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References

George M. Peavy DVM, DABVP
Director Comparative Medicine Programs
Beckman Laser Institute and Medical Clinic
University of California

“I have 20 years of CO2 laser surgical experience…
There are pros and cons to each type of delivery system. The articulated arm units retain a collimated beam (photons moving parallel and in phase with each other) that is directed through a lens, therefore, permit higher power densities by being able to focus the power into beam diameters of 0.2mm or less. On the other hand, you generally end up having to position your hand further away from the tissue making incision or precision ablation a little more challenging, and the bulk of the handpiece and articulated arm make visualization in confined spaces (e.g. pharynx) a major hassle.

Articulated arm units require HeNe beam superimposition over the invisible CO2 laser beam for accurate beam direction onto the incision/ablation site. Articulated arms can be knocked out of alignment, requiring technical adjustment to regain superimposition of the beams or re-centering of beam on the lens, and certainly could have HeNe beam performance problems (but that is not common).

Waveguide delivery systems allow you to work with your hand much closer to the tissue surface negating the need for a HeNe beam and alignment issues, and giving you much better control for procedures requiring precise beam placement, but over time wear decreases waveguide transmission efficiency and periodically they need to be replaced. Between the 2 delivery modes, for use in small animal, exotic, pocket pet and avian procedures my personal preference would be for the … waveguide unit. If I were to be doing large animal procedures, I would use an articulated arm unit because of the smaller spot size, and likely would use a unit from the human market that gives more than 20W (probably a 40-100W output).

Now then, since beam delivery may not be the only factor of concern to selection of a laser system here, let me comment on a few other factors that I would use in CO2 laser system selection. These are general comments and are not intended to endorse or criticize any specific product.

It is important to have all 3 power modes: continuous wave, pulsed (millisecond pulse combinations) and superpulse (microsecond domain pulses) capabilities.

Power output of the unit is important – I would not select a unit that had a maximum output any less than 20 W. Superpulse needs to provide at least 10W average power, and the individual micropulses need to be 700 microseconds or less in duration, and are generally 50-100W peak power each.

With an articulated arm unit I would check beam quality by directing the beam in a defocused manner onto a paper surface and look to see if the burn was uniform or spotty within the beam diameter (this test is not applicable to a waveguide delivery system, that is a subject for another post at another time).

The laser tube/chamber will be glass with synthetic gaskets or stainless steel – you probably can guess the difference in life expectancy between the two designs. Check on the rated performance life of the tube/chamber of the unit that you are considering (number of hours of use that can be expected before tube/chamber replacement), and the cost of tube replacement (not just the cost of the tube, but labor, shipping and availability of service).

Is the unit water or air cooled? (Water cooled units add another layer of performance and replacement concerns). Check out availability of technical support – can you get a laser technician or laser engineer on the phone or is the sales rep the technical support? Is service of the unit available locally, within the US or does the unit have to be returned to China? What is the typical turnaround time for service and can you get a loan unit while yours is out for service? What does the warranty cover and for how long? Can you get a service policy, what does it cover and what will it cost? And lastly, what kind of training support do you get from the company?”

Noel Berger and Peter H. Eeg
Veterinary Laser Surgery, A Practical Guide
Blackwell Publishing, ISBN 978-0-8138-0678-5
(Drs Berger and Eeg are current Accuvet laser users and customers of Luxarcare)

Page 101, “Pain Management…”

We… have a steadfast belief in the reduction of recurrent pain response when proper CO2 laser energy is applied to a target tissue.

Pages 70-71, “Delivery Systems”

CO2 lasers employ either articulated arm or the hollow waveguide.

Articulated arms … can be cumbersome to use. The mirrors can also cloud or become misaligned over time. This may require off-site servicing and be costly and they are not always easy to change out. Most articulated arms are less positional, especially when working in the oral cavity or ear, and require more care when handling.

