Soft tissue application of lasers

Recurrent equine capillary haemangioma treated with adjunctive laser photocoagulation therapy: a case report

The aim of the present work was to describe a case of recurrent capillary haemangioma at the coronary border of the left front limb in a 6-month-old thoroughbred filly successfully treated with diode laser ablation and adjunctive laser photocoagulation therapy.

A retrospective comparison of carbon dioxide surgical laser and non-laser excision for removal of cutaneous and subcutaneous soft-tissue sarcomas in dogs

Aims: To compare the duration of anaesthesia, surgery, and postoperative hospitalisation, the proportion of tumours excised with complete histologic margins and immediate postoperative surgical site complications in dogs undergoing removal of cutaneous or subcutaneous soft tissue sarcomas (STS) by either carbon dioxide (CO₂) laser or non-laser surgical excision methods. Methods: Medical records of dogs that underwent surgical excision of cutaneous and subcutaneous STS at the University of Missouri between December 2004 and May 2018 were evaluated. The study population consisted of client-owned dogs that underwent CO₂ laser (n = 4) or non-laser (n = 20) excision of a single STS. Data recorded included: signalment, duration of anaesthesia, surgery and postoperative hospitalisation, tumour characteristics, completeness of histologic margins, postoperative complications, adjunctive therapy, and other procedures at the time of surgery. Results: There was no evidence of a difference in mean age, body weight or tumour size between groups. Similarly there was no evidence of a difference in the duration of anaesthesia or surgery, or in the proportion of dogs whose STS were removed with complete histologic margins between dogs whose STS was removed using laser or non-laser surgical excision methods. However, the duration of postoperative hospitalisation trended towards being longer for the laser excision group (p = 0.061). Conclusions: These data provide preliminary evidence that excision of cutaneous or subcutaneous STS with CO₂ surgical laser is comparable to non-laser methods for the measured outcomes.

Evaluation of various carbon dioxide laser settings on the time and number of laser beam passes required to make a full-thickness skin incision and amount of laser-induced tissue artifact

OBJECTIVE

To evaluate the time and number of laser beam passes required to make full-thickness skin incisions and extent of laser-induced tissue artifacts following use of a CO₂ laser at various settings.

SAMPLE

24 skin specimens from six 5-month-old porcine carcasses.

PROCEDURES

4 full-thickness skin specimens were harvested from the flank regions of each carcass within 30 minutes after euthanasia and randomly assigned to 4 treatment groups. Three 5-cm-long incisions were made in each specimen with a CO₂ laser (beam diameter, 0.4 mm) set to deliver a continuous wave of energy alone (groups 1 and 2) or in superpulse mode (groups 3 and 4) at 10 (groups 1 and 3) or 20 (groups 2 and 4) W of power. The time and number of passes required to achieve a full-thickness incision were recorded, and extent of laser-induced tissue artifact (as determined by histologic evaluation) was compared among the 4 groups.

RESULTS

Mean time required to make a full-thickness skin incision for groups 2 and 4 (power, 20 W) was significantly less than that for groups 1 and 3 (power, 10 W). Mean number of passes was lowest for group 2 (continuous wave at 20 W). Extent of laser-induced tissue artifact was greatest for group 4 (superpulse mode at 20 W).

CONCLUSIONS AND CLINICAL RELEVANCE

Results provided preliminary information regarding use of CO₂ lasers to make skin incisions in veterinary patients. In vivo studies are necessary to evaluate the effect of various CO₂ laser settings on tissue healing and patient outcome.

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.

Combined carbon dioxide laser and cryosurgical ablation of rostral nasal septum squamous cell carcinoma in 10 dogs

BACKGROUND

Squamous cell carcinoma (SCC) is the most commonly reported neoplasm of the nasal planum and treatment is focused on localized disease. Rostral maxillectomy and/or nasal planectomy are considered standard of care for excision of nasal planum SCC; however, the cosmetic outcome of these procedures can be deemed unacceptable by many pet owners.

OBJECTIVES

The study aim was to evaluate the efficacy of combination carbon dioxide (CO₂ ) laser surgery and cryosurgery as a palliative treatment modality in dogs with nasal SCCs.

ANIMALS

Ten client-owned dogs with nasal SCC were included: seven neutered males, two spayed females and one intact male, with a median age of 12.5 years (range 9-15 years).

METHODS AND MATERIALS

Tumour CO₂ laser ablation was followed by cryosurgical ablation of the visible tumour, adjacent and subjacent tissue. Three rapid freeze-slow thaw cycles were performed.

RESULTS

Eight of 10 dogs were Labrador retrievers. The ages ranged from 9 to 14 years. Overall median survival time was 260 days with two dogs still alive at the time of writing.

CONCLUSIONS AND CLINICAL IMPORTANCE

Combined CO₂ laser and cryosurgical ablation was practical, cost-effective and provided an excellent aesthetic outcome in dogs with SCCs restricted to the nasal septum, while providing acceptable palliation of local disease.

Canine eosinophilic granuloma of the digits treated with prednisolone and chlorambucil

BACKGROUND

Canine eosinophilic granuloma (CEG) is an uncommon disease. Lesions are typically located in the oral cavity and other cutaneous sites, but are rarely reported to affect the digits. The majority of cases are treated with prednisolone as a monotherapy; alternative treatment options include corticosteroids administered in combination with azathioprine, antihistamines, electrochemotherapy with bleomycin, and surgical resection. Neither chlorambucil nor laser previously have been reported as treatments.

