4Protecting the Patient.........................................................................11
2.5Treatment Room Requirements............................................................11
2.6Safety Requirements for the Laser Unit and its Accessories......................11
2.7Pilot Laser Safety Instructions .............................................................12
2.8Laser Smoke.....................................................................................12
2.9Laser Safety Officer............................................................................13
2.10Treating Surgeon...............................................................................13
2.11Electrical Safety.................................................................................13
2.12Grounding the Unit ............................................................................14
2.13High-Voltage Danger..........................................................................14
2.14Fuses...............................................................................................14
2.15Safety Devices ..................................................................................14
2.16Rating Plate and Warning & Information Labels......................................16
2.17Nominal Ocular Hazard Distances (NOHD).............................................18
3Description of the Unit...............................................................19
3.1Some General Remarks on the Laser Principle........................................19
3.2The CO2Laser ...................................................................................19
3.3Range of Application ..........................................................................20
3.4General Description of the System .......................................................21
3.5System Design Options.......................................................................21
4Installation ..............................................................................23
4.1Unpacking the Unit & User’s Inspection.................................................23
4.2Laser Location...................................................................................23
4.3Laser Operation Notices......................................................................23
4.4Rear Side of the Unit (with Connections)...............................................24
4.4.1Rating Plate (Nameplate) .............................................................................. 24
4.4.2Footswitch Connection .................................................................................. 24
4.4.3Mains Connection......................................................................................... 24
4.4.4Cable Holder................................................................................................ 24
4.4.5OR Door Interlock ........................................................................................ 25
4.4.6Equipotential Bonding Pin.............................................................................. 25
4.4.7Fuses Located in Mains Filter.......................................................................... 25

MCO25plus Operating Instructions
V 4.1 3
4.5Connecting the Articulated Mirror Arm ..................................................25
4.5.1Preparing the Laser Unit................................................................................ 26
4.5.2Unpacking the Articulated Mirror Arm.............................................................. 27
4.5.3Mounting the Articulated Mirror Arm ............................................................... 28
4.5.4Securing the Articulated Mirror Arm ................................................................ 29
4.6Application Handpiece ........................................................................29
4.7Switching on the Unit .........................................................................30
4.8Adjusting the LCD Contrast .................................................................30
4.9Basic Setting.....................................................................................30
4.9.1Time Mode .................................................................................................. 30
4.9.2Frequency Mode........................................................................................... 31
4.9.3Operating Mode Selection.............................................................................. 31
4.10Language Options..............................................................................31
4.10.1Selecting a Language.................................................................................... 31
4.11Functional Checks..............................................................................31
4.11.1Checking the Optical System (Visual Inspection)............................................... 32
4.11.2Testing the Optical System............................................................................ 32
4.11.3Testing the Irrigation Air Output..................................................................... 32
4.12Handing Over the Unit to the User........................................................33
5Controls, Indicators & Display.....................................................34
5.1Starting the Unit................................................................................34
5.2Button Explanations ...........................................................................35
5.3Control Panel (Time Mode)..................................................................36
5.4Control Panel (Frequency Mode) ..........................................................37
5.5Control Button Explanation..................................................................38
5.6Function Key Explanation....................................................................39
5.7Display Content Explanation................................................................41
5.8Switching off the Laser Unit.................................................................43
5.8.1Upper Parking Position.................................................................................. 44
5.8.2Lower Parking Position.................................................................................. 45
5.9Emergency Shutdown.........................................................................47
5.10Relocating the Unit ............................................................................47
6Operating the Unit ....................................................................48
6.1Setting the Laser System Parameters ...................................................48
6.2Continuous-Wave Mode ......................................................................48
6.2.1Parameters in Continuous-Wave (CW) Mode .................................................... 48
6.3Single-Pulse Mode..............................................................................48
6.3.1Parameters in Single-Pulse Mode.................................................................... 49
6.4Pulse-Train Mode...............................................................................49
6.4.1Parameters in Pulse-Train Mode ..................................................................... 49
6.5Superpulse Mode ...............................................................................50

