Endosurgery will make healthcare easier

7 May 2002

Surgeons at the Louisiana State University School of Veterinary Medicine are performing state-of-the-art surgery procedures that use optic devices to view body cavities, providing a variety of diagnostic and corrective procedures that are less invasive than conventional procedures.

The procedures, known as endosurgery, also offer the benefit of reduced trauma to the patient. Endosurgery has been used for many years in human surgical procedures, and in recent years veterinary surgeons have begun using endoscopic technology to enhance the surgical procedures available for animals.

LSU surgeons use these optic devices equipped with a light source and camera, called endoscopes, to view body cavities. The scopes are used for laparoscopic, thorascopic and arthroscopic procedures, which are surgeries of the abdomen, chest, and joints, respectively. 

The surgeon makes two to three small incisions to insert the viewing and surgical equipment into the cavity, as compared to conventional open procedures with one large incision. The surgeon can view the entire surgical procedure on a video monitor, giving him or her better visualization of the area.

"The advantage is that the surgeon only has to make a few small incisions to accommodate the equipment. The recovery is quicker and it reduces trauma for the animal," said Dr. Cheryl Hedlund, chief of Companion Animal Surgery.

One of the challenges of endosurgery is it that requires a high level of skill, training and teamwork. All LSU surgeons received extensive training for the new devices and each procedure requires a team.

Laparoscopy allows viewing of the abdomen by inflating the cavity with air and inserting a scope. Hedlund and Dr. Giselle Hosgood most commonly utilize laparoscopy for liver biopsies. Pancreatic and intestinal biopsies are also common laparoscopic procedures, as well as exploration for metastatic disease, removal of abdominally-retained testicles and placement of feeding tubes. Most surgical procedures performed via an open procedure are amenable to endosurgical techniques.

Laparoscopy and thoracoscopy are the newest surgical procedures used in horses. According to equine surgeon Dr. Daniel Burba, laparoscopy offers the advantages of easier ovariectomy procedures, or removal of the ovaries, and removal of testicles retained in the abdominal cavity. Thoracoscopy allows for easier evaluation of problems such as lung disease.
 
"With laparoscopy, the horse can actually stand for the ovariectomy and there is much less trauma and blood loