State of the Art Laser Surgery

What is a laser?

LASER stands for Light Amplification by Stimulated Emission of Radiation. A laser is an opto-electronic device that produces highly concentrated light rays. Laser power may range from milliWatts (in CD-ROM drives and laser pointers) to dozens of Watts (industrial and medical applications) and over trillions of Watts (pulsed lasers in scientific and military applications).

What is laser surgery?

Interaction of laser light with tissue provides a fundamentally different approach to surgery. In laser surgery, a highly focused laser beam can efficiently ablate (either vaporize or chip away) the living tissue. At the same time, it seals (welds) capillaries, small blood vessels, lymphatics, and nerve endings, with significant benefits to both patients and surgeons. See more here on laser surgery and dental CO₂ lasers.

What is the most efficient soft-tissue surgical laser?

Soft Tissue Laser Surgery is different from Hard Tissue Laser Surgery (bones and teeth in dentistry) and Laser Eye Surgery (eye sight corrective surgeries) by particular types of lasers. Lasers differ from each other by the wavelength of light they produce. The most commonly used surgical laser in soft tissue surgery is the CO₂ laser. The CO₂ laser wavelength (10.6 micrometers) is highly absorbed by water contained in soft tissue. Because of its outstanding versatility and precision, the CO₂ surgical laser is the most efficient and dominant soft tissue surgical laser since the 1960s. Laser surgery is widely practiced in many applications of human as well as veterinary medicine.

Timothy L. Holt, DVM and Fred A Mann, DVM, MS

..laser surgery offers better hemostasis and visibility, less post-operative swelling, and decreased post-operative pain. In certain procedures, better hemostasis and visibility will reduce overall surgical time.

“Soft Tissue Application of Lasers” Vet Clin Small Anim 32 (2002) 569-599, Elsevier Science (USA)

Laser surgery benefits for patients

Less Bleeding: As it cuts, the laser seals small blood vessels. This drastic reduction in bleeding enables a number of new surgical procedures that are not practical with conventional scalpel.

Less Pain: The CO₂ laser beam seals nerve endings and lymphatics, resulting in less edema and pain. The patient experiences a far more comfortable post-operative recovery.

Reduced risk of infection: This is one of the unique features of the CO₂ laser beam. It efficiently kills bacteria in its path, producing a sterilizing effect.

Quicker recovery time: Reduced risk of infection, less bleeding, less pain and less swelling often allow the patient a far quicker recovery after the surgery.

Veterinary Laser Surgery

General surgery procedures:

Traumatic wound debridement, Perianal tumors, Toe Nail Lasing, Amputations, Tumor bed ablations, Ceruminous adenocarcinoma, Vaginal Fold Excision, Chemodectoma Chronic, Mast cell tumors, Colorectal tumor debulking or resection, Cranial cruciate ligament rupture debridement, Granulation tissue shaving, Cystotomy, Deep mass removal, Everted saccule resection, Vital pulpotomy, Fibrosarcoma, Graft bed preparation-infected wounds, Hemangiopericytoma, Hepatic carcinoma – hepatic lobectomy, Lipoma & Liposarcoma resections, Operculectomy, Perianal urethostomy stricture revisions, Pericardectomy, Rhabdomyxoma of flank, Subtotal prostatectomy, Tendon sheath tumors hemangiopericytoma, SCC and infiltrating lipoma, Thyroidectomy, Enterotomy, Transitional cell carcinoma of bladder, Perianal fistulas, Tumor/mass removal, Urethral prolapse resections, Urinary bladder polyps, Vaginal tumor excisions – leiomyoma, SCC and fibrosarcoma, Anal saculectomy.

Bert A. Shelley, DVM, MS

The carbon dioxide laser is a very effective tool for treating diseases of the perianal region. The skin of the perianal region is thin and sensitive. The carbon dioxide laser offers a‘no touch’ method of excising these lesions, which helps decrease postoperative discomfort and irritation. The carbon dioxide laser is very effective in controlling hemorrhage from vessels smaller than 0.5 mm. This is sufficient in controlling most hemorrhage caused from the rich blood supply of the perianal region. The perianal region is contaminated with bacteria. The carbon dioxide laser photothermally vaporizes bacteria, so that bacterial numbers are decreased, which helps reduce the risk of postoperative infections. These factors help the patient recover quicker and return to function sooner.

The light emitted from a carbon dioxide laser has a wavelength of 10,600 nm, which is in the far-infrared light spectrum. This wavelength of light is highly absorbed by water, creating a thermal effect. Because all soft tissues in the body are composed mainly of water, the carbon dioxide laser penetrates very shallow into tissue, and there is very little collateral thermal damage. This interaction makes the carbon dioxide laser a useful tool for incising, excising, and photoablating soft tissue and allows for fine, controlled dissection of tissue. The axiom of ‘what you see is what you get’ applies to the properties of the carbon dioxide laser. Finally, the carbon dioxide laser seems to have a lower learning curve when compared with other types of lasers.

“Use of the carbon dioxide laser for perianal and rectal surgery.” Vet Clin Small Anim 32 (2002) 621-637, Elsevier Science (USA)

Ophthalmology surgery procedures:

Conjunctiva treatment, Cherry Eye, Distichia, Ectopic cilia, Lacrimal Punctotomy for Epiphora, Entropion, Meibomium Gland Excision, Eyelid tumor removal, Hemangioma removal, Scleral corneal mass removal, Keratectomy, Mast cell tumors, Squamous cell carcinoma removal, Epiphora.

