Laser Surgery

Introduction

One of the newest modalities we have to provide state of the art surgery is our carbon dioxide laser. This is a proven laser that has been around for 30 years. Only recently has it been adapted to veterinary medicine in a clinical setting. The Long Beach animal Hospital is one of only a handful of animal hospitals in California that have this capability.

We have a couple of short QuickTime movies showing the laser in action. You will need Quicktime on your machine from www.apple.com to get them to play. If you have a modem connection to the internet they will take a few minutes to download.

Advantages

There are several advantages to the CO₂ laser surgery:

1. Pain Reduction

Your pet will experience significantly less post operative pain in almost every instance. As a matter of fact, the pain reduction is so great that we perform declaws on cats only with a laser beam. This reduction in pain is a result of the unique characteristics of the laser beam as it cuts nerve endings, preventing the raw ends that are characteristic of scalpel blades.

2. Swelling Reduction

Whenever an incision is made in tissue with either a scalpel blade or scissors inflammation is started in the affected tissue. This inflammation is a result of interaction with the circulatory and lymphatic systems. Because the laser beam effectively cauterizes the lymphatic system there is much less post operative swelling. This makes your pet much more comfortable while it is convalescing from surgery.

3. Control of Infection

The laser beam operates at a temperature of over 200 degrees Fahrenheit. This makes it highly effective at killing bacteria that have the potential to cause an infection. This is particularly important in areas where it is difficult to prevent bacteria from contaminating the surgical site. Examples include abscesses and cat declaws.

4. Minimal Surgical Bleeding

When an incision is made with a scalpel blade small blood vessels are cut in the skin and the layer of tissue just under the skin. These blood vessels can ooze throughout the surgery and even postoperatively. Traditionally they are taken care of by clamping them with hemostats, cauterizing, or holding gauze sponges on them until they stop. All of these procedures take time, which means the surgery takes longer and there is more post operatively swelling. The laser beam is a highly effective coagulator of small blood vessels. Less bleeding during surgery means less anesthetic time and faster recovery time.

Except for cat declaws, where use of the laser beam is mandatory in our hospital, the decision to use laser during surgery is made only by one of our doctors. Even though lasers are used effectively in many surgical procedures they are not used in every surgery. They are especially useful in oral surgery, growth removals, and amputations of small extremities. We also use it in small animals, especially birds, because of the laser's great effectiveness at minimizing bleeding.

The following sections give specific examples of the use of the carbon dioxide laser in our hospital.

Declaws

This is a particularly prevalent request for people that want to keep their cats indoors. Prior to a declaw we advise keeping the nails trimmed short or the administration of Soft Paws on the nails. One of our nurses will gladly give you a demonstration of these options.

Prior to the introduction of the carbon dioxide laser all declaws were done with a scalpel blade. It is a very precise surgical procedure that our doctors have performed thousands of times. Unfortunately, the post operative period was painful, the feet were bandaged, and most cats had to stay in the hospital for several days. On older cats this surgery was even harder on the pet.

The advent of declaws with the laser surgery has substantially minimized these drawbacks. There is usually no bleeding during the surgery so a tourniquet is no longer used. Most of them can even go home the day of surgery but we prefer to keep them for observation for 1-2 days. Most cats have so little pain or discomfort they are jumping and running before nature has had time to complete the healing process. Always restrict their activity at home for the first few days to prevent this problem.

This cat's nails have grown into its pads due to the owner's inability to care for it properly. This is a painful situation and makes him a candidate for a front declaw.

The following pictures are from an actual declaw that we performed at our hospital. If you do not want to view them click here to see the paws immediately after surgery.

The laser beam (it is invisible to the naked eye) has started the incision at the top of the toe. It will cut through skin and tendons along with ligaments in between the digits. Bone is not cut during the procedure. The nail, with its attached bone (called phalanx 3), is removed.

As the surgery progresses the sides of the nail where the ligaments are located are cut.

The surgery is complete with no bleeding or trauma to any bone. The top arrow in this picture points to the bone at the joint of the 2nd knuckle. The bottom arrow points to the intact pad that has not been touched either. a drop of surgical tissue glue will be put on the pad to cover the end of the bone.

This is what the foot looks like immediately after surgery. There is no bleeding or swelling and bandages are not needed in most cases.

Oral Lesions

Pets commonly get lesions on the gum tissue in their mouths. Some of these lesions are benign while others are malignant. Some of them cause severe inflammation and pain, a problem that is prevalent in cats. The laser beam excels at removing some of these oral lesions.

This dog has a large growth (arrow) that is covering its tooth. At this time we do not know if it is benign or malignant, so it should be removed.

The growth is being removed with the laser beam. The jaw is upside down compared to the picture above. This is for better surgical access.

There is no bleeding during the procedure. The laser beam also neutralizes the bacteria that are rampant in the mouth. There will be no need for stitches or post surgical antibiotics in this case. The gums will return to their normal pink color in a very short time. This pet has no need for pain medication and it had its normal appetite upon returning home.

Ear Amputation

The laser is particularly beneficial in amputations. Its ability to minimize bleeding allows the surgery to progress much faster. This section shows the amputation of the ear of a dog that has a Mast Cell tumor. This is a malignant tumor that requires aggressive surgery if it is to be controlled.

Ears are very vascular and bleed extensively when they are cut. as you can see from this picture taken at the beginning of the procedure there is no bleeding.

Four weeks post operatively healing is complete.

Skin Tumor

Another area where it is highly advantageous to use the laser is removing skin tumors. On some of the small tumors the lesion can be completely ablated by the laser and there is no needs for stitches. On larger skin tumors the coagulation of the small blood vessels minimizes operative bleeding. Just like in the declaw, these pets have less discomfort during the healing period because of the lack of raw nerve endings and less inflammation.

