Use of the Carbon Dioxide Laser in Veterinary Surgery Geoffrey N. Clark, DVM
Medical technology continues to become more advanced each year, and as a result, new treatment options become available to veterinarians. The latest innovation making an impact in veterinary surgery is the carbon dioxide laser. Use of this precise surgical instrument has long been considered superior to traditional surgery for a variety of procedures in human surgery, but it was thought to be impractical for veterinary use. Recent advances in laser design and technology have made the CO2 laser more accessible and affordable for veterinarians in practice. A laser is an intense beam of light that can be focused into an extremely small spot and delivers a large amount of energy. In surgery, this energy is converted into heat and it exerts specific effects on the patient's tissues. Several different types of lasers are used in surgery, with the carbon dioxide laser being the most commonly used in small animals. The CO2 laser is used primarily to create precise incisions without the instrument itself touching the tissues. Small blood vessels are sealed off by the laser, resulting in decreased bleeding at the surgery site. The laser also seals nerves and lymphatic vessels, so there is less postoperative swelling and decreased pain sensation in canine and feline surgical patients. An additional advantage is that the laser is capable of sterilizing a contaminated surgical site by vaporizing bacterial organisms. Many common veterinary surgical procedures have been performed using the CO2 laser. The greatest application for this new technology appears to be in surgery of the oral cavity and upper airways. The laser is quite useful for management of dogs with brachycephalic syndrome. One of the major components of this syndrome is an elongation of the soft palate that interferes with breathing. The CO2 laser has been used effectively to treat this condition by removing the excess portion. This greatly improves breathing efficiency and provides better exercise tolerance. Surgery of the larynx can also be performed with greater precision using the CO2 laser. Many tumors of the oral cavity, such as those involving the gingiva, tongue, and tonsils, can be removed with the laser. In our hospital, we have also found the CO2 laser to be ideal for removing eyelid tumors. Because no stitches are required when the laser is used, the eye is less irritated and the need for suture removal is eliminated. A special application for the laser in feline surgery is management of squamous cell carcinoma. This form of neoplasia occurs on the nasal planum, pinnae of the ears, and in the oral cavity involving the gingiva, tongue, and oropharynx. Resection and primary closure is rarely an option for this tumor type, but the CO2 laser allows for vaporization of the tumor and second intention healing. As an additional advantage, the cat is much more comfortable during healing as the nerve endings and vessels have been sealed by the laser. The CO2 laser has also proved to be quite useful for other surgical conditions that can be difficult to manage, such as perianal fistulas and chronic external ear canal diseases. In both instances, the laser can be used to vaporize unhealthy tissue, or with a more focused beam, it can be used as a scalpel to dissect tissue. When used for ear canal ablation, there is considerably less bleeding and greater postoperative patient comfort. Another advantage of using the laser in chronic, infected tissue is that the laser will also vaporize bacterial and fungal organisms. This may lead to less complicated healing in these potentially difficult surgical patients.
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