Flexible waveguides are more versatile in restricted areas. They allow for easier maneuvering of the handpiece intra-operatively. … Hollow waveguides are considered by many to be the latest technological advance … These devices are very maneuverable and positioning is often more natural. … The per unit cost of these delivery systems is also less than articulated arm transmission systems.

Pages 71-72, “Age of Equipment”

The most current technology uses an RF excited laser medium… The RF allows for minimal creation of heat…, which in turn allows for use of simpler passive cooling of the unit that does not require refilling, pumping, or repair.

Older technology uses… DC electrical energy to excite the molecules to emit photons. A much greater amount of heat is generated during this process. This type of technology requires … cooling via a radiator and cooling fluid passed over the canister to dissipate heat. These older systems also have o-rings at the end of the canisters that continually expand and contract during the heating. These o-rings can eventually crack, permitting the molecules inside the canister to leak out.

Newer laser devices use power calibration … that give accurate readings of actual energy output from the tip of the laser handpiece. This better assures the user that the correct power density is being achieved. The operator without technical support can also do this calibration. Sharing of (surgical) techniques is also more accurate when this type of equipment power calibration is available.

Page 91, “Economic Considerations…”

…consider surveying your best 50 to 100 clients on their feelings about your proposed new charges for laser surgery. You may be surprised at how accepting they are of this type of new technology and the improvement in care it can provide for their pets.

Page 94, “Indirect Benefits”

Most clinicians that we have spoken with who use laser energy to enhance and augment their treatment options feel that laser energy increases their visibility among both clients and potential clients.

Page 140, “Introduction to Clinical Applications…”

The major disadvantage of using articulated arms for transmitting laser light is their fragility. They may also be much less flexible and more unwieldy… It is also extremely difficult and costly to maintain these devices in perfect alignment for proper use.

Page 148, “Routine Procedure Considerations”

The CO2 laser wavelength has a high absorption coefficient in water that makes it ideal for soft tissue incisions and ablations because it results in the least amount of collateral tissue damage…

On the other hand, wavelengths generated by diode or Nd:Yag … lasers are poorly absorbed by cellular water…

References

“Use of CO2 laser as an adjunctive treatment for caudal stomatitis in a cat”, John R. Lewis, Anson J. Tsugawa, Alexander M. Reiter,J Vet Dent. 2007 Dec;24(4):240-9.

“Using Biomedical Lasers in Veterinary Practice”, M.D. Lucroy and K.E. Bartels, Veterinary Medicine, October 2000.

“Devocalization of Dogs by Carbon Dioxide Laser Surgery”, Scott M. Anderson, DVM, Charles L. Lippincott, DVM, Journal of the American Animal Hospital Association, Vol.27, May-June, 1991.

“Comparison of the Influence of CO2-laser and Scalpel Skin Incisions on the Surgical Wound Healing Process”, L. Miguel Carreira, Pedro Azevedo, ARC Journal of Anesthesiology. 2016;1(3):1-8.

“Current Techniques in Small Animal Surgery IV”, Kenneth E. Bartels, DVM, Williams & Wilkins, Baltimore, Maryland, pg. 45-52, 1998.

“Carbon Dioxide Laser Surgery in Dogs”, Geoffrey Clark, DVM, Canine Sports Medicine Update, October, 1997.

“Lightning Fast Lasers”, Rick Moran, Cats, January, 1998.

“Lasers and Veterinary Surgery”, Stephen E. Klause, DVM, M.S., and Steven M. Roberts, DVM, The Compendium, Vol. 12. No.11, November, 1990.

“Laser Surgery Improves Veterinary Surgical Care”, Medco Forum, January, 1998.

“Let There Be Light”, Alison Netsel, Cats and Kittens, July 1998.

“Reducing Hazards from Laser and Electrosurgical Procedures”, Veterinary Forum, January, 1999.

“Latest Developments in Feline Medicine”, Elaine Wexler-Mitchell, DVM, Cat Fancy, April, 1998.

