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Topic: CO2 laser mastectomY

Forum: Recommend Your Resources — Book reviews, favorite web sites, products, articles.

Posted on: Jul 21, 2017 03:16PM

snowday123 wrote:

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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Nov 13, 2017 12:06PM - edited Nov 13, 2017 02:33PM by sas-schatzi

Just as an aside, some here haven't had surgery yet, please, review the link I will add. I may have missed that I added it. It's about toradol use during surgery. It has evidenced based info behind it. We researched it heavily in 2015. The initial link has a video and includes links to the other threads where the research articles are located.

https://community.breastcancer.org/forum/73/topics/843381?page=1#idx_23


Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Nov 13, 2017 12:09PM sas-schatzi wrote:

Thanks Snowgirl, Chef, Datny, and bridgegirl. This will take awhile. Never know how long. I hope you stick around for company.

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Nov 13, 2017 12:33PM - edited Nov 14, 2017 10:10AM by sas-schatzi

I contacted Gainesville University of Florida Veterinary College. 770-532-0491.

They don't use lasers for surgery, but they use it on certain types of resistant infected wounds. The action of the laser is similar to the Wound Vac used in the human community. The laser vaporizes the infected tissue and the tissue bleeds. With the Wound Vac, it sucks the infected tissue away.

The concept that is similar to both is they cause bleeding in the wound bed. With that bleeding oxygen rich red blood cells are brought to the site. Anaerobic Bacteria doesn't like oxygen. regenerating tissues love oxygen rich blood. Plus, in the blood are the white blood cells that attack bacteria. It's a win win situation. But this is a new wrinkle, I need to track if laser is being used for wounds in the human community. The dominoes sre starting to fall :)

I checked in with Medical (human) two wound care outfits. One at UF Gainesville, they are not using it on humans, but I find it interesting that just across the way in the vet school they are. The other company , is Healogics, super large company that contracts out for wound care throughout the USA. The also have Research and Development (R&D).

This causes me to ask why isn't laser therapy not been researched for wound care in humans?

This breadcrumb may not seem like it is on topic, but the crumbs will eventually come together.


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Nov 13, 2017 12:38PM snowday123 wrote:

on the topic of surgery and minimizing immune suppression, I read a study that suggested that cox 2 !inhibitor and propanolol were good combination to take before during and after surgery. risk of bleeding with cox 2 but that's less of a concern with the laser surgery. The integrative oncologist I was seeing prescribed for me. She thought it was a well designed human study, that it was worth trying. Didnt save study or dosage but it's out there on pub med

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Nov 13, 2017 02:18PM - edited Nov 14, 2017 10:13AM by sas-schatzi

Hi Snowday, there is extensive research being down with NSAIDS. Cox 2 inhibitor is an NSAID. Please, read the link. reToradol. The research on Toradol is further along than the COX and Betablocker research. There are links on the Science thread re: all of these. The link I'd like you to start with is three or four boxes back.

Personally, my BC stats said I should met's early. That was 2009. I have had thyroid cancer since, but the docs deny a connection, but my research says there's a connection. Plus my brain tumor dx 'd the same day as BC was also denied to be related. But my research determined it could go either way Meningioma (M) and Breast cancer BC======== M<------->BC. It was kind of funny after neurosurgery folks denying a connection between M & BC, I was entered into a longitudinal study looking at that very connection for the southeast USA. Go figure.

But over time I have come across studies that may explain why I haven't met'sd One is on Beta blockers. I did a thread on that and another person did a thread on Betablockers & NSAIDS.

Use of Toradol was used on my first two surgeries(didn't know that previously), but not subsequent sx's and I have been on a betablocker since 2006

I will soon be doing a thread on Melatonin.

but back to the present project.

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Nov 13, 2017 02:26PM - edited Nov 13, 2017 03:00PM by sas-schatzi

This is a dog study: It looked at Vital signs and heart rate comparing skin incision response . Remember what we know is that Co2 lasers are being used in the Vet and Human community, but not for the same reasons. I wiped out some info so have to go back and try and recreate it.

