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May 2024
Are You Laser Focused?
Is a surgical laser a valuable tool or an expensive toy? Many veterinarians are wondering the same thing. On one hand, the promise of less pain and inflammation, better hemostasis and potentially faster healing is appealing. On the other, it is reasonable to be skeptical of whether clients will opt for the increased surgical costs.
Pros and Cons of a Surgical Laser
Perhaps you’ve recently been contemplating the purchase of a surgical laser. You’ve read some literature or spoken with reps from one or more of the companies that sell this type of equipment and are wondering whether this is a valuable tool or an expensive toy. Many veterinarians have the same question. On one hand, the promise of less pain and inflammation, better hemostasis, and potentially faster healing is appealing. On the other hand, it is reasonable to be skeptical of whether clients will opt for the increased surgical costs.
In my case, nearly 20 years ago, I made the decision to buy, enrolled in some continuing education focused on laser surgery, and subsequently purchased a 15-watt articulated arm CO2 surgical laser. I am pleased to report that I never regretted the purchase for a moment. The anticipated reluctance from the clients never materialized.
In fact, I took the approach of doing no overt marketing to the clients. I decided that we would charge an additional fee of $75 for the use of the laser during any routine surgery and charge a time-based fee for extended use in complicated cases. When clients brought their pets in for scheduled surgery, my reception and technician staff simply asked pet owners whether they would like to have the laser used as part of the surgery. Naturally, the pet owners would inquire what the benefits were.
They were informed that the primary benefits were reduced pain and bleeding. We found that 85% of all clients elected to use the laser and accepted the additional charge with no hesitation, questions, or need for further “sales pitch.”
I’m not suggesting that this approach was ideal, or savvy, but with little guidance at the time, it was very effective. Because of the overwhelming acceptance by the clients and the fact that there are minimal consumables associated with its use, we were able to generate enough additional profit in six months to cover the cost of the unit and turn a healthy profit in the first year.
Types of Surgical Lasers
There are four major classes of lasers (I–IV) that vary in power. The classifications are a reflection of the potential for injury to tissue and eyes and not directly related to their applications. Lasers in higher classes have more power output and therefore more potential for injury. Of the four laser classes, most surgical lasers used in veterinary practice are typically Class IV lasers while therapeutic lasers are generally Class IIIb or IV.
Laser units are also differentiated by their laser light source. CO2 lasers are generally the most widely used and are practical for most routine veterinary surgical procedures. Diode lasers have the advantage of performing better in fluid environments and in endoscopic applications. Yttrium aluminum garnet (YAG) lasers are ideal for specialized use in microsurgery such as neurologic and urinary tract procedures. Many surgical lasers also have a Class I or II alignment beam that provides a visual guide to where the higher power surgical laser beam is aimed prior to activation by the surgeon.
Surgical lasers have either an articulated arm with a series of mirrors and lenses that focus and direct the beam, or employ a flexible fiberoptic waveguide, with or without a consumable tip, to deliver the laser energy to the target tissue. The waveguide lasers are a bit less cumbersome to manipulate in confined spaces, but surgeons quickly adapt to whichever type of laser they use. Laser units have control panels that allow the operator to adjust power and the pulse frequency of the laser light dependent on the application, giving the surgeon a wide range of options dependent on the surgical conditions. Additionally, the surgeon can “defocus” the beam by increasing the distance between the tissue and the focal point of the laser beam. This permits the laser light energy to be distributed over a greater area, decreasing the effective power delivered in applications such as ablation and hemostasis.
Surgical lasers provide a very precise tool for incising and excising tissue while sealing small blood vessels and nerve endings.
Pros and Cons
So what are the pros and cons? Surgical lasers provide a very precise tool for incising and excising tissue while sealing small blood vessels and nerve endings. The claims that they can reduce surgical pain, hemorrhage, and possibly swelling are well founded. Additionally, laser energy is locally antimicrobial, potentially reducing surgical site infection.