“CO2 Laser Treatment of Traumatic Pulpal Exposures in Dogs”, Petra Wilder-Smith, DMD, George M. Peavey, DVM, David Nielsen, DVM, Anna-Marie Arrastia-Jitosho, DMD, Lasers in Surgery and Medicine, 21:432-437 (1997).

“Carbon Dioxide Laser Ablation for Treatment of Limbal Squamous Cell Carcinoma in Horses”, R.V. English, DVM, M.P. Nasisse, DVM, M.G. Davidson, DVM, JAVMA, Vol 196, No 3, February, 1990.

“Waves of the Future”, Kimberly S. Herbert, The Horse, 1995.

“Lasers and Veterinary Surgery”, Stephen E. Klause, DVM, M.S., and Steven M. Roberts, DVM, The Compendium, Vol. 12. No.11, November, 1990.

“Laser Surgery Improves Veterinary Surgical Care”, Medco Forum, January, 1998.

“CO2 Laser Surgery in Veterinary Dermatology”, Robert O. Schick, DVM, Mary P. Schick, DVM, Clinics in Dermatology, 1999.

“The Effect of CO2 Laser Pulse Repetition Rate on Tissue Ablation Rate and Thermal Response”, V. Venugopalan, IEEE Trans Biomed Eng, October 1991.

“Pulsed CO2 Laser Tissue Ablation: Effect of Tissue Type and Pulse Duration on Thermal Damage”, J.T. Walsh et. al., Lasers Surg Med, 8 (2), 1988.

“Subjective and Objective Measurements of Postoperative Pain in Cats”, A.J. Cambridge et. al., JAVMA, September, 2000.

“Use of Carbon Dioxide Laser for Treatment of Elongated Soft Palate in Dogs”, G.N. Clark and K.R. Sinibaldi, JAVMA, June, 1994.

“Reducing Hazards from Laser and Electrosurgical Procedures”, Veterinary Forum, January, 1999.

“Surgical Lasers, Textbook of Small Animal Surgery”, M.D. Lucroy and K.E. Bartels. Slatter, 3rd Edition, 2001.

“Evaluation and Installation of Surgical Laser Systems”, D.B. Apfelberg, Spribger-Verlag, New York, 1987.

“Medical Lasers: Science and Clinical Practice”, J.A.S. Carruth & McKenzie, Adam Hilger, Bristol, 1986.

“Safety with Lasers and Other Optical Sources”, D.H. Sliney and M.L. Wolbash, Plenum Pub. Corp, New York, 1980.

“Medical Lasers and Their Safe Use”, D.H. Sliney and S.K. Trokel, Springer-Verlag, New York, 1992.

