Laparoscopic Surgery

What is a biopsy?

A biopsy is a procedure to remove a piece of tissue or a sample of cells from a patient so that it can be examined and/or tested in a laboratory.

Why is a biopsy taken?

Veterinarians take biopsies to help obtain a diagnosis and formulate a treatment plan for your pet. The tissue sample is submitted to a pathologist to be examined under a microscope. This allows the pathologist to determine the cells’ type, shape, and internal activity. The pathologist’s report will help the veterinarian evaluate the patient for many disease processes such as infection, inflammation, and cancer.

Why perform a biopsy laparoscopically?

One of the main advantages of a laparoscopic biopsy is the ability to visually inspect the surface of organs and tissues to be biopsied through a much smaller incision than an open approach. The incision for a laparoscopic biopsy is typically 5-12 mm long. This small incision contributes to less tissue damage and faster recoveries. Many pets can go home the same day, requiring only minimal pain medication. Additionally, some organs such as the liver are better visualized with a laparoscope than with an open approach. The laparoscopic visual inspection and biopsy is not intended to replace other tools such as x-ray, CT scan or ultrasound, but rather to complement them.

What is a cryptorchid neuter?

This is the surgical removal of one or both testicles when they are not in the normal placement in the scrotum but instead are retained either inside the abdomen or in the tissues under the abdominal skin.

Why perform a cryptorchid neuter?

Retained testicles put the dog at an increased risk for testicular cancer and torsion. Testicular torsion is when the testicle twists, potentially cutting off blood flow and causing pain. Performing a cryptorchid neuter not only prevents the dog from reproducing but may also prevent the serious medical conditions mentioned above.

Why perform a cryptorchid neuter laparoscopically?

It can often be difficult to determine the location of a retained testicle on physical examination. By making a small incision in the abdomen and inserting a laparoscope, the surgeon can visually inspect and determine if the testicle is in the abdomen. If it is, the surgeon can grasp and remove it through an incision that is often much smaller than the traditional open approach. If the testicle is not in the abdomen, the surgeon can then direct their attention to tissue in the flank of the abdomen. Thus, the laparoscopic approach may prevent unnecessary damage caused by exploration in the incorrect location of the patient. Both the smaller incision and the proper location of the retained testicle are benefits of the laparoscopic approach that often contribute to faster recoveries and less postoperative pain. Most pets can go home the same day, requiring only minimal pain medication.

What is cystoscopy/urethroscopy?

Cystoscopy/urethroscopy is the use of a special scope, via the urethra, to visually inspect the inner surface of the urethra and bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In some cases, when necessary, biopsies can be taken of the inside of the bladder or urethra.

Why is a cystoscopy/urethroscopy performed?

Veterinarians perform these procedures to supplement other modalities such as x-rays, ultrasound, and labwork to help reach a diagnosis and formulate a treatment plan when your pet is experiencing urinary tract problems. Symptoms of urinary tract disease include blood in the urine, urine leakage, and/or frequent urination. In some cases, inspection of the urinary tract will reveal stones (similar to kidney stones in humans) that may or may not show up on x-rays. The location of these stones and their numbers will play a key role in your pet’s treatment plan.

Why might a cystoscopy/urethroscopy be an advantage over an open approach?

Urethroscopy is valuable because in male dogs, most of the urethra cannot be visualized without the use of scopes. Most pets recover faster and have less pain from cystoscopies/urethroscopies than an open conventional approach because there is no surgical incision.

What is a cystotomy?

A cystotomy is a surgical procedure where the contents inside the bladder and its tissues are visually inspected. In what is known as an “open” procedure, the surgeon makes an incision through skin and abdominal muscles to get access to the bladder.

Why is a cystotomy performed?

This procedure is most commonly done to remove bladder stones (rock-like structures that have formed in the urinary bladder).

Why perform a cystotomy laparoscopically?

In most cases the visual inspection of the inside of the bladder can be accomplished through a smaller incision than is required by an open procedure. The 5mm scope can be used in such cases and can result in less tissue damage, less postoperative pain, and quicker recovery versus an open procedure. Many times, the magnification from the scope allows the surgeon to see stones or “sand” that they cannot see or feel on a traditional cystotomy because they are so small. Removing these stones and any particles of sand helps to decrease the recurrence of stones in your pet (although there are many causes of stone formation). A separate procedure is often performed in addition to visually inspect the inside of the urethra (making sure no stones are stuck in the urethra). This urethral inspection is performed using a scope.

What is a prophylactic gastropexy?

A prophylactic gastropexy is usually a non-emergency preventive surgical procedure in which a dog’s stomach is surgically attached to the inner muscle (transversus abdominis muscle) of the abdominal wall.

Why are prophylactic gastropexies performed?

A condition occurs in some dogs in which the stomach twists or flips, cutting off the blood supply to this organ and other portions of the digestive tract. When it occurs, it is life-threatening and usually requires an emergency surgery. This condition has several names. The medical term is gastrointestinal dilatation and volvulus (GDV). This is also commonly called “bloat,” although technically the bloat is the dilatation of the stomach. (This is an important distinction since animals can still bloat even if they’ve had a gastropexy, but this is most commonly a medical emergency rather than a surgical emergency.) GDV is most common in large, deep chested dogs such as Great Danes, Saint Bernards, Samoyeds, Weimaraners, Irish Setters, Gordon Setters, Standard Poodles, Basset Hounds, Doberman Pinschers, and Old English Sheepdogs, but can occur in any breed. A veterinary surgeon will perform the gastropexy preventively to help keep GDV from happening.

