CO2 laser mastectomY
Hi All,
I'm debating between regular scalpel surgery with top NYC surgeon or CO2 laser with a Dr Ansanelli that no medical persons have any familiarity with. I know he's legit as a friend spoke with an oncologist that sees his patients. The oncologist said his patients seem fine but he'd always go with a top surgeon.
I'm concerned about recurrence and hoping that laser will give me an edge given my Her2+/hormone- status. Had a multi focal tumor - additional risk for recurrence. Animal studies and human studies with other cancers show reduced recurrence. But no recent breast cancer studies because no one is using it...
Thanks in advance for any info!
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Snowday,
I had an amazing co2 laser surgery almost 6 years ago with Dr Ansanelli and I'm still NED. NO chemo or hormonal tx.
He ONLY performs surgery for BREAST cancer. He worked through Columbia Pres?? in NYC for years using the laser and the other surgeons were losing BC patients to Dr A's simple, clean, outstanding technique. And so it goes.
IMO etel, he IS a TOP surgeon and has pioneered the co2 laser surgery. check out his website at laserbreastcancersurgery.com
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HI
Im considering seeing Dr. Ansanelli.
Does he do reconstruction as well? If so, is it done at the same time?
Also, does he do nipple sparing?
Thanks
Randi
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No - I had mastectomy with him and he doesn't do reconstruction. Totally adequate surgery but no talk of reconstructive options. I used him because I wanted to avoid general anesthesia and I read an old study suggesting that CO2 laser might reduce risk of recurrence (based on small study with rats.) Total gamble on my part based on little evidence but I felt it might improve my odds . If reconstruction is important to you I'd find a surgeon known for their results
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don't know about nipple sparing - but I'd find a surgeon with lots of experience doing that. He's very old school - good at what he does I think, but limited. I don't not have have what to compare it to...
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I have been researching CO2 laser surgery, and have spoken to Dr. Ansanelli. My concern is that he is the only one in the US to do this type of surgery and he is well into his 80s. Would appreciate if you would let me know if you did the surgery and if not, why .Thanks for any info you can give me
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I think he's in his seventies but regardless he's got a lot of experience with the laser. I was trying to avoid general anasthesia and subsequent pain meds used after traditional surgery.
I was out of his office 40 minutes after the surgery and running errands with my husband. used half tablet of prescription pain med left over from excisional biopsy before bed that first night but after that no pain meds - not even Tylenol I was sore for a few days it was more uncomfortable than painful. Drainage was minimal. I did have to insist he use the blue dye to find my sentinel nodes. He sent three to pathologist and the were clean.
I'm satisfied with my surgery. Scar is neat and healing nicely. The pathology dept at Cornell reviewed my mastectomy slides and confirmed the margins were clear. I feel that the CO2 laser would be standard technique but for the usual medical resistance to change - especially change with expensive equipment and a steep learning curve for the surgeon. My insurance did not reimburse for the surgery, btw.
Good luck whatever route you choose - there are a lot of great surgeons out there - many women have positive mastectomy experiences with easy recovery using traditional surgery route.
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snowday, would you let us know how long it took you to recover? From what I understand, recovery time is days vs weeks. Were you able to avoid general anesthesia? Also, would it be possible to let us know the price range.
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I paid $16,000 dollars for surgery, operating room and anesthesiologist. We submitted to insurance but they refused to reimburse.
As to ease of recovery, mom had a heart attack four days after I had my mastectomy and I drove her to her doctor, than to crowded nyc emergency room where I spent seven hours with her. I didn't need any pain meds after surgery except for the first evening I took half a pill of left over pain med. After that nothing - very little drainage as well. I am small breasted so that might have increased ease of recovery. But easier than dental visit. Not needing general anasthesia or pain meds afterward was huge for me as I don't do well with narcotics.
Also, my youngest daughter is eight years old and didn't want her scared by overnight hospital stay and possible prolonged recovery. I was mobile the evening of the surgery. Ran errands and accompanied husband on long dog walk. Maybe that wasn't so smart in retrospect
I do know woman that have had easy mastectomy recoveries with traditional surgery as well. Many, many women say it wasn't as bad as they expected. I think the reconstruction modifications (expanders etc) might be what makes recovery harder for some women.