This skin tumor is on the back of a dog. The surgeon has just started the skin incision as evidenced by the dark line on the skin.

An elliptical incision is made around the growth to ensure that we completely remove the whole growth and there will be no puckering of the skin when sutures are placed.

Once the elliptical incision has been completed the underside of the tumor is removed down to healthy tissue. This ensures that we remove the whole tumor.

The tissue that remains has been cauterized. This kills additional tumor cells and helps kill bacteria. This "char" is gently wiped with saline soaked gauze to reveal healthy pink tissue underneath.

Four sutures are placed in the skin to complete the surgery. These will be removed in 10-14 days.

Iguana Abscess

The laser can also be used on a wide variety of species. Many of the critters we care for are very small and cannot withstand the loss of even a few drops of blood during surgery. The laser's ability to coagulate the small blood vessels encountered in these cases makes it a highly advantageous way to perform surgery.

The laser is not limited to just cutting skin. In this case it is cutting the scales of an iguana with an abscess.

We are using a forceps to gently open the abscess so we can remove the abscessed material. If a scalpel blade had been used to make this incision there might have been bleeding at this point.

The infected material is mechanically removed. It is very thick and does not flow out of the wound like an abscess in a dog or cat.

In this picture the laser is performing another important function that is unique to laser's. We are using a special tip and have set the machine on a rapidly pulsed setting that allows us to vaporize infected tissue that might be still present but can't be seen.

Dog Neuter

Routine surgeries like dog neuters can also be performed with the laser. The minimal bleeding and post operative pain control are major reasons to perform this surgery with the laser.

The skin incision, an area that is highly vascular in the dog, is started with the laser.

Once we are through the skin we encounter a layer of tissue that covers the testicle.

This layer is also cut with the laser, again with no apparent bleeding. We are now down to the last layer of tissue that covers the testicle.

The testicle bulges out of the incision as the last layer is cut. Cutting through all of these layers with the laser takes a little longer than the scalpel. The lack of bleeding, and of course the post operative decrease in pain, makes it worth it.

The testicle still has tissue attached to it that must be incised before the testicle can be completely pulled out through the incision. This tissue is clamped with a hemostat and cut with the laser (the arrow points to the tip of the laser). The testicle is under the surgeon's thumb. You can visualize the extensive blood supply of the testicle at the bottom of the screen as the testicle is gently pulled out of the incision. This is the area that will have 2 sutures placed around it

The testicle has now been fully released from its connecting tissue and has been pulled up and towards the left, exposing the start of its blood supply and the vas deferens (the white structure). You can see the tissue that was clamped with the hemostat and cut with the laser at the lower right of the incision (arrow).

The testicle has been cut, and the blood supply with its vas deferens, with 2 sutures around them, are gently placed back into the incision.

The neuter is now complete and the surgeon is getting ready to close the skin incision. If the surgeon decides to put in sutures that need removing, they will be removed in 14 days.

We have a short Quicktime movie of how me make the skin incision with the laser. Double click on the movie to get it to start.

Ear Hematoma

The laser works great for ear hematoma because a smaller opening is needed to drain the fluid. This minimizes scarring of the ear.

The laser has ability to selectively go through layers of tissue in a gentle and controlled fashion.

The opening made in the ear is small. Several of these small openings are usually needed to drain out the fluid that has built up in the ear.

Here is the final appearance of the healed ear 2 weeks after surgery.

This is the size of a typical opening in a ear hematoma when the laser is not used. This longer incision causes more scarring, more discomfort, and takes longer to suture.

Ear Tumor

Laser are particularly beneficial in removing tumors in hard to reach places. This dog has a tumor in its ear canal. The tumor is the cauliflower like growth just to the right of the arrow.

This is the appearance of the ear canal immediately after surgery. The lack of bleeding and the gentle nature of the laser minimizes irritation to the sensitive structures in the ear canal.

This is the growth that was removed.

Warts

We are commonly presented with pets that have numerous warts throughout their bodies. They are caused by viruses, will commonly occur, are found mostly in older pets, and are benign. For these reasons we do not aggressively pursue their removal. We will remove them if they are bleeding, causing discomfort, are getting rapidly larger, or if we anesthetize a pet for some other reason that warrants anesthesia.

This is a typical wart on the back of a dachshund that has been anesthetized for its severe dental disease. While it is getting its teeth cleaned we used the laser to rapidly ablate the wart.

The post operative appearance immediately after it has been ablated by the laser. There is no need for sutures in this case.

Oral Tumor

A tumor that can be encountered in dogs and cats is called sqamous cell carcinoma. These pictures are of a dog that had one on its left jaw, called the mandible. The only way to completely cure this tumor is to remove the jaw on that side, a surgery called a hemimandibulectomy. In this case the owner decided against it, and will have the growth removed as much as possible with the laser, following up with radiation therapy.

The tumor is identified by the white arrow. It had been removed 1 year earlier, but as expected with this type of tumor, has recurred. This time the surgery will be with the laser for maximum comfort for Jackey.

The post operative appearance immediately after it has been removed by the laser. Minimal bleeding and swelling are apparent.

We were able to suture gum tissue over the defect left by the surgery. It is hard to tell in this picture that any surgery was performed at all.

Mammary Tumor

We have a short movie showing part of the removal of a mammary tumor on a cat. We made an incision in the skin with the scalpel so you can identify the area that we will be removing with the laser. Double click on the movie to make it play.

Laser Theory

A carbon dioxide laser emits a high energy beam of infrared (invisible to the human eye) radiation in the form of light waves that has many veterinary applications. If you would like to learn more about the mechanics of lasers in general, including safety procedures, how they work, and why we use the carbon dioxide laser as opposed to other lasers, click here.