Endoscopy and minimally invasive Endosurgery  

4 April 2024 -

Almost all procedures in human surgery are done at least partially using minimally invasive techniques as this has been shown to be safer and less painful for the patient whilst providing better access for the surgeon and quicker recovery/shorter hospital stays.

Most veterinary practices have access to flexible endoscopes for gastrointestinal and respiratory endoscopy. Many practices are now doing bitch spays and cat spays laparoscopically and have seen the benefits for their patients as well as appreciating the improved tissue handling, reduced tissue trauma and minimal haemorrhage. Minimally invasive surgery is also extremely popular with clients who want the least painful options for their pets, so they will seek out practitioners who can perform these procedures.

Equipment set up costs for minimally invasive Endosurgery are equivalent to a medium range ultrasound machine and the costs can be recouped from day one just by doing routine elective surgery such as spays. However to get the full benefit of the equipment and provide the best service for our patients it makes sense to broaden the range of minimally invasive procedures carried out.

Almost all abdominal procedures carried out in general practice can be done either entirely laparoscopically or lap assisted and the equipment can be used to access many other parts of the body with very few additions.

Thoracoscopy

Opening the chest by traditional open thoracotomy is an extremely traumatic and painful procedure for the patient, requiring a prolonged recovery. Conversely, thoracoscopy is considerably less traumatic, affords better access to the thoracic cavity and in many cases the patient only requires an overnight stay. Even quite complex procedures such as pericardectomy, thoracic duct ligation and persistent right aortic arch can be accomplished thoracoscopically. It is also an ideal technique for exploratory surgery and biopsy.

Rhinoscopy

Access to the nasal cavity is very limited by conventional means and lesions can only be viewed indirectly by radiography, CT or MRI. Rhinoscopy affords the surgeon a direct view of almost the whole of the nasal mucosa enabling removal of foreign bodies, biopsy and ablation of tumours and treatment of conditions such as aspergillosis and nasopharyngeal stenosis.

Urethrocystoscopy

We all see urinary tract problems in dogs and cats almost on a daily basis. Often these are treated empirically and can be frustrating to treat if they recur. Urethocystoscopy allows direct visualisation of the urinary tract in the bitch and queen as well as treatment of many common conditions such as ectopic ureters, paramesonephric remnants, transitional cell carcinoma, polyps, uroliths, and others. Male dogs and cats can usually be treated using flexible endoscopes or by lap assisted cystoscopy.

Video-Otoscopy

Video otoscopy permits a much enhanced view of the whole ear canal and in some cases the tympanic bulla. More effective cleaning and treatment of infections, masses and lichenification can be carried out.

Arthroscopy

Direct visualisation of joint spaces and treatment of joint lesions through small holes means quicker patient recovery with minimal trauma.

Flexible endoscopy

Examination of the gastrointestinal tract and bronchial tree with effective biopsy technique affords a minimally invasive diagnostic intervention as well as the treatment of some conditions but requires training in the correct handling of instrumentation.

All of these modalities and more are covered in the GPCertEndo course, as well as elective procedures such as laparoscopic spays, which will allow you to get the most out of your investment in equipment, increase profitability and greatly improve the welfare and quality of life of your patients. As an added bonus, clients enthusiastically seek out practices that can carry out these procedures as they appreciate the benefits for their pets.

Philip Lhermette, BSc (Hons) CBiol FRSB BVet Med FRCVS