The economics of surgical laser technology in veterinary practice.

A decision to invest in and develop laser technology should only be made after a thorough investigation and comparison of the available types, vendors, available features, and purchasing options. A sound marketing program must then be used for introducing laser technology to the staff, clients, and colleagues. Without adhering to such a program, a practice will [figure: see text] not experience the necessary profitability following the purchase of a laser. Staff enthusiasm and support will dwindle, and ultimately the laser investment will be viewed unfavorably. When marketed properly, however, the investment in a surgical laser will provide outstanding profitability. The return on investment can be provided by using the support staff for client education, by offering laser technology for routine elective procedures and complex procedures, and by adhering strictly to a fee schedule. Add that to the truly remarkable results obtained using laser surgical techniques, a practice will be greatly enhanced.     

Newer diagnostic and surgical techniques and their impact on anesthesia.

There are several newer diagnostic and surgical techniques available to veterinarians today. Careful anesthetic management is essential when using these modalities both to avoid accidents and to enable their use. For example, total intravenous anesthetic techniques can be used if the airway is occupied by an endoscope or laser surgery is being performed in the airway. The anesthesiologist must also be aware of the physiological changes that may occur during procedures such as laparoscopy and act to minimize their impact on patients.     

Lasers in ophthalmology.

Laser technology continues to progress with the addition of new lasers, new delivery systems, and new applications. The introduction of lasers to veterinary ophthalmology has radically changed the level of care that we can provide to our patients. The development of the diode laser has particularly had an impact on veterinary ophthalmology. The diode's affordability, portability, and broad applications for veterinary patients have allowed laser surgery to become a routine part of veterinary ophthalmology practice. Educating the public and veterinary community in available laser techniques will generate improved ophthalmic care and provide more data on which to build future applications.     

Lasers in the surgical treatment of canine prostatic neoplasia and selected tumours of the male reproductive system

Light-based technologies are applied in various fields of medicine: for example optical diagnostics, light-activated therapy and surgery. Although light-based surgical procedures had hardly been a novelty, the revolutionizing moment for surgery came with the first use of light to cut tissue. Nowadays, surgical lasers are routinely used across numerous medical specialties, including gynaecology and urology. They are a part of the surgical treatment of benign prostatic hyperplasia, prostate carcinoma, penis carcinoma, genital skin lesions and orchidectomy. While in human urology lasers continue to establish their position as one of the standard surgical tools, veterinary patients are rarely treated with what here is still considered a technical innovation. However, through research on laser treatment of the prostate hyperplasia conducted on a canine model, veterinary medicine has gained a massive portion of data. It may prove beneficial for our clinical patients. In this review, we introduce the very principles of laser surgery as well as its current and future applications in oncologic surgery of the canine prostate gland and the male reproductive system.     

Chronicle of laser usage in equine surgery

Laser is the acronym for light amplification by stimulated emission of radiation; the first laser beam was generated in 1960 and initially used for medical application in 1963. Today's modern surgical laser units produce an intensely focused light beam of uniform wavelength that interacts with a variety of biological cell types to vaporize, cut, coagulate, or shrink tissues. The resulting effect depends on the optical properties of the tissue and the wavelength, power output, spot size, and duration of laser beam application. Different lasers are suited to specific surgical tasks relative to their beam wavelength, power output, mode of operation (continuous, pulsed or superpulsed), and application (contact or noncontact) and instrumentation. The documented advantages of laser surgery over conventional surgical procedures are improved hemostasis, the ability to ablate or vaporize tissue, endoscopic access to body cavities, improved postoperative comfort, and shorter hospitalization and recovery times. By the mid-1980s, laser use in equine surgery was reported; the carbon dioxide and neodymium:yttrium-aluminum-garnet were the first models integrated into practice. The primary application of laser technology in equine surgery was for the correction of various upper-respiratory tract abnormalities and still remains the most prevalent use through endoscopy. Today, surgical lasers are used for the treatment of problems in the urinary, reproductive, and musculoskeletal systems, in addition to the skin and the eye. When we combine advances in laser technology and the practice of equine surgery, the result is clinicians better equipped to treat and manage the more difficult cases.     

