BOAS staphylectomy tools compared: CO₂ laser vs cut-and-sew vs LigaSure (413 dogs, JAVMA)

Choosing a staphylectomy technique is one of the most practical decisions in BOAS surgery. We all want the same things in the first 24–72 hours: a stable airway, minimal swelling, and fewer major post-op setbacks.

A recent JAVMA study reviewed 413 BOAS staphylectomy cases (2012–2024) and compared short-term major complication rates across several commonly used techniques.

What techniques were compared

The paper grouped cases by staphylectomy method, including:

• Cut-and-sew (scissors/excision with suture closure)
• CO₂ laser staphylectomy
• Bipolar vessel-sealing device (BVSD) using the LigaSure Precise handpiece (Medtronic)

To keep this post simple and clinically useful, we’ll focus on the two comparisons most veterinarians weigh in their everyday decision-making: CO₂ laser vs. cut-and-sew and CO₂ laser vs. BVSD (LigaSure).

Group sizes in the dataset were:

• Cut-and-sew: 94
• CO2 laser: 101
• BVSD (LigaSure): 104

What the paper counted as a “major complication”

Major complications were defined as meaningful postoperative events that typically required significant management escalation. Examples included aspiration pneumonia, temporary tracheostomy, persistent regurgitation, post-op respiratory crisis requiring reintubation or oxygen supplementation, or erratic recovery requiring sedation, among others.

The key results (major complication rates)

Across the whole cohort, major complications occurred in 15.5% of dogs.

By technique, reported major complication rates were:

• Cut-and-sew: 20.2% (19/94)
• CO₂ laser: 12.9% (13/101)
• BVSD (LigaSure): 18.3% (19/104)

Putting those differences into plain language

CO₂ laser vs cut-and-sew

• 12.9% vs 20.2% major complications
• That’s 7.3 percentage points lower with the CO₂ laser technique
• Or about 36% lower relative to cut-and-sew (7.3 / 20.2)

CO₂ laser vs BVSD (LigaSure)

• 12.9% vs 18.3% major complications
• That’s 5.4 percentage points lower with the CO₂ laser technique
• Or about 30% lower relative to BVSD (5.4 / 18.3)

A helpful note from the authors’ modeling

In multivariable analysis, cut-and-sew had significantly higher odds of major complications compared with CO₂ laser (OR 2.9, 95% CI 1.2–7.4).

Why this matters for BOAS workflows

For veterinarians building or refining a BOAS surgery workflow, this paper reinforces a practical takeaway:

• In a large real-world dataset, the CO₂ laser technique was associated with a lower rate of major short-term complications compared with both cut-and-sew and BVSD (LigaSure).

Where VetScalpel fits

VetScalpel exists to support the CO₂ laser soft-tissue technique in veterinary surgery with a platform designed for surgical workflow, consistency, and team training.

And a point we’re proud to share: the study’s co-author, Dr. Eric Hans, has an Aesculight CO₂ laser on site. This earlier-generation laser preceded today’s VetScalpel systems. (The JAVMA paper itself does not list CO₂ laser brands, but the study reflects the type of CO₂ laser airway workflow many referral hospitals have used and continue to evolve.)

Read the full JAVMA article

If you’d like to discuss implementing or upgrading a CO₂ laser workflow for BOAS cases, VetScalpel can help you evaluate setup, technique integration, and team training. Contact us.