OBJECTIVES

To describe an alternative therapy for treatment of CEG; using chlorambucil in combination with prednisolone for those cases that fail to respond to prednisolone alone. The new treatment was chosen according to good clinical practice and after owner consent.

ANIMALS

Two client owned dogs.

METHODS

One case was initially treated with carbon dioxide laser to debulk the lesions. Both cases were treated with a combination of oral prednisolone and chlorambucil.

RESULTS

Both dogs experienced rapid resolution of lesions with prednisolone and chlorambucil therapy. Case 1 remained in remission three months after withdrawing medication. Case 2 experienced relapse 10 weeks after discontinuing therapy but was well controlled on maintenance prednisolone with chlorambucil at low, well tolerated doses.

CONCLUSIONS AND CLINICAL IMPORTANCE

Although CEG appears to be an uncommon disease, it should be included as a differential diagnosis for dermal, nodular lesions affecting the digits. Chlorambucil appears to be an effective and well tolerated prednisolone sparing agent for treatment of CEG. Carbon dioxide laser ablation appears to be an effective method of debulking CEGs.

Use of CO2 Laser as an Adjunctive Treatment for Caudal Stomatitis in a Cat

Lasers have become a popular tool in veterinary practice, particularly the carbon dioxide (CO2) laser. In humans, the CO2 laser is used most commonly in oral and maxillofacial soft tissue surgery due to its favorable interactions with oral soft tissues. Other types of lasers are better suited for use on hard tissues such as enamel and dentin. This article reviews the history of laser use, physics of laser-tissue interaction, delivery systems, and laser types used in dentistry and oral surgery. This is followed by a case report describing the use of CO2 laser as an adjunctive treatment for therapy of refractory caudal stomatitis in a cat.

A Novel Approach to Brachycephalic Syndrome. 2. Laser-Assisted Turbinectomy (LATE)

OBJECTIVE

To introduce a new surgical procedure based on interventional, laser-assisted removal of obstructing turbinate tissue to improve endonasal airway patency in brachycephalic dogs and to confirm the short and long term results using computed tomography (CT) and rhinoscopy.

STUDY DESIGN

Prospective clinical study.

ANIMALS

Brachycephalic dogs (n = 158; 70 Pugs, 77 French Bulldogs, 11 English Bulldogs) referred for treatment of severe respiratory distress because of brachycephalic syndrome.

METHODS

Computed tomography and anterior and posterior rhinoscopy were performed to evaluate endonasal obstruction. Laser-assisted turbinectomy (LATE) using a diode laser was performed as part of a multilevel surgery. Nasal conchae that were causing airway obstruction were removed.

RESULTS

The obstructing parts of the conchae were safely and efficiently removed by LATE, shaping a patent nasal airway in all dogs. The newly developed surgical procedure involved 3 steps: turbinectomy of the (1) concha nasalis ventralis; (2) rostral aberrantly growing turbinates (RAT); and (3) caudal aberrantly growing turbinates (CAT). Complications of the procedure included transient intraoperative hemorrhage in 51 of 158 dogs (32.3%); however, a temporary tamponade was necessary in only 2/158 dogs (1.3%). After 6 months, regrowth of turbinates required resection of possibly re-obstructing tissue in 25/158 dogs (15.8%; 1 Pug and 24 French Bulldogs).

CONCLUSION

LATE is an effective method for creating a patent nasal airway in brachycephalic dogs with intranasal obstruction.

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.

Nonsutured Hotz-Celsus technique performed by CO2 laser in two dogs and two cats

It is described a new version of modified Hotz-Celsus technique performed in four patients, two cats and two dogs. The surgery was carried out using CO(2) laser in order to avoid bleeding and decrease the anesthetic time. Besides, the wound created was not sutured and it healed by secondary intention without any complication. As a conclusion, this modification is a successful alternative to treat entropion in a safe and fast way.

Equipment for oral surgery in small animals

This article provides an overview of equipment used for oral surgery. Specific instruments and materials used when performing relevant operative procedures are also mentioned in other articles in this issue.

Cutaneous progressive angiomatosis on the muzzle of a dog, treated by laser photocoagulation therapy

A 10-year old, female, cocker spaniel was presented with a bleeding lesion on the muzzle and nasal planum observed initially as a small raised nodule at 1 year of age. This became clinically more pronounced at 5 years of age, progressively enlarged thereafter and was diagnosed initially as a vascular tumour. On clinical examination, multiple confluent nodules of variable diameter (0.5-1.5 cm) deformed the outline of the nose. Histological examination revealed a progressive angiomatosis with multifocal infiltrative growth of increased dermal vascularization with different sized and type of anastomosing vessels lined by a monolayer of reactive endothelium, often arranged as papillary projections into the lumina. Partial nosectomy, the first therapeutic approach, was unsuccessful and the lesion relapsed within 6 months. However, subsequent laser photocoagulation therapy provided a good cosmetic outcome, no relapse 1 year later, and appeared to provide an effective alternative to ablation surgery.

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.