I have contacted Aesculight that provided the C02 laser for this study. The have a veterinary division and a medical division(humans). This person is in charge of both divisions. She should have a good handle on what's happening in the USA. Hopefully she will call soon.

"Comparison of the Hemodynamic Response in General Anesthesia between Patients Submitted to Skin Incision with Scalpel and CO2 Laser Using Dogs as an Animal Model. A Preliminary Study"

by L. Miguel Carreira1, 2, 3, R. Ramalho3, S. Nielsen4, and P. Azevedo3
1Faculty of Veterinary Medicine, University of Lisbon (FMV/ULisboa), Portugal
2Interdisciplinary Centre Research Animal Health (CIISA), FMV/ULisboa, Portugal
3Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
4Aesculight – Bothell, United States of America

Originally published in the ARC Journal of Anesthesiology, October 2017


Abstract

Objectives: The study based on dog model animal, aims to evaluate if there are differences in the hemodynamic responses between patients submitted to skin incision with a blade scalpel and with a CO2 laser, using measurement changes in heart rate (HR) and arterial blood pressure (ABP) (including systolic-SAP, diastolic-DAP, and median-MAP) associated with different patient pain level perceptions during surgical procedures.

Methods: A sample of 50 dogs (N=50) of both genders, aged between one and five years, with no cardiovascular diseases, but with a soft tissue surgical clinical condition was used. The sample was divided into two groups each comprising 25 individuals. One group had midline skin incisions made with a scalpel (GS), and the other had midline skin incisions made with a CO2 laser (GL), specifically an Aesculight®. The study design considered only one surgical time point, T1 (midline skin incision), at which HR and ABP-SAP, DAP, and MAP-were measured using a high definition oscillometry (HDO) device, which allowed a fast and accurate read of the parameters. For statistical analysis, P-values <0.05 were considered significant.

Results: All the patients presented the same pattern variation for the HR and ABP, with lower values being recorded for patients which had the midline skin incision made with the CO2-laser. The variations between GL and GS were statistically significant with a value of P<0.001 for all the ABP parameters, but not for HR (P=0.12).

Conclusions and Relevance: Our results indicate that the use of CO2 laser in surgery surpasses the conventional scalpel, by lowering the nociceptive system stimulation, decreasing the autonomic nervous system activity and stabilizing the hemodynamic clinical signs such as the SAP, DAP, and MAP, which in turn promote reduced anesthetic consumption and thus offer greater safety to the patient.

Keywords: Dog; Surgery; CO2 Laser; Scalpel; Anaesthesia, Pain

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Nov 13, 2017 02:35PM MTwoman wrote:

So tried to do a bit of research on the harmonic scalpel, proposed as having a lower risk for seroma (mixed results):

https://www.ncbi.nlm.nih.gov/pubmed/27142863

https://www.ncbi.nlm.nih.gov/pubmed/28350973

and as an alternative to traditional surgical techniques:

https://www.ncbi.nlm.nih.gov/pubmed/23089404

and axillary dissection:

https://www.ncbi.nlm.nih.gov/pubmed/24186056

Here's a meta-analysis of harmonic scalpel vs electrocautery dissection:

https://www.ncbi.nlm.nih.gov/pubmed/26544716

https://www.ncbi.nlm.nih.gov/pubmed/12188072


Dx 12/10/2002, DCIS, Right, 1cm, Stage 0, Grade 2, 0/3 nodes, ER-/PR-, HER2- Surgery 12/20/2002 Lumpectomy: Right; Lymph node removal: Sentinel Surgery 12/23/2003 Reconstruction (right): Nipple reconstruction Surgery Reconstruction (right): Saline implant Surgery Reconstruction (right): Tissue expander placement Surgery Mastectomy: Right
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Nov 13, 2017 02:36PM - edited Nov 13, 2017 02:48PM by sas-schatzi

Snowday, here's the thread I wrote on betablockers

https://community.breastcancer.org/forum/73/topics/845083?page=4#idx_92

This is the other thread on the science forum about the study on cox2 (NSAID) and Propranolol(beta-blocker)https://community.breastcancer.org/forum/73/topics...