Feel free to ask me further questions
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Thanks you so much for sharing all these! I am definitely considering the procedure and will contact their office. I may come back and ask more questions as I am going through the motions.
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sure - anytime. Good luck
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Very old study abstract 1986, by Anasinelli If I find anything else I'll post it
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This is an news article from 2016. It has a video interview with him.
http://www.foxnews.com/health/2016/11/03/unique-treatment-for-breast-cancer-laser-surgery.html
Last paragraph: " The carbon dioxide laser method was approved by the Food and Drug Administration (FDA) and has been used to treat head and neck, tongue and vocal cord cancer."
It doesn't say for breast work, It take research to see if Anasinelli put through for the approval. It would seem he had to have approval b/c of liability. Add to that the liability related to where he does surgery.
I did find that there is increasing use in the Vet-animal community.
What I find very odd about this is when a new method is introduced and morbidity(illness) & mortality(death) abreviated M&M, are not associated with a new approach, usually someone jumps on it. Usually, it's teaching hospitals because they are the pioneers for new approaches.
The fact that he has been doing this since the early and maybe earlier than 1990, I find very very odd. Can't tell you how odd.
I could relate histories of other procedures that used other equipment that burst into use for many procedures, once initial introduction had been made and the M&M was good.
The biggest being the Laproscope. We poke Laproscopes into every orifice and body part now.
Robots are used for many, many surgeries. My crani was done by a robot with a doc standing at a control panel.
What I read of his surgeries, 1 he always has the regular biopsy before his surgery. 2. The laser allows for great surgical field control i.e. dry--because bleeders are zapped) 3. his statistics on recurrence are less than other approaches
If his approach, does have a lower recurrence rate. I'm stunned. But there appears to have been no study of this. It's just his stats.
Just the decreased from complication of anesthesia, reduced surgical complications i.e infection, clots, seromas. bleeding, something isn't right here.
Well, perhaps we can make a difference. Bombarding the hospital he's connected with to research expansion and study of what he is doing. Advancements in care are often consumer driven.
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Haven't found anything in Europe ---YET, but decided to look for " List Laser assisted surgery" Brings up many citations for procedures, but not a simple list. Decided to look at Wikipedia. WELLL, oodles of procedures are now laser assisted.
Laser is used in many places of the body, but Wiki doesn't mention Mastectomy. But as we know Anasinelli is the only one doing this. Shame on the surgical world to have not pioneered this. I'm pissed. This could have been accomplished long before now. Once you see how many body parts where it is used, I think you will be unhappy too.
https://en.wikipedia.org/wiki/Laser_surgery
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sas, thank you for doing the search. I came across same info. I also found that his procedure is FDA approved. And found an article on pubmed from 1994, a 10 year follow up, showing no recurence and no edema for the co2 laser group. The control group had women with both. The study is small, only 60 persons in each group, so while definitely promising, can't fully rely on it.
However, the laser cut should be very clean if done properly, and implicitly should lead to good surgery outcome.The next best thing would be electrosurgery, I am wondering if anyone had that for mastectomy.
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Datny, I saw that 1994 citation, but in the research world the citations of 86 and 94 would be considered interesting, but since there has been no studies they are again "interesting". A mere beginning. We should be at the usual state now i.e laser assisted mastectomy
Electrosurgery is standard, it's called cautery. Burn the tissue. Been around for decades. Don't want to tell you what the OR smells like when it's used. It establishes a dry field by burning tissue, BUT the burn doesn't just stop, the tissue next to it gets heated too. That tissue causes a lot of pain post-op. Lasers are precision point. Tissue next to it isn't heated. That's why the easy recovery.
Now that the subject has been brought up, it's a head slap for me. Then weigh that against all the other surgeries being done with the laser devise for absolutely this reason. is why I'm so pissed.
Perhaps, I should ask what you mean by electrosurgery?
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By electrosurgery I did mean tissue cutting by electrode. I assumed the mastectomy is done by scalpel, I had no idea electrosurgery is being used for this procedure. This can also cut and seal the wound immediately, so still better than just scalpel.