MCO25plus Operating Instructions
4 V 4.1
6.5.1Parameters in Superpulse Mode ..................................................................... 51
6.6Scanner Operation* ...........................................................................51
6.6.1Mounting the Scanner................................................................................... 51
6.6.2Articulated Mirror Arm for Scanner Operation................................................... 54
6.6.3Display....................................................................................................... 55
6.6.4Scanner Operating Modes (C1…C4)................................................................. 56
6.6.5Line Scan (C5)............................................................................................. 56
6.6.6Parameters in Scanner Mode.......................................................................... 58
6.6.7Permanent Scanning..................................................................................... 64
6.7Memory Functions..............................................................................65
6.7.1Storing and Accessing Parameters .................................................................. 65
6.8Pilot Laser ........................................................................................69
6.8.1Switching off the Pilot Laser........................................................................... 69
6.9Performing the Laser Treatment...........................................................69
7Accessories..............................................................................71
7.1General Accessories ...........................................................................71
7.2Protective Goggles.............................................................................72
7.3Micromanipulators .............................................................................72
7.4Scanner............................................................................................73
7.5Special Accessories ............................................................................73
8Maintenance.............................................................................74
8.1Routine Maintenance Work..................................................................74
8.1.1Cleaning the Unit ......................................................................................... 75
8.1.2Cleaning the Focusing Handpieces .................................................................. 75
8.1.3Cleaning the Scanner Handpieces................................................................... 76
8.1.4Cleaning the Backstops and Angled Tips .......................................................... 77
8.1.5Cleaning the ENT Set Components.................................................................. 78
8.1.6Coded Accessories........................................................................................ 79
8.2Maintenance Work to Be Performed by Gebrüder Martin’s Technical Service80
8.3Safety Checks ...................................................................................80
9Troubleshooting........................................................................83
9.1Error Indication on the Display ............................................................83
9.2Error Messages and Measures to Be Taken ............................................83
9.2.1Interlock Error............................................................................................. 83
9.2.2Please Connect Scanner................................................................................ 83
9.2.3Temperature Error........................................................................................ 83
9.2.4Water Flow Error.......................................................................................... 83
9.2.5“Confirm”.................................................................................................... 84
9.3Other Messages.................................................................................85
9.4Error Symptoms Without LCD Messages................................................85

MCO25plus Operating Instructions
V 4.1 5
10Quick Reference Guide...............................................................86
10.1Preparatory Measures/Checks..............................................................86
10.2Switching on the Unit .........................................................................86
10.3Setting Parameters ............................................................................87
10.4Performing the Therapy......................................................................87
10.5Switching off the Unit.........................................................................87
11Technical Specifications .............................................................88
12Test Certificates........................................................................90

MCO25plus Operating Instructions
6 V 4.1
1Product Liability and Warranty
Gebrüder Martin will accept no responsibility for the safety, reliability and proper functioning of
the unit unless:
•all readjustments, modifications or repairs that become necessary are carried out by
persons authorized to perform such work,
•all electrical installations of the treatment room comply with the relevant IEC regulations in
force at the time,
•the unit is used in accordance with the Operating Instructions supplied with the product.
Any modification or repair work performed by persons not specially authorized by the
manufacturer to carry out such tasks shall void the warranty.
The user is strictly required to observe all operating instructions provided herein.
Consequently, the manufacturer will assume no liability – whether within or after the warranty
period – for any damage caused by improper handling of the unit, the articulated arm or the
accessories.
Therefore, be sure to read and understand these Operating Instructions before putting the unit
into service.
Our Standard Terms and Conditions of Sale effective at the time shall apply.
Notice:
This system is subject to a 24-month warranty except for the laser tube, which is
warranted for 2,000 operating hours or 24 months at a maximum.

