*IN THE NAME OF GOD*

summary Basics of laser in surgery from Incision time to Restoration

Dr.Alborz Mirzadeh Th e development of non-invasive, non-toxic, and non-pollutant methods for the treatment of diff erent illnesses represents a constant concern of scientists from the medical fi eld worldwide. In this category fi t the methods based on the use of laser systems, which are successfully applied both in human and veterinary medicine due to the special properties of laser radiation: monocromaticity, coherence, intensity, and directionality. Th e aim of this paper is to present the laser systems used in several domains of veterinary medicine and some experimental results obtained by diff erent authors. Fields of laser use in veterinary medicine Protecting life and human and animal health is a constant concern of both doctors and specialists in various fi elds (biochemistry, biophysics, biology, etc.). Th eir joint eff orts have led to the development of new methods of treatment based on new discoveries and technology including laser. The first use of lasers in veterinary medicine was in larynx surgery in dogs (1) and horses (2). Th e results obtained in these early studies paved the way for the current use of the laser in general surgery, small animal targeting liver lobe resection, partial excision of the kidneys, and tumor excision or resection (intra-abdominal, intra-thoracic, breast, brain). At the same time, experiments on the use of laser for photodynamic therapy of tumors in animals and laser phototherapy have begun. What’s in a Name?

• Low-intensity-level • Therapeutic Laser Laser • Low Level Laser • Photobiostimulation Therapy Laser • Low Power Laser • Photobiomodulation Therapy Laser • Low Level Laser • • Mid-Laser Low Power Laser • Low-energy Laser • Medical Laser • Soft Laser • Biostimulating Laser • Low-reactive-level • Bioregulating Laser Laser What is Laser Therapy? Light Amplification by the Stimulated Emission of Radiation

Laser Compressed light of a wavelength from the cold, red part of the spectrum of electromagnetic radiation • Monochromatic - single wavelength, single color • Coherent - travels in straight line • Polarized - concentrates its beam in a defined location/spot What Does It Do? Laser light waves penetrate the skin with no heating effect, no damage to skin & no side effects.

Laser light directs biostimulative light energy to the body’s cells which convert into chemical energy to promote natural healing & pain relief. Optimizes the immune responses of blood & has anti-inflammatory & immunosuppressive effects. Laser surgery

Laser surgery is a type of surgery that uses a laser (in contrast to using a scalpel) to cut tissue.

Laser surgery is commonly used on the eye. Techniques used include LASIK, which is used to correct near and far-sightedness in vision, and photorefractive keratectomy, a procedure which permanently reshapes the cornea using an excimer laser to remove a small amount of the human tissue.

Types of surgical lasers include carbon dioxide, argon, Nd:YAG laser, and potassium titanyl phosphate, from among others Equipment

Surgical laser systems, sometimes called "laser scalpels", are differentiated not only by the wavelength, but also by the light delivery system: flexible fiber or articulated arm, as well as by other factors.

CO2 lasers were the dominant soft-tissue surgical lasers as of 2010. Applications Eye surgery

Various types of laser surgery are used to treat refractive error. LASIK, in which a knife is used to cut a flap in the cornea, and a laser is used to reshape the layers underneath, is used to treat refractive error. IntraLASIK is a variant in which the flap is also cut with a laser. In photorefractive keratectomy (PRK, LASEK), the cornea is reshaped without first cutting a flap. In laser thermal keratoplasty, a ring of concentric burns is made in the cornea, which cause its surface to steepen, allowing better near vision. Lasers are also used to treat non-refractive conditions, such as phototherapeutic keratectomy (PTK) in which opacities and surface irregularities are removed from the cornea andlaser coagulation in which a laser is used to cauterize blood vessels in the eye, to treat various conditions. Lasers can be used to repair tears in the retina. References 1

Al‐Watban, F.A.H. et al. (2007) Low‐level laser therapy enhances wound healing in diabetic rats: a comparisonof different lasers. Photmed Laser Surg. 25(2):72–77.

Anders, J.J. and Wu, X. (2015) Comparison of light penetration of 810 nm and 904 nm wavelength light in anesthetized rats. Lasers Med Sci. 30(8):2041.

Anderson, R.R. and Parrish, J.A. (1981) The optics of human skin. J Invest Dermatol. 77(1):13–19. ANSI. (2014) American National Standard for Safe Use of Lasers. ANSI Z136.1 – 2014. American National Standards Institute, Washington, DC.

Assis, L. et al. (2012) Low‐level laser therapy (808 nm) reduces inflammatory response and oxidative stress in rat tibialis anterior muscle after cryolesion. Lasers SurgMed. 44(9):726–735.

