Laser surgery advancement through increased power, refined pulse controls, and miniaturized handpieces

    By Anna “Anya” Glazkova, Ph.D. For The Education Center
    Originally Published In Veterinary Practice News, October 2017 – Download as a PDF

    David D. Duclos, DVM, a board-certified veterinary dermatologist, has more than 20 years of experience with CO2 laser surgery. As the first veterinarian who has used VetScalpel®, the newest 45 Watt surgical CO2 laser system with 30 Watts of SuperPulse (SP) (Figure 1), Dr. Duclos shares his unique insight.

    Q: How would you summarize the advances that VetScalpel brings to surgery?

    A: The new high-power settings (up to 45 Watts with 30 Watts SP) enable really fast laser surgery—at the speed of a scalpel. I consider the introduction of miniaturized handpieces (Figures 1-3) and the addition of 35 customizable presets (Figure 4), along with improvements to controls, laser ergonomics, and the clinical library (Figures 5-9), as true advancements. With the VetScalpel system, Aesculight has raised the bar, again, for surgical laser manufacturers in the veterinary space. Another important consideration is that VetScalpel lasers are supported with first-rate customer service operation from the Aesculight’s manufacturing facilities here, in Seattle, Wash.

    Q: Dr. Duclos, what do you think about the specific refinements in the new VetScalpel system?

    A: The VetScalpel laser has some nice improvements. The calibration screen goes to 6 Watts automatically, so I don’t have to press the power button multiple times to get it to 6 Watts. The ability to increase and decrease the power on the right side of the touch-screen display in increments of 10 to 15 percent is really convenient. All I have to do is pick a mid-range power setting. For instance, if the laser is set at 800 milliWatts (mW), with one press of the button, I can increase the power to 1,600 mW, and with two presses, I can increase it to 3,200 mW. This is a very handy function—probably the most useful of the new system.

    Q: How would you compare the new adjustable handpiece with the original adjustable handpiece (Figure 2)?

    A: The new adjustable handpiece is very neat. It is not as big and bulky as the previous one, so I will probably use it all the time.

    Q: VetScalpel laser offers a redesigned wide ablation nozzle. Where would you use the handpiece with the wide ablation nozzle (Figure 3)?

    A: It is useful for large areas of ablation, so for surface tumors greater than 6 to 10 millimeters, the wide tip would simplify ablation. Also, it is the only tip useful for interdigital cysts on the paws or elbows, Bowenoid in-situ carcinomas, viral warts, and apocrine cysts in ears.

    Q: Did you feel any difference between the new fiber waveguide and the previous Aesculight one?

    A: The new fiber waveguide works just like the previous one, except I don’t have to worry about where the mast is, as the waveguide comes right out of the laser.

    With the VetScalpel system, Aesculight has raised the bar, again, for surgical laser manufacturers in the veterinary space.

    Q: As you pointed out, VetScalpel does not have a mast (Figure 4). How has this affected your surgical experience?

    A: The mast was not a huge problem, but I did have to pay attention to the direction in which the mast was pointed, and when I moved around, I had to ensure the mast moved in the right direction. Without the mast, I don’t have to worry about its angle. It’s simply another convenience feature—one less thing to focus on while doing a surgery.

    Q: The control panel has been simplified compared to the previous-generation Aesculight and old Luxar laser systems (Figure 5). What do you think about this new software (functionality, ease of use, appearance, etc.)?

    A: The VetScalpel control panel is definitely much better. I can change the amount of laser energy quickly without having to search for settings that might work. With the Aesculight system, the modes were listed by letters A, P, C, and D, with no obvious logic to which ones had slow speed (hertz, or pulses per second) and which ones were faster. I made a chart for my own reference and then would have to press the buttons up and down until I could find the right one.

    With this VetScalpel system, the pulse modes have a logical letter and number scheme. “S” for slow, “M” for medium, “F” for fast, and “U” for ultrafast. Also, each mode is grouped with several pulse duration settings. For example, I can choose fast setting F1-5, and all I have to do is move the power up or down to go through all nine levels of the F1 group. This is very easy—people will really appreciate this function.

    The other thing about the control panel is that previously I had to pay attention to the percentage of duty cycle and then mentally do the math to convert the Watts I chose, combined with the pulses per second, to get the Joules. The new system shows me all of this information on the control panel—it conveniently calculates the Joules and Watts for me automatically, so that I don’t need to do the math each time (Figure 5). This really saves time and gives me a visual number right there, so I know exactly where I am in my power delivery to the patient.

    Because total Joules per pulse and average Watts are displayed, and it is possible to increase/decrease power in 10 to 15 percent increments, adjusting power is very easy. As an example, my usual starting point for ablation or cutting is 12 Watts, SP, repeat mode, 29 Hz (this is the new fast-setting group, F2-5). At this setting, I can see on the right side of the control panel that the on time per pulse is 25 msec, and that each pulse is delivering 8.7 Watts, or 8,700 mW (Figure 6).

    My second setting is 8 Watts, continuous wave (CW), in fast-setting group F1-4 at 20 Hz, so on the right side of the display I can see that I am getting 20 msec on time per pulse, and it is delivering 3.2 Watts to the target tissue.

    I like to power up both so that during surgery I can start with more power on the SP function and then to go to lower power; all I have to do is press the SP button and it goes to the CW setting of F1-4 8 Watts, delivering 3.2 Watts. If this is too much power, all I have to do is press the “down” arrow button to decrease power to 2.5 Watts, or one more press and I get 1 Watt. This is nice for things like sebaceous gland tumors, when more power is needed in the beginning; afterward—to clean up the deep part—it takes only one press of the SP button to lower the power. At the very end, one or two presses of the down arrow on the far right allow me to drop the Watts as needed.

    For delicate areas, such as eyelids, I also have a two settings arrangement, i.e., one is SP and one is CW. The first is S2-2 at 3 Watts on SP repeat mode at 2 Hz for a total of 60 mW; the second setting is S2-2 CW at 4 Watts to deliver 80 mW. With the power function up and down, I can decrease the power as needed when approaching the end of the eyelid tumor. During the surgery I can switch between SP and CW with one button press. And if necessary, I can lower the power settings from 3 to 4 Watts to reduce the amount of tissue being removed. This gives surgeons great control over a delicate area and allows removing just the tumor tissue while avoiding the damage to the eyelid (Figure 7). A magnification head set helps to better visualize the eyelid tumor.

    David D. Duclos, DVM, DACVD, is a small-animal practitioner in Lynnwood, Wash., where he is the owner and clinical dermatologist at the Animal Skin & Allergy Clinic. He completed his residency in veterinary dermatology at the University of Pennsylvania. He is an associate clinical instructor for the Western University College of Veterinary Medicine in Pomona, Calif., and teaches senior veterinary students as externs at his clinic. He frequently hosts veterinary students from other veterinary medical colleges around the U.S. and in Europe who are seeking to learn about the specialty of veterinary dermatology during their third and fourth year of veterinary school. In addition, Dr. Duclos teaches veterinary residents in dermatology who are seeking to learn more about laser surgery for two- to four-week externships sponsored by the American College of Veterinary Dermatology. He recently has begun to take part in the One Health initiative, recognizing that the health of people is connected to the health of animals and the environment. The goal of One Health is to encourage the collaborative efforts of multiple disciplines-working locally, nationally, and globally to achieve the best health for people, animals, and our environment. He authored a number of book chapters and scientific papers on various subjects in veterinary dermatology. He lectures extensively in the U.S., Canada, and Europe. Dr. Duclos is well known in the veterinary dermatology specialty for his expertise in CO2 laser surgery and for his interest in clinical photography.

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