MCO25plus Operating Instructions
V 4.1 7
2Safety Instructions
The following provisions and recommendations are based on:
DIN EN 60825-1 (2003-10) Safety of laser products – Part 1: Equipment classification,
requirements and user’s guide
DIN EN 60601-1 (1996-03) Medical electrical equipment – Part 1: General requirements
for safety
DIN EN 60601-1-2 (2002-10) Medical electrical equipment – Part 1–2: Electromagnetic
compatibility; Requirements and tests
DIN EN 60601-1-4 (2001-04) Medical electrical equipment – Part 1–4: Programmable
electrical medical systems
DIN EN 60601-2-22 Medical electrical equipment – Part 2–22: Particular
requirements for the safety of diagnostic and therapeutic
laser equipment
BGI 832 “Betrieb von Lasereinrichtungen (Anwendung der
Unfallverhütungsvorschrift ‘Laserstrahlung’” (BGV B2))
(Regulations for the prevention of accidents – laser
radiation)
MDA (MPG) German Medical Devices Act (see Medical Devices Directive
/MDD)
In addition to the above, all relevant local provisions and regulations – which may provide
otherwise – must be observed as well!
2.1 General Provisions
Installation and initial start-up of the unit must be carried out by qualified persons who have
been specially trained and authorized by Gebrüder Martin to perform such work.
Please use the unit only after the following steps have been performed:
•Handing over of the unit in perfect working order plus user training/instruction (to be
provided by Gebrüder Martin or an authorized agent);
•acceptance of the unit by the purchasing department;
Important notice!
All persons involved in the operation of this unit must be fully familiar with these
Operating Instructions. Note that improper handling (i.e. any action not in
compliance with the instructions given in this manual) may lead to injuries
and/or equipment damage.
Improper handling as well as modifications or repairs performed by non-
authorized persons shall void the manufacturer’s warranty!

MCO25plus Operating Instructions
8 V 4.1
•formal appointment of a Laser Safety officer by the owner/operator of the unit (in acc. with
§ 6 BGV B2 (Germany) or equivalent local regulations concerning the prevention of
accidents);
•appointment of a person who is responsible for the unit; providing user instruction to that
person as well as to other potential operators of the unit;
•setting up a logbook for the medical device;
•registration of the unit with the respective employers’ liability insurance association and the
official body responsible for labor safety matters (if applicable);
•carrying out all safety measures;
•making sure that all operational procedures, as well as measures to be taken in case of
trouble/failure, are fully understood.
When using the unit in medical practice, all relevant regulations for the prevention of accidents
must be strictly observed. Such medical use includes all diagnostic, surgical or therapeutic
applications involving laser radiation (in the broadest sense). The owner/operator of the unit
and the Safety officers (e.g. the Laser Safety officer) are responsible for the proper
performance of all required safety measures, thus ensuring that the use of the laser will pose
no danger to the patient, the treating physician or any other person present during laser
operation.
Moreover, the following supplementary provisions should be observed:
•The MCO25plus may be operated only by qualified and duly authorized personnel. These
persons must be fully familiar with the laser system and have a complete understanding of
all safety measures required. The names of these authorized persons must be recorded in
the medical device logbook.
•Operating staff training should be repeated on an annual basis (refresher courses); all
participants in such training should confirm their participation in writing.
•Whenever the unit is not in operation, it must be protected against unauthorized use (e.g.
by locking it and keeping the key in a safe place).
•The unit must be operated and serviced in accordance with these Operating Instructions;
this also applies to the regular safety checks that are required.
The MCO25plus is a Class IIb unit (acc. to the MDD),
classifies as a Class IV laser (acc. to DIN EN 60825-1)
and carries the CE-mark in acc. with Directive 93/42/EEC.
We recommend the owner/operator of the unit to maintain the following documents and keep
them accessible at any time:
•medical device logbook or equipment ID card
•Operating Instructions

MCO25plus Operating Instructions
V 4.1 9
Accidents involving personal injuries must be reported to the appropriate authority without
delay.
2.2 Laser Safety
This unit is a Class IV laser, which means that both the laser beam as such and the diffuse
laser light reflected from surfaces may be harmful.
The laser area is defined as the area in which the maximum permissible exposure (MPE) values
that are normally binding may be exceeded. This includes any accidental deflections of the
laser beam. All doors providing access to the laser area must be marked with warning lamps.
Therefore, the following safety measures must be strictly observed:
•Any person present in the laser area while the laser is being used must be aware of the
dangers posed by laser radiation and must wear protective goggles. The patient’s eyes
must be adequately protected as well.
•The owner/operator of the unit is responsible for providing suitable protective equipment.
•The organ most endangered by laser radiation is the human eye. Therefore, all persons
present in the laser area must wear protective goggles (rated 10,600 nm L4 or higher)
whenever the unit is switched from “standby” to “laser ready” mode.
•Never stare directly into the red pilot laser light! Please note that the protective goggles
just mentioned do not protect against the red pilot laser radiation!
•When performing open surgery, the entire operating room is considered the laser area.
•Never keep potentially explosive substances in the laser area, as easily flammable
materials could catch fire!
•If laser radiation is applied to organs, body cavities or tubular structures in which easily
flammable gases or vapors may be present, protective measures must be taken to
eliminate any fire and explosion hazards.
•Objects capable of reflecting the CO2radiation must either be covered or removed
altogether from the laser area. Windows and reflecting walls should also be covered with
suitable materials. Moreover, adequate protective measures must be taken if harmful
gases, dust, smoke or secondary radiation could be generated, or if potentially explosive
gas mixtures could be formed, as a result of the impact of laser radiation on certain
substances or materials.
•Instruments that need to be brought into the beam path in the course of the treatment
must have such a shape and finish that dangerous reflections are largely excluded.
The unit emits radiation in the non-visible spectral range of 10,600 nm. Such
radiation can cause irreversible damage to the eyes, skin and other organs!
Use protective goggles – D 10,600 nm L4 – in accordance with DIN EN 207
requirements!

MCO25plus Operating Instructions
10 V 4.1
•The laser area should always be kept as small as possible and should be screened off,
making sure that this area cannot be accessed by unauthorized persons. The number of
people present in the laser area should always be kept to a minimum.
•At least once a year, all persons working in the laser area must be informed about
pertinent safety requirements and measures to be taken, and must be instructed in using
the device. Such training must be recorded, including a list of all participants.
2.3 Explosion and Fire Hazards
Class IV laser systems (DIN EN 60825-1) represent a potential ignition source. When laser
radiation is absorbed, the laser energy is transformed into heat. This increases the reactivity of
the irradiated material. When working with the MCO25plus, the user therefore is required to
observe the following measures in order to prevent laser-induced fires and explosions:
•Materials that have a high ignition potential (such as flammable liquids of all danger
classes) should never be used either during or prior to the laser treatment.
•Highly flammable or oxidizing (fire-stimulating) gases – such as oxygen and nitrous oxide –
may be used for endolaryngeal operations only in conjunction with special safety measures
(use of a laser-proof tube) in order to prevent laser-induced tube ignition.
•Be very careful when using easily flammable materials (such as pads, compresses, etc.) in
the operating area. In specific,
•never bring the laser beam in direct contact with flammable objects;
•always use the pilot beam for aiming purposes;
•moisten potentially flammable materials;
•switch off the laser beam immediately after use;
•protect the laser unit against accidental/improper use by switching it from “laser
ready” to “standby” mode; switch off or lock all applicator systems connected to
the laser unit whenever those systems are not being used.
•In the event of an accidental laser beam release, it must always be guaranteed that neither
the patient nor staff members present in the operating room are exposed to dangers and
that easily flammable materials will not catch fire.
•The use of combustible anesthetic gases or oxidizing gases, such as nitrous oxide (N2O) or
oxygen, should be avoided. When saturated with oxygen, some materials (such as cotton)
may catch fire at the high temperatures generated during the normal use of the laser unit.
The solvents of adhesives and flammable solutions used for cleaning and disinfection
should be given sufficient time for evaporation before using the laser.
Attention should also be given to endogenous gases that could catch fire.
Attention!
Never operate the unit in the vicinity of easily flammable narcotics or highly
volatile mixtures such as alcohol or benzine/petroleum spirit. Never use oxygen
for gastro-intestinal irrigation in endoscopic applications!