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Nov 13, 2017 02:50PM sas-schatzi wrote:

Whewheeeeeeeee MT I'll be reading forever Thank you so much. So, appreciated.

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Nov 13, 2017 02:52PM MTwoman wrote:

They're mostly abstracts, but interesting nonetheless.

Dx 12/10/2002, DCIS, Right, 1cm, Stage 0, Grade 2, 0/3 nodes, ER-/PR-, HER2- Surgery 12/20/2002 Lumpectomy: Right; Lymph node removal: Sentinel Surgery 12/23/2003 Reconstruction (right): Nipple reconstruction Surgery Reconstruction (right): Saline implant Surgery Reconstruction (right): Tissue expander placement Surgery Mastectomy: Right
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Nov 13, 2017 03:04PM sas-schatzi wrote:

MT that's good. I've read one and I have an opinion. I'll bring each one forward as I read it and give an opinion.

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Nov 13, 2017 03:08PM - edited Nov 14, 2017 10:15AM by sas-schatzi

2012 https://www.ncbi.nlm.nih.gov/pubmed/23089404


Study "Conclusion: Using the Harmonic FOCUS scalpel in breast conserving surgery and axillary lymph mode dissection significantly reduced the length of surgery and decreased the axillary numbness rate as compared to conventional methods".


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Nov 13, 2017 03:20PM - edited Nov 15, 2017 02:26PM by sas-schatzi

2013 https://www.ncbi.nlm.nih.gov/pubmed/24186056

"(study conclusion)Our study confirms that in patients with BC requiring ALND the use of HDDs is more time efficient than conventional surgery, and reduces intraoperative bleeding, the amount of drainage, and the risk of seroma formation. These results may lead to several short- and long-term advantages. Thus, a careful evaluation of the cost-benefits of nontraditional tools, such as HDDs, should be performed in all patients undergoing modified radical or partial mastectomy and ALND for BC."

////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

2016 https://www.ncbi.nlm.nih.gov/pubmed/27142863

Study "Conclusion: In our hands, HF use was not superior to CD in limiting seroma formation in ALND for breast cancer. Increased seroma formation in surgeries >2.5 h in duration is commensurate with surgeries involving mastectomy and ALND (>2.5 h in our study), which entails greater and sustained tissue and lymphovascular trauma."

/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

2016 https://www.ncbi.nlm.nih.gov/pubmed/28350973

Study "Conclusion :No statistical difference, more study needed." Paraphrased for brevity.

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Nov 13, 2017 03:57PM - edited Nov 14, 2017 10:16AM by sas-schatzi

2015 https://www.ncbi.nlm.nih.gov/pubmed/26544716

This study is a Meta-Analysis. That means it's looking and comparing results of multiple other studies.

Study "Conclusion: Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for breast cancer, without increasing operative time. Harmonic scalpel can be recommended as a preferential surgical instrument in modified radical mastectomy"

2002 https://www.ncbi.nlm.nih.gov/pubmed/12188072

This is also a Meta-Analysis and is the oldest study in the group

Study "Conclusion: Modified radical mastectomy using harmonic scalpel is feasible and learning curve is short. Harmonic scalpel significantly reduces the blood loss and duration of drainage as compared to electrocautery."

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Nov 13, 2017 04:04PM sas-schatzi wrote:

reserved


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Nov 13, 2017 04:14PM - edited Nov 14, 2017 09:30AM by sas-schatzi

My opinion. The first Meta-analysis was in 2002 It's conclusion was that harmonic scalpel was a good thing. Isn't that nice. Time went on.

The key questions in all the studies relate to time i.e. length of surgery and whether morbidity was affected. The common question to all the studies was post- op seroma and bleeding. Remember, I just got done reading six abstracts looking for differences and commonalities. Then a huge puzzle popped up

The 2015 Meta-Analysis(MA) looked at 11 studies for it's conclusions. Two of the studies listed here were published in 2016 a year after MA study, were in direct opposition of the 2015 meta-analysis study. That's surprising. Very surprising.

