Surgical CO2 laser in the small animal mobile practice

    By Janine S. Dismukes, DVM For The Education Center

    Originally published in Veterinary Practice News, August 2015 – Download as a PDF

    FIGURE 1A: Dr. Janine S. Dismukes’ mobile practice van.

    FIGURE 1A: Dr. Janine S. Dismukes’ mobile practice van.

    In 2004, I attended the Ralph Lee Veterinary Conference in Myrtle Beach, S.C., and heard Dr. John Godbold speak about surgical lasers. I immediately recognized that less bleeding, less swelling and less pain were higher standards to which I would hold my practice. That same conference, I registered for the hands-on surgical laser lab, and I was hooked!

    At that time, I was an associate in a small animal practice. I returned from the conference insisting that the practice needed a surgical laser for our patients and to exemplify our state-of-the-art image.

    The practice purchased a laser, and during the next few years, I attended all the surgical laser CE courses I could. Interesting enough, Aesculight is the only surgical laser company that provides and promotes surgical laser continuing education for veterinarians.

    FIGURE 1B: Dr. Dismukes’ surgical suite.

    FIGURE 1B: Dr. Dismukes’ surgical suite.

    In 2008, I started a small animal mobile practice (Figures 1A-1B). All surgeries are done with the flexible waveguide Aesculight CO2 surgical laser (Figure 1C). My laser has the ability to work in the SuperPulse mode, which allows for sufficient tissue relaxation (cooling) between high-peak laser pulses to minimize the zone of thermal necrosis (Wilder-Smith and colleagues[1] report sub-50 micron zone of thermal necrosis achieved with a 0.25 mm laser spot-size tip used with the flexible waveguide CO2 laser).

    The SuperPulse mode ensures char-free ablation, incision and excision. And it is easy to control the depth of coagulation/hemostasis on the margins of the cut. I use the laser almost every day that I am seeing patients. I perform all the usual surgeries of a small animal practice, such as spays, neuters, biopsies, mass removals, Meibomian gland removals and more. The laser’s precision, and its control of bleeding, swelling and pain, have removed my reluctance to do enucleations, amputations and aural hematomas.


    FIGURE 1C: Aesculight surgical laser.

    FIGURE 1C: Aesculight surgical laser.

    I would emphasize the usefulness of the CO2 laser for oncologic surgeries. The laser operates photo-thermally; in other words, it cuts, ablates and coagulates soft tissue in a non-contact mode (with a beam of light). This mode of laser-tissue interaction can minimize the intraoperative contamination of the wound with tumor cells.[2,3]

    Another advantageous peculiarity of the CO2 laser surgery is that it causes no muscle contraction (compared to electrosurgery).[4] F.A. Mann points out in the April issue of VPN the importance of the hemostatic ability of the CO2, laser (i.e., due to the bloodless surgical area). Excisions can be more conservative than a conventional scalpel.[4]

    The ability of the laser to achieve pain-free hemostasis is unmatched in any type of soft tissue surgery, especially in highly vascular parts of the animal, such as around the face, the ears and the genital area.

    Since having the laser, I have successfully performed many surgeries that I would not have attempted with a scalpel—mass removal on a hemophiliac cat, many soft-palate resections and tonsillectomies for brachycephalic breeds, rhinectomy to remove SCC on white cats, ablation of feline stomatitis and removal of lick granulomas. I get referrals from other veterinarians in my area to perform laser procedures on their patients and even on my colleagues personal pets.

    Clinical Cases

    The following five clinical cases are examples of using the Aesculight CO2 laser in my mobile veterinary clinic.

    CASE 1

    An 8-year-old male neutered domestic short-haired cat presented for excision of a squamous cell carcinoma of the right pinna and nasal planum.

    CASE 2

    A 7-year-old female spayed Boston terrier presented for excision of a rectal polyp. The area presented a challenge due to its high vascularity and the risk of intra- and post-operative bleeding.

    CASE 3

    Aphrodite, an 11-year-old female spayed domestic short-haired cat, presented for a low-grade nerve sheath tumor. The condition was complicated by the patient’s hemophilia, which posed a serious risk of intra-operative hemorrhage. Due to its ability to create efficient hemostasis, the laser was chosen for the surgery. One unit of whole blood and one unit of plasma were on hand but not needed.

    CASE 4

    Cherokee, a 2-year-old male Irish setter, presented for intermediate congenital entropion of the left bottom eyelid.

    CASE 5

    A 5-year-old female spayed boxer presented for a surgical repair of an aural hematoma of the left pinna.

    Janine Sagris Dismukes, DVM, graduated from North Carolina State University’s College of Veterinary Medicine in 1998. Upon her graduation, she was recognized with a Clinical Proficiency Award and an Excellence in Aesthesia Award.

    Dr. Dismukes began her career as an associate at a small animal veterinary hospital in north Raleigh, NC. A few years later, she joined an excellent small animal practice in Cary, N.C. She became a member of the Veterinary Surgical Laser Society and attended numerous lectures and hands-on laboratories using CO2 and diode lasers beginning in 2004. In 2006, she was certified by the Veterinary Surgical Laser Society with the American Veterinary Medical Association. She has taught laser laboratories at state and national veterinary conferences, including NAVC in Orlando, WVC in Las Vegas and the AVMA Convention in Boston.

    1. Wilder-Smith P, Arrastia AM, Liaw LH, Berns M. “Incision properties and thermal effects of three CO2 lasers in soft tissue.” Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79(6):685-691.
    2. Holt TL, Mann FA. “Soft tissue application of lasers.” Vet Clin Small Anim 2002, 32:569-599.
    3. Berger N, Eeg PH. Veterinary Laser Surgery: A Practical Guide. Iowa: Blackwell Publishing, 2006.
    4. Mann FA. “The utility of carbon dioxide laser in oncological surgery.” Veterinary Practice News. Apr 2015:40-41.

    This Education Center article was underwritten by Aesculight of Woodinville Wash., the manufacturer of the only American-made CO2 laser.