LASER SURGERY Class 4 > 500 mW Surgical lasers Introduction  Surgery using a laser to cut tissue instead of a scalpel  Laser scalpel  Highly focused laser beam efficiently ablates (either vaporize or chip away) the living tissue.  At the same time, it seals (welds) capillaries, small blood vessels, lymphatics, and nerve endings, with significant benefits to both patients and surgeons. MECHANISM OF ACTION Photovaporolysis  Char – remnant of non-fluid cellular component. Photoplasmolysis Crater  Zone of carbonization- the limit of vaporization  Zone of coagulation and thermal necrosis- Slightly farther away from the center. This zone will eventually die.  Zone of hyperthermia- Farthest from the center. Beyond these zones there is no effect Depth of the crater and the diameter of these zones are directly related to power density. 20-watt Carbon Dioxide laser with plume evacuator  Highly absorbed by water, making it perfect for tissue cutting, vaporization and acoustical destruction.  Thermal injury to surrounding tissue is very superficial.  Lateral thermal injury of 0.05 mm to 0.1 mm  Because there is such minimal lateral thermal damage, injury to surrounding tissues is limited to what you see during application of the laser energy. General parameters for CO2 laser use  Routine incision: Spot Diameter: 0.4 mm Power Setting: 6 to 10 W  Routine ablation/vaporization Spot Diameter: 0.8 mm Power Setting: 10 to 20 W  Delicate location incision: Spot Diameter: 0.3 to 0.4 mm Power Setting: 3 to 6 W  Routine excision: Spot Diameter: 0.8 mm Power Setting: 8 to 15 W LASER USES  Less Pain - The laser seals nerve endings as it cuts. So the patient will have less pain.  Less Bleeding - The laser seals small blood vessels during surgery and speeds up surgery by minimizing bleeding.  Less Swelling - No physical contact except the invisible laser beam. The tissue will not be crushed.  Sterilization - The laser sterilizes the surgical site as it cuts. Bacteria and viruses are vaporized by the laser during laser surgery.  Faster Recovery - Less bleeding and swelling will result in faster healing.  Precision - The beam direction and power can be controlled precisely to remove thin layers of tissue and produce minimal side effects on the surrounding healthy tissue.  Reduced hospitalization time - All above factor will greatly reduce the procedure time. Laser surgery benefits for surgeons Unique surgical capabilities: Laser surgery improves many surgical procedures by making them simpler and reducing risk. This enables surgeries that are not practical with conventional methods.

1. Submitted to:
Dr.B.R.Balappanavar
Dept. of Veterinary Surgery
and Radiology Submitted by:
Kanteshkumar M J
Jr. MVSc
LASER SURGERY

2.  A laser is a device that emits light (electromagnetic
radiation) through a process of optical amplification based
on the stimulated emission of photons.
 The term “laser” originated as an acronym for Light
Amplification by Stimulated Emission of Radiation .
Definition

3.  Intangible
 Yet able to transfer energy due to mass effect of photons
 Photon
-Specific packets of electromagnetic energy that give light its
mass and therefore allow to do work.
-Described by Max Planck (1905) as
E = h f
(E=Energy, h=Plank’s constant , f=Frequency)

4.  Neil Bohr’ model of atom
explains it.
 Electrons in specific atoms
and molecules can alter
their energy state to lower
or higher levels without
being getting destroyed.
How a photon is produced?

5. Einstein (1905) proposed stimulated emission.
Photons can be produced, amplified & induced
to cascade geometrically in a continuous positive
feedback mechanism.
Accredited as Father of modern lasers.
Now stimulated emission

6.  It was technologically possible in the mid-twentieth century to
prove the utility of selected materials for energy
transformation.
 Simply applying electrical energy to a material caused the
repeated release of photons
 The first actual physical model for coherent stimulated
radiation emission was in sophisticated microwave
equipment developed to produce radar.
 Charles Townes created MASER—microwave amplification
by stimulated emission of radiation
 A.L. Schawlow (1958) provided the idea of an “optical type
maser” or LASER

7. History
Einstein (1905) proposed stimulated emission.
Dr. Theodore Maiman (1960) under the direction of Dr.
Henry Gould demonstrated consistent laser energy
with the production of a ruby crystal laser
Hence a laser was realized in true physical form
1964 first used in veterinary medicine shortly in a
laser assisted vocal cord nodectomy

8.  Coherent- in phase in space & time
 Monochromatic- one color/wavelength
 Collimated- single direction, tight beam, parallel paths
What is special?