I looked at common authors and I didn't note any. The publications are from around the world. When doing a literature search either for a meta-analysis or a new study, the search is going to encompass the world of publications. So, the folks doing the 2016 studies had to be aware or should have been aware of the 2015 study.

Again to have two non-committal publications at essentially at the same time as a very positive MA is unusual, and concerning. It would take a very serious look as to how and why that occurred. One non committal study was done in Australia and the other was done in Italy based on author information. Both countries are strong into research. Edit: The MA was done in China or at least by folks based in China. Again a meta-analysis is a look back at existing (world) literature. Generally, one MA goes back to the last MA which would have been 2002. The Australia and Italy study published their specific findings, but still surprised they didn't support the MA findings. Anywhooses.

This is exactly why you never look at one study and make a conclusion. So, what do you do?

If it were me I'd go with the request to your surgeon to use a harmonic scalpel. Asking how skilled they are with and how many approximate cases have they used it ? The 2002 meta-analysis study identified "learning curve is short". As an old OR nurse, that tells me profiency(sic) in using the instrument isn't out of bounds and can be rapidly learned for the experienced physician.

The harmonic scalpel has been around a long time. That tells me all residents in at least USA accredited programs, are trained from day one with it, i.e. back into the 1990's. Figuring that a meta-analysis was written in 2002, teaching hospitals used them routinely. Generally, once a physician completes their residency, they follow the tenets and training that they were taught in residency, but if the hospital that they practice at didn't use the equipment then they wouldn't. But, generally, to attract newly minted docs or older experienced docs, hospitals will purchase new devices and equipment. This makes the docs happy and keeps the non-teaching hospitals up to date.

The tools available to a surgeon as I stated in a long ago previous post are going to be scalpel, electrocautery, scissors, clamps, ties, harmonic scalpel. Many other tools, but not germain to the discussion. When and how a tool is used is based on the skill of the surgeon and situation presented.

Key factors: 1. approach does no harm 2. shorter the surgery the less the complications. Not just with the site, but also systemically(whole body) 3. more controlled everything is on the surgical field (operation site) the less post- op problems i.e seroma and bleeding. 4. I'll add if I think of something else. :)


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Nov 13, 2017 06:21PM - edited Nov 13, 2017 06:22PM by sas-schatzi

What has been excellent for me is delving into research about the harmonic scalpel. Prior to this, I considered it a nice tool. I took it for granted. This study today allows for generating interest and discussion into the C02 laser.

Which is better?

The horse race is on :)

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Nov 13, 2017 06:42PM - edited Nov 14, 2017 10:18AM by sas-schatzi

Other questions determined today.

The approaches in the animal and human community are different. Yet, there is a cross over in tools and approaches. When there is a cross over in tools and approaches that is because of research. In this case surgery and wound care.

What generally, is unknown to the lay community is that when something breaks through for use, it leads back to one person. Whole programs or buildings are done to attract one person or team.

Dr Anasinelli hasn't yet told me regarding why he left the research community. I'm going to be arrogant enough to guess. He tried hard to convince them that it was a new and better way. He got tired of trying to convince people and went on his own to complete a lifetime of work. Noon tomorrow I/we will know.

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Nov 13, 2017 11:30PM sas-schatzi wrote:

Well, that was a fun day :)

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Nov 14, 2017 10:19AM sas-schatzi wrote:

Getting excited to Dr A. Added more questions.

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Nov 14, 2017 10:28AM - edited Nov 15, 2017 03:01PM by sas-schatzi

Snow I just re-read all the posts in preparing for Dr A's call. I missed where your doc put you on the betablocker. Is that right? Personally, I think the research into it is strong. I am biased though b/c I'm on it. Sheesh I shouldn't be biased, it's the bane of anyone that purports to research. Haha

What drug and dose are you on?

Did you do the NSAID Cox 2 inhibitor? How did you do it? Pre-op or just post-op? Did Dr A agree?

