Understanding laparoscopy in veterinary surgery

General practitioners are incorporating this increasingly common minimally invasive surgery into their menu of services

George Kling performed the world’s first laparoscopy in 1901, and like many of the first medical procedures, this one was performed on a dog. 121 years later to the present day: Laparoscopic surgery has become the standard of care for most surgical procedures in human medicine and is now complemented by robotic surgery.

Laparoscopic surgery, sometimes referred to as keyhole surgery or minimally invasive surgery (MIS), involves the use of high-quality telescopes connected to a digital video camera. The camera is connected to a fiber-optic cable and a light source, which then transmits images to an associated screen.

To create enough work space to manipulate organs and instruments, the peritoneal cavity is inflated with carbon dioxide to move the abdominal wall away from the internal organs. Peritoneal access is usually obtained using a specialized instrument called a Veress needle, which is placed blindly into the peritoneal cavity to establish pneumoperitoneum, or with a modified Husson technique, allowing direct imaging of the peritoneal access.

Although we are far from robotic surgery that has become readily available in veterinary medicine, laparoscopy has experienced rapid growth over the past twenty years, and for many purposes in veterinary surgery (see appearance). It’s available in most specialty hospitals, and many general practitioners are incorporating laparoscopy into their practices. It has grown to the point that the subspecialty fellowship program within the American College of Veterinary Surgeons is only intended for advanced training in soft tissue MIS.

Use the correct tools

Laparoscopic surgery can be performed using multiple trocars placed through small incisions (multi-port laparoscopy) or with a single incision using a port device, allowing multiple ports to be used within them (single-port laparoscopy). The decision about the technique to be used depends on the preference of the surgeon and the nature of the procedure to be performed.

An adrenal tumor is dissected endoscopically from the renal vein and vena cava in a cat with hyperaldosteronism.

Catheterization and cleaning of the bile duct to assess patency during laparoscopic cholecystectomy for the gallbladder mucosa.

Most surgical instruments today are available in laparoscopic form and are usually 5mm or 10mm diameters. The instruments have shafts covered with an insulated sheath, allowing simultaneous use with monopolar electrocautery and optimization for endoscopic application. Hinged shapes are also available for certain instruments, which can improve triangulation.

In addition to ordinary instruments, many specialized devices have greatly increased the number and complexity of procedures performed endoscopically. Examples of these devices include endoscopic staplers, sample retrieval bags, and bipolar vessel sealing devices. Most veterinary surgeons will declare the last of these tools an absolute must for most laparoscopic procedures.

Demonstrate benefits to patients

The advantages of laparoscopic surgery are well known and have been proven by numerous veterinary studies. Laparoscopic surgery has been associated with reduced pain compared to traditional open surgery1,2 A faster return to normal activity.3,4 In addition, some literature indicates that the rate of postoperative wound infection may be lower with less invasive methods.5

Intracorporeal suturing to complete endoscopic gastrostomy to prevent gastric dilatation and volvulus (GDV).

Intraoperative view of leiomyomas of the gallbladder prior to laparoscopic cholecystectomy.

Recent studies have shown that cholecystectomy, a tedious procedure not without major complications, can be performed laparoscopically with minimal morbidity and mortality with appropriate patient selection.6 In addition, some procedures such as adrenalectomy have been performed faster through laparoscopy compared to the traditional open method.7

Disadvantages of practices

As with all things, laparoscopy has its drawbacks. These include increased processing times, an increase in the cost of specialized equipment, and the need for specialized training in MIS. However, these drawbacks can be compensated for by the surgeon’s expertise and the increased availability of training opportunities, such as the International Veterinary Assessment Veterinary Endoscopy Skills Program.

growing market

The number of procedures that can be performed laparoscopically has increased significantly. More routine procedures such as oophorectomy, liver biopsy, and laparoscopic-assisted gastrostomy are done and can be done with minimal specialized equipment.

With the advent of the razor suture material, full gastric stabilization operations can be performed endoscopically, as this material greatly reduces the challenge of suturing within the body. The introduction of high-resolution 4K screens and near-infrared imaging enables stunning image quality and the ability to highlight abnormal tissues that would normally not be visible.

With the continuous advancements in medicine and technology, the future will offer more possibilities to the world of management information systems. We hope these advances find their way into veterinary medicine, which is where it all began.

Justin Ganji, DVM, DACVS-SAis a specialist surgeon at the Veterinary Surgical Centers in Vienna, Virginia, and an assistant professor of small animal and minimally invasive surgery at Virginia Maryland College of Veterinary Medicine in Blacksburg, Virginia.

references

  1. Devitt SM, Cox RI, Healy J. Duration, complications, stress and pain of open hysterectomy versus simple laparoscopic-assisted oophorectomy and hysterectomy in dogs. J Am Vet Med Assoc. 2005; 227 (6): 921. doi: 10.2460/javma.2005.227.921
  2. Walsh PJ, Remedios AM, Ferguson JF, Walker DD, Cantwell S, Duke T. Thoracoscopy versus open partial pericardiectomy in dogs: a comparison of pain and morbidity after surgery. veterinary surg. 1999; 28 (6): 472. doi: 10.1111/j.1532-950x.1999.00472.x
  3. Kolb WTN, Mayo BD, Brown DC. The effect of laparoscopic versus open oophorectomy on postoperative activity in young dogs. Veterinary Surg. 2009; 38 (7): 811-817. doi: 10.1111/j.1532-950X.2009.0572.x
  4. Mayhew Budd, Brown DC. Prospective evaluation of two prophylactic intraoperative endoscopic gastric fixation techniques compared with laparoscopic assisted gastrostomy in dogs. veterinary surg. 2009; 38 (6): 738. doi: 10.1111/j.1532-950X.2009.0554.x
  5. Mayhew BD, Freeman L, Kwan T, Brown DC. Comparison of surgical site infection rates in clean and contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007-2008). J Am Vet Med Assoc. 2012; 240 (2): 193-198. doi: 10.2460/javma.240.2.193
  6. Kanai H, Hagiwara K, Nukaya A, Kondo M, Aso T. Short-term result
    Laparoscopic cholecystectomy for benign gallbladder disease in
    76 dogs. J Vet Med Sci. 2018; 80 (11): 1747–1753. doi: 10.1292/jvms.18-0266
  7. Taylor CJ, Monet E. Comparison of outcomes between laparoscopic and open adrenalectomy in dogs. veterinary surg. 2021; 50 (Appendix 1): O99-O107. doi: 10.1111/vsu.13565

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