Chapter 15 - Laser in Veterinary Surgery Flashcards
What are the four types of lasers currently used in veterinary medicine?
A) CO2, Nd, Ho, and diode B) CO2, HeNe, Nd, and argon C) Nd, diode, ruby, and excimer D) CO2, argon, HeNe, and Ho
A) CO2, Nd, Ho, and diode
What is the wavelength range of visible light?
A) 100 to 400 nm B) 400 to 700 nm C) 700 to 1000 nm D) 1000 to 1500 nm
B) 400 to 700 nm
At what wavelength are CO2 lasers most effective for tissue incision?
A) Greater than 2500 nm B) 600 to 1400 nm C) 1064 nm D) 800 nm
A) Greater than 2500 nm
What is the power density of a CO2 laser set to 50 W with a focal spot size of 0.16 mm?
A) 6300 W/cm² B) 248,880 W/cm² C) 150,000 W/cm² D) 100,000 W/cm²
B) 248,880 W/cm²
How many watts is the CO2 laser in continuous mode set to in the second example?
A) 50 W B) 10 W C) 8 W D) 5 W
C) 8 W
What is the approximate power density of a CO2 laser set to 8 W with a focal spot size of 0.4 mm?
A) 248,880 W/cm² B) 6300 W/cm² C) 10,000 W/cm² D) 5000 W/cm²
B) 6300 W/cm²
What is the energy equivalent of 1 joule?
A) 1 W × 1 sec B) 2 W × 1 sec C) 0.5 W × 2 sec D) 1 W × 2 sec
A) 1 W × 1 sec
What type of tissue reaction occurs when the laser beam is absorbed?
A) Reflection B) Transmission C) Coagulation D) All of the above
D) All of the above
What tissue component is primarily responsible for absorption in surgical lasers?
A) Air B) Hemoglobin C) Bone D) Muscle
B) Hemoglobin
What is the typical effect of thermal energy generated by lasers?
A) Immediate healing B) Vaporization C) Cooling D) None of the above
B) Vaporization
What temperature must tissue reach to be completely vaporized?
A) 50°C B) 75°C C) 100°C D) 200°C
C) 100°C
How is power density expressed in surgical lasers?
A) W/m² B) W/cm C) W/cm² D) J/m²
C) W/cm²
What is the typical range of wavelengths for diode lasers?
A) 2500 to 3000 nm B) 600 to 900 nm C) 400 to 600 nm D) 700 to 1400 nm
B) 600 to 900 nm
What type of lasers are primarily used for coagulation?
A) CO2 lasers B) Nd lasers C) Diode lasers D) Both B and C
D) Both B and C
How does increasing the laser wattage affect power density?
A) It decreases power density B) It does not affect power density C) It increases power density D) It only affects tissue reaction
C) It increases power density
Figure 15-1. Wavelengths of surgical lasers (in nm). Ultraviolet (UV) wavelengths are generally absorbed by protein, whereas the visible and infrared wavelengths are generally absorbed by water or pigmented melanin or hemoglobin. Wavelengths in common veterinary use are in gray. Er, Erbium; GAA, gallium-aluminum-arsenide; Ho, holmium; KTP, potassium titanyl phosphate; Nd, neodymium; YAG, yttrium-aluminum-garnet.
Figure 15-2. Tissue absorption of common surgical laser wavelengths. The visible spectrum is beneath the visible range. The near-infrared GAA diode and Nd:YAG lasers are highly absorbed by dark pigment. However, note the increased absorption of the GAA diode on the water curve compared with the Nd:YAG laser. The Ho:YAG and CO2 lasers are both highly absorbed by water. Er, Erbium; GAA, gallium-aluminum-arsenide; Ho, holmium; Nd, neodymium; UV, ultraviolet; YAG, yttrium-
aluminum-garnet.
The spot size of a laser beam is measured in millimeters and the following formula can be used to calculate the power density:
Figure 15-3. Power density decreases with the square of the increase in spot size, which in turn increases with distance from the surface. The beams depicted are all CO2 laser beams from machines set to 50 W. The power densities shown below each demonstrate the profound reduction in tissue effect by increasing spot size. Moving the hand piece away from the tissue increases spot size.
Figure 15-5. Absorption length of various wavelengths of surgical lasers in nonpigmented skin. Wavelengths commonly used in veterinary medicine are marked dark gray; wavelengths (nm) are stated beside the names. The far-infrared Ho:YAG and CO2 lasers are highly absorbed by water; therefore, they penetrate minimally into skin, whereas the near-infrared Nd:YAG or GAA Diode lasers are absorbed more by the darker pigments of the deeper layers. DTP, Diagnostic and therapy systems for psychology; GAA, gallium-aluminum-arsenide; Ho, holmium; Nd, neodymium; YAG, yttrium-aluminum-garnet.