Why perform a prophylactic gastropexy laparoscopically?

In a laparoscopic prophylactic gastropexy, the skin incision for the procedure is typically 25-50mm. This is much smaller than the incision made for a conventional open approach. The laparoscope with its integrated camera allows the surgeon to isolate the area of the stomach to be sutured to the body wall. The selected area of the stomach is grasped and surgically attached to the muscle at the previously mentioned incision. This forms a permanent adhesion (scar) that prevents the stomach from flipping. This minimally invasive laparoscopic approach to prophylactic gastropexies often contributes to faster recoveries and less surgical discomfort. Many pets go home the same day, requiring only minimal pain medication.

What is a rhinoscopy?

Rhinoscopy is the visual inspection of the nasal cavity using a tube-like rigid or flexible instrument equipped with a light and optical lens. When combined with other modalities such as CT scans, x-rays, and laboratory tests, a rhinoscopy can be very helpful in discovering the cause of signs and symptoms of disease in this area.

What information can a rhinoscopy provide?

There are many situations where visually inspecting the nasal passages and obtaining biopsy samples can be very helpful in pet care. Examples would include fungal disease, bacterial disease, cancer, anatomical/structural defects, and foreign material such as weed seeds in the nasal cavity. Often the earlier the information is obtained, the less severe the discomfort to your pet.

What are the advantages of using scopes to visually inspect the nasal cavity?

Rhinoscopy allows a much less invasive approach than an open surgical approach. This less traumatic approach results in less pain and faster recovery.

What is a spay (ovariectomy/ovariohysterectomy)?

A spay is the surgical removal of reproductive organs from a female dog. When only the ovaries (egg producing organs) are removed, it is known as an ovariectomy. When both the ovaries and the uterus (womb) are removed, it is known as an ovariohysterectomy. Both procedures are assisted using an instrument called a laparoscope. When placed into a dog’s abdomen via a small incision, the laparoscope allows the surgeon to directly visualize the surface and color of the patient’s reproductive tract. Under this direct visualization, blood vessels to the ovaries are identified, sealed, and dissected free using electrocautery. In the case of an ovariectomy, the ovaries are removed independently through the incision in the skin. With the ovariohysterectomy protocol, the ovaries remain attached to the uterus as these structures are exteriorized through the skin incision; they are then cut free and the uterine vessel is sutured closed. A spay is almost always a non-emergency procedure.

Why is a spay done?

Both traditional open spays and laparoscopic spays are done to prevent pets from being able to reproduce. Additional benefits of spaying dogs include eliminating unwanted heat cycles and the risk of ovarian cancer, as well as decreasing the risk of breast cancers, uterine cancers, and uterine infections (pyometra).

Why perform a laparoscopic assisted spay instead of a traditional open approach?

Studies show that a laparoscopic spay is less painful to your dog. In a traditional spay, the lining of the abdomen (peritoneum) is commonly impacted when separating the ovaries from the body. In contrast, with a laparoscopic spay the ovaries are usually dissected away from the body in a way that leaves the peritoneum intact. It is this difference that likely explains why laparoscopic spays are less painful.

Direct visualization of the abdomen with a laparoscope versus the traditional open approach also allows veterinarians to better evaluate if there are any blood vessels that are incompletely sealed. Incompletely sealed vessels can lead to postoperative bleeding that may need additional surgery to correct.

Direct visualization reduces the possibility of ovarian tissue being left in the abdomen because the magnification allows the surgeon to verify the location of the ovary. Retained ovarian tissue can produce the sex hormone estrogen, resulting in dogs having heat cycles. These heat cycles can be more than just a nuisance; they can lead to uterine stump infections that can be very dangerous to the patient.

The increased safety and decreased pain with laparoscopic spays allow surgeons to safely reduce risk by decreasing the time dogs stay in the hospital post-spay.

What is video otoscopy?

Video otoscopy is the use of a specialized camera and scope (rather than a standard veterinary otoscope) to examine a pet’s ear canal.

Why is otoscopy done?

Otoscopy allows a veterinarian to visually inspect your pet’s ear canal and ear drum. This, along with other tests (for example, microscopic examination of debris in the canal), allows the veterinarian to make a diagnosis and formulate a treatment plan. Dogs’ ear canals are shaped differently than humans; as a result, using standard veterinary otoscopes sometimes makes the ear canal inspection more uncomfortable, sometimes requiring light sedation of your pet.

Why use video otoscopy?

Specialized veterinary video otoscopes are designed to provide better visualization of the surface of the ear canal and ear drum using increased light and 5-6X magnification. The image of the canal can be displayed on a video monitor; this allows veterinarians to share this surface inspection with colleagues and owners. Additionally, the improvements in visual inspection of the ear canal and ear drum using video otoscopy over standard otoscopy often decreases the need for sedation.