MCO25plus Operating Instructions
V 4.1 11
2.4 Protecting the Patient
The patient must be protected against injuries caused by improper use of the laser system. In
particular, this means
•protecting the patient’s eyes with suitable antilaser goggles or by using a light- and
radiation-proof cover;
•protecting those organs and tissues of the surgical site which may not be exposed to laser
radiation, using diffuse-reflection or radiation-absorbing materials such as moist towels or
compresses;
•prevention of laser-induced fires (see section 2.3), especially in endolaryngeal
interventions;
•effective removal (evacuation) of developing toxic smoke, particularly in the laryngeal
region;
•preventing the ignition of easily flammable intestinal gases during rectoscopic
interventions;
•preventing fires caused by direct laser radiation when using artificial respiration techniques
such as jet ventilation, particularly in connection with easily flammable, oxidizing gases.
2.5 Treatment Room Requirements
•All rooms in which the MCO25plus is used must be marked at the entryways/doors with a
laser radiation warning sign (see “laser star” symbol provided in the accessories kit).
•A warning lamp must be installed at all doors leading to the laser area. When these lamps
are on, the laser area may only be entered by authorized persons wearing appropriate
protective goggles.
•As far as possible, all doors leading to the laser area should be kept shut while the laser
system is being used.
•All surfaces reflecting the CO2laser light well must either be removed from the laser area
or adequately covered.
2.6 Safety Requirements for the Laser Unit and its Accessories
•All instruments used should have matte surfaces guaranteeing diffuse reflection of the CO2
laser light.
•All optical equipment used for observing the surgical field must have been specially
designed for use with laser systems. Besides, such equipment may only be used in
connection with suitable auxiliary filters that meet the requirements for laser protective
goggles.
•Never switch on the laser system unless all parts of the housing have been properly fixed
in place. Be aware that uncontrolled laser radiation may escape as long as the laser unit is
open! Moreover, an open housing poses a hazard of coming into contact with dangerously
high electric voltages or current.

MCO25plus Operating Instructions
12 V 4.1
•If the laser unit is found to be in any way defective, the findings must be duly entered in
the device logbook and reported to the Laser Safety officer. Besides, either Gebrüder
Martin or a service technician authorized by Gebrüder Martin to carry out repairs should be
contacted as soon as possible. Never use the system as long as it is defective!
2.7 Pilot Laser Safety Instructions
The radiation emitted by the red pilot laser (diode laser, wavelength 635 ± 10 nm) is relatively
harmless. For example, this type of radiation cannot damage the skin or ignite any materials
present in the operating room. However, it can harm the human eye! Eye damage cannot be
ruled out if intensive pilot laser light accidentally hits the eye several times during a working
day.
The pilot light brightness can be adjusted by the operator. The maximum intensity is about
2 mW, which corresponds to laser class 3B.
In contrast, the scattered radiation produced by the pilot laser light (e.g. the light reflected by
the target tissue) is completely harmless even at maximum output power (2 mW).
To sum it up: No special eye protection (such as protective goggles) is required in connection
with the pilot laser light, provided that the instructions outlined above are duly observed.
As the pilot laser light takes the same path through the optical fiber system as the CO2laser
beam, it can be conveniently used to check the laser delivery system for integrity. If no pilot
laser spot is produced at the distal end, or if the spot has a low intensity or unclear/irregular
shape, this may indicate damage or malfunction in the delivery system.
2.8 Laser Smoke
The application parts installed at the front end of the articulated mirror arm are connected to
the laser unit’s irrigation gas connector. The irrigation gas exits the focusing handpiece at its
distal end, usually together with the laser beam. Its function is to clear the optical beam path
Attention!
Upon switching on the unit, visible pilot laser radiation is emitted at the front end
of the applicator system (focusing handpiece or scanner) if the pilot laser has not
been switched off by pressing the yellow-backlight pilot laser button. To avoid
eye damage, never stare into the beam exit (aperture) of the applicator system
when this button is on! Note that while the “D 10600 nm L4” antilaser goggles
provide adequate protection against CO2laser radiation, they are ineffective with
regard to pilot laser radiation!
Caution!
Laser smoke (plume) could contain viable tissue particles.