Bayat, M. (2014) The necessity for increased attention to pulsed low‐level laser therapy. Photomed Laser Surg. 32(8):1–2.

Brondon, P. (2009) Pulsing influences photoradiation outcomes in cell culture. Lasers Surg Med. 41(3):222– 226.

References 2 Burger, E. et al. (2015) Low‐level laser therapy to the mouse femur enhances the fungicidal response of neutrophils against Paracoccidioides brasiliensis. PLoS Negl Trop Dis. 9(2):e0003541.

Calisto, F.C. et al. (2015) Use of low‐power laser to assist the healing of traumatic wounds. Acta Cir Bras. 30(3):204–208.

Cheida, A.A. et al. (2002) Resonance response of cell tissue structures to impulse frequency of infrared laser radiation of low intensity. Vopr Kurortol Fizioter Lech Fiz Kult. 6:33–35.

Chermetz M. et al. (2014) Class IV laser therapy as treatment for chemotherapy‐induced oral mucositis in onco‐haematological paediatric patients: a prospective study. Int J Paediatr Dent. 6:441–449.

Doillon, C.J. et al. (1988) Relationship between mechanical properties and collagen structure of closed and open wounds. J Biomech Eng. 110(4):352–356.

Emanet, S. K. et al. (2010) Investigation of the effect of GaAs laser therapy on lateral epicondylitis. Photomed Laser Surg. 28(3):397–403. References 3 Enwemeka, C.S. (2009) Intricacies of dose in laser phototherapy for tissue repair and pain relief. Photomed Laser Surg. 3:387–393.

Gal, P. et al. (2006) Histological assessment of the effect of laser irradiation on skin wound healing in rats. Photomed Laser Surg. 24(4):480–488.

Gobbo, M. et al. (2012) Acneifrom rash due to epidermal growth factor receptor inhibitors: high‐level laser therapy as an innovative approach. Lasers Med Sci. 27(5):1085–1090.

Gobbo M. et al. (2014) Evaluation of nutritional status in head and neck radio‐treated patients affected by oral mucositis: efficacy of class IV laser therapy. Support Care Cancer. 7:1851–1856.

Hamblin, M.R. and Demidova, T.N. (2006) Mechanisms of low level light therapy. Proc of SPIE. 6140(612001):1–12. Hashmi, J. et al. (2010) Effect of pulsing in low‐level light therapy. Lasers Surg Med. 42(6):450–466.j

Hawkins, D. and Abrahamse, H. (2007) Phototherapy – a treatment modality for wound healing and pain relief. African J Biomed Res. 10:99–109. References 4 Hodjati, H. et al. (2014) Low‐level laser therapy: an experimental design for wound management: a casecontrolled study in rabbit model. J Cutan Aesthet Surg.7(1):14–17.

Hopkins, T. J. et al. (2004) Low‐level laser therapy facilitates superficial wound healing in humans: atriple‐blind, sham‐controlled study. J Ath Train.39(3):223–229.

Joensen, J. et al. (2012) Skin penetration and time‐profiles for continuous 810nm and superpulsed 904nm lasers in a rat model. Photomed Laser Surg. 30(12):688–694. Karu, T. (1989) Photobiology of Low Power Laser Therapy. Harwood Academic Publishers, London.

Karu, T. (1999) Primary and secondary mechanisms of action of visible to near‐IR radiation on cells.J Photochem Photobiol B. 49(1):1–17.

Karu, T. and Kolyakov S.F. (2005) Exact action spectra for cellular responses relevant to phototherapy. Photomed Laser Surg. 23(4):355–361.

Karu, T. et al. (1997) Nonmonotomic behavior of the dose dependence of the radiation effect on cells in vitro exposed to pulsed laser radiation at 820 nm. Lasers Surg Med. 21(5):485–492.

References 5

Karu, T. et al. (1999) Studies into the action specifics of a pulsed GaAlAS laser (820 nm) on a cell culture. Lasers Life Sci. 9:211–219.

Kaya, G.Ş. et al. (2011) The use of 808‐nm light therapy to treat experimental chronic osteomyelitis induced in rats by methicillin‐resistant Staphylococcus aureus.

Photomed Laser Surg. 29(6):405–412.Kovacs, K. (2015) Low Level Laser Therapy of Serious Wounds of Dogs. Poster presentation. ASLMS Annual Meeting. April 24–26, 2015.

Orlando, FL.Kubota, J. (2002) Effects of diode laser therapy on blood flow in axial pattern flaps in the rat model. Lasers MedSci. 17(3):146–153.

Lanzafame, R.J. et al. (2007) Reciprocity of exposure time and irradiance on energy density during photoradiation on wound healing in a murine pressure ulcer model. Lasers in Surg Med. 39(6):534–542.

