Laser surgery in veterinary medicine

378 Pages·2019·32.104 MB·English

by  Winkler, Christopher J

Laser Surgery in Veterinary Medicine
Laser Surgery in Veterinary Medicine
Edited by
Christopher J. Winkler, DVM, DABLS, VMLSO
Suffolk Veterinary Group Animal Wellness and Laser Surgery Center
Selden, New York, USA
This edition first published 2019
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Library of Congress Cataloging‐in‐Publication data has been applied for
ISBN: 9781119486015
Cover Design: Wiley
Cover Images: Photo credit – Gaemia Tracy, Photo credit – Katalin Kovacs, Photo credit – Christopher J. Winkler
10 9 8 7 6 5 4 3 2 1
v
Contents
Dedication and Acknowledgments viii
About the Editor ix
Foreword x
Preface xii
List of Contributors xv
Disclaimer xvii
About the Companion Website xviii
Part I The Science of Laser Surgery 1
1 Laser Physics and Equipment 3
Peter Vitruk
2 Understanding and Utilizing Power Density 14
Noel Berger
3 Laser–Tissue Interaction: Selecting a Laser for Surgery 22
Christopher J. Winkler
4 The Ideal Laser Scalpel 32
Peter Vitruk
5 Combining Laser Surgery with Laser Therapy (Photobiomodulation) 42
David S. Bradley
6 Laser Safety in the Operating Theater 52
Christopher J. Winkler
Part II Laser Surgery in Canines and Felines 61
7 Elective Laser Surgery Procedures 63
Paul Sessa and Andrew Brockfield
8 Oral Laser Surgery Procedures 84
Jan Bellows
9 Laser Surgery Procedures of the Nose and Throat 99
Ray A. Arza
vi Contents
10 Laser Surgery Procedures of the Ear 106
Louis N. Gotthelf
11 Periorbital and Eyelid Laser Surgery Procedures 116
Daniel M. Core
12 Ophthalmic Lasers for the Treatment of Glaucoma 129
Noelle La Croix and Jay Wayne
13 Dermatologic Laser Surgery Procedures 141
David Duclos
14 Urogenital and Perianal Laser Surgery Procedures 164
William E. Schultz
15 Oncological Laser Surgery Procedures 198
Devin Cunningham and F. A. (Tony) Mann
16 Laser Photodynamic Therapy Procedures 206
Katalin Kovács
17 Surgical Lasers in Minimally Invasive and Endoscopic Small Animal Procedures 217
David S. Sobel
18 Laser Neurosurgical Procedures 239
Gaemia Tracy
Part III Laser Surgery in Equines 245
19 Equine Laser Surgery Procedures 247
Lloyd P. Tate and Kathryn B. Tate
Part IV Laser Surgery in Exotics Species 265
20 Laser Surgery Procedures in Small Exotic Animals (Small Mammals, Reptiles, and Avians) 267
Eva Hadzima, Maros Pazej, and Katherine Weston
21 Laser Surgery in Aquatic Animals (Sea Turtles) 292
Brooke M. Burkhalter and Terry M. Norton
Part V Integrating Surgical Lasers in Your Veterinary Practice 313
22 Tips and Tricks for Veterinary Laser Surgeons 315
Les “Laser Les” Lattin
23 Pain Management in Laser Surgery Procedures 320
Noel Berger
24 Laser Surgery in the Mobile Practice 324
Janine S. Dismukes
Contents vii
25 Economic Considerations for Laser Surgery 327
John C. Godbold, Jr
Part VI The Future of Lasers in Veterinary Medicine and Surgery 335
26 The Future of Lasers in Veterinary Medicine and Surgery 337
Christopher J. Winkler
Appendix A: Glossary 341
Appendix B: Certifying and Academic Laser Organizations 346
Appendix C: Tables of Laser Settings 347
Index 359
viii
Dedication and Acknowledgments
This book is dedicated in loving memory to those who To my editors, Erica Judisch, Purvi Patel, Susan
still remain with us in our hearts, particularly to Donna Engelken, and Sandeep Kumar, for all of your advice and
and Robert Sessa, and to Jack Winkler. assistance.
This book would not have been possible without the To my own staff past and present, for all of your help
efforts of an extraordinary group of contributing veteri- and enthusiasm for this project.
narians, experts, and their staffs, in the field of laser To all of our patients who have helped us learn, and
medicine and surgery. The past year has been a wonder- those that these efforts here are intended to help in the
fully illuminating education in each of your fields, and I future, this is for you.
am proud to bring your brilliant work to others’ atten- To my family and friends for their support, especially
tion. It has been the greatest of pleasures collaborating to my parents Nancy and Joseph, whose own dedication
with you. A heartfelt thank you to you all. and faith and love are an everlasting source of
To John C. Godbold, Jr., DVM, whose mentorship, inspiration.
encouragement, patience, time, and input were invaluable To my children John and Kevin, my greatest endeavor,
and instrumental in the creation of this book. I am hon- and to Nicole, my wife and companion in this our
ored to call you my teacher, my colleague, and my friend. adventure. I love you very much.
To Mr. Stephen Fisher, MBA, of the American Board of
Laser Surgery, for his generous correspondence and aid
with reference materials and figures.
ix
About the Editor
Christopher J. Winkler, DVM graduated from Ross continues to advise educating bodies on veterinary laser
University School of Veterinary Medicine in 2001, and curricula, and offers his services as a laser consultant to
worked on Long Island, NY, as an emergency room vet- veterinarians and equipment manufacturers.
erinarian and associate general practitioner before pur-
chasing Suffolk Veterinary Group in 2006. Incorporating
surgical lasers into his practice in 2010, he soon added
laser therapy and began formal training a short time
later, earning certifications in Veterinary Laser Medicine