For the veterinarian who is new to the technology, surgical time can initially be prolonged; however, with experience and familiarity, it is not significantly different than using a scalpel. In fact, lasers can decrease surgery time. For some procedures such as soft palate resection in brachycephalic dogs, surgical time drops from 30–45 minutes or more using traditional instruments and suturing, to literally 10 minutes with little or no hemorrhage or swelling to manage.
Compared to some other capital investments, adding laser surgery to your practice can provide a significant profit center as well.
There are very few cons, but there are some. Lasers are not inexpensive; however, most veterinarians find that the cost can be quickly recouped.
Additionally, laser use is limited to predominantly superficial soft tissues and those that can be easily exteriorized, although most of a general practice’s surgical cases likely fall within this category.
For the veterinarian who is new to the technology, surgical time can initially be prolonged, however with experience and familiarity, it is not significantly different than using a scalpel. In fact, lasers can decrease surgery time.
The plume created from vaporized tissue is potentially harmful to the operator and those nearby. Manufacturers offer “smoke” evacuators, which, if used properly, significantly mitigate this risk.
Novice users often initially use excessive power or move the laser through tissue too slowly, resulting in significant collateral tissue damage and reduced healing. This is usually overcome with experience and education on proper technique, and the learning curve for appropriate use of a surgical laser is fairly short. Any veterinarian who is comfortable with surgical techniques can easily master laser surgery.
Laser light can cause permanent retinal damage and injury to exposed collateral tissue (including your own). Protective glasses are essential and are provided by all manufacturers and after-market suppliers. Proper technique and appropriate handling of the device should minimize the risk of collateral tissue injury. It is imperative to remember that laser light reflected off of shiny surfaces such as surgical instruments can also result in injury to the pet or health care team nearby.
While laser use around the oxygen-rich environment associated with anesthesia carries inherent risk, that risk can be easily mitigated with proper technique, even in and around the intubated oral cavity.
It should go without saying that, like any other piece of medical equipment, if it doesn’t get used, it cannot generate revenue. Sure, lasers are arguably just another means to incise or excise tissue. But they do have capabilities that can make surgery quicker and more convenient for you and less bloody and painful for your patients.
Before You Buy
If you are considering buying one for your practice, it behooves you to speak to one of the surgical laser manufacturers about options and costs. Also, speak to colleagues who have incorporated laser surgery into their practice as they can provide useful tips on situations in which they utilize the laser and how they sell and charge for the service.
Then, develop a plan to market the service to your clients. Laser manufacturers provide effective client brochures and clinic signage which will highlight the benefits to your patients. This educational material, delivered at the time of the recommendation for surgery, will help in your team’s efforts. As with most services, clients generally accept associated costs if they perceive value associated with it. Be sure that you educate the staff so that they understand—and can convey—the benefits of offering this service to your clients.
Veterinary technicians have a unique opportunity to provide education to the clients and to answer any questions that a client might have about laser surgery immediately following an appointment where surgery is recommended. They are also integral to keeping the equipment prepared for surgery and in assisting with evacuation of the vaporized plume and ensuring the safety of the patient and staff during the procedure.
There is a wealth of literature references and several very good textbooks that focus on the use of surgical lasers in veterinary medicine. Below are several references that may be useful in your decision-making process.
Photo credits: ©AAHA/Robin Taylor
Further Reading
- Clark, Geoffrey DVM. “Carbon Dioxide laser surgery in dogs.” Canine Sports Medicine Update, October, 1997
- Godbold J. “CO2 Laser surgery: Selecting the best delivery system.” Veterinary Practice News. 2011;6.
- Godbold J. “CO2 Laser surgery: Standard of care.” Veterinary Practice News. 2012;3:22-23.
- Lucroy M.D. and Bartels K.E. “Surgical Lasers,” Textbook of Small Animal Surgery. Slatter, 3rd Edition, 2001
- Winkler C.J. “The ideal laser scalpel.” Laser Surgery in Veterinary Medicine. Hoboken, NJ: Wiley Blackwell; 2019:32-41.