Margi A. Gilmour, DVM, ACVO

The CO₂ laser does have a valuable role for vaporization of eyelid masses, particularly when located adjacent to the medial canthus making scalpel excision and closure difficult; for treating diffuse eyelid papillomatosis; and for safely extending surgical margins after excision or debulking of neoplasms, such as fibrosarcoma and squamous cell carcinomaof the eyelid, limbus, or nictitans.

Vet Clin Small Anim 32 (2002) 649-672. Elsevier Science, (USA)

ENT and oral surgery procedures:

Oral mass excision, Gingivectomy/plasty Incisional Biopsy, Aural Hemotoma, Bulla curettage, Ear canal ablation, Correction of faulty ear carriage, Epulis removal, Gingival hyperplasia, Sublingual tissue, Laryngeal granuloma, Ventriculochordectomy, Laryngeal scar removal, Ear crop, Lymphocytic plasmacytic stomatitis, Nasal Hyperkeratosis, Nasal Planum Resection, Osteosarcoma of palate, Ear canal polyps, Partial mandibulctomies, Periodontal flap surgery, Partial maxillectomies, Proliferative otitis – sterilization and ablation, Laryngeal web revision, Ramulas, Salivary gland removal, Salivary mucoceles, Soft palate resection, Squamous cell carcinoma, Stenotic nares, Folds, Sublingual Sialocele, Acanthomastous Epulis, Tongue lesions, Tonsillectomy, Everted laryngeal saccules, Throughing for crown impressions.

Jan Bellows, DVM

Carbon dioxide (CO₂) lasers are used in oral surgery for precisely cutting or vaporizing soft tissue with hemostasis. CO₂ lasers intended for dental applications are CW lasers. The CO₂ wavelength is absorbed by the water content of oral tissues. Thermal necrosis zones of 100 to 300 lm at cut tissue edges are typical, providing better oral structure safety compared with other lasers (neodymium:yttrium aluminum garnet [Nd:YAG], argon, and diode), which may penetrate up to several millimeters. With the CO₂ laser,‘what you see is what you get’ compared with the Nd:YAG laser where no immediately visible change appears in the tissue surrounding the zone of vaporization. With the Nd:YAG laser, it is difficult to estimate the true extend of thermal necrosis. This advantage of replacing traditional excisional techniques with CO₂ laser ablation permits removal of the damaged epithelium with as little as 0.1 to 0.2 mm of reversible thermal injury to the submucosa. CO₂ lasers are used for oral, soft tissue procedures, such as gingivectomy, gingivoplasty, frenectomy, and biopsy. Tissue vaporization is more efficient with the CO₂ laser than with other lasers discussed because of the direct absorption of this wavelength by water..

“Laser Use in Veterinary Dentistry” Vet Clin Small Anim 32 (2002) 673-692. Elsevier Science, (USA)

Dermatology surgery procedures:

Acral lick granuloma ablation, Cutaneous masses: skin tags, Follicular cysts and tumors, Gingival hyperplasia and epulis, Hyperkeratosis of digital pads /nasal planum, Hemostasis, Malignant melanoma, Localized demodex, inclusion cysts, papillomas, Epibulbar melanoma, Pigmented viral plaques, Actinic keratosis, Pinnal tumors, Feline ceruminous cystomatosis, Calcinosis circumscripta, Squamous cell carcinoma removal, Viral papillomas, Wound management (acute and chronic), Nodular sebaceous hyperplasia, Plasma cell pododermatitis.

David Duclos, DVM

The CO₂ laser proved to be an excellent choice for laser surgery because of the ability to limit the zones of damage to microsurgery with little to no collateral damage. This laser is the primary laser in use today in veterinary dermatology. The operator can easily control the device for use in three ways: skin incision, lesion excision, and ablation. It can be readily controlled for precise microsurgery or can be used for ablating larger lesions. Because of its high absorption by water, there is little to no collateral tissue damage with this laser when used properly. …the ability for the operator to control the effect of the laser beam essentially to the area that you can see with no collateral damage, has led to wide use of this laser in many areas of medicine, including veterinary dermatology…

“Lasers in Veterinary Dermatology” Vet Clin Small Anim 36 (2006) 15-37, Elsevier Science (USA)

Equine surgery procedures:

Sarcoid removal, Acute Scrotal Hernia Repair, Fibroma/Neurofibroma, Umbilical hernia repair, Basal Cell Mastocytoma, Entrapped epiglottis procedure, Granulation tissue removal, Lymphoid polyps, Cryptorchidectomy, Melanoma, Palmer digital neurectomy, Castration, Removal of Hydroceles, Scirrhous cord resection, Neoplasia, Squamous Cell Carcinoma, Guttural pouch membrane ablation, Ethmoid hematoma, Ablation of penile and cervical lesions, Proud Flesh.

Stephen W. Crane, DVM

…surgical lasers have extended the operative precision, range, and morbidity reduction… Equine upper airway surgery has also been revolutionized, and there are certainly many applications yet to be developed.

“Lasers in Medicine and Surgery” Vet Clin Small Anim 32 (2002) xi-xii. Elsevier Science (USA)