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Nov 14, 2017 11:47AM snowday123 wrote:

Forgot to mention in my original post. I used propanolol and Lodine (etodolac) because that was what was used in the study I showed her. She'd never heard of its use around surgerybefore


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Nov 14, 2017 11:53AM snowday123 wrote:

no longer on propanolol but think I'll ask her for prescription - interesting research and might help with my migraines.

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Nov 14, 2017 11:56AM - edited Nov 14, 2017 11:58AM by sas-schatzi

Snow, well, you found that rat study. In my thread you likely saw where a gal from some foundation wrote a "protocol" and it wasn't based on research. It was based on the rat study. I wrote that qualifier at the top of the thread.

I wrote to the manager of that foundation and they wrote back stating the person was no longer with them and apologized.

I'd have to refresh myself with what's going on. My memory isn't the steel trap it used to be :)

I do find it exciting though. Because if these drugs do pan out as to reducing recurrence, it would be wonderful.

Are you still on the drugs or did you take them only around the surgery?

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Nov 14, 2017 08:14PM sas-schatzi wrote:

Disappointed I didn't talk with Dr A. Answering machine only. OH well, I'll let you know if I talk with him.

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Nov 15, 2017 11:16AM sas-schatzi wrote:

Talked with Dr A, today, great conversation, I'll edit the question page. it'll take a little while.

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Nov 15, 2017 01:59PM - edited Nov 15, 2017 02:31PM by sas-schatzi

Okay I finished editing. I may edit more for clarity, but not content. I won't note that I edited it. I have asked Dr A to review content. If he wishes to change something for accuracy I will.

In the first portion, in discussion re: why laser assisted mastectomy hasn't been developed I wrote.

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.

This is exactly why I'm here working on this. To correct this failure of the scientific and medical communites, we will have to develop some strategies. This will take some time. Then there will need to be the standard research. Regretfully, we are looking at several years. But change doesn't happen without some work.

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Nov 15, 2017 02:49PM - edited Nov 15, 2017 02:52PM by sas-schatzi

Snowday and all, This is a project that is going to take weeks to months. How do you feel about me creating a new topic on the science thread and transferring posts there? Not all posts would be transferred. Only those that would allow for the flow of information.

I could start a new thread from where it 's stopped now, but that would leave out a lot of info already studied.

I would link back to here in the topic box.

Snowday, low dose propranolol is used for migraines as you have noted. But remember all drugs have consequences. It is a beta blocker. That has consequences for peripheral vascular resistance(blood pressure), cardiac conduction and force of contraction. It, also, has an impact on the lung and eyes and other organs innervated by the sympathetic nervous system

It is a sympatholytic adrenergic blocker with beta 1 & 2 affects/effects. Hahaha I haven't had to say that in awhile. Before asking to go on it permanently, please, study it thoroughly. I know already you are a good researcher and do lot's of studying. Good luck with your study and let me know if you need help with understanding the info.

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Nov 15, 2017 03:05PM sas-schatzi wrote:

Snowday go to clinicaltrial.gov if you haven't been there yet. It will list all the past studies on Lodine & propranolol, and Toradol if you are interested. There was a work done with lodine and propranolol separately and then it was combined. Actually you can mossy around, something else may pique your interest. :)

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Nov 15, 2017 04:06PM snowday123 wrote:

thank you so much for all the effort you're putting into this. The study of propanolol and lodine was with people - they looked at immune markers that are normally suppressed after surgery and noted that the drugs prevented some of them.

I'll try to find the study link and I'm going to dig around online for the studies you've referenced.

As for why laser isn't in use for breast cancer surgeries - Dr Sylvia Formenti, head of radiation oncology at Cornell in NYC, has been trying for a decade to have radiation treatments given to women in a prone position. She has written research papers showing it lessens damage to heart and lungs. Free and easy to learn but not still not standard practice.

Considering that most women get lumpectomies nowadays and consequsubsequent radiation it's puzzling that this is not widespread practice.

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