Endoscopy And Keyhole Surgery
Beaumont Veterinary Centre is excited and proud to be one of the first general practices in Devon to offer the benefits of endoscopic or “keyhole” surgery. Using both flexible and rigid video-endoscopes dramatically reduces the pain and trauma of surgery and results in much improved recovery and convalescence times whilst minimising postoperative complications. These techniques are usually only available at referral centres, but we believe that the huge benefits of keyhole surgery should be available to as many patients as possible without the worry of the high costs of referral. We are always increasing the number of procedures we carry out but the following is a brief description of those currently available.
Keyhole or endoscopic surgery is widely used in the human field but not in veterinary surgery. Beaumont Veterinary Centre is one of the first general practices in Devon to offer a wide range of minimally invasive endoscopic procedures.
This type of surgery greatly reduces patient pain and trauma, dramatically improves recovery times, reduces post – operative problems, reduces surgical time and provides the surgeon with a much better view of tissues. The traditional bitch spay involves an abdominal incision (often quite large), elevation of the ovaries by traction and tying off the ovarian blood vessels, cutting the supporting tissues of the ovaries and uterus or womb and finally tying off and removing the uterus together with the ovaries (an ovariohysterectomy). The wound is stitched in 3 layers and the skin stitches removed in 10 days.Keyhole spay involves removing just the ovaries (ovariectomy) in most cases. Ovariectomy has been the standard procedure in Europe for over 30 years and studies have shown that there is no medical advantage to removing a healthy uterus – the long term health outcomes are the same for ovariectomy and ovariohysterectomy.
The main benefits of keyhole spay are much reduced trauma and pain for the patient and a much shorter post operative recovery with much fewer wound problems. In most cases bitches will have a large area clipped underneath and two small (0.5 – 1 cm) incisions. There may be self dissolving stitches or no stitches at all!! It is important to remember that the uterus is left behind and owners should make any other veterinary practice they attend aware of this. If the uterus is diseased in any way it can still be removed by keyhole surgery – we just need 3 holes instead of 2! The investment in special equipment and training to carry out these procedures means that we charge about £95.00 more than traditional surgery but those owners who have had this procedure done for their pets are amazed at the speed of recovery and how well they are post operatively. If you have any questions about keyhole surgery or would like to have this done for your pet, please telephone the surgery – we are very happy to discuss all aspects of these procedures.
This technique involves using keyhole surgery to examine the abdominal organs – liver, spleen, kidneys, pancreas, bowel, bladder and reproductive organs. Standard exploratory surgery (laparotomy) involves a large incision and can be very traumatic. The highly magnified image produced by the video-endoscope allows wonderful visualisation of organs with minimal trauma.
Laparoscopic Removal Of a Retained Testicle
Standard surgery to remove an abdominally retained testicle involves a large incision along the sheath and lower abdomen to gain access. Recovery is often painful and complications are common. Keyhole surgery is carried out through two small incisions as above and is the gold standard method of treating this problem.
Whilst non–invasive techniques such as X-ray and ultrasound can tell us a lot about internal organs, there is sometimes no substitute for seeing the problem “up close and personal”! Diagnosis is extremely important for treatment planning and prognosis – 50% of needle biopsies are non-diagnostic, but over 95% of laparoscopic biopsies will be diagnostic. Keyhole procedures are quick and minimally traumatic which is very important in patients that may already be ill. Keyhole biopsy is particularly suited for liver, spleen, pancreas and kidney biopsy. Bowel biopsies are usually done by a laparoscopically-assisted technique which requires a (slightly!) larger incision but is still much preferable to open surgery.
The chest is much more difficult to access by standard surgical techniques and open chest surgery is generally accepted to be very painful, often requiring prolonged hospitalisation and recovery. Keyhole techniques are much better tolerated and allow detailed examination of the chest cavity, lungs and heart. As with laparoscopy, biopsies are easy to perform and well tolerated, with patients back on their feet and pain free within a few hours.
Thoracoscopic Pericardial Window Technique
Pericardial effusion or haemorrhage is an unusual but life threatening condition affecting mainly large breeds of dog. Build up of fluid or blood in the sac surrounding the heart compresses the heart and causes heart failure. Drainage of the fluid by needle is sometimes curative but better and more permanent drainage can be achieved by creating a hole or “window” in the pericardial sac. Traditional surgery for this procedure is painful and involves prolonged recovery – keyhole surgery is extremely well tolerated and most patients go home within 48hours! RHINOSCOPY AND SINUSCOPY Full examination of the nasal passages and sinuses is impossible without a rigid endoscope. The technique can be used to remove foreign bodies, for diagnosis of nasal or sinus inflammation, flushing sinuses and the treatment of nasal infections (especially fungal infection due to Aspergillosis) and tumours.
Cystoscopy And Vaginoscopy
Examination of the bladder, urethra and female reproductive tract is impossible by standard surgery without causing significant trauma. Rigid endoscopy is easy, well tolerated and quick to perform for diagnostic purposes. Surgical procedures can also be carried out to remove polyps, de-bulk tumours and remove bladder stones (this is often done by a laparoscopically-assisted technique). A piece of wood in the nasal chamber Fungal infection – Aspergillosis Urethral Tumour Bladder Stones Bladder Stone
Many people will know about keyhole joint surgery, yet this technique is still uncommon in veterinary practice. Standard procedures to open up a cause significant irritation to the joint which results in prolonged recovery – keyhole procedures greatly reduce this operative trauma and actually allow a more detailed examination of the joint due to the magnified image of the video-endoscope.
Whilst we examine the ears everyday with a standard auroscope in the consulting room very successfully, some cases require more detailed examination. This usually requires sedation or anaesthesia, but the highly magnified image from the videoendoscope provides very detailed examination of the ear canal and if necessary, the middle ear chamber too. Foreign bodies can be retrieved, biopsies taken, polyps and tumours removed and the ear cleaned and flushed. Inflammed ear-drum obscured by discharge Foreign material in horizontal canal Normal appearance of ear drum
Flexible endoscopy has been widely used in veterinary practice for a long time. These endoscopes are used to examine the upper and lower gastrointestinal tracts and the respiratory system in particular. Their main value is allowing diagnosis of a wide range of conditions usually by taking biopsies as minimally invasively as possible, but removing foreign bodies can also be done – this dog had swallowed an 8-inch metal kebab stick!! A stone stuck in windpipe (above) and after removal (below) Colonoscopy Gastric Tumour