9. Practically saying

12.  Common Components of all Lasers
 Optical resonant cavity
 Tube or cylinder, more length than width
 Highly reflective mirror cap
 Partially transmitting but highly reflective mirror cap at opposite
end
 Lasing Medium
 solid ruby or Nd:YAG,
 liquid dyes
 gases CO2 or Helium/Neon
 External energy source
 Chemical
 Electrical
 Optical

13.  Pumping
 These atoms spontaneously decay to a relatively long-lived, lower
energy, metastable state.
 A population inversion is achieved when the majority of atoms have
reached this metastable state
 Lasing action occurs when an electron spontaneously returns to its
ground state and produces a photon.
Lasing Action

14.  If the energy from this photon is of the precise wavelength, it
will stimulate the production of another photon of the same
wavelength and resulting in a cascading effect.
 The highly reflective mirror and partially reflective mirror
continue the reaction by directing photons back through the
medium along the long axis of the laser.
 The partially reflective mirror allows the transmission of a small
amount of coherent radiation that we observe as the “ beam ”.
 Laser radiation will continue as long as energy is applied to the
lasing medium.

15. Lasing Action Diagram

16. COMMONlly USED LASER LIGHTS

18.  Energy-
 The capacity for doing work.
 Joule (J)
 Fluence
 Energy delivered per unit area
 j/ cm 2
 Power
 Amount of energy delivered per unit of time
 Ability to do work over a given period of time watt (W)
 Power density
 Radiant power striking a target per unit area of a cross section of
a laser light beam
 W/cm2
Power of laser light

19. Classified by the FDA’s Center for Devices &
Radiological Health based on the Accessible Emission
Limit (AEL).
 Class 1 < 0.5 mW Laser pointers
 Class 2 < 1.0 mW Toys
 Class 3A < 5 mW CD-players
 Class 3B < 500 mW Therapeutic lasers
 Class 4 > 500 mW Surgical lasers
LASER Regulation

20.  Class 3B < 500 mW Therapeutic lasers
LOW LEVEL LASER THERAPY

21. Relatively a new biotechnology that uses the
science of photobiostimulation to speed healing
Cold laser therapy or soft laser therapy
Painless
Non-invasive
Works with the body’s own healing mechanisms
No harmful side-effects.
WHAT ?

22. Cont….
Different colours are used in veterinary medicine
Infra-red, at about 800 nm or greater
Red, at about 610 - 800 nm
Gives body the pure energy to use for healthy
cellular regeneration

23.  The laser handset is held over the
skin for a few minutes in each
setting, although it can be used
through clothes for intimate areas.
Different programmes use a range
of settings with various wave-
lengths and phasing to penetrate to
the best level within the body and
interact directly with the
appropriate cells. Sessions last no
more than an hour and most clients
notice the benefits from the very
first session.
Procedure

24. Main areas of application of LLLT
EFFECTS

25.  Stimulation of wound healing
 Promotes faster wound healing/clot formation
 Helps generate new & healthy cells & tissue
 Increase collagen production
 Develops collagen & muscle tissue
 Increase macrophagic activity
 Stimulates immune system
 Alter nerve conduction velocity
 Stimulates nerve function
Physiological Effects

26.  Biostimulation
 improved metabolism, increase of cell metabolism
 Increases speed, quality & tensile strength of tissue repair
 Improved blood circulation & vasodilation
 Increases ATP production
 Analgesic
 effect Relieves acute/chronic pain
 Anti-inflammatory & anti-edematous effects
 Reduces inflammation
 Immunoregulation
 stimulates IMMUNOGLOBINS and LYMPHOCYTES
Physiological Effects