Publications

  1. Godbold J. CO2 laser surgery: selecting the best delivery system. Veterinary Practice News. 2011;6.
  2. Godbold J. CO2 laser surgery: standard of care. Veterinary Practice News. 2012;3:22-23.
  3. Duclos DD. CO2 laser surgery: dermatologic applications. Veterinary Practice News. 2012;6:32.
  4. Gores B. CO2 laser beneficial in oncologic surgery. Veterinary Practice News. 2012;7:18-19.
  5. Norsworthy G. CO2 lasers treat many feline ailments. Veterinary Practice News. 2012;8:24-25.
  6. Fleck R. CO2 laser for equine veterinarians. Veterinary Practice News. 2012;9:34.
  7. Seki M. Introducing veterinary CO2 laser surgery in Japan. Veterinary Practice News. 2012;10:24-25.
  8. Vitruk P. Soft tissue cutting with CO2, diode lasers. Veterinary Practice News. 2012;11:24.
  9. Berger N. CO2 lasers useful everyday for every surgeon. Veterinary Practice News. 2012;12:28-29.
  10. Vitruk P. Surgical CO2 laser demystified. Veterinary Practice News. 2013;1:28-29.
  11. Seki M. The CO2 laser-assisted no-gauze spay. Veterinary Practice News. 2013;2:26-27.
  12. Duclos DD. Recurrent interdigital draining tracts treated with CO2 laser ablation. Veterinary Practice News. 2013;3:30-31.
  13. Schultz W. Vulvoplasty using the CO2 laser. Veterinary Practice News. 2013;6:38-39.
  14. Schultz W. Laser removal of anal glands. Veterinary Practice News. 2013;7:40-41.
  15. Bellows J, McMorran E. CO2 laser-assisted management of feline stomatitis after extractions. Veterinary Practice News. 2013;8:36-37.
  16. Schultz W. CO2 laser–assisted castration. Veterinary Practice News. 2013;9:40-41.
  17. Core DM. CO2 laser allows bloodless repair of stenotic nares. Veterinary Practice News. 2013;10:32-33.
  18. Leclerc J. Fibrosarcoma in a goldfish treated with CO2 laser. Veterinary Practice News. 2013;11:30.
  19. Doskey P. CO2 lasers in management of neoplasia. Veterinary Practice News. 2013;12:24-25.
  20. Sessa P. CO2 laser surgical approach to the ventral abdominal incision. Veterinary Practice News. 2014;1:32-33.
  21. Bellows J, McMorran E. CO2 laser gingivoplasty for orthodontic care. Veterinary Practice News. 2014;2:34.
  22. Duclos DD. CO2 laser excision of skin tumors. Veterinary Practice News. 2014;3:32-33.
  23. Schultz W. Meibomian adenoma removal with the surgical CO2 laser. Veterinary Practice News. 2014;4:30-31.
  24. Schultz W. Correcting mild entropion with a CO2 laser. Veterinary Practice News. 2014;5:42-43.
  25. Berger N. Open their mouths and open your eyes. Veterinary Practice News. 2014;6:30-31.
  26. Seki M. Advantages of CO2 laser mastectomy. Veterinary Practice News. 2014;7:44-45.
  27. Bradley D. CO2 laser surgery – a rewarding endeavor. Veterinary Practice News. 2014;8:42-43.
  28. Gilsleider E. CO2 laser applications for exotics. Veterinary Practice News. 2014;9:38-39.
  29. Schultz W. How to use CO2 laser to perform gingivectomy and remove epulis. Veterinary Practice News. 2014;10:46-47.
  30. Doskey P. CO2 lasers hit the mark in small places, even ferrets. Veterinary Practice News. 2014;11:36-37.
  31. Vitruk P. How CO2 lasers cut, coagulate soft tissue. Veterinary Practice News. 2014;12:36-37.
  32. Schultz W. Learn to use CO2 laser for repair of oral-facial clefts. Veterinary Practice News. 2015;1:36-37.
  33. Suárez M, Glazkova A. CO2 laser excision of a CHP. Veterinary Practice News. 2015;2:44-45.
  34. Glazkova A. Interview with Paul Sessa, DVM – evolution of surgical laser technology. Veterinary Practice News. 2015;3:40-41.
  35. Mann FA. The utility of carbon dioxide laser in oncological surgery. Veterinary Practice News. 2015;4:42-43.
  36. Core DM. The CO2 laser in urogenital surgeries. Veterinary Practice News. 2015;5:34-35.
  37. Duclos DD. Canine fibroadnexal hamartomas treated by CO2 laser excision. Veterinary Practice News. 2015;6:32-33.
  38. Glazkova A. Treating sea turtle fibropapillomatosis with CO2 laser surgery. Veterinary Practice News. 2015;7:34-35.
  39. Godbold J. Surgical Laser Basics: 5 Tips for the Novice User. Clinician’s Brief. 2018;8.
  40. Dismukes JS. Surgical CO2 laser in the small animal mobile practice. Veterinary Practice News. 2015;8:36-37.
  41. Arza R, Glazkova A. Soft tissue oral surgeries by CO2 laser. Veterinary Practice News. 2015;9:34-35.
  42. Arza R. Elongated soft palate resection with a CO2 surgical laser. Veterinary Practice News. 2015;10:32-33.
  43. Winkler C. Using CO2 lasers in small animal practice. Veterinary Practice News. 2015;11:40-41.
  44. Arza R. Performing canine episioplasty with CO2 laser. Veterinary Practice News. 2015;12:32.
  45. Winkler C. CO2 laser can excise ear, perianal growths. Veterinary Practice News. 2016;1:50-51.
  46. Schultz W. How to ablate canine vertical ear canal with CO2 laser. Veterinary Practice News. 2016;2:42-43.
  47. Vitruk A. Laser surgery according to Dr. Don Noah. Veterinary Practice News. 2016;3:40-41.
  48. Arza R. Using CO2 laser on acral lick granulomas. Veterinary Practice News. 2016;4:32-33.
  49. Schultz W. How to use CO2 laser for paraphimosis. Veterinary Practice News. 2016;5:46-47.
  50. Glazkova A. How New York vet learned to love lasers. Veterinary Practice News. 2016;6:40-41.
  51. Norsworthy G. CO2 laser can treat many feline ailments. Veterinary Practice News. 2016;7:36-37.
  52. Winkler C. Use CO2 laser to excise trichoblastoma. Veterinary Practice News. 2016;8:38-39.
  53. Bellows J. Chronic feline stomatitis? Try extraction, CO2 laser. Veterinary Practice News. 2016;9:40-41.
  54. Bellows J, McMorran E. Use CO2 laser on gingival enlargement. Veterinary Practice News. 2016;10:36-37.
  55. Cannon A. Excise keratoacanthomas with CO2 laser. Veterinary Practice News. 2016;11:32.
  56. Vitruk P. Why soft-tissue CO2 laser performs well. Veterinary Practice News. 2016;12:36.
  57. Bellows J. Give CO2 laser a try with oral ulceration. Veterinary Practice News. 2017;1:40-41.
  58. Man B. How to remove aural polyp with flexible-fiber CO2 laser. Veterinary Practice News. 2017;2:42.
  59. Schultz W. Elongated soft palate resection with a flexible fiber CO2 laser. Veterinary Practice News. 2017;3:48-49.
  60. Bellows J. Flexible fiber CO2 laser—a definitive instrument for tongue surgery. Veterinary Practice News. 2017;4:44-45.

