By Anya Glazkova, Ph.D. For The Education Center
Originally published in Veterinary Practice News, June 2016 – Download as a PDF
Christopher J. Winkler, DVM, Dipl. ABLS, is a surgeon and the owner of Suffolk Veterinary Group Animal Wellness and Laser Surgery Center in Selden, Long Island, N.Y. One of only six veterinarians to become a diplomate of the American Board of Laser Surgery, he began using lasers in general practice care in 2010.
In this interview, Dr. Winkler offers his view of the numerous clinical benefits of laser surgery and shares his journey toward becoming a laser veterinarian.
Q: How did you learn about laser surgery?
A: During the recession our practice was struggling to make ends meet while a local retailer’s vaccination program drew our clients and our livelihood away. I sought to offer something they couldn’t, something that wasn’t widely offered in the area that people would still seek out. In 2010 a representative for a laser surgery company stopped in one day and I decided to try it. We began branding the practice with this special service, and as I learned more about it I developed an intense interest in laser medicine and surgery and what they could do.
Q: How difficult was it to learn to use your laser? How did you learn? What was most helpful in the learning process?
A: I obtained fellow ABLS diplomate Dr. Noel Berger’s and Dr. Peter Eeg’s textbook “Veterinary Laser Surgery” almost as soon as I’d purchased my first surgical laser, and found its introduction to laser physics, biophysics and case studies it presented to be invaluable in expanding my knowledge base and clinical proficiency. I also began taking courses and wet labs in laser surgery, the most notable being Dr. John Godbold’s. His is an amazing course, and I ended up taking it twice for lack of others like it. I think he was surprised to see me back and he asked me about it, and I just said it was what I wanted to do.
Finally, and perhaps most importantly, I made a conscious decision to use the laser for every procedure. Taking the time to incorporate the use of the laser while not being afraid to try different suggested settings for different procedures and situations was also a very helpful learning process and increased my confidence in its everyday use.
Q: When did you incorporate the Aesculight laser into your practice and what motivated you to do so?
A: Dr. Godbold is a strong proponent of the Aesculight technology, and he encouraged me to switch to it. It did not take much persuasion to do so, as I was exposed to the advantages of the Aesculight laser over my own in his wet labs. We were able to incorporate an Aesculight laser into our practice soon after I completed the ABLS board certification in 2015.
Q: How did you decide to become ABLS-certified?
A: I was doing an internet search to continue my laser training and proficiency when I came across the ABLS website. I was intrigued, although I admit I was daunted at first by the idea of achieving a diplomate status this far into my career, as my peers had all began studying specialties right out of veterinary school. This was different, however, learning entirely at my own pace, and my wife persuaded me to take the next step to begin the process as I was so interested in the subject of laser medicine and surgery. I also discovered Dr. Berger had based his own remarkable veterinary text on the American Board of Laser Surgery’s own notes, which also helped lead to my decision to undertake the board’s training myself. It is the education the ABLS has provided me which I value the most.
Q: How much did the ABLS training help in mastering laser surgery?
A: Immensely. The board has greatly advanced my knowledge and understanding of laser physics, safety and how laser light interacts with living tissues, and the certification process was very challenging as I learned about human applications alongside veterinary ones. The training has helped me plan laser surgeries and use the Aesculight’s programmable features such as Superpulse more effectively, and I bear in mind closely what is or may be happening at the tissue and cellular level as I operate. Special safety considerations are also a large part of the training, and we have incorporated this carefully into our practice as well. Perhaps foremost is my ability to share communication of laser concepts far more effectively with my clients, other laser professionals and my colleagues.
Q: For what type of surgeries do you use your laser?
A: I use the laser for any and all types of soft-tissue surgery (Figure 1). There are only a very few instances where I will use a scalpel blade anymore, such as preparing a specimen for biopsy or using a blade where I cannot reach with the laser handpiece, but this is very rare. I most often use the laser for spays, neuters and mass removals. Most routine procedures are usually fully healed in less than a week, thanks to adjunctive use of laser therapy incorporated into our surgeries.
Q: In which surgeries is the laser absolutely essential, and what would you likely not attempt without the laser?
