April 17, 2009
Tom Tully, DVM, Dipl. ABVP (avian), ECAMS, a professor of zoological medicine at Louisiana State University, says his Ellman Surgitron 4.0 MHz dual-frequency radiosurgery unit is indispensable in his practice of avian and exotics medicine.
“I can use the unit throughout a surgery,” he says. “I can make the initial incision using a needle electrode and, while using the same hand piece and pressing a different button, switch from a cutting to one of cut and coagulation. And when you’re working on patients as small as 20 grams, hemostasis is very important.
“Depending on the size of the patient, I have different electrodes available,” he adds. “I like to switch out electrode tips to meet specific surgical needs.”
One limitation to radiosurgical equipment arises when operating in a fluid environment.
“Any time there is a pooling of blood, you will not get the optimum performance from the electrode,” Dr. Tully says. “The blood must be removed, and then the electrode can be applied for hemostasis.”
In regard to hemostasis, Tully says that one of the greatest equipment enhancements to the 4.0 MHz radiosurgical unit has been the ability to transition between the hand piece and bipolar forceps without touching the unit. “These forceps allow you to clamp down on a vessel and provide very precise hemostasis,” he says.
Among radiosurgery’s many uses, veterinary oral surgery is one area in which the technology is noticeably on the rise. However, as with other applications, its use remains largely a matter of preference.
Michael Bomar, DVM, of Colonial Park Veterinary Hospital in Wichita Falls, Texas, says he uses his Bovie electrosurgical unit in a wide variety of surgical procedures. “However, in the mouth, we tend to use our laser,” he says. “We feel that it is more forgiving to the tissue and also to the surgeon.”
Giselle Hosgood, BVSc, Ph.D., FACVSc, Dipl. ACVS, professor and chief of companion animal surgery in the department of veterinary clinical sciences at the Louisiana State University School of Veterinary Medicine, notes that some veterinarians feel that radiosurgery’s use is not appropriate for oral surgery.
However, she says she—as well as many oral surgeons on the human side—regularly uses it effectively in the mouth.
“It’s important that radiosurgery is used appropriately, meaning the equipment is on the proper setting,” says Dr. Hosgood, who uses a Valleylab Surgistat B unit. “Untrained individuals may use the instrument at too high a setting, their application of the electrode may be imprecise, or they may apply too much force.”
Indeed, proper application of radiosurgical technology lends itself to an array of uses in oral surgery.
Don DeForge, VMD, FAVD, FWAR, an adjunct instructor at Northwestern Connecticut Community College in oral radiology, oral surgery and periodontology, uses Ellman’s Surgitron 4.0 MHz dual-frequency radiosurgery unit for everything from oral biopsies to prosthodontics.
“This technology allows the operator the ability to incise tissue with minimal tissue damage and accelerated healing,” he says. “It allows the ability to cut with simultaneous coagulation. The fully rectified, fully filtered waveform allows cutting in juxtaposition to bone without any danger to the patient.”
Dr. DeForge says he uses radiowave radiosurgery for multiple applications in major oral surgery, as well as in periodontal surgery, soft tissue flap creation for exodontia, operculectomy for embedded dentition and vital pulp therapy (endodontics).
In addition to a wide variety of uses in the mouth, radiosurgery is also increasingly being used in ophthalmologic applications.
William Miller, DVM, Dipl. ACVO, of Advanced Animal Eye Care in Memphis, Tenn., practices veterinary ophthalmology exclusively. He says he uses his Ellman Surgitron on any highly vascular tissue with low sectility, such as eyelids, mucosa and conjunctiva.
“Using a radiofrequency unit, I do not have to distort tissue with stretching devices,” he says. “Hemostasis reduces swelling and shortens healing time.”
Dr. Miller says some of the latest applications for radiosurgery include eyelid surgery and the removal of vascular tumors. He says intraocular procedures still often require the use of a different modality.
“However, I am developing techniques that may lend themselves to intraocular surgery,” he says. “I recently removed an intraocular tumor with minimal complications.”
Lori Luechtefeld, of Los Angeles, is a regular contributor to Veterinary Practice News. Read her extended coverage of radiosurgical trends in the July issue.
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