Veterinary Associations

Association of Avian Veterinarians – www.aav.org
AAEP – www.aaep.org
AAHA – www.aahanet.org
ACVC – www.acvc.org
ACVIM – www.acvim.org
ACVS – www.acvs.org
Auburn Universtity – www.vetmed.auburn.edu
AVMA – www.avma.org
Canadian VMA – www.canadianveterinarians.net
CanWest Veterinary Conference – www.avma.ab.ca
Central Veterinary Conference – www.thecvc.com
Coastal Veterinary Conference – www.vetmeetings.com
Colonial Veterinary Conference – www.vetmeetings.com
Colorado State – www.cvmbs.colostate.edu
Cornell University – www.vet.cornell.edu
Great Smokies – www.vetmeetings.com
International Conference on Exotics (ICE) – www.exoticdvm.com
IVECCS – www.veccs.org
Midwest Veterinary Conference – www.ohiovma.org
Mississippi State University – www.cvm.msstate.edu
North American Veterinary Conference – www.navc.com
Penn Conference – www.vet.upenn.edu
Purdue University – www.vet.purdue.edu
SCAV Winter Conference – www.vetmeetings.com
Southeast Veterinary Conferenc – www.vetmeetings.com
Southern Veterinary Conference – www.jcvma.com
Southwest Veterinary Conference – www.swvs.org
The Ohio State University – www.vet.ohio-state.edu
UC Davis – www.vetmed.ucdavis.edu
University of Tennessee – www.vet.utk.edu
Univetsity of Wisconsin – www.vetmed.wisc.edu
Veterinary Dental Forum – www.veterinarydentalforum.com
Western Veterinary Conference – www.wvc.org
Wild West Veterinary Conference – www.wildwestvc.com

Dental and Surgical Lasers

LightScalpel – www.lightscalpel.com