What a new CO₂ laser surgeon needs to know: A graduate’s take

By Cameron Henke, DVM, and Paul Sessa, DVM For The Education Center
Originally Published In Veterinary Practice News, August 2018 –Download as a PDF

Prologue from Paul Sessa, DVM

As a seasoned laser user, it has been my pleasure to give some direction and training to students that have come through my practice. I’m particularly proud of Cameron Henke, DVM, my resident and a 2017 graduate. He grew up in our practice, and he has been a laser assistant for many years, but his thoughts on the advantages of using the flexible waveguide laser system in our practice will, I hope, inspire others to get the training and guidance to bring this technology to more patients.

A recent grad’s view: Cameron Henke, DVM

Bright eyed and bushy tailed. That is the way a majority of us new graduates enter our first job as a practicing veterinarian. Yet, quite often, reality sets in and I hear the concerns and self-doubt of fellow new graduates about performing surgery on their own. It can be a scary thing performing your first surgery as the “person in charge” without a clinician or classmate over your shoulder to double check every decision and action. One thing that has set my experience apart for the past few months is the use of an Aesculight CO₂ surgical laser. It has given me exceptional results and a tremendous boost in my confidence to perform almost every procedure we were just so recently taught in school. It has allowed me to benefit myself, my technicians, my boss, and senior clinicians, my clients, and most importantly, my patients. The name of the game is time.

We all understand that in a veterinary clinic, time is money, and this is where the CO₂ laser comes in so handy. The concept of minimizing oozing and bleeding allowing for better visualization of tissue planes and the surgical field has maximized my efficiency as a new surgeon. The increased visualization means I am able to more accurately assess the tissue, my cuts, and my sutures placement. I am not dependent on a surgical assistant or alternating scalpel for hemostatic forceps, surgical scissors, electrosurgical instruments, and so on. Although it does not rid myself of a complete surgical pack, I find I use far less total instruments in routine spays and neuters than I ever had while using cold steel. This means I can do more spays and neuters, freeing more staff for other doctors, and freeing senior clinicians from having to assess my work, all of which culminates into more money for the practice.

Along with monetary gains, shorter time also means increased safety. The fact that a new grad can cut anesthesia time is a significant confidence booster to our clientele who see an unfamiliar face trying to convince them of an elective surgery. This only adds to saving money on anesthesia costs on the clinic, which can be passed onto clients in the continuously competitive spay and neuter market. While common procedures show obvious benefits, the most advantageous perceptions from my point of view have been on nonroutine procedures such as cystotomies, mass removals, and brachycephalic surgery with naresplasty and elongated soft-palate resection. If any concerns existed about the precision and exactness in cutting capacity of a laser, you can lay those to rest—even in the hands of an inexperienced surgeon, such as me, I am able to do fine layer tissue separation and make exact consistent planes in my dissections.

Finally, I’ve seen far fewer postsurgical complications in my patients since starting with the CO₂ laser. I am still unsure if fewer issues directly result from:

• Decreased inflammation and less pain to the patients (less self-induced complications from licking/chewing/scratching)
• Coagulation of the microvasculature and lymph vessels that normally contribute to seroma formation and swelling
• Reduced tissue damage compared to the thermal change from electroscalpels and mechanical tissue crushing from cuts with cold steel
• Lack of actual contact of the instrument with the tissue (a unique characteristic of the laser), which decreases the risk of infection.

Regardless of the cause, my patients and clients both benefit from improved clinical results of CO₂ laser surgery. This has greatly increased my confidence and my superiors’ confidence in my surgical capabilities. I truly believe I could not have made such rapid gains in surgical performance and quality of care for my patients in such a short amount of time had I not been spoiled with the assistance of our Aesculight CO₂ surgical laser.

Dr. Sessa’s advice regarding CO₂ surgical lasers to new users

• It is an amazingly precise instrument. It will make you a more confident surgeon.
• You will be able to master the basics of the laser in a very short time. The learning curve is not that steep. Have courage.
• Hand-to-eye and foot coordination is a must. This means moving efficiently so you make a single-pass full-thickness incision (hand speed helps the surgeon regulate the depth of incision; removing foot off the foot switch stops lasing).
• Smooth movements will produce a more uniform result with a consistent incision depth and less char formation.
• Do not be afraid of power increases as you gain skill. Higher power settings will increase your efficiency. Just do not sacrifice precision for speed. Two really overwhelming benefits of the laser are its accuracy/precision and the visibility it provides in a dry surgical field (in surgeries like cystotomy, aural procedures, elongated soft palate resection, etc.).
• The flexible waveguide Aesculight laser provides an infinitely adjustable power setting just by the simple change in tissue-to-tip distance. That, coupled with the varied pulse settings, makes even the most delicate surgery more manageable.
• Don’t be afraid of the physics. Knowing how laser light interacts with tissue will help you to be a better surgeon.

Paul Sessa, DVM
Dr. Paul 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, Calif.

Cameron Henke, DVM
Dr. Henke attended St. George’s Veterinary University in Grenada and completed intensive clinical rotations at Auburn University in Alabama. He graduated in December 2017 and will complete a postgrad internship at Advanced Veterinary Specialists in Santa Barbara in 2018-2019. He has worked at Salida Veterinary Hospital as a kennel assistant in high school, a veterinary technician after college, and as a staff veterinarian.

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