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Laser surgery - overview

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Introduction

  • Use of lasers for industrial, military and medical use expanded greatly since invention in 1960.
  • Technology used in clinical veterinary medicine only for last 10 years.
  • Types of surgical lasers used most often in veterinary medicine include:
    • Carbon dioxide (CO2 - 10,600 nm).
    • Diode (805/980 nm).
    • Nd:YAG devices.
  • Wavelengths expressed in nanometers (10 to the power of minus 9 m) and account for the absorption characteristics of each type.


Uses

  • Lasers have many uses based on capabilities for providing following effects:
    • Photothermal.
    • Photomechanical.
    • Photochemical.
  • Most surgical lasers deliver a photothermal effect by coagulating and vaporizing tissue.
  • Control of a surgical laser requires balance between laser power (watts) and beam diameter (cm2) expressed as power density and duration laser beam is in contact with target tissue (fluency).
  • Balancing power density and fluency with laser's wavelength provides exquisite control for incisional or tissue ablative applications.

General advantages

  • Very precise removal of tissue.
  • Simultaneous sealing of small blood vessels and lymphatics which minimizes hemorrhage.
  • Thermal sealing of transected nerves which can provide some pain control.

Specific advantages

  • Carbon dioxide laser (10,600 nm) is a far infrared laser that transmits a wavelength that is highly absorbed in water. Scatter of energy is minimal so tissue effect is very precise and associated with little collateral photothermal damage, if used correctly.
  • Surgical lasers in the near infrared range of wavelengths (diode - 805 or 980 nm/Nd:YAG - 1064 nm) are more highly absorbed by hemoglobin, melanin and tissue proteins. In addition, energy is more widely scattered in target tissue.
  • Laser energy can be delivered through small optical fibers, therefore very useful for minimally invasive endoscopic applications.
  • Fiber delivered laser energy can be used in both contact and non-contact (free beam) modes.


Disadvantages

  • Purchase is a sizeable investment for a veterinary practice and may require fee adjustment.

Specific disadvantages

  • Near infrared lasers (diode/Nd:YAG) produce a tissue effect that is much wider and less controlled than that produced by the CO2 laser.
  • Control of tissue effect of diode/Nd:YAG is less precise and requires a longer learning curve than CO2 laser.
  • Currently used CO2 surgical lasers provide energy delivery through a hollow waveguide or an articulated arm, therefore less useful for endoscopic application.

Technical considerations

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Types of lasers used for veterinary surgery

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Use of lasers in companion animal surgery

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Emerging technologies

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Conclusion

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Bartels K E, Higbee R G, Bahr R J et al (2003) Outcome of and complications associated with prophylactic percutaneous laser disk ablation in dogs with thoracolumbar disk disease: 277 cases (1992-2001). JAVMA 222 (12), 1733-1739 PubMed.
  • Wynn V M, Davidson E B, Higbee R G et al (2003) In vitro effects of pulsed Holmium laser energy on canine uroliths and porcine cadaveric urethra. Lasers Surg Med 33 (4), 243-246 PubMed.
  • Davidson E B, Davis M S, Campbell G A et al (2001) Evaluation of carbon dioxide laser and conventional incisional techniques for resection of soft palates in brachycephalic dogs. JAVMA 219 (6), 776-781 PubMed.

Other sources of information

  • Lucroy M D & Bartels K E (2003) Lasers in Veterinary Medicine. Textbook of Small Animal Surgery. 3rd edn, Saunders, Philadelphia, PA. pp 227-235.
  • Bartels K E (2002) Ed Lasers in Medicine and Surgery. Veterinary Clinics of North America - Small Animal Practice. 32, 3.
  • Fry T R & Bartels K E (2000) Laser Surgery. Small Animal Surgery Secrets. Hanley and Belfus Inc Medical Publishers, Philadelphia, PA. pp 54-57.
  • Bartels K E (1998) Laser Surgery. Current techniques in Small Animal Surgery IV. Williams and Wilkins, Baltimore, MD. pp 45-52.

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