References 6

Larkin, K.A. et al. (2012) Limb blood flow after class 4 laser therapy. J Ath Train. 47(2):178–183.

Longo, L. et al. (1987) Effects of diode‐laser silver arsenide‐aluminum (Ga‐Al‐As) 904 nm on healing of experimental wounds. Lasers Surg Med.7(5):444–447.

Martin, R. (2003) Laser accelerated inflammation/pain reduction and healing. Practical Pain Management. 3(6):20–25.

Martz, E. and Steinberg, M.S. (1972) The role of cell‐cell contact in “contact” inhibition of cell division: a review and new evidence. J Cell Physio. 79(2):189–210.

Meireles, G.C. et al. (2008) Effectiveness of laserphotobiomodulation at 660 or 780 nanometers on the repair of third‐degree burns in diabetic rats. Photomed Laser Surg. 26(1):47–54.

Mendez, T.M. et al. (2004) Dose and wavelength of laser light have influence on the repair of cutaneous wounds.J Clin Laser Med Surg. 22(1):19–25. 7 References

Mester, E. et al. (1968) The effect of laser beams on the growth of hair in mice. Radiobiol Radiother (Berl). 9(5):621–626.

Moriyama, Y. et al. (2009) In vivo effects of low level laser therapy on inducible nitric oxide synthase. Lasers Surg Med. 41(3):227–231.

Nussbaum, E.L. et al. (2003) Effects of low‐level laser therapy (LLLT) of 810 nm upon in vitro growth of bacteria: relevance of irradiance and radiant exposure.J Clin Laser Med Surg. 21(5):283–290.

Ottaviani G. et al. (2013) Effect of class IV laser therapy on chemotherapy‐induced oral mucositis: a clinical and experimental study. Am J Pathol. 183(6):1747–1757.

Ottaviani, G. et al. (2015) Study on Human Skin Fibroblasts and Data Related to ATP Content after Laser Exposure Compared to a Control Group. International Centre for Genetic Engineering and Biotechnology and the University of Trieste. References 8

Paraguassu, G. et al. (2014) Effect of laser phototherapy (660nm) on type I and III collagen expression during wound healing in hypothyroid rats: animmunohistochemical study in a rodent model.Photomed Laser Surg. 32(5):281–288.

Pavletic, M.M. (2010) Basic Principles of Wound Healing.Atlas of Small Animal Wound Management and Reconstructive Surgery, 3 edn., pp. 18–28. Wiley‐Blackwell, Hoboken, NJ.

Peavy G.M. (2002) Lasers and laser‐tissue interaction. Vet Clin Small Anim. 32(3):517–534.

Peplow, P.V. et al. (2010) Laser photobiomodulation of wound healing: a review of experimental studies inmouse and rat animal models. Photomed Laser Surg. 28(3):291–325.

Redondo, M.S. (2015) Laser therapy approach to wound healing in dogs. Available from: http://www.vettimes. co.uk/article/laser‐therapy‐approach‐to‐wound‐healingin‐ dogs/(accessed November 30, 2016).

References 9 Silva, D.C. et al. (2013) Low level laser therapy (AlGaInP) applied at 5J/cm2 reduces the proliferation of Staphylococcus aureus MRSA in infected wounds and intact skin of rats. An Bras Dermatol. 88(1):50–55.

Skopin, M.D. and Molitor, S.C. (2009) Effects ofnear‐infrared laser exposure in a cellular model of wound healing. Photodermatol Photoimmunol Photomed. 25(2):75–80.

Stadelman, W.K. et al. (1998) Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg.176(2A Suppl.):26S–38S.

Stadler, I. et al. (2001) 830‐nm irradiation increases the wound tensile strength in a diabetic murine model.Lasers Surg Med. 28(3):220–226.

Tuner J. and Hode L. (2002) Some basic laser physics. In:Laser Therapy – Clinical Practice and ScientificBackground, pp. 12, 21–22. Prima Books AB,

Grängesberg.Tuner J. and Hode L. (2004) The Laser Therapy Handbook,pp. 78–80. Prima Books AB, New York. References 10

Vasheghani, M.M. et al. (2008) Effect of low‐level light therapy on mast cells in second‐degree burns in rats. Photomed Laser Surg. 26(1):1–5.

Wood, V.T. et al. (2010) Collagen changes and realignment induced by low‐level laser therapy and low‐intensity ultrasound in the calcaneal tendon. Lasers Med Surg. 42(6):559–565.

Wray, S. et al. (1988) Characterization of the near infrared absorption spectra of cytochrome aa3 and haemoglobin for the non‐invasive monitoring of cerebral oxygenation. Biochimica et

Biophysica Acta.933(1):184–192.