Laser applications for corneal disease

The clinical use of the carbon dioxide (CO2) laser and diode laser is increasing in veterinary medicine. New applications for their use are being explored, including ophthalmic applications. The use of lasers for small-animal corneal disease is fairly limited due to several factors. The ideal laser for corneal use is the excimer laser due to its extremely precise photoablative capability. However, the excimer laser is unlikely ever to become practical for veterinary use. The frequency of corneal disease in small animals in which tissue ablation is indicated is relatively low. And for most of these diseases, routine surgical techniques work as well or better than laser ablation. The CO2 laser can be used on corneal tissue, but must be used very cautiously so as not to ablate too deeply, creating serious scarring or perforation. There are also concerns regarding its effect on corneal nerves, stromal collagen, and corneal endothelium. The CO2 laser can be very effective in ablating limbal tumors with corneal extension. The use of the laser is less invasive, technically less difficult, and faster because of excellent hemostasis. The diode laser, due to its high melanin absorption, can be used effectively to ablate epibulbar melanomas with corneal stromal invasion.     

The use of lasers for treatment of upper respiratory tract disorders.

Lasers have become important tools for the equine surgeon in the treatment of upper respiratory tract disease in the horse. Multiple wavelengths and delivery systems are available. Indications for the use of lasers in the upper respiratory tract primarily include minimally invasive procedures not possible with conventional surgical instrumentation. New applications for the use of lasers to treat upper respiratory disease are likely to evolve with the development and introduction of new wavelengths and delivery systems.     

Surgical conditions in the llama

Various surgical conditions of llamas are discussed, based on the author's experience, that of colleagues at Colorado State University Veterinary Teaching Hospital, and what little information is available in the literature. Some surgery is described for the correction of congenital abnormalities, some of which may be inherited. Sterilization of affected animals should be performed to prevent further occurrence of such defects. Many of the surgical techniques used in llamas are adaptations of methods used in other domestic species. Knowledge of the anatomical differences (especially in the gastrointestinal tract) as well as the other idiosyncracies of this species is essential for a successful surgical outcome. In time, refinements of these techniques as well as reports on the use of different or newer techniques will appear in the literature.     

Laser use in veterinary dentistry.

Lasers have been used in human dentistry since the 1960's. Lasers can provide a veterinary dentist access to difficult to reach areas with a relatively bloodless surgical field. Due to vaporization of nerve endings, human patients undergoing laser dental treatment reveal less pain compared to scalpel driven procedures. Dental applications for the commonly used lasers are discussed, as are special safety precautions. Many dental procedures enhanced by a carbon dioxide laser are covered. Future applications for the laser in veterinary dentistry are also discussed.     

The veterinary technician's role in laser surgery.

The use of surgical lasers in veterinary practice has grown significantly since 1996. Many veterinarians have studied and implemented the basic physics and tissue didactics required to successfully incorporate a surgical laser program into their practice. The support role of the veterinary technician is crucial to ensuring an efficient, safe, and successful outcome of any surgical laser procedure. The technician's role may include practice management duties, client communication, and laser safety officer duties. Although there are a variety of lasers, the most common types used in veterinary practice are carbon dioxide (CO2) and diode. This article presents an overview of the veterinary technician's role as a key support person in ensuring a safe and positive outcome in the implementation of CO2 and diode lasers in a veterinary practice.     

Standing laser surgery of the head and neck.

The use of carbon dioxide and Nd:YAG lasers has expanded the capabilities of equine surgeons. These lasers are used to incise, vaporize, and coagulate tissue with minimal hemorrhage and reduced morbidity to the patient. In this article, practical fundamentals of laser surgery are briefly reviewed, and selected standing laser procedures of the head and neck are discussed.     

Feline onychectomy and elective procedures.

The development of the carbon dioxide (CO2) surgical laser has given veterinarians a new perspective in the field of surgery. Recently developed techniques and improvisations of established procedures have opened the field of surgery to infinite applications never before dreamed of as little as 10 years ago. Today's CO2 surgical laser is an adaptable, indispensable tool for the everyday veterinary practitioner. Its use is becoming a common occurrence in offices of veterinarians around the world.     

Ureteral obstructions in dogs and cats: a review of traditional and new interventional diagnostic and therapeutic options