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By electrosurgery I did mean tissue cutting by electrode. I assumed the mastectomy is done by scalpel, I had no idea electrosurgery is being used for this procedure. This can also cut and seal the blood vessels immediately, so still better than just scalpel.
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Datny, we haven't met before, sorry it's unfair, Hi. I'm a very old nurse. Generally, I stay up with things. I'm an old OR nurse too. Been around laser surgery since the 80's. Just didn't think of it for mastectomy. When I read tonight it was being used for soooooooo many other things. Truly, it's unacceptable that the precision hasn't been applied to mastectomy. I will tell a couple stories.
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Making some progress, I have a plan.
I have an appointment on Tuesday at 12noon to talk with Dr. Anselli. RE: what has been discussed here YAY.
Prior to that I said I would post here and ask for folks to formulate questions for him. I then would send them prior to our conversation. Along with my question(s).
I will also, be sending him this link for his review and preparation for our phone call.
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1. My Main Question: Knowing the history of laser surgery and that there are many procedures that laser is used as the treatment of choice, why hasn't the surgical community advanced research for the use of laser with mastectomy? (sas-schatzi)
These are my words now not DR A's, it's complicated. But my assessment that his laser assisted method was not supported by the wider surgical community was correct. He will be sending an article that I will post later.
The benefit of doing the look at the harmonic scalpel that is posted on the next page is that we have a good comparison of use between conventional surgery and harmonic scalpel use in surgery. The factors studied were Intraoperative blood loss, post-operative drainage, length of surgery time, seroma development etc. There has been no such study for the comparison of conventional surgery, harmonic scalpel assisted surgery and laser surgery. This is a huge FAILURE of the scientific and medical community b/c lasers have moved into use for many other soft tissue related procedures.
2. What do you suggest in trying to advance research into C02 laser assisted surgery? He believes advancements in any field are often consumer driven.
3. Are you training surgeons to carry on the use of C02 Laser Breast Cancer surgery? (Chef127)( very happy past patient that sings praises of your care far and wide). He does have docs acting as assistants, as a consequence are learning his technique by involvement. My words now, to formally train he would have to have a program.
4. His facility is accredited by the same organization that accredits hospitals. Joint Commission on Accreditation of Healthcare Organizations. JACHO.
5. How many laser assisted surgeries have you done? 1000's, no tally, but he has been doing this since the late 1980's.
6. Is your patient selection limited by comorbidities i.e diabetes, high blood pressure, heart disease? Medical clearance is required of all patients to be done at his facility. My words now, industry standard is the doctor doing the medical clearance is the patients PCP.
7. Who is monitoring vital signs and EKG, are they Advanced Cardiac Life Support Trained(ACLS) and does the facility have a crash cart?. An Anesthesiologist monitors the patient and administers drugs for IV as needed.
8. Is the patient placed on low level oxygen i.e. 2 liters? The Anesthesiologist determines if patient needs to have oxygen during the procedure.
9. Does the patient have an IV ? Yes
10. Does the patient get a block? No
11. Is local anesthesia used ? Yes, Lidocaine
12. What is the average length of your surgery? 1-2 hours
13. Do you do double mastectomy's? Yes, but usually will preform the second mastectomy in a few days.
14. Do you do prophylactic mastectomies? Yes
15. Do you do nipple sparing mastectomy? Yes
16. Do you do Sentinel lymph node removal? Yes. My words now, I forgot to ask by which method.
17. Full lymph node dissection? He doesn't believe in full lymph node dissection b/c of the risk of lymphedema. He determines how many to remove.
18. Intraoperative blood loss average? Zero, because the laser seals the capillary bleeders. Larger blood vessels are handled in the conventional method (clamp and tie). My words now, there would be a small amount.
19. Are drains used? Yes, always b/c of serous drainage. The drain is usually just in the breast area. May place a drain in the axillary area as determined at the time of surgery.
20. One month ago, a patient review said they had a 10 day hospital admission?(Datny) He was unaware of this situation. StateD it must have been a medical problem not related to surgery. My words now, It would be highly unusual if an admission was related to surgery, that the admitting physician would not contact the surgical physician to review the case, even if the surgical physician didn't have admitting privileges.