MCO25plus Operating Instructions
V 4.1 13
by blowing away any smoke (so-called laser plume) produced during laser application.
A smoke evacuator is used to remove the smoke altogether from the surgical site. This can
either be a fixed-installation device for exclusive use in the laser room, or a separate unit
operated in conjunction with the laser. Smoke evacuators are available from Gebrüder Martin
on request. Installation is carried out either by Gebrüder Martin itself or a service technician
specially authorized by Gebrüder Martin to perform such work.
2.9 Laser Safety Officer
According to the relevant (German) regulations for the prevention of accidents (relating to
laser radiation – BGV B2), the owner/operator of the system is required to formally appoint a
Laser Safety officer. This officer has the following responsibilities:
•Carry out all required safety measures;
•provide instruction, to all persons involved, on required safety measures and the proper
use and operation of the unit;
•mark the laser area;
•check the alarm devices for proper functioning;
•provide laser protective goggles;
•ensure proper application of the unit in the course of the therapy;
•keep the key to the laser system in a safe place;
•store the unit away in a safe place when not in use;
•ensure the proper connection of the laser system after relocation;
•maintain the medical device logbook (or equipment ID card) properly.
2.10 Treating Surgeon
The therapeutic application of the unit requires the user to be sufficiently experienced in
working with CO2laser systems. The treating physician (therapist) is responsible for the safe
and proper use of the medical laser system. He/she must ensure that all safety measures are
duly observed and must be familiar with laser-specific surgical techniques. The theoretical
knowledge and practical expertise that are mandatory for the proper use of the laser in clinical
practice can be acquired through specialized training courses (for details, please contact
Gebrüder Martin, Tuttlingen).
2.11 Electrical Safety
The unit is a Class 1 system (acc. to IEC 601-1), which means that it must be connected to a
duly grounded supply system in accordance with the specifications contained herein.
•Only the power cord supplied may be used for mains connection.
•Both the power cord and the mains connector must be in perfect working order. Never use
them if found to be defective.

MCO25plus Operating Instructions
14 V 4.1
2.12 Grounding the Unit
The unit is grounded via the grounding conductor integrated in the power cord. This is an
important prerequisite for the safe operation of the unit. If the power cord is connected to the
supply source in accordance with the relevant electrotechnical regulations, proper grounding is
automatically ensured.
The yellow-and-green potential equalization cable must be connected to the equipotential
bonding conductor/pin provided in cardiac intervention rooms (see standard requirements for
rooms used for medical purposes).
2.13 High-Voltage Danger
Dangerous high voltages are present in the laser unit!
The user is not entitled to dismantle the unit. Any repair or maintenance work necessary must
be carried out by Gebrüder Martin or by a service technician specially authorized by Gebrüder
Martin to perform such tasks.
2.14 Fuses
Defective fuses may be replaced only by an authorized service technician.
2.15 Safety Devices
In designing this laser system, we strictly adhered to the principle of providing utmost user
and patient safety in combination with user-friendliness. As a result, the system is extremely
easy to operate and the technical safety devices incorporated in the system effectively prevent
maloperation.
After switching it on, the system is automatically set to “standby” mode. This means that the
CO2laser beam cannot be activated at this stage. To activate the laser radiation, it is
necessary to connect the articulated mirror arm first (otherwise, the “Interlock Error” message
is displayed).
At the front end of the application system connected to the laser head (i.e. at the fiber tip or
the distal end of the focusing handpiece), the visible pilot laser radiation is emitted with an
output power of 2 mW, which is equivalent to a Class 3B laser system. Its brightness can be
decreased in line with Class 3B safety regulations.
As soon as the system is ready to emit laser radiation, the “laser ready” button light comes on.
However, the shutter – as the final safety device in the series – is kept shut until the
footswitch is pressed down to release the beam.
A clearly audible alarm signal is sounded as long as laser radiation is being released. As
regards irradiation time, the footswitch has absolute priority over the selected pulse times.
This means that the irradiation process is reliably interrupted as soon as the footswitch is
released, even though the preset pulse time may not have elapsed yet.

