By Jackie Brown

Surgical lasers offer numerous benefits, including little to no hemorrhaging (resulting in a clear operative field), reduced swelling and pain, and increased precision. Lasers can yield superior results compared to scalpels, particularly with certain procedures. As the technology continues to improve, their veterinary applications grow.

"The most significant trend in laser surgery over the past several years is the availability of higher power lasers with up to 40 watts in continuous wave and 25 watts in super pulse," said Peter Vitruk, Ph.D., MInstP, CPhys, Dipl. ABLS, founder of Aesculight LLC, a Seattle-area designer and manufacturer of veterinary surgical lasers. "Higher laser power enables scalpel speed cutting with all the benefits of highly ergonomic flexible waveguide CO₂ surgical lasers. This increase in power is completely revolutionizing laser surgery in veterinary medicine."

According to Dr. Vitruk, the design of modern laser units has come a long way.

"The new and improved flexible fiber CO₂ laser delivery system uses highly ergonomic and light pen-like, tipless handpieces, giving the surgeon far less stress than the older (1980s technology) bulky articulated arm systems," he said. "The units have become more durable and more versatile. This is due to incorporating new technology within the actual laser, as well as improved delivery and instrumentation at the distal end."

Surgical laser units also take up less space than they once did.

"Smaller units are being manufactured that allow for more portability," said Daniel J. Burba, DVM, Dipl. ACVS, McCasland Professor of Biomedical Laser Surgery at Oklahoma State University. "A lot of surgical lasers are essentially tabletop units. Of course, safety is constantly being improved."

Lasers in Practice

Carbon dioxide and diode lasers are the two most commonly used in veterinary practice.

"The CO₂ is the most practical laser for veterinary practice, unless the practice performs endoscopy procedures, in which case the fiber-based diode would be the route to go," Dr. Burba said.

Lasers offer many benefits, especially for minimally invasive surgery, Burba added.

"This is especially important in spinal surgery, including disk ablation of the vertebral articular fusion," he said. "Laser is also being used to assist with fusion of other low-motion joints, referred to as facilitated ankyloses. For equine, lasers are being used to treat intrauterine disorders in mares and upper-respiratory tract disorders in horses, especially performance horses. Surgical lasers are also being used for urolith fragmentation, and new ways are being looked at using surgical lasers and chemotherapy for primary skin tumors."

Steven Dunbar, DVM, owner and founder of Yorba Regional Animal Hospital in Anaheim, Calif., has been using a CO₂ laser for about 15 years, and he uses it for a variety of applications, from small lumpectomies to more complicated nasal surgeries.

"I mainly use it to do surgeries that the device is well-fitted for, and, although these surgeries can be done in other ways, I find CO₂ laser works the best," he said. "I use the laser almost daily with a local to remove small skin masses like sebaceous adenomas while the client waits in the exam room. I find it works the best for soft palate resections because it greatly reduces swelling, and the surgery is simpler than using a scalpel and suturing.

"CO₂ laser also works great for nasal surgery—inside the nose and elongated alar fold correction," Dr. Dunbar said. "With otoscopes, I have removed polyps from ear canals. For practices that do feline declaws, the laser greatly reduces bleeding and pain."

Stephanie DeMarco, DVM, associate medical director of VCA Kirkwood Animal Hospital in Newark, Del., also has been using a laser in practice for the past 15 years.

"It helps tremendously with difficult-to-resect masses (ear canal, oral tumors) and hemostasis," Dr. DeMarco said. "The laser reduces intraoperative hemorrhage, swelling, inflammation and pain. It's amazing how much more you can see in a surgery that previously was very bloody and left visualization to a minimum. Now, the surgeon has a clean and clear view of the entire surgical site."

Some trends in the use of laser surgery in the veterinary field include eye surgery (entropion and growth removal) and complex mass removals, she said.

"Mass removals include both full en bloc removal, as well as debulking of masses that may not be surgically resectable," DeMarco said. "Often, masses are too big or too vascular to cut out, so the hemostatic properties of the laser significantly improve that. I see my own clients, as well as clients who are referred because of a surgical mass that cannot be removed traditionally. Sometimes those masses are malignant, and their size prevents complete removal, but it's wonderful to know that I can offer an option that will give the pet comfort and the owner time. Sometimes we are lucky and the surgical laser is able to help us with complete removal of the mass. Like anything else, it is just a tool in our toolbox, but one I would not want to be without."

Additionally, DeMarco said laser can improve the outcome of canine perianal fistulae, which can be removed surgically and then followed by laser ablation. Laser ablation also is beneficial for acral lick granulomas and papillomas in dogs, and eosinophilic plaques (rodent ulcers) in cats.

Aesculight's Vitruk said there is increased evidence of better clinical results for a variety of conditions when using a laser, pointing to more than 50 case studies posted on the company's website (aesculight.com/case-studies).

The Future of Lasers

Lasers have many more potential uses than just surgery. Burba said that work is being done investigating use of lasers for tissue welding.

"We think of lasers as cutting and destroying tissue, but just think if lasers could mend tissue," he said. "That would be a big step."

DeMarco pointed to the use of lasers in "oncology/chemotherapy to recognize malignant or abnormal tissue.

"With further advancement in technology, [we might be able to use] the laser to reach places in the body that the veterinarian cannot yet reach," she said.

Although the cost of surgical lasers has decreased since the early years, units remain expensive. However, the return on investment might justify the expense.

"They can be a profit center by allowing you to do surgeries that you might be less inclined to do," Dunbar said. "Removing growths during a patient visit with a local anesthetic is fast and convenient, especially for those old 'warty' dogs. My clients love it."

Originally published in the April 2017 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!