27.  Numerous disorders which respond
 Arthritis
 Hip dysplasia
 Post surgical pain relief and faster healing
 Numerous skin conditions
 Gingivitis
 Otitis - Ear infections/inflammation
 Wound healing
 Insect bites/stings
 Lacerations/abrasions
 Cystitis -bladder infections/inflammation
 Burns
 Plus many more

30. Mechanism of Action

31. Mechanism of Action
Red light affects all cell types
Absorbed by the mitochondria present in all cells
Cytochromes (respiratory chain enzymes) within the
mitochondria have been identified as the primary
biostimulation chromophores ( primary light-absorbing
molecules ).
Cytochrome c oxidase (Cox) is the primary photo-acceptor
increased oxidation of Cytochrome c and increased
electron transfer
Increased ATP production

34. The light-induced increase in ATP synthesis and increased
proton gradient leads to an increasing activity of the Na + /H +
and Ca 2+ / Na + antiporters, and of all the ATP driven carriers
for ions, such as Na + / H + ATPase and Ca 2+ pumps .
ATP is the substrate for adenyl cyclase.
Controls the level of cAMP.
Both Ca 2+ and cAMP are very important second
messengers.
Ca 2+ regulates almost every process in the body(muscle
contraction, blood coagulation, signal transfer in nerves, gene
expression, etc.).
MECHANISM OF ACTION

35. Mechanism of Action

36. Redox couples
NAD/NADH,
NADP/NADPH,GSH/GSSH etc
Change in redox state activates
numerous intracellular signalling
pathways
DNA/RNA synthesis, enzyme
activation and cell cycle
progression
Mechanism of Action

37. Gridding Technique
Divide treatment areas into grids of square
centimeters
Wanding Technique
A grid area is bathed with the laser in an
oscillating fashion; distance should be no
farther than 1 cm from skin
Scanning Technique
No contact between laser tip in skin; tip is
held 5-10 mm from wound
Point Application
(Acupuncture point)
Treatment Techniques

38. Class 4 > 500 mW Surgical lasers
LASER SURGERY

39.  Surgery using a laser to cut tissue
instead of a scalpel
 Laser scalpel
 Highly focused laser beam efficiently
ablate (either vaporize or chip away)
the living tissue.
 At the same time, it seals (welds)
capillaries, small blood vessels,
lymphatics, and nerve endings, with
significant benefits to both patients
and surgeons.
Introduction

41. Photovaporolysis

42. Char – remnant of non-fluid cellular component

43. Photoplasmolysis
Canine lithotripsy by Ho:YAG laser

44. How it controls
bleeding
 How it
minimizes pain
sensation

45. Zone of carbonization- the limit of
vaporization
Zone of coagulation and thermal necrosis-
Slightly farther away from the center. This
zone will eventually die.
Zone of hyperthermia- Farthest from the
center. Beyond these zones there is no effect
Depth of the crater and the diameter of these
zones are directly related to power density.
Crater

46. 20 watt Carbon Dioxide laser with plume evacuater
Highly absorbed by water, making it
perfect for tissue cutting, vaporization
and acoustical destruction.
Thermal injury to surrounding tissue
is very superficial.
Lateral thermal injury of 0.05 mm to
0.1 mm
Because there is such minimal lateral
thermal damage, injury to surrounding
tissues is limited to what you see
during application of the laser energy.

47. General parameters for CO2 laser use
Routine incision: Spot Diameter: 0.4 mm
Power Setting: 6 to 10 W
Routine ablation/vaporization Spot Diameter: 0.8 mm
Power Setting: 10 to 20 W
Delicate location incision: Spot Diameter: 0.3 to 0.4 mm
Power Setting: 3 to 6 W
Routine excision: Spot Diameter: 0.8 mm
Power Setting: 8 to 15 W

48. Less Pain - The laser seals nerve endings as it cuts. So the patient will
have less pain.
Less Bleeding - The laser seals small blood vessels during surgery and
speeds up surgery by minimizing bleeding.
Less Swelling - No physical contact except the invisible laser beam. The
tissue will not be crushed.
Sterilization - The laser sterilizes the surgical site as it cuts. Bacteria and
viruses are vaporized by the laser during laser surgery.
Faster Recovery - Less bleeding and swelling will result in faster healing.
Precision - The beam direction and power can be controlled precisely to
remove thin layers of tissue and produce minimal side effects on the
surrounding healthy tissue.
Reduced hospitalization time - All of above factor will greatly reduce the
procedure time.
Why use laser?

