Minimally Invasive Surgery in Small Animal Veterinary Medicine
By Dr. Matthew Nicholson
Many of us are aware of the advances in human surgical techniques like laparoscopy for removal of the gall bladder or arthroscopy to remove or repair torn cartilage in the knee. These techniques have been developed and improved upon over the years. Benefits of these minimally invasive surgical techniques include smaller surgical scars, less discomfort when compared to traditional surgery, and quicker return to function. You may not be aware that these same techniques are available and commonly used in veterinary medicine for the same reasons.
Minimally invasive surgery of joints is achieved with the placement of an arthroscope, a thin flexible fiberoptic scope and instruments through small incisions while a balanced sterile fluid passes through the joint. The most common indications for arthroscopy in dogs are torn ligaments and cartilage in the knee, ligament and tendon injuries, and cartilage abnormalities in the shoulder, and the elbow. Other joints may include the ankle, hip, and wrist.
The most common injury requiring surgical intervention we see in practice is a torn cranial cruciate ligament in the dog’s knee. The cranial cruciate ligament in the dog is similar to the anterior cruciate ligament (ACL) in people. Prior to surgical stabilization of the knee, we perform arthroscopy to evaluate all structures and address abnormalities requiring intervention. The most common concurrent injury we find during the arthroscopy is a torn cartilage (meniscus). Many people have had this same injury and can attest to the level of pain as a result of a torn meniscus. In most cases, successful repair of the cartilage is not feasible, therefore removal of the torn tissue is necessary. Failure to recognize this concurrent injury would result in ongoing discomfort for the pet. Arthroscopy provides superior visibility due to the magnification, allowing us to more easily spot and correct a torn meniscus.
Minimally invasive surgery of the abdominal cavity, or laparoscopy, is performed with the aid of a thin laparoscope with light, gas to distend the abdomen (often carbon dioxide), and instruments. The laparoscope and instruments are placed into the abdominal cavity through small incisions. In veterinary medicine, there are many procedures that can be performed with this technique. Common procedures include spay of female dog or cat (ovariohysterectomy—removal of the ovaries and uterus versus ovariectomy, or removal of just the ovaries), removal of retained testicles in the male dog, biopsy of organs, and removal of the gall bladder or kidney.
Preventive procedures are performed laparoscopically to help avoid a condition or disease. The most common preventive procedure performed, other than spaying and neutering, is gastropexy. Gastropexy is creating a surgical adhesion or attachment of a portion of the stomach to the abdominal wall to prevent the stomach from rotating. This condition, gastric volvulus or gastric dilation and volvulus (GDV), is common in deep-chested, large or giant breed dogs. GDV is an emergency, and a patient diagnosed with the condition requires immediate attention and surgery. A preventive laparoscopic gastropexy can be performed to eliminate this risk. The recovery following this procedure is rapid, due to small incisions and very little discomfort for the patient. Compared to the surgical procedure and attention needed for a patient diagnosed with GDV, the cost is significantly less as well. If you have questions regarding this procedure, or question if you should consider this for your pet, please consult your veterinarian.
We know there is a lot of information to digest and things to consider in the event that a pet requires surgical intervention for preventive care or for necessary medical treatment. We pet owners are increasingly, and rightly, seeking the same treatment options for our pets as we would for ourselves. Fortunately, veterinary medicine has advanced to a point where this is not an unreasonable or unrealistic expectation.
If you find your own pet in a situation requiring surgery, know that many minimally invasive treatment options are out there and explore these less invasive treatment alternatives with your pet’s veterinary caregiver before moving forward with more invasive procedures.
Matthew Nicholson, DVM, DACVS is staff surgeon at Valley Surgical Center in Winchester. For information, visit www. VeterinarySurgicalCenters.com or call 540-450-0177.