21. Infections? Risk of infection is reduced b/c the laser vaporizes the tissue and any bacteria present.
22. Lymphedema? He doesn't remember any patients developing lymphedema. Stated scarring is responsible for lymphedema, smaller lymph vessels are sealed by the laser, and he does as few lymph nodes as he determines need to be done.
23. Seroma? Rarely occurs. My words now, remember as he is using the laser to cut away the breast tissue from the muscle wall, he is sealing the ends of the capillaries and the smaller lymph vessels. When those are well sealed you will have less drainage. A normal tissue response when traumatized i.e. surgery, is that inflammation occurs and the tissue will seep serous fluid. Serous fluid is yellowish. This is normal. What is seen in the standard surgical approach to mastectomy is the drainage is often red. Red is bloody. That's b/c in the standard surgery approach the capillaries aren't sealed as they are with a laser. When there is large amounts of bloody drainage, then a larger vessels was missed or a suture tie let loose. Key word hematoma. The approach then is to wait until the body manages it by clotting or surgical re-entry to control bleeding. If the collection is serous, the approach is to allow it to drain off until the inflammatory response in the area is decreased. This would be evidenced by steady reduction of fluid. If the drain is taken out to early before the natural reduction of tissue seeping fluid that fluid can builds up. This is termed seroma.
24. Large motor nerve transection to arm? Has never had this occur.
25. Average number of post-op visits? Varies based on need, but usually a few. Out of town patients that return home, he communicates with the doctor based on situation. -26.What do you use for post-op pain med? Usually, Extra Strength Tylenol, no narcotics-27. Do patients get reconstruction after surgery with you? No, the mastectomy is completed. He then waits for pathology and treatment determination by the MO (see next question).
28. Do you make a referral or do they have to find their own doc? Dr A makes a referral to a plastic surgeon for reconstruction or patient finds there own reconstruction doc and then he assists by communication. Except to this is when a partial mastectomy/lumpectomy is done, he performs a mastoplexy (repair of site) will be done by him at time of the lumpectomy.
29. Who steps in for you if you have a problem during surgery? Doctor assistant or Surgical physicians assistant. My words now, we didn't discuss specifics.
Except in a few instances when I edited this piece, I removed who asked the question. I may edit further for clarity, but not content. I will not note edit.
I have asked Dr A to review content. If he wishes to change something for accuracy I will.
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I have spoken to Dr. Ansenelli and also his staff. My main question which keeps on bugging me and this has been brought up many times on here is why is no one else doing this except a very experienced surgeon in Plainview NY. I have searched and searched. What also comes up for me is Dr. A's age. He is in his late 80s and this concerns me. I asked the office who can step in if need be for him while in or before surgery. I did not get an answer except to tell me that he is in amazing shape for his age. That concerns me since the question is still open as to who else can step in in his office to do the same work if the need arises.
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As folks add questions, I will add it after my main question with your name in parentheses. That will reduce my work when I email him b/c I can just cut and paste that box. I may leave room for his answers and he can type his answers. I have done that before and it does work well.
I did find today that short threads have discussed this on BCO since 2008. It's a shame, a wasted decade. I do believe the weight of the power of BCO can force some research somewhere. I did contact the Mods and ask that they give the info PM to the science person on staff and asked them to follow this. My stated goal was that we work towards research on this. It will take awhile.
But we are very powerful, we CAN get it done. It just takes persistence and follow through.
I'm even thinking after we get all the info we want of doing a Change.org petition directed at the American College of Surgeons (ACS), and the American Medical Association (AMA) which controls " FREIDA, the AMA Residency & Fellowship Database® from more than 10,000 programs—all accredited by the Accreditation Council for Graduate Medical Education (ACGME)." NCCN National Comprehensive Cancer Network too.
Why would this work?
1. We can amass lots of signatures.
2. Change like this is very responsive to consumer pressure. People all over the country and farther away pestering their docs with the question "WHY isn't this available?"
3. High publicity that this hasn't been researched.
4. It will reach all the surgical residencies through the AMA and FREIDA.
Now to be patient and work the present problem of gathering info.