Objective – To describe and review both traditional and newer diagnostic and therapeutic options for canine and feline ureteral obstructions currently being performed clinically in veterinary medicine. Data Sources – A Medline search with no date restrictions was used for this review. Human Data Synthesis – The human literature would support the use of minimally invasive endourological techniques for the treatment of nearly all causes of ureteral obstructions, whenever possible. This typically includes extracorporeal shockwave lithotripsy, intracorporeal lithotripsy via retrograde ureteroscopy or antegrade percutaneous nephroureterolithotomy, ureteral stenting, percutaneous nephrostomy tube placement, and laparoscopic endopyelotomy. Typically open surgery is only suggested in cases of ureteral or gynecological malignancy when en bloc resection is considered a good option, or when various methods of endourological techniques have failed. Veterinary Data Synthesis – The veterinary literature is scarce on the use of interventional endourological techniques for the treatment of ureteral obstructions and has been growing over the last 5 years. The current literature reports the use of extracorporeal shockwave lithotripsy for ureteral stones, as well as the use of ureteral stents for the treatment of trigonal obstructive transitional cell carcinoma, ureterolithiasis, and ureteral strictures. Traditional surgical interventions, like ureterotomy, ureteronephrectomy, and ureteral reimplantation is more vastly reported and accepted. This review will focus on new clinical data using interventional endourological techniques for ureteral obstructions. Conclusions – Various treatment options for ureteral obstructions are now available for veterinary patients, and the trend away from traditional surgical techniques will hopefully be followed now that they are technically and clinically available for dogs and cats.     

Recent advances in equine abdominal surgery

Laparoscopy is a minimally invasive procedure that has applications as a diagnostic, therapeutic and prognostic technique. Specialized equipment is necessary to perform equine laparoscopy, and there is a large range of instruments, both disposable and non-disposable available. Laparoscopic procedures described include ovariectomy, cryptorchidectomy, adhesiolysis and herniorrhaphy. Laparoscopy can be performed in a standing or dorsally recumbent position, depending on surgeon preference, patient status and the procedure to be performed. Stapling equipment is frequently used in gastrointestinal surgery in horses. Advantages include decreased surgical time and a decrease in the risk of contamination. Stapling equipment is often used in creating anastomoses, both in the large and small intestines, as well as in vessel ligation. New surgical techniques intended to decrease adhesion formation include the use of carboxymethylcellulose and bioresorbable patches. Indwelling abdominal drains can be used for peritoneal lavage following surgery and also appear to decrease the risk of adhesion formation. Improvements in post-operative care, including the treatment of post-operative ileus and endotoxaemia can significantly improve the outcome of horses that have undergone surgery for abdominal disorders. Recommendations for the use of prokinetic agents in horses with ileus vary widely. Prokinetic agents include local anaesthetics, macrolide antimicrobials, cholinergic agonists and dopamine antagonists. Endotoxaemia is common in horses following surgery for gastrointestinal disorders. The antibiotic polymyxin B binds to the circulating endotoxin molecule, decreasing its half-life in the intra-vascular space and reducing associated inflammation. This drug appears to be an effective and affordable treatment option for horses with endotoxaemia. The use of specific cyclooxygenase inhibitors in veterinary medicine have been studied recently. Selective cyclooxygenase-2 inhibitors may provide comparable anti-inflammatory and analgesic properties to the non-selective non-steroidal anti-inflammatory drugs. These drugs appear to have similar clinical effectiveness and will hopefully minimize deleterious side effects. The optimal healing of ventral midline incisions in horses is related to many factors including appropriate suture patterns and bite size, in addition to appropriate post-operative exercise recommendations. Recent advances in surgical techniques and post-operative care should decrease the morbidity and mortality associated with abdominal surgery. This article provides an overview of some of these advances.     

Use of the harmonic scalpel for soft palate resection in dogs: a series of three cases

Soft palate resection is performed to resect a redundant or diseased soft palate, often associated with brachycephalic airway obstructive syndrome (BAOS). Resection has been associated with numerous complications, including coughing, bleeding, pharyngeal oedema, respiratory obstruction and death. Traditionally, the surgery is performed by sharp dissection and suturing, but other reported techniques include the use of an electrothermal sealing device or a laser. Operative time for sharp dissection is approximately 12 min, but is shortened to around 5 min when using a laser, as the haemostatic properties of the instrument negates the need for post-resection oversewing. The successful use of a harmonic scalpel to resect redundant soft palates in three dogs is described. The resected soft palates were not oversewn and the surgical time was comparable with that for laser surgery. The first dog had a minor bleed 6 h postoperatively, possibly associated with suboptimal placement of the harmonic scalpel cutting jaws. The following two patients had no postoperative complications. The harmonic scalpel laparoscopic handpiece allowed excellent visualisation of the surgical field and rapid performance of the procedure. All three patients had markedly improved postoperative respiratory function. Cleaning and resterilisation permitted multiple reuse of the handpiece, making it cost-competitive with other surgical techniques.     

