Top Doctors: Is laser better than scapel?
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
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.
Dr. Louis J. Auguste
2035 Lakeville Rd.
516-775-2070
Dr. Erna Busch-Devereaux
270 Pulaski Rd.
631-423-1414
Dr. Bradley Cohen
15 Park Ave.
631-581-4400
Dr. Charles Conte
600 Northern Blvd.
516-487-9454
Dr. Gene Coppa
1999 Marcus Ave.
516-562-2870
Dr. Rajiv Datta
Surgery Oncology
1 Healthy Way
516-632-3350
Dr. George Denoto
139 Plandome Rd.
516-627-5262
Dr. John Francfort
580 Union Blvd.
631-321-6801
Dr. Gary Gecelter
139 Plandome Rd.
516-627-5262
Dr. Michael Grieco
10 Medical Plaza
516-676-1060
Dr. Michael Khalife
300 Old Country Rd.
516-741-4138
Dr. Stanley Klausner
100 Hospital Rd.
631-475-8846
Dr. Lewis Kurtz
310 E. Shore Rd.
516-482-8657
Dr. Hormoz Mansouri
175 Jericho Tpke.
516-682-4800
Dr. Brian O'Hea
Dept. Surgery
3 Edmund D Pelligrino Rd.
Stony Brook
631-444-1795
Dr. William Reed Jr.
Winthrop Surgical Assoc.
120 Mineola Blvd.
516-663-3300
Dr. Dan Reiner
2800 Marcus Ave.
516-622-6120
Dr. Carlos Romero
173 Mineola Blvd.
516-741-6464
Dr. Lisa Sclafani
650 Commack Rd.
631-623-4000
Dr. Marc Shapiro
Medical Center
Nicolls Rd. HSC T-18 Bldg.
Stony Brook
631-444-1045
Dr. Gerard Vitale
10 Medical Plaza
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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