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Datny, there is a combo of instruments used in surgery. Which one is used at a given moment is determined by what the action is. Scalpels, electrocautery, clamps, ties, and a newer devise called Harmonic scalpel. The harmonic scalpel uses ultrasonic vibration which is a different type of energy than the standard electrocautery. Therefore, does less damage to surrounding tissue. Wiki gives a nice explanation.
https://en.wikipedia.org/wiki/Harmonic_scalpel
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My question is "Are you training surgeons (apprentice) to carry on the use of co2 Laser Breast Cancer surgery?
I want this option available to all of us. Me, my daughter, and any woman who wants a cleaner, safer option than the knife. I consulted with 2 reputable breast surgeons and the only option I was given was a MX and total nodal clearance. After viewing all my records,(MRI, mammo's and a clinical exam) Dr A successfully lazed my 4.5cm tumor, more than 25% of my large breast, leaving my breast in tact, and its cancer free 6 years later. Oh, it looks great too thanx to the oncoplasty he threw in for good measure, LOL.
My out of pocket cost was $3,500. Best $$ spent, ever.
SAS, you do good work, thanx.
xoxoMaureen
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sas, thank you for the info! I am still wondering which one would be used by most surgeons doing mastectomy? Standard scalpel or something else?
Regarding dr.Ansenelli, I do have similar concern as expressed by bridgegal above. Moreover, I came across the recent review on google (one month old), where the patient describes ending in ER and requiring 10 days of hospitalization following his procedure. So would be great to hear his side of the story.
Overall this technique does have great advantages, so would be great to make it more accessible.
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Chef, you story of NED after 6 years is GREATtttttttttttttt(tone Tony the tiger).
Datny can I help you phrase the question re: the patient that had the hospital stay?
Re:" I am still wondering which one would be used by most surgeons doing mastectomy? Standard scalpel or something else?" What I stated in my post about scalpel, electrocautery, clamps, ties, and harmonic scalpel, I missed scissors. All have a moment in time for their use based on what is happening in the surgical field.
For example. the knife that is used to cut the skin is put in a special cup on the surgical table. It isn't used again. . Some bleeders are cauterized, some are clamped and tied, Some clamped and the tip of the cautery are applied to the tip of the clamp. The Harmonic scalpel is used where the others aren't indicated and vis versa.
Usual surgery takes minimum an anesthiologist, a surgeon, a scrub nurse(instrument worker), an assistant to hold retraction of tissues, and an assistant surgeon/ surgical PA for a mastectomy, circulator. I count six people. DR. A shows 2 people in the video/pictures. But What he isn't showing is a third person that must be monitoring vital signs. That's an absolute even if anesthesia isn't given. Leads to another question. "Who is monitoring vital signs and EKG, Are they Advanced Cardiac Life Support Trained(ACLS)?"
Datny, surgery is cut, burn, tie(cut the tie tie). Or cut, clamp, tie, cut the suture(tie). It's been that way for a millennia.
Seriously, or almost seriously back to Aristotle. I have read how they handled breast surgery in Aristotle's time. Now getting a little OCD may have been a different guy like Hippocrates. Anyway, read the history of breast cancer and his words on it in the time.
I see what we are discussing as a movement forward. Until someone can explain to me WHY we haven't made that movement forward, I will not stop.
Yes, Lasers are expensive. BUT if we reduce morbidity and mortality, they are worth it. Plus, there is a laundry list of procedures that are listed in Wikipedia where lasers are used. They are all soft tissue related. What's a breast---soft tissue. (The opposite of soft tissue is bone)
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Now what I can see, is that perhaps, we may be getting into too finite a questioning of Dr Ansanelli. He has successfully treated patients since the mid 1980's. I'm not saying to exclude further questions, but sometimes it can be too much.
Don't let that hinder your questions, but ............let's not ask what he has for breakfast and why he has lived so long. Hmmmmm. Maybe that is a good question?
I have decided to send him the link tonight. He then at his leisure can follow along. For all we know he may even join in.
Edit: 12:30 am Missive and link sent to VincentAnsanelli@gmail.com. I have mascared his name throughout here. I will correct all at one point, but it's late now.
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Thank you for the detailed info sas and for your efforts in contacting the dr. Wish you succes in your efforts in bringing this surgical procedure into the mainstream!
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my sentiments exactly --a big thank you to Sas
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