MCO25plus Operating Instructions
V 4.1 15
To ensure that the irradiation parameters selected cannot be accidentally changed during the
laser treatment, all control-panel buttons are blocked (inoperable) as long as the footswitch is
held down.
A microprocessor helps to keep the laser output power at a constant level (in accordance with
the value selected, and within system-specific tolerance limits). In case the system is unable to
maintain the selected power level any longer, an appropriate message is displayed on the LCD
and a substitute value offered to the user.
In “laser ready” mode, Class IV infrared laser radiation is emitted upon operating the
footswitch. Therefore, all persons present in the laser area (i.e. the closed room or screened-
off part of a room where the application of dangerous radiation is permitted) are required to
wear protective goggles when the laser warning lamps come on (for details, see section 2.2).
The option of using an external door contact as part of the safety system is described in
section 4.4.5.
With the emergency stop device, the system can be immediately shut down in a case of
emergency.

MCO25plus Operating Instructions
16 V 4.1
2.16 Rating Plate and Warning & Information Labels
Figures 2.1, 2.2 and 2.3 show the rating plate and the warning and information labels affixed
to the laser unit (including label position).
Fig. 2.1 1 “Laserstrahlung” (Laser Radiation) and “Laserklasse” (Laser Class)
warning labels according to DIN EN 60825
Visible and invisible
LASER RADIATION!
Avoid skin or eye contact
with direct and indirect
(scattered) radiation!
Class 4 laser

MCO25plus Operating Instructions
V 4.1 17
Fig. 2.2 Label positions
1 Identification label
2 Rating plate (nameplate)
Fig. 2.3 Warning label
1 Position of label at back end of articulated arm
Max. power: 30 W
Max. peak power: 250 W (superpulse)
Pulse length: 3 ms – 10 s
Wavelength: 10,600 nm
Pilot laser wavelength: 635 ±10 nm
Pilot laser power: 3 mW
Laser class: 4
(
DIN EN 60825-1: 10.03
)
Aperture for visible and invisible
laser radiation at distal end of
laser fiber or laser applicator!

MCO25plus Operating Instructions
18 V 4.1
2.17 Nominal Ocular Hazard Distances (NOHD)
For the accessories permitted for use with this laser, the following safety clearances (NOHDs)
must be observed, as otherwise the limit values for permissible laser irradiation and irradiance
would be exceeded!
Accessory NOHD
Specifications Item Number
Focusing handpiece, 50 mm 3 m Focal distance = 50 mm 76-100-05
Focusing handpiece, 127 mm 5 m Standard focusing
handpiece 76-100-10
Focusing handpiece, 200 mm 7 m Focal distance = 200
mm 76-100-15
Special optics set for nasal
operations 14 m Cannula, straight or angled 76-600-00
Soft Scan Plus scanner 5 m Handpiece, f = 127 mm 76-500-30
7 m Handpiece, f = 200 mm 76-500-60
Table 2.1: Safety distances (NOHD) for MCO25plus accessories

