Veterinary Laser Surgery: A Practical Guide

236 Pages·2006·14.438 MB·English

by  Noel Berger, Peter H. Eeg(auth.)

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Peter H. Eeg, DVM, BSc,
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Written by experts in the field, Veterinary Laser Surgery:
writer on the subject of the use of
A Practical Guide strives to help general and specialty laser energy in general veterinary
veterinary practitioners understand, implement, and practice. He is a Past President
expand the use of laser energy in safe and rational ways of the Veterinary Surgical Laser N
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for both surgical and therapeutic procedures to further
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Noel Berger, Peter H. Eeg
Veterinary Laser Surgery
A Practical Guide
Veterinary Laser Surgery
A Practical Guide
Noel Berger
DVM, MS, DABLS
President, ex officio, Fellow
Veterinary Surgical Laser Society, LTD
Boston Road Animal Clinic, Inc.
Sutton, Massachusetts
Peter H. Eeg
BS, DVM
Executive Vice President
Veterinary Surgical Laser Society, LTD
Director of Small Animal Services and Laser Medicine
Poolesville Veterinary Clinic
Poolesville, Maryland
© 2006 Blackwell Publishing First edition, 2006
All rights reserved
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Original Graphic Art by Bob Feaster
Portions of Chapter 3 originally appeared in Laser Surgery in
Gynecology: A Clinical Guide, (c)1993 Elsevier Inc. Reprinted
with permission from Elsevier.
To our families and colleagues
We strive to improve quality of life every day.
Contents
Foreword ix
Preface xi
Acknowledgments xiii
Part I Theory of Laser Surgery 1
01 General Principles of Laser Energy and Biophysics 3
02 Power Density and the Basic Effects of Radiant 19
Energy on Tissue
03 Fundamentals of Laser-Tissue Interactions 29
04 Types of Laser-Tissue Interaction Related to the 43
Rate of Heat Transfer Through Soft Tissue
05 Laser Systems, Wavelengths, and Technology Selection 63
Part II Practical Laser Surgery 77
06 Safety Considerations 79
07 Economic Considerations for Use of Laser Energy 91
in Veterinary Medical Practice
08 Pain Management Considerations for Laser Surgery 101
Procedures
Part III Clinical Laser Technique and Procedures 109
09 Diode Lasers in Small Animal Veterinary Medicine 111
10 Introduction to Clinical Applications of CO Laser 139
2
Energy in Veterinary Medical and Surgical Services
Case Studies 183
Suggested Reading 225
Index 227
vii
Foreword
Albert Einstein first described the concept of laser as an acronym forLight
Amplification by Stimulated Emission of Radiation in 1917. It took more
than forty years to pass before Theodore Maiman created the first laser,
which was initially applied to surgical use. Since that time, lasers in medi-
cine and surgery have widely expanded our abilities to more effectively
fight disease and greatly improved our patient outcomes and comfort.
Laser techniques in oncologic surgery have become effective alterna-
tives to radical tumor resection and to palliative tumor treatment meth-
ods.1 CO and Nd:YAG laser excision has been shown to provide almost
2
a 50% improvement in the control of local disease in-vivo compared with
scalpel resection in rodent mammary gland tumors and human oral mu-
cosal lesions.2,3 Lasers provide light with the necessary wavelength at the
intensity sufficient for photodynamic therapy (PDT) for treating cancer-
ous and non-cancerous lesions.4,5 Specific laser wavelengths can be cou-
pled to flexible fiber optics, which provides the possibility of improved
surgical access via endoscopy, allowing for minimally invasive procedures
and enhanced patient outcomes in the areas of upper respiratory, optic,
gastrointestinal, genitourinary, and neurological surgery.
Despite the incredible development and advances that lasers have un-
dergone in human surgical and therapeutic applications, lasers in veteri-
nary practice have long been regarded as “surgical toys,” given their ex-
pense and cumbersome size which made them impractical for private
practice. In the past decade, however, technological breakthroughs have
resulted in compact, portable, and reliable lasers that are economically
feasible for both the general and specialty veterinary hospital. Laser use
in clinical veterinary practice has become the newest “tool” for improved
patient care and wider therapeutic options, but also poses additional
health and safety hazards for the veterinary staff.
An understanding of laser light properties and interaction with tissue
will result in optimal patient outcomes without increased risk to the sur-
geon, staff, or pet. For veterinarians to fully appreciate the advantages of
laser energy, they must first understand how laser energy interacts with
and affects living tissues before recommending or attempting to apply this
technology to companion animals. The human literature has demon-
strated these beneficial effects in lab animal studies and human clinical tri-
als. These studies support the use of laser energy for the enhancement of
quality of life and control of disease in the veterinary patient. They also
provide a foundation for the commonly accepted laser surgical techniques
and procedures which are constantly being implemented and refined in
thousands of private veterinary practices around the world. Our pets can
finally benefit from the very technology for which many research animals
were used to perfect these laser surgical procedures on people. This book
ix
Foreword serves as a practical guide to the general and specialty veterinarian to un-
derstand and use laser energy in a safe and rational fashion to enhance
our patients’ quality of life and our overall standard of care.
Barbara R. Gores, DVM
Diplomate, American College of Veterinary Surgeons
Veterinary Specialty Center of Tucson
4909 N. La Canada Drive
