By Ed Gilsleider, DVM For The Education Center
Originally published in Veterinary Practice News, September 2014 – Download as a PDF
In my practice a flexible fiber CO2 surgical laser is used daily. Whether for dermal neoplasia, any soft tissue surgery, laparotomies or orthopedics, I request its use.
Fittingly, I cannot think of a more valuable piece of equipment when surgeries are performed on exotics that are frequently brought into our practice than the CO2 surgical laser. (See figures 1a – 6 for regular laser surgeries.)
In my experience, it allows for an easier, more comfortable recovery from surgery and a quicker return to function (e.g., patients in figures 6 and 7b show no discomfort in their post-operative recovery). Concern about blood loss, pain and swelling is all but eliminated as the laser cuts, ablates or coagulates soft tissue.
This is especially important for tiny patients like rodents, rabbits, birds, reptiles, amphibians, primates and fish. For example, in the November 2013 issue of Veterinary Practice News, Jacque-Marie Leclerc, DVM, of France, described a CO2 laser surgical treatment of fibrosarcoma in a goldfish.[1]
He pointed out that his flexible fiber Aesculight laser had been crucial for the treatment and that he could not have obtained such a good result without the technology, a key element for convenience, speed and success.
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- Figure 1a: Tail tip neoplasia in a ferret, pre-operative view.
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- Figure 1b: Neoplasia shown in 1a was excised with the CO2 laser. Immediate post operative view.
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- Figure 2: Sugar glider castration and tail tip amputation were performed utilizing the CO2 laser. Note the bloodless operatory field. No sutures were required.
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- Figure 3: Pre-operative view. Abscessation in rabbits is not uncommon. Bloodless laser excision in situ can be easily accomplished with the CO2 laser.
Clinical Benefits
• The ability to control hemorrhage is critically important. A loss of just several drops of blood may exsanguinate a patient or at least initiate a trend towards hypovolemia. The laser helps to control bleeding. With it, blood vessels less than 0.6 mm in diameter can be effectively coagulated and sealed, which enables a bloodless field of view.[2]
Laser surgery, therefore, saves time the surgeon and the team would otherwise have had to spend maintaining the surgical site free of blood. This leads to a shorter surgery and anesthesia time. In addition, the laser’s ability to control bleeding ensures a better aesthetic result. Figures 2, 7a and 8b show bloodless laser surgeries in progress.
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- Figure 4: Laser castrations and ovariohysterectomies are performed regularly in mini pigs.
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- Figure 5: Green iguanas frequently require toe amputations to eliminate bacterial infections. No sutures are required when the laser is utilized.
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- Figure 6: Orthopedics may be facilitated with the CO2 laser. Depicted is a fennec fox recovering from a femoral head ostectomy. Note his painless posture.
• Another critical advantage of the laser over a conventional scalpel is the laser’s ability to prevent infection. All cutting is done with the focused laser beam without the tip directly touching the wound, which reduces the risk of infection. In addition, laser energy has sanitizing effect; i.e. it kills bacteria where it cuts.
Figure 5 shows the successful result of CO2 laser surgery in a green iguana. In this case, as often happens with green iguanas, amputations were needed to eliminate bacterial infections and the CO2 laser was the perfect surgical tool for this purpose.
• Pain management is of paramount importance post-operatively, especially with exotics. Birds, rodents, rabbits and primates will pick and barber their wounds and incisions, if hurting. Even when sutures are buried, pain frequently ends in dehiscence or even worse, evisceration. If the skin doesn’t look or feel normal, self-destruction and mutilation may ensue. The laser incision drastically reduces post-operative pain because of its effect on sensory innervation. Figure 6 depicts a fennec fox recovering after a femoral head ostectomy. The patient appears comfortable and not in pain.
• Post-operative swelling is another concern that may be eliminated with laser surgery. Unless I am ablating tissue, when I work with the laser in the continuous wave mode, I will utilize the SuperPulse mode for soft tissue incisions. With it, there is less heat and tissue charring and therefore, less collateral damage. Swelling and distension may cause patient pain, stress, inactivity, inappetence and a slower recovery, and the use of the laser ensures little to no postoperative swelling.
• Laser utilization may shorten the stay away from home. A shorter hospital stay allows the patient to return to its home environment or habitat sooner. This decreases the patient’s stress, and facilitates a return to normal feeding and therefore eliminations. As with all animals, the less the stress, the faster the recovery.
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- Figure 7a: This lemur neonate has a proptosed left globe, resulting from the mother traumatizing it. Emergency enucleation was required. Laser utilization enabled a rapid, bloodless enucleation.
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- Figure 7b: The lemur recovering from the emergency enucleation shown in 7a.
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- Figure 8a: Chinchillas can ingest foreign objects, necessitating an enterotomy. This patient required surgery to remove plastic obstructing the small bowel.
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- Figure 8b: Surgery was quick and virtually painless because the CO2 laser was used.
Benefits for the Practice
Financially, the laser is an asset. Firstly, the repertoire of surgeries we offer has increased. The CO2 laser has also made our practice more efficient, i.e., the ability to control bleeding and maintain good visualization intraoperatively reduces operatory time; shortened surgical time enables the clinician to perform more surgeries per day or week.
An additional fee is added to the procedure when the laser is utilized, creating an additional revenue stream for the practice. And clients typically do not mind paying the additional fee for a much better quality of care for their pets. Since our practice has started offering CO2 laser surgery, referrals have increased, as the ability to provide laser surgery separates our practice from others. It also emphasizes our high standards of patient care.
Conclusion
Our flexible fiber CO2 laser has helped us to expand the surgical capabilities of our practice. We have increased our client pool by offering a broader spectrum of services, achieving great surgical results and promoting compassionate post-operative care with diminished swelling, pain and reduced bleeding, need for sutures and/or bandages.
The laser incision drastically reduces post-operative pain.
Of course, the laser is only a surgical tool and does not offer solution to surgical problems by its mere existence. But with proper training and practice, it allows the clinician to dramatically improve surgical outcomes and provide the highest quality of care possible for the patients. We have found the use of our laser very rewarding.
Dr. Ed Gilsleider is a 1982 graduate of Kansas State University. He has been in Claremore, Okla., in his mixed animal practice since graduation. He has been married to Lisa for 36 years, has four adult children and six grandchildren.
References
- Leclerc J-M. Fibrosarcoma in a goldfish treated with CO2 laser. Veterinary Practice News. Nov 2013; p. 1.
- Berger N, Eeg P. Veterinary Laser Surgery: A Practical Guide. Laser Systems, Wavelengths, and Technology Selection 5: 63-75, 2006.
This Education Center story was underwritten by Aesculight of Bothell, Wash., manufacturer of the only American-made CO2 laser.