The carbon dioxide laser: an alternative surgery technique for the treatment of common cutaneous tumors in dogs

Background

Tumors of the skin and subcutaneous tissue are the largest group of canine neoplasms. Total excision is still the most effective method for treatment of these skin tumors. For its universal properties the carbon dioxide (CO₂) laser appears to be an excellent surgical instrument in veterinary surgery. Laser techniques are alternatives to traditional methods for the surgical management of tumors. The aim of this study was to compare various types of laser techniques in skin oncologic surgery: excision, ablation and mixed technique and to suggest which technique of CO₂ laser procedure is the most useful in particular case of tumors in dogs.

Findings

The study was performed on 38 privately-owned dogs with total number of 40 skin tumors of different type removed by various CO₂ laser operation techniques from 2010–2013. The treatment effect was based on the surgical wound evaluation, the relative time of healing and possible local recurrence of the tumor after 3 months post surgery. Local recurrence was observed in two cases. The study showed that in 30 cases time needed for complete resection of lesions was less than 10 minutes. Time of healing was longer than 12 days in 6 cases (42.8%) with tumor excision and in 14 cases (87.5%) where excision with ablation technique was performed.

Conclusions

The advantages of the CO₂ laser surgery were better hemostasis, precision of working, non-contact dissection, less instruments at the site of operation and minimum traumatization of the surrounding tissues.     

Neuromuscular blocking agents.

In summary, with proper vigilance, neuromuscular blocking agents can be used safely in anesthetized equine patients to optimize conditions for certain surgical procedures. By appropriate use of neuromuscular monitoring techniques and reversal agents, residual blockade and muscle weakness should be avoided, allowing the horse to recover to standing without difficulty. Research is ongoing to develop the ideal muscle relaxant, one that has a rapid onset, predictable duration and recovery times, and negligible hemodynamic effects. As newer agents become available, they should be evaluated for their suitability for use in equine patients.     

Comparison of Nd:YAG surgical laser and Remorgida bipolar electrosurgery forceps for canine laparoscopic ovariectomy

Objective— To investigate and compare technique, surgical time, and complications of canine laparoscopic ovariectomy using Nd:YAG surgical laser and Remorgida bipolar electrosurgery forceps.
Study Design— Randomized, prospective clinical trial.
Animals— Female dogs (n=40) for elective ovariectomy.
Methods— Dogs had bilateral ovariectomy with one ovary randomly assigned to removal by use of Nd:YAG surgical laser with a 600 μm optical fiber in contact mode and the other ovary to removal by use of a Remorgida forceps (featuring bipolar electrocoagulation with simultaneous sharp resection). Duration of predetermined surgery intervals and complications were compared between techniques. Additionally, the effects of several intraoperative variables on surgical time were evaluated.
Results— Ovariectomy by use of Remorgida forceps required significantly less time than laser ovariectomy but intraoperative hemorrhage was not reduced. Surgical time was significantly increased in obese dogs, depending on the amount of fat in the ovarian ligament. Intraoperative hemorrhage had no significant influence on surgical time.
Conclusion— Both ovariectomy techniques were effective but the Remorgida forceps can be used as a relatively inexpensive, stand-alone device that decreases surgical time compared with Nd:YAG laser ovariectomy.
Clinical Relevance— Novel techniques, such as laser and combined bipolar electrosurgical and cutting forceps aim to reduce surgery duration, complication rates and recovery time in laparoscopic surgery.     

Tenth Annual ACVS 2000 Symposium

The Tenth Annual ACVS Veterinary Surgical Symposium will be held on September 21–24, 2000, at the Hyatt Regency Crystal City, in Arlington, Virginia. Small animal and equine surgical seminars will be presented and include orthopedic and soft-tissue diseases and techniques. Special sessions will be held on critical care, anesthesia, and dentistry. Laboratories will include arthroscopy, laser surgery, ultrasound, emergency procedures, and dentistry surgery. The symposium will offer a large exhibit hall with equipment, services, pharmaceuticals, and diagnostic tests.
To receive meeting information, e-mail acvs@aol.com ; call 301-913-9550; fax 301-913-2034; visit http://www.acvs.org ; or write ACVS, 4401 East West Highway, Suite 205, Bethesda, MD 20814–4523.     

Bandaging, endoscopy, and surgery in the emergency avian patient.

This article is divided into three parts and describes procedures used in avian medicine after initial stabilization. The first part includes the application of bandages and splints for fractures. The second part describes the use of endoscopy to examine the choana, oral cavity, trachea, and, to a lesser extent, internal organs. The last part discusses equipment required and techniques used for esophagostomy tube placement, air sac cannulation, and surgery, with approaches to the coelomic cavity and a select number of surgical procedures. This article is intended to provide the emergency animal clinician with knowledge necessary to provide basic stabilization for avian patients and knowledge of procedures that can be performed by the experienced clinician.