49.  Unique surgical capabilities: Laser surgery improves many surgical
procedures by making them simpler and reducing risk. This enables
surgeries that are not practical with conventional methods.
 Enhanced visibility of the surgical field: The laser light seals capillaries
and small blood vessels as it cuts, thereby dramatically reducing
bleeding. This results in a much clearer and drier surgical site.
 Increased precision and control: The focal spot size of the beam may
be adjusted down to a small fraction of a millimeter or expanded for a
much wider coverage. The laser power may be set for rapid removal of
relatively large tissue amounts, or adjusted to remove only one cell layer
at a time.
 Reduction of surgery time: The hemostatic effect of the laser beam and
the improved visibility of the surgical field often reduce the duration of the
surgery
Laser surgery benefits for surgeons

50.  Declaws
 Scalpel blade or a nail trimmer is the traditional way of declaws, that was painful and
time consuming. Laser surgery to declaw will make cats have little pain
 Ear Hematoma
 One of the CO2 laser features, selectively and gently going through layers of tissue,
makes the CO2 laser excellent for ear hematoma due to the small opening needed to
drain the fluid.
Skin Tumor
 Laser can completely ablate the small tumors lesion and make pets have less
discomfort during the recovering time.
 Dog Neuter
 CO2 laser can also treat dog neuters due to the advantages of minimal bleeding and
less pain.
 Amputation
 The laser is particularly good at amputations. Minimal bleeding during the laser
surgery allows the surgery to perform much faster.
Operations

51. Canine Skin Incision

52. Canine Skin Incision

53. Canine Dewclaw Amputation

54. Canine Dewclaw Amputation

55. Feline Ovariohysterectomy

56. Feline Ovariohysterectomy

57. Canine Aural Hematoma

58. Canine Aural Hematoma

59. Canine Aural Hematoma

60. Uncomplicated Acral Lick Granuloma

61. Uncomplicated Acral Lick Granuloma

62. Canine Cystotomy

63. Lasers have a wide range of utility in veterinary practice
The LLLT technique is very versatile for numerous
medical applications.
LLLT is non invasive, painless with no side effects
LLLT provides a unique way of healing in sync with the
natural healing processes of the body
More research has to be done to understand the
interaction of Laser light with cells and tissues.
Conclusion

64. Laser surgery is a specialized technique of performing
surgery.
The great advantage of laser surgery in large animals is
that it allows your surgeon to reach obscure areas and
perform surgery through a minimally invasive approach.
Laser surgery provides a better alternative for a blood
less and pain less surgery.
It makes possible otherwise the difficult procedures
It helps in faster recovery of patients
Conclusion

65.  Veterinary Laser Surgery A Practical Guide By Noel Berger, Peter H. Eeg
 Veterinary Cold Laser Therapy By Wm. L. Inman BS, DVM, CVCP
 What is Cold-Laser Therapy? By Craig Amrine L.Ac.
 Laser Surgery in Small Animal Practice—A Personal Perspective John C
Godbold Jr, DVM
 Low Level Laser Therapy By Laurence J. Walsh. The University of
Queensland, Brisbane, Australia.
 Mechanisms of Low Level Light Therapy By Michael R. Hamblin
 Veterinary Cold Laser Therapy By Wm. L. Inman BS, DVM, CVCP
 www.Wikipedia.org
 http://www.acvs.org
 http://low-level-laser-therapy.org
References

66. Laser will not make a practitioner a better surgeon;
however, it will allow a good surgeon to do surgery
in a way that helps their patients and owners.