Top Doctors: Is laser better than scapel?

Dr. John Francfort, chairman of the surgery department Dr. John Francfort, chairman of the surgery department at the Good Samaritan Hospital Medical Center in West Islip. (Oct. 10, 2011) Photo Credit: Audrey C. Tiernan

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Everywhere you turn, it seems, a medical clinic is advertising its laser technology. Doctors tout its benefits for eye surgery, tumor treatment, removal of varicose veins and more.

But an old-fashioned treatment -- surgery with a scalpel -- may, in fact, be a better idea in some cases, especially when lasers haven't been proven to provide an extra benefit.

Here's what you should know if you're considering surgery:

1. LASERS AREN'T ALWAYS APPROPRIATE

Laser surgery, which uses an energy beam to cut or seal tissue, is commonly used in vein surgery -- such as to treat varicose veins -- and in surgery for the eyes, said Dr. John Francfort, chairman of the surgery department at Good Samaritan Hospital Medical Center in West Islip.

Less commonly, physicians use it to treat tumors, such as those of the head and neck region, he said. In dermatology, lasers are used to remove wrinkles, tattoos and birthmarks. Gynecological surgeons sometimes use laser surgery for uterine fibroids or endometriosis.

But lasers have failed to show success in other kinds of surgery, such as operations on the breast and on hemorrhoids, Francfort said. "Laser sounds sexy and space-age, and in a sense it is," he said, "but it's not suitable for all patients." One problem, he explained, is that the heat from lasers can burn the body's tissue, making their use inappropriate for some types of surgery.

Instead, surgeons use knives and electrocautery -- which seals wounds with heat -- in most conventional surgeries, said Dr. Louis J. Auguste, a surgeon with North Shore-LIJ Health System in New Hyde Park.

2. YOU STILL MAY FEEL PAIN AFTER LASER SURGERY

Whether a laser or a scalpel is used to make incisions, Francfort said, the patient probably will experience pain during recovery. A cut by a laser is still a cut. But, patients often misunderstand how lasers work and expect they'll result in much less pain, he noted.

Still, laser surgery can provide major benefits when compared with conventional surgery with a scalpel, Francfort said. In vein surgery, for example, patients may have less discomfort and be able to return to normal activities more quickly, and they may not need to be anesthetized, he said.

3. INSURANCE TYPICALLY COVERS LASER SURGERY

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Laser procedures cost more than those that use knives because the equipment required is expensive, Francfort explained. However, insurance companies will pay for laser operations as long as there's medical evidence supporting a procedure, he said.

4. DON'T CONFUSE LASER WITH MINIMALLY INVASIVE SURGERY

"Patients very often ask to have 'laser surgery,' " Auguste said, "but, in fact, they want to have a minimally invasive procedure, such as a laparoscopic or arthroscopic procedure." Those types of surgery are both performed through small incisions. Laser surgery refers to the type of tool that's used in a procedure. And it's the physician, not the patient, who generally decides what type of surgical tool to use, Francfort said.

5. LASER IS NO LONGER THE LATEST OPTION

Auguste said he doubts that lasers will be adapted to be used in more types of procedures in the future. Instead, he said, other types of devices that use energy are being created for use in surgery.

Some of the devices use sound waves to cut and seal small blood vessels, he said, and another approach is cryoablation, in which some cancerous tumors can be frozen into an ice ball that eventually disintegrates.

 

Surgeons

 

This is the 16th installment of a 26-week series in which Newsday presents Castle Connolly's list of top Long Island doctors.

@Newsday

Dr. Louis J. Auguste

2035 Lakeville Rd.

New Hyde Park

516-775-2070

Dr. Erna Busch-Devereaux

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270 Pulaski Rd.

Greenlawn

631-423-1414

Dr. Bradley Cohen

15 Park Ave.

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Bay Shore

631-581-4400

Dr. Charles Conte

600 Northern Blvd.

Great Neck

516-487-9454

Dr. Gene Coppa

1999 Marcus Ave.

Lake Success

516-562-2870

Dr. Rajiv Datta

South Nassau Cancer Center

Surgery Oncology

1 Healthy Way

Oceanside

516-632-3350

Dr. George Denoto

139 Plandome Rd.

Manhasset

516-627-5262

Dr. John Francfort

580 Union Blvd.

West Islip

631-321-6801

Dr. Gary Gecelter

139 Plandome Rd.

Manhasset

516-627-5262

Dr. Michael Grieco

10 Medical Plaza

Glen Cove

516-676-1060

Dr. Michael Khalife

300 Old Country Rd.

Mineola

516-741-4138

Dr. Stanley Klausner

100 Hospital Rd.

Patchogue

631-475-8846

Dr. Lewis Kurtz

310 E. Shore Rd.

Great Neck

516-482-8657

Dr. Hormoz Mansouri

175 Jericho Tpke.

Syosset

516-682-4800

Dr. Brian O'Hea

Stony Brook University

Dept. Surgery

3 Edmund D Pelligrino Rd.

Stony Brook

631-444-1795

Dr. William Reed Jr.

Winthrop Surgical Assoc.

120 Mineola Blvd.

Mineola

516-663-3300

Dr. Dan Reiner

2800 Marcus Ave.

Lake Success

516-622-6120

Dr. Carlos Romero

173 Mineola Blvd.

Mineola

516-741-6464

Dr. Lisa Sclafani

650 Commack Rd.

Commack

631-623-4000

Dr. Marc Shapiro

Stony Brook University

Medical Center

Nicolls Rd. HSC T-18 Bldg.

Stony Brook

631-444-1045

Dr. Gerard Vitale

10 Medical Plaza

Glen Cove

516-759-5559

Dr. Robert Zingale

158 E. Main St.

Huntington

631-271-1822

 

How they were picked

 

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Not every good physician makes the list. Rather, the list is a way for patients to get started on their search for the best medical professional. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

 

To see the whole list . . .

 

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.

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