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LARGE ANIMAL SURGERY

Use of biomedical lasers in small-animal orthopedics has been more limited than similar applications in human or equine surgery for two reasons: Expensive arthroscopic equipment is not always applicable or readily available, and it is harder to use on the smaller joints of cats and dogs. Lasers have not been effective thus far for ablation of bone, although various wavelengths from the free electron laser are being evaluated. Ablation with a CO2 laser of the synthetic polymer methylmethacrylate during removal or revision of total hip prostheses from dogs also has been evaluated recently.Surgical laser techniques for equine urogenital and laryngeal procedures were intially reported in 1983.

Clinical and histological evaluation of the CO2 laser's ability to prevent the growth of painful nerve masses in a horse's forefoot after surgery was introduced in 1984. Laparoscopic use of flexible, hoolow fibers with the CO2 laser has been described as a clinical possibility. Developing an economical transendoscopic system to deliver higher powers from currently available CO2 lasers might generate increased interest in their clinical use.The effectiveness of the CO2 laer for cutting horse skin has also been compared with other incisional methods and was found to produce adjacent thermal injury comparable to that from an electrosurgical unit. Other uses of lasers in soft-tissue procedures in large-animal surgery include excision and ablation of tumors and excessive growths of scar tissue, known as proud flesh in horses, with CO2, Nd:YAG, argon-ion, KTP, diode and holmium lasers.

The CO2 and Nd:YAG lasers have proved to be the most effective for rapid excision and vaporization when operated at powers greater than 40 W.In addition, procedures that require meticulous control of hemorrhaging such as excision of penile hematomas, have been performed successfully using an Nd:YAG laser through an optical fiber in contact mode. The CO2 laser's use for preparing a wound bed for skin grafts (called a pinch graft) has found favor among some surgeons since recipient pockets can easily be created in a "no touch" mode that helps control bleeding and can actually sterilize the wound. In addition, precise tissue dissection in the equine abdominal cavity for laparoscopic oophorectomy )removal of the ovary) was found to be safe and effective using CO2 laser energy through a hollow waveguide.

Traditionally, laryngotomy has been used to perform in the pharynx and larynx of horses, but the required use of a general anesthetic often extends recovery time. For the past 12 years, a few equine surgeons have used transendoscopic laser techniques in both contact and noncontact modes. Transendoscopic use of the Nd:YAG laser in the horse has been and continues to be an effective method for treating certain upper airway obstructions.The advantages of approaching minimally accessible lesions, the ability to perform procedures with local rather than general anesthesia and the decrease in recovery time have provided the motivation for continuing this successful effort. Objective protocols have provided effective treatments for nasal pharyngeal obstructions and laryngeal problems such as hyperplasia, enlargement of lymph glands, epiglottic entrapment or dorsal displacement of the soft palate.

Such methods make ventriculectomies possible and have provided adjunctive therapy for diseases of the gutteral pouches connected to the eustachian tubes of horses. Specifically, transendoscopic delivery of Nd:YAG and diode laser energy has provided treatment for endometrial cysts that cause infertility, an otherwise hard-to-approach condition (Figure 4).

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