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LIMITED ORTHOPEDICS

As in small animals, orthopedic applications in large animals have been limited. As delivery methods improve and systems with appropriate wavelengths (Ho:YAG at 2.1 micrometers and Er:YAG at 2.94 micrometers) become more affordable for veterinarians, applications will undoubtedly increase as they have in human medicine, especially in equine surgery. Use of the CO2 laser for intra-articular cartilage vaporization has had favorable results, although delivering this wavelength into a joint is technically difficult.

A report on the use of the Ho:YAG for "low-power" stimulation of healing articular cartilage in the horse has generated interest in possible clinical applications in both human and veterinary medicine. Low-power infrared laser energy, which could accelerate the healing of sutured wounds, has been advocated as an adjunct to postsurgical therapy for equine trauma and for soft-tissue conditions such as teat lacerations in cattle.

A recently described minimally invasive standing method for treating angular limb deformities in foals using the Nd:YAG laser shows excellent potential.As biomedical laser technology merges with military and industrial advances, improvements in existing devices as well as the development of new ideas will continue at astonishing rates. Recent changes in health care philosophy accompanied by more limited funding sources mandate the use of minimally invasive and minimally damaging procedures that should lower overall costs. Veterinary medicine can and should be in the forefront during these exciting times, adding an essential dimension to the development of cutting-edge technology.

Research on basic laser-tissue interaction and selective tissue destruction is increasingly important for achieving the therapeutic goal of minimally invasive procedures for a variety of conditions. Destruction of alimentary tract mucosa is possible using holmium laser energy endoscopically. Intersitial laser hyperthermia to treat malignant tumors will become an effective part of the veterinary oncologist's armamentarium, as will expanded use of photodynamic therapy.

Photothermolysis using appropriate chromophores for selective tissue destruction and sterilization/disinfection is currently being proven an effective treatment for tumors and trauma in clinical and laboratory settings. Minimally invasive urologic techniques for ablation of bladder, urethral and prostatic conditions in small animals will become more common as technology is refined, smaller endoscopes are developed, delivery systems are improved and new laser wavelengths are investigated.

SOFT-TISSUE PROCEDURES

Laser lithotripsy is now possible using both visible and infrared wavelengths. This technology may eventually allow minimally invasive removal of kidney stones and gallstones in animals. Fusion or welding of blood vessels, alimentary tract, ureter or urethra, skin and even bone may be possible. Application of lasers for micromanipulation of gametes and improvement of fertilization and hatching rates during in vitro fertilization are nearly clinical veterinary realities. The use of lasers for soft-tissue dental procedures is already feasible and, with continuing investigations, hard-tissue dental procedures should become so. The Ho:YAG and Er:YAG have already been used for enamel resurfacing and ablation in animals.The existence of diode lasers with wavelengths from the ultraviolet to the far-infrared means that user-friendly, durable, portable, less-expensive laser systems are definitely on the horizon. Currently, FDA-approved high-power diode lasers are available for both clinical and investigational use from manufacturers such as SDL, Diomedics, Cynosure and Applied Optronics.

At this point, diode laser development and technologies that provide smaller but more durable clinical devices for multiple applications seem to hold the greatest promise. In addition, the use of lasers in diagnostic tools and sensors is one of the fastest-growing branches of biomedical laser development. Minimally invasive methods for detecting malignant cells, abnormal tissue and metabolites have tremendous potential. Laser diagnostic technologies could have a significant impact on veterinary medicine if costs for such devices become resonable.

In 1968, the removal of a vocal cord nodule in a dog demonstrated one of the first practical clinical applications of the continuous-wave CO2 laser. Since that time, many other research teams have relied on animal models to determine initial laser parameters and efficacy of new wavelengths, and for final evaluation of new surgical procedures prior to use in human medicine.

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