A: The most notable uses for the laser I can think of are oral surgeries; surgeries of the nose, pinna and ear canals; ocular and eyelid surgeries; cystotomies and mass removals from the bladder wall; perianal surgeries; and liver lobe biopsy. Such cases share common desirable goals of excellent hemostasis and visualization, fine precision of operation and reduced post-operative discomfort and complication, all of which the surgical laser excels at achieving. I would not attempt surgeries such as a soft tissue palate resection or a mass removal from the urinary bladder or ear canal without the laser (Figures 2, 3 and 4).
Q: What laser features do you find most useful and why?
A: The lightweight hand piece and hollow wave guide are far more comfortable, flexible and precise than that of the older articulated arm laser I was using, while the Aesculight itself is much more powerful with a wider array of programmable options, making the procedures I was performing much faster and easier, with fewer complications and even faster healing rates. SuperPulse allows collateral tissues to cool without extensive thermal damage, while Single Pulse allows timed, controlled, precise application, which make the removal of such conditions as dystichia very simple.
Q: Talk about the clinical benefits of your surgical laser that you personally observed? What did you notice or learn while using the laser?
A: The ability to perform rapid outpatient procedures with a minimal local anesthetic, such as mole and skin tag removals, or opening a cat bite abscess without the need for a drain, has expanded our repertoire by allowing us to quickly operate without creating a great deal of interference in our schedule.
One of my first cases was a young kitten with a very large abscess. I used the laser to precisely debride diseased tissue while leaving underlying structures intact, something I could not have done with a scalpel in the area I was operating. I was astonished at the excellent results and the rapid recovery such a young patient made.
Just this week (Figures 5A, 5B, 5C, 5D) I removed a benign trichoblastoma from between the plantar foot pads of a dog. The mass had been occasionally opening and causing discomfort for the pet and a nuisance for his owner. The mass would have been difficult to remove conventionally without a great deal of bleeding, while the laser accomplished the removal without any bleeding or damage to underlying vessels, resulting in a very rapid yet successful procedure. The dog has shown no discomfort in its recovery and has been walking normally without lameness. The laser yet again demonstrated its ability to operate in a difficult location while affording excellent visualization of the surgical site through hemostasis, in a fashion that made the pet’s recovery easier and more comfortable.
Q: Is there anything else you would like to share?
A: I remain perplexed that lasers have not received a wider following in the veterinary field. I suppose history may have something to do with it. Change is sometimes difficult to accept. Humanity has been operating with the use of sharp instruments for millennia, while the use of lasers in medicine and surgery is barely 60 years old.
Working in emergency care made me a strong proponent of retaining basic skills in medicine and surgery. The medical profession must take care not to specialize in technology to an extent that we risk being helpless should we find ourselves without it in a crisis. But part of our mandate as veterinarians is to reduce animal suffering and improve their lives, and certain technologies make this possible to a greater degree than before. Lasers deserve to stand equally alongside such mainstays as radiology, ultrasound and endoscopy. The surgical laser improves surgery by decreasing pain, bleeding and post-operative swelling and discomfort, and enabling a faster recovery.
Although many veterinarians have embraced this technology, it has been a very slow process, and I have heard of those who obtain such units and then fall back on what they have learned and leave these amazing machines to collect dust in the corner. It is for these reasons that I think learning about lasers should be incorporated at the university level, allowing veterinary students to know and experience these valuable tools early in their career, rather than discard the idea of them so cavalierly, or believe that they can only be used for a limited set of conditions.
A background knowledge of laser physics, biophysics and safety is essential to mastering the use of the laser. I would love to take part in an effort to see that all veterinary students begin receiving such an education in laser medicine and surgery, a field of science and technology we are only beginning to understand can have such a profound positive impact on our patients’ lives and well-being. This field will only continue to grow and be a part of our profession, and we must see that the next generation of veterinarians continues to understand and incorporate it as best they can.
Anya Glazkova earned her doctorate at the University of Washington. She helps conduct laser surgery educational programs at Aesculight and LightScalpel LLC.
This Education Center article was underwritten by Aesculight of Bothell, Wash., the manufacturer of the only American-made CO2 laser.