By Anya Glazkova, Ph.D. For The Education Center
Originally published in Veterinary Practice News, March 2015
Dr. Sessa earned his DVM from the University of California, Davis, in 1984. He practiced medicine in Escalon before joining the Veterinary Emergency Clinic in Modesto, Calif., in 1985. In 1990 he transferred to the Associated Veterinary Emergency Services Clinic in Stockton, Calif., while developing his Animal Home Health Mobile Care practice. Dr. Sessa now practices at Salida Veterinary Hospital in Salida, California.
Paul Sessa, DVM, shares the highlights of his transition from the older generation surgical CO2 laser to a newer, higher power surgical laser platform based on flexible fiber beam delivery with tipless handpieces.
Q: Dr. Sessa, you have had a flexible-waveguide CO2 laser for over 10 years. Why did you choose it over the articulated arm design? Also, what differentiates CO2 laser surgery from diode or even electrocautery systems?
Dr. Sessa performing laser surgery.
A: Simply put, the articulated arm systems represent outdated technology. I mean, how do you even compare holding a state-of-the-art, pen-like handpiece to operating a bulky, heavy articulated arm? And that aiming beam does not even come close to the flexibility, the finesse that you are able to achieve with the flexible waveguide.
As far as diode lasers and electrocautery are concerned, they simply cause more thermal damage to adjacent tissue. Compared to electrocautery in particular and some diode lasers, my CO2 laser does not mechanically traumatize tissue—it is a non-contact approach.
Q: How often do you use your laser?
A: We use it for about 10 surgeries per week. We’re not a big surgery practice; however, when we do perform surgery, we always inform our clients about the benefits of the laser for their pets, and we find these benefits are important to them. Laser surgery certainly differentiates us from other veterinary practices in our area, and that’s a big deal.
I think I’ve forgotten how to use a scalpel blade— and I’m not missing it!
Q: When you upgraded from your older laser to the higher power Aesculight machine, what can you say about your experience? How do the two systems compare?
A: The new AE-3020 machine is a huge leap forward, in particular the greater cutting power, more flexibility, considerably less char, the benefits of the new adjustable handle, the built-in clinical library. My older Luxar LX-20SP was a great laser, don’t get me wrong. However, my new Aesculight has many important features and improvements that were simply unavailable to me before.
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- Beginning of skin incision—0.25 mm spot size.
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- Subcutaneous incision—0.4 mm spot size. Note the bloodless surgical field.
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- Epulis removal in a dog—immediately pre-operative view. The handpiece is adjusted to the 1.4 mm spot size for ablation.
Q: Your new system is much more powerful than your previous one, which of course required some getting used to. Could you describe the transition from one laser system to another?
A: The learning curve to the Aesculight should be minimal for most surgeons. Of course, having twice the power entails having a certain experience and ability to utilize the laser at those higher wattages, but it’s absolutely worth it for particular procedures.
CO2 laser surgery in general has a shorter learning curve (compared to ultrasound and endoscopy, for example), because with the laser “What you see is what you get” in terms of tissue interaction. It’s almost analogous to learning how to drive stick-shift; most people learn within about a week. For veterinarians, it’s about the same thing with laser surgery.
Q: How did this enhanced cutting power affect your practice?
A: It’s very important. Having that capacity to achieve higher power settings is beneficial for procedures involving larger animals, areas like the back of the neck for larger dogs, areas which involve dealing with thicker skin, equine applications as well, certainly.
So in other words, we are able to expedite and facilitate certain surgeries with the Aesculight that were otherwise more cumbersome and slower to perform with the older machine.
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- Cystotomy in progress—note excellent hemostasis.
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- Feline forelimb amputation—laser cutting muscle attachments.
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- Feline forelimb amputation—prior to removing the scapula.
Q: How would you characterize the financial impact the upgrade has had on your practice?
A: I first started with a 12-watt laser. After gaining some experience, I upgraded to a 20 watt / 10 watt SuperPulse, and later I traded that in for the new AE-3020. The upgrade in clinical value for my patients definitely coincides with my revenues from laser surgery going up from about $500 per week to several thousand!
Again, the reality is that the enhanced power and improved flexibility enable me to do more surgeries with greater speed, to cut through tissue much faster— cartilage is no problem, spays and neuters are achieved with a remarkably dry field. I appreciate the power density.
In essence, client satisfaction is very high because of what I am able to do with the technology I have available. Of course, medical devices don’t come cheap these days. However, if a veterinary practice has two doctors or more and has a surgical suite that’s used four days a week, then the financial element of the decision is a no-brainer: They will be able to pay for the laser in under a year. My laser pays for itself.
Q: How important is the adjustable focal spot tipless handpiece for your surgeries?
A: It’s a totally new way of doing surgery. The tipless handle has been great. It’s a terrific way to adjust power density without changing the setting on the laser control panel. 0.25 mm spot for skin, 0.4 mm for subcutaneous dissection, and the 1.4 mm for ablation— to have everything in one handpiece, to be able to change between different spot sizes during surgery and then easily defocus at the same time—it’s an absolute joy to use.
It’s very durable, much harder to break. It’s also easier for the staff to clean and sterilize and we have no broken ceramic tips anymore. From the worth standpoint, this handpiece literally pays for itself in terms of staff time. We save about $40-$50 a day, four times a week—the time and the expenses associated with taking care of tips. Laser tips are still a great way of doing surgery, don’t get me wrong; it’s just this tipless handle is that much better!
This Education Center article was underwritten by Aesculight of Bothell, Wash., manufacturer of the only American-made CO2 laser.
Anya Glazkova, Ph.D., is a recent graduate of the University of Washington in Seattle. She helps conduct laser surgery educational programs at Aesculight and LightScalpel LLC.
