Carbon dioxide (CO2) lasers have become a standard of care in veterinary surgery. Delivering the ideal wavelength (10.6 Ìm) for all soft tissue surgery, CO2 lasers provide increased precision and result in reduced hemorrhage, swelling, pain and tissue trauma. CO2 lasers also facilitate many laser-improved and laser-specific procedures. Since entering veterinary medicine in the late 1990s, flexible hollow wave guide CO2 lasers have been adapted to the needs of diverse practice types. Now mainstream, this cutting-edge technology is being used in general practices as well as specialty and referral practices. General Small Animal Practice Thousands of small-animal practices in North America use CO2 surgical lasers every day. Jeff Goodall, DVM, of Sunnyview Animal Care Centre in Bedford, Nova Scotia, notes, “We purchased the CO2 laser in November 2003, and we made the use of the laser mandatory for elective surgeries within one year of purchase.” He reports that he now uses his flexible hollow wave guide CO2 laser in over 98 percent of his surgeries. Dr. Goodall’s CO2 laser also facilitated other welcome developments in the practice by “attracting more qualified and experienced staff to our practice when we advertised for positions. They were looking for a laser practice, and we inherently had standards that attracted them.” With his CO2 laser, Goodall established a standard of care that allows him to do better surgery and to attract the best staff and the best clients. Dermatology Practice CO2 surgical lasers have become a standard of care in specialty practices as well, such as in Dr. David Duclos’ Animal Skin and Allergy Clinic in Lynnwood, Wash. Duclos was one of the first veterinary dermatologists to use the CO2 laser in his specialty. He notes that his CO2 laser “removes tissue with less bleeding, less pain and swelling, and because it can be focused precisely, it will only remove the desired tissue without damage to the surrounding structures.” Avian and Exotic Practice Avian and exotic practices also have experienced paradigm shifts in terms of their standard of care. Lee Bolt, DVM, of Asheville, N.C., is a pioneering veterinarian in the avian and exotic specialty. “I have been using a CO2 laser since 1999 in my small animal and exotics practice,” Dr. Bolt says. “I wouldn’t practice without it now. I use it every day.” With respect to his equipment preferences, he adds, “I have a diode laser, but the CO2 laser is the way to go if you have to pick the most versatile modality.” Equine Practice Many large-animal practices incorporate CO2 lasers. Because of horses’ thicker tissues, higher-powered laser systems are often favored by equine surgeons. “I recently upgraded to the 40 watt CO2 laser and I have been impressed with the ability to treat the large tumor masses that I often have to deal with,” reports Robert V. Fleck, DVM, of Rainland Farm Equine Clinic in Woodinville, Wash. “I also have found the higher wattage and superpulse setting have made incisions a breeze since the horse has relatively thick skin. All in all, I don’t know how I could go back to a pre-laser practice situation.” Feline Practice CO2 surgical lasers are important in feline practices as well. Judy Karnia, DVM, owner of the Scottsdale Cat Clinic in Scottsdale, Ariz., a feline-only practice, notes that she uses a CO2 surgical laser “for all surgical procedures.” “It enables us to perform surgeries more quickly,” Karnia said. “We definitely see an improvement in recovery for the patients. We also believe that our clients regard the fact that we use the surgical laser as one more proof that we strive to offer the best medical care we can.” Clockwise from top left: Pre-, during and after photos of the ablation of nasal hyperkeratosis performed by Dr. Godbold. He considers hyperkeratosis a laser-specific procedure: ‘It just can’t be done any other way. One of the most important laser surgery-improved procedures is the feline onychechtomy. Melissa Suarez, DVM, of Arbor Hills Veterinary Centre in Plano, Texas, explains: “The critical difference is hemostasis. With the laser, there’s no tourniquet and there’s no bleeding.” Mobile Practice In central North Carolina, an accomplished CO2 laser surgeon has taken her laser on the road. Janine Sagris, DVM, began her practice in 2008 in a 24-foot mobile veterinary hospital. Since then, the clientele of Mobile Laser Veterinary Services has grown exponentially. “I have a flexible hollow wave guide CO2 laser in my mobile surgery suite,” Dr. Sagris says. “The laser is not optional for my personal pets, so I have the same high standard of care for my clients and patients. I perform everything from spays and neuters to leg amputations and soft palate resections with my CO2 laser. “Other veterinarians call on me to perform laser surgeries on their personal pets,” Sagris adds. “I also get many surgical referrals from other veterinarians for specific laser procedures on their clients’ pets.” Referral Practice Barbara R. Gores, DVM, an ACVS board-certified surgeon and a founding owner of Veterinary Specialty Center of Tucson, Ariz., uses her CO2 laser every day. “I use the CO2 laser in the majority of my soft-tissue procedures because of the advantages both to me as the surgeon and to my patient, Dr. Gores says. “I perform a lot of tumor removals, and the laser allows me to do a much more thorough job of dissection and excision of these neoplasms. I have so much better hemostasis. I can concentrate on achieving the most ideal tissue planes in my dissection, rather than spending my time on controlling bleeding and hemorrhage. The improved visualization allows me to perform a much more accurate dissection.” Gores adds that “Due to the non-contact nature of laser surgery, there is much less tissue manipulation, which greatly reduces swelling and edema, thereby greatly improving patient comfort postoperatively. This lessens the incisional licking, scooting and rubbing, which makes both the pet and the owner much happier.” Conclusion Hollow wave guide CO2 lasers are now an important tool in veterinary surgery. They have become a standard of care in general practices and in specialty and referral practices. The technology has continued to develop with the introduction of higher powered lasers that allow broader use and the development of more laser-specific applications. Continued refinements, like tip-less handpieces for the flexible hollow wave guide lasers, ensure that their use will continue to elevate the quality and scope of veterinary surgery. John C. Godbold Jr., DVM, is a small-animal practitioner from Jackson, Tenn. With a special interest in laser technologies, he has been a frequent continuing education presenter throughout North America and Europe for more than 10 years, and has trained thousands of colleagues how to use their CO2 lasers. This Education Series article was underwritten by Aesculight LLC of Woodinville, Wash., manufacturer of the only American-made CO2 laser. <HOME>