Tucson, AZ 85704-1507
520-795-9955
[email protected]
Notes
1. Paiva, M.B. et al. Nd:YAG Laser therapy for palliation of recurrent squamous cell
carcinomas in the oral cavity. Lasers Surg Med 2002;31:64-69.
2. White, J.M., et al. Nd:YAG and CO laser therapy of oral mucosal lesions. J Clin
2
Laser Med Surg 1998;16:299-304.
3. Maker, V.K.; Elseth, K.M.; and Radosevich, J.A. Reduced in-vivo local recurrence
with contact neodymium:yttrium-aluminum garnet (Nd:YAG) laser scalpels. Lasers Surg
Med 1995;111:290-298.
4. McCaw, D. Photodynamic Therapy Can Successfully Treat Tumors. Vet Pract News
2001; 23.
5. Lucroy, M.D. Photodynamic therapy for companion animals with cancer. Vet Clin
Small Anim 32 (2002) 693-702.
x
Preface
Laser light is a unique, extremely powerful, and very selective form of en-
ergy with the unparalleled ability to do beneficial work on living tissue.
How it interacts with and changes living tissue is the central point to
which many specialties strive to understand laser energy. For any veteri-
narian to have a full appreciation of the power that laser energy can have
on their patients’ quality of life, they must first understand the many
physical and technical nuances that interrelate to provide this energy
form. Laser energy can be applied directly to target tissue or administered
to distant lesions at a remote site through fiber optic components. Each
wavelength of laser energy has its own specific interaction with target tis-
sues. Veterinary clinicians must fully appreciate the variation in tissue in-
teraction by specific laser energy wavelengths before attempting to apply
this technology to their patients.
Surgical and therapeutic use of lasers began in human medicine in the
early 1960s. Unlike many technologies, the size, reliability, and portabil-
ity of laser units has improved so rapidly that they are both economically
and practically feasible for the general and specialty veterinarian.
The growth of laser use in veterinary medicine has progressed in the op-
posite fashion to standard-held dogma of university implementation and
general acceptance first, followed by private practitioners’ usage and ac-
ceptance. The ease of implementation and laser company tutorial courses
have spawned a private general clinical usage and experimentation with-
out great oversight from traditional educators. Only now are universities,
at the request of laser companies and practicing veterinarians, securing
and implementing lasers in their clinical protocols. It will still be some
years before extended study and research into specific uses of laser energy
already accepted by practicing veterinary clinicians will be verified in the
traditional university study fashion. Anecdotally accepted techniques and
procedures being refined and implemented in thousands of private veteri-
nary practices in the United States and around the world will support the
use of this type of energy system for enhancement of patient quality of life
and relief of animal disease and suffering.
This book strives to help general and specialty veterinary practitioners
both understand and implement the use of laser energy in a safe and ra-
tional fashion for the improvement of patient quality of life.
xi
Acknowledgments
My first professional responsibility is always to focus on the welfare of
my patients. When I first began experimenting with surgical lasers in
1996 I felt alone and in front of the pack with no one to guide me through
the process. Fortunately, in a very short period of time, I was able to suc-
cessfully perform surgical procedures for my patients more favorably.
Immediately, my excitement grew and I felt driven to share my knowledge
and experience with my colleagues. It was imperative that the veterinary
profession should know what worked and what didn’t. Seemingly invin-
cible with lasers, I began using the tool for just about everything that I
could do with a surgical blade or scissors. It was good, very good. My sur-
gical cases were turning out better than ever before. I was able to ap-
proach surgical problems in an entirely different light! Now, I felt as
though more complicated surgical cases were well within my abilities, and
certainly after performing them successfully, my practice grew.
From an economic perspective, this has been one of the most exciting
additions to my career. Laser surgery has allowed me to add more serv-
ices that my practice can offer. My staff feels like they are special because
they are part of a laser surgical facility, and they got to play with a lot of
toys like video equipment and digital imagery as well as the laser and
safety devices. Referrals from other veterinarians are common, and my ca-
reer satisfaction has soared because I can help more patients, and I believe
that I help them better.
This book is the result of many years of good experiences with lasers in
surgery. My outpouring is the result of support from many friends and
family. The desire I have is for every veterinary practitioner to be comfort-
able and competent in laser surgery. Hopefully this labor will help inspire
you. There has been much effort by many to produce this work, and I
wish to thank my lovely wife, Gayle, for giving me the freedom to learn
and to teach. Also my three children Grace-Ann, Benton, and Samantha
for never saying, “Daddy I miss you, please don’t go,” when I had to leave
town to lecture or lead a wet lab. Also, my staff of laser technicians, es-
pecially James Koproski and Erik Bishop, for getting just the right shot
when we needed to take a picture during a surgical procedure. Good
Lord, thank you for giving me this life to share with others.
Noel Berger DVM, MS, DABLS
* * *
In preparing and compiling this book, I relied on my clinical experi-
ences and independent research to gain an appropriate working laser pro-
gram for my patients, clients, and clinical practice. I greatly appreciate the
xiii