MCO25plus Operating Instructions
V 4.1 19
3Description of the Unit
3.1 Some General Remarks on the Laser Principle
LASER is an acronym meaning “Light Amplification by Stimulated Emission of Radiation”. The
laser (light source) consists of an active medium and an excitation source. This excitation
source transforms (“pumps”) the active medium from its normal state into a stimulated energy
state (high energy level). The medium then begins to return to its normal state (transition to
lower energy levels), and in this process photons are emitted. This radiation is optically
amplified with the help of an optical resonator consisting of a highly reflecting mirror and a
partially transmitting one. Via the partially transmitting mirror, part of the laser light is coupled
out and is then used for medical purposes.
The main characteristics of the laser light include:
1) High degree of beam parallelism – very little beam divergence.
2) Monochromaticity – light of a very narrow wavelength range, equivalent to a single
color in the spectrum of electromagnetic radiation.
3) Coherence – all photons emitted are in phase (in terms of both space and time).
The active medium (lasing material) can either be a gas, a liquid dye or a solid. Most gas
lasers consist of atoms or small molecules or a mixture of both. In the case of solid-state
lasers, the active medium consists of atoms or ions doped (bound) in a solid-state host crystal.
In the case of dye lasers, the active medium consists of molecules of a relatively high
molecular weight, dissolved in a liquid.
For the pumping energy that is needed, either direct current, high-frequency energy or – as in
the case of solid-state lasers – a light source is used. Under specific pumping energy
conditions, the so-called “population inversion” phenomenon can be observed in all of the
above materials. This means that it is possible to induce laser light emission at a specific
wavelength characteristic of the active medium used. The high light intensity gain is achieved
by way of optical back-coupling, which means that the radiation emitted is reflected with the
help of (laser) mirrors (the optical laser resonator).
3.2 The CO2Laser
The continuous-wave (CW) CO2laser is a gas laser which emits high-intensity radiation at a
wavelength of 10,600 nm. The medium used is a CO2-N2-He gas mixture contained in a sealed
tube. As the tube has a relatively long life, gas refilling is required only after several thousand
operating hours. The direct-current discharge excites the gas molecules. The excited CO2, in
turn, emits photons. The coherent light generated in the optical resonator exits the resonator
through the semitransparent output mirror and is then delivered through the articulated mirror
arm. The laser light intensity can be controlled via the electric energy pumped into the gas
discharge.

MCO25plus Operating Instructions
20 V 4.1
3.3 Range of Application
The therapeutic effect produced by the continuous-wave CO2laser light is based on the
conversion of radiation energy into heat, a process that triggers both reversible and
irreversible tissue reactions (hyperthermia, coagulation, vaporization). Since radiation of the
CO2wavelength is easily absorbed in water or human tissue, it is characterized by a very
strong superficial impact, a low penetration depth and very good vaporization properties. The
specific therapeutic effect of this type of radiation mainly depends on the following three
factors:
•power density (irradiation intensity)
•irradiation time (treatment/exposure time)
•tissue characteristics
The irradiation intensity achieved on the tissue surface is a function of:
•the effective distal laser output power (tissue side)
•the diameter of the beam hitting the tissue
The tissue characteristics that are of primary importance for medical laser therapy include:
•tissue absorptivity
•heat conductivity and thermal capacity (among other factors, water content and perfusion
rate)
The application possibilities of the Martin MCO25plus are numerous. Apart from a low
penetration depth and a precise cut, its laser-surgical advantages include low patient strain
and fast wound healing.
The main application areas of the MCO25plus include:
•ENT •dermatology
•gynecology •plastic surgery
•tumor surgery •proctology
•neurosurgery •bronchology
•dental
To ensure proper use of the MCO25plus in clinical practice, theoretical background knowledge
and sufficient practical experience/training are indispensable prerequisites. We recommend
attending appropriate “laser medicine” training courses (basic and specialized, as offered by
Laser- und Medizin-Technologie Berlin GmbH, for example) in order to acquire the specific
technical knowledge required. It should also be noted that the proper and safe use of the unit
is ensured only if the user strictly observes all of the measures and application instructions
contained herein. Therefore, before putting the unit into service, all potential users should
sufficiently familiarize themselves with the system, using the operating manual supplied.