Figure 15-4. Focusing hand piece that would be used on an articulating arm of a CO2 laser. The arrow points to the spot of maximum focus for creating a precise incision with minimal effect on margins of wound. The stylus contacts the tissue to fix the focal point and provide a feel on the tissue for making the incision. Below that point, power decreases with distance from the end of the stylus. Slight defocus allows vaporization of tissue with a relatively high-power density, and more distance reduces power density to coagulation of tissue protein.
Figure 15-6. Range of tissue changes from laser beam. With sufficient power density, a laser beam has a central area of tissue vaporization/ablation shown by the crater in this drawing. A layer of carbonization occurs when tissue that has been significantly heated cools to produce char. The area of thermal necrosis is where tissue is heated beyond physiologic limits and later sloughs off. The goal of incisive surgery is to use adequate power density to create as little carbonization and thermal necrosis as possible.
Figure 15-7. Pulsed laser energy compared with continuous laser energy. Pulsing higher power densities for short durations (vertical bars) produces a more efficient tissue effect with less collateral tissue heating compared with a continuous beam (horizontal bar) emitting the same average power (fluence). The tissue cools slightly between the pulses.
What is a common effect of multiple inefficient passes with a laser?
A) Decreased wound width B) Increased thermal injury C) Improved healing D) None of the above
B) Increased thermal injury
How does the size of the focal spot influence laser interactions with tissue?
A) Smaller spot increases thermal injury B) Larger spot improves cutting C) Smaller spot improves cutting D) Size has no effect
C) Smaller spot improves cutting
What happens to the edge of vaporized tissue?
A) It remains intact B) It forms a char C) It heals immediately D) It undergoes hyperemia
B) It forms a char
How can the absorption of a laser beam by tissue be maximized?
A) By using a longer wavelength B) By adjusting the chromophore content C) By increasing the distance from the laser D) By using a lower power setting
B) By adjusting the chromophore content
What is the effect of char on laser efficiency?
A) It enhances efficiency B) It has no effect C) It decreases efficiency D) It causes immediate healing
C) It decreases efficiency
What does photocoagulation result in?
A) Complete tissue destruction B) Reversible necrosis C) Irreversible necrosis D) Immediate tissue healing
C) Irreversible necrosis
What can contribute to inflammation at the surgery site?
A) Removal of black char B) Presence of black char C) Efficient tissue absorption D) Proper laser settings
Presence of black char
What type of energy interaction is photoablation?
A) Transmission B) Reflection C) Complete ablation D) Coagulation
C) Complete ablation
What is the ideal laser type for tissue incision?
A) Nd B) Diode C) CO2 D) Ho
C) CO2
What can cause iatrogenic damage during laser procedures?
A) Reflection of laser light B) Excessive coagulation C) Inadequate tissue absorption D) All of the above
A) Reflection of laser light
What happens to tissue due to latent thermal necrosis?
A) Immediate healing B) Ischemia and necrosis C) Enhanced regeneration D) None of the above
B) Ischemia and necrosis
How does increasing the focal spot size affect coagulation?
A) It decreases coagulation efficiency B) It increases coagulation efficiency C) It has no effect on coagulation D) It makes cutting more efficient
B) It increases coagulation efficiency
What is the primary focus of a surgeon using a CO2 laser?
A) Maximize thermal injury B) Incise tissue in a single pass C) Coagulate blood D) Increase wound width
B) Incise tissue in a single pass
What effect does prolonged exposure to a laser have on tissue?
A) It cools the tissue B) It causes increased thermal damage C) It heals the tissue D) It has no significant effect
B) It causes increased thermal damage
What is the primary characteristic of laser beams?
A) Divergent B) Diffuse C) Collimated D) Scattered
C) Collimated
What is the acronym of LASER?
Light Amplification by Stimulated
Emission of Radiation
How many types of laser exist in veterinary medicine?
carbon dioxide (CO2),
neodymium:yttrium-aluminum-garnet
(Nd:YAG ),
holmium:yttrium-aluminum-garnet (Ho:YAG ), and diode
What happens when laser light is transmitted through tissue?
A) Absorption occurs B) Reflection occurs C) Iatrogenic damage may occur D) Coagulation occurs
C) Iatrogenic damage may occur
What does increased laser contact time typically lead to?
A) Decreased coagulation B) Increased thermal necrosis C) More efficient cutting D) Immediate healing
B) Increased thermal necrosis
How many watts does a typical CO2 laser operate at for cutting?
A) 5 W B) 10 W C) 50 W D) 100 W
C) 50 W
What type of laser is best for tissue ablation?
A) CO2 laser B) Nd laser C) HeNe laser D) Both A and B
D) Both A and B
What is one potential complication from excessive laser use?