and Surgery from the American Board of Laser Surgery
(ABLS) in 2015, and Veterinary Medical Laser Safety
Officer from the American Institute of Medical Laser
Applications (AIMLA) in 2016.
Dr. Winkler has spoken on laser surgery and laser ther-
apy and served as an associate laser surgery wet‐lab
instructor for a number of national veterinary confer-
ences including the NAVC, AVMA, and WVC. He has
also conducted webinars on laser therapy for veterinary
technicians and Ross University students, and published
articles on laser surgery for Veterinary Practice News.
He is a member of the American Society for Laser
Medicine and Surgery (ASLMS), and is a faculty member
of both the American Laser Medicine College and Board
(ALMCB) and the American Laser Study Club (ALSC),
for which he also sits on the editorial board of its journal.
He receives referrals from veterinarians locally and
nationally for laser surgery and laser therapy cases,
x
Foreword
My love affair with lasers and other light based medical superb. He is one of only six veterinarians in the world
technologies began in 1999 with a picture in a veterinary certified by the American Board of Laser Surgery. No
trade magazine. The picture, accompanying an article one is more qualified to be the editor and a contributing
about a simple CO laser surgery procedure, was intrigu- author of Laser Surgery in Veterinary Medicine.
2
ing, a bit mysterious, and somehow very exciting. Dr. Winkler has gathered together an impressive group
Our first date was a few weeks later when the repre- of scientists and veterinarians from academia, industry,
sentative for a surgical laser company brought a CO specialty practices, and general practice as chapter con-
2
laser to my practice for a demonstration. After putting tributors. Together with Dr. Winkler, the contributors
the laser in my hands for the first time, the representative give the veterinary community an authoritative source of
talked me through several procedures. Seeing tissue information about laser surgery.
vaporize was more intriguing, more mysterious, and The chapters on the science and safety of laser surgery
exquisitely more exciting than the picture. I was in love, are detailed and clearly presented. They include excel-
and my first CO surgical laser was delivered within a lent illustrations and diagrams that help simplify the
2
month. complexities of laser–tissue interaction.
For early adopters of lasers, one of the challenges was The chapters on clinical applications contain practical
an almost complete lack of information about the science guidelines about species‐specific procedures, and help
of laser–tissue interaction and no information about its make this book a practical and usable clinical reference.
use in specific veterinary surgery procedures. Progress The inclusion of many intraoperative pictures clarifies
was made and new applications became more common the contributing authors’ text descriptions.
because early adopters were willing to share their clinical The chapters on integration give a road map for suc-
experiences. We sought any potentially helpful publica- cessful incorporation of laser surgery into a practice.
tion, we networked to share case reports, and we cele- And, the final chapter gives a glimpse into the future of
brated when laser surgery texts were published in 2002 laser surgery and what we can look forward to.
and 2006 (Bartels 2002; Berger and Eeg 2006). A valuable feature of this book is the information about
For me, sharing case reports led to making presenta- laser settings for procedures. Current surgical lasers
tions about laser surgery, and leading wet labs and work- have higher power, are more efficient, have improved
shops in which my co‐faculty and I learned as much as software, and an increased number of delivery options.
participants. Eighteen years and over 600 educational Since laser settings may vary depending on the specific
events later, I continue to join participants in a quest for equipment being used, tables for recommended settings
up‐to‐date information about surgical lasers and their use a standardized format applicable to multiple equip-
use in veterinary medicine. Laser Surgery in Veterinary ment options. Practitioners can adapt the recommenda-
Medicine now gives us that information. tions to a wide range of equipment.
Teaching wet labs and workshops has given me the Another valuable feature is that it is noncommercial.
opportunity to work with many talented colleagues Just as with the tables of settings, the text describes treat-
serving as co‐faculty. One of the most notable is ment procedures and protocols in generic, noncommer-
Dr. Christopher J. Winkler. cially specific ways.
Chris joined the teaching team for a CO laser wet lab Contributing authors do not recommend specific laser
2
I was leading several years ago and immediately excelled manufacturers. Rather, they describe a broad range of
in teaching the technology one‐on‐one. Since then he equipment and discuss the differences, benefits, and lim-
has continued to be one of my first choices for co‐faculty. itations between them.
His depth of knowledge, understanding of the science, Laser Surgery in Veterinary Medicine will be the go‐to
and ability to apply that science to clinical applications is source of knowledge and reference for veterinary