A) Decreased energy transfer B) Improved healing C) Necrosis of adjacent tissue D) Increased visibility of tissue
C) Necrosis of adjacent tissue
What effect does laser energy have on water-rich tissues?
A) It cools them B) It enhances cutting C) It causes rapid vaporization D) It has no effect
C) It causes rapid vaporization
What type of interaction involves complete destruction of target tissue?
A) Absorption B) Reflection C) Photoablation D) Coagulation
C) Photoablation
What is the typical characteristic of laser beams compared to ordinary light?
A) They spread out quickly B) They are less intense C) They are monochromatic and directional D) They are incoherent
C) They are monochromatic and directional
How does the wavelength affect laser-tissue interactions?
A) Longer wavelengths are absorbed more B) Shorter wavelengths cause more scattering C) Wavelength has no effect on interactions D) Both A and B
D) Both A and B
What is the hallmark of coagulating-type surgical lasers?
A) Low thermal damage B) Minimal scatter C) Latent thermal necrosis D) High cutting efficiency
C) Latent thermal necrosis
What is the power density of a CO2 laser set at 50 W with a 0.16-mm focal spot size?
A) 248,880 W/cm² B) 398,680 W/cm² C) 1,990,446 W/cm² D) 1592 W/cm²
) 248,880 W/cm²
At what frequency do pulsed lasers deliver energy, as mentioned in the text?
A) 100 Hz B) 200 Hz C) 300 Hz D) 400 Hz
B) 200 Hz
What is the power density provided by 400 W power spikes in pulsed mode?
A) 248,880 W/cm² B) 1,990,446 W/cm² C) 50,000 W/cm² D) 398 W/cm²
B) 1,990,446 W/cm²
What is the wavelength range of the Nd
or diode laser?
A) 800 to 900 nm B) 980 to 1064 nm C) 500 to 600 nm D) 1000 to 1100 nm
B) 980 to 1064 nm
How many days postoperatively does tissue sloughing occur after laser coagulation?
A) 1 to 3 days B) 2 to 5 days C) 5 to 7 days D) 10 to 14 days
B) 2 to 5 days
What is the recommended dosage of phenylbutazone for horses?
A) 1.0–2.2 mg/kg, BID B) 2.2–4.4 mg/kg, BID C) 4.0–6.0 mg/kg, SID D) 1.5–3.0 mg/kg, SID
B) 2.2–4.4 mg/kg, BID
How many doses of dexamethasone are initially recommended postoperatively?
A) 1 to 2 doses B) 2 to 3 doses C) 3 to 4 doses D) 5 to 6 doses
B) 2 to 3 doses
What percentage of the heat applied is required to cool tissue in thermal relaxation time?
A) 25% B) 50% C) 75% D) 100%
B) 50%
In contact laser surgery, how many different fiber types are mentioned for delivering heat?
A) One type B) Two types C) Three types D) Four types
B) Two types
What is the effective power range of Nd
lasers typically used?
A) 10–30 W B) 50–100 W C) 100–150 W D) 150–200 W
B) 50–100 W
What percentage of laser energy is absorbed by pigmented tissues?
A) 25% B) 50% C) 75% D) 100%
C) 75%
What power density results from a focused CO2 laser beam?
A) 1592 W/cm² B) 248,880 W/cm² C) 398 W/cm² D) 1,990,446 W/cm²
B) 248,880 W/cm²
What is the power density of a defocused CO2 laser beam at a 4-mm spot?
A) 1592 W/cm² B) 248,880 W/cm² C) 398 W/cm² D) 50 W/cm²
C) 398 W/cm²
What is the typical duration for administering pharyngeal spray?
A) 3 days B) 5 days C) 7 days D) 10 days
C) 7 days
Which laser’s maximum depth of tissue penetration is only 0.03 mm?
A) Nd B) Diode C) CO2 D) Helium Neon
C) CO2
What is the duration of time recommended for the administration of corticosteroids?
A) 2–3 doses, then daily B) 3–5 doses C) 5 days D) 7 days
B) 3–5 doses
What minimum power density should be avoided to reduce latent thermal necrosis?
A) 100 W/cm² B) 250 W/cm² C) 500 W/cm² D) 50 W/cm²
D) 50 W/cm²
What is the interval time range for cooling between laser pulses?
A) 0.5 to 1 second B) 1 to 3 seconds C) 2 to 5 seconds D) 5 to 10 seconds
B) 1 to 3 seconds
What is the difference in tissue damage from CO2 laser compared to Nd
?
A) CO2 has more necrosis B) Nd has more necrosis C) Both have the same necrosis D) Neither causes necrosis
B) Nd has more necrosis
How many specific techniques are recommended for avoiding tissue overheating?
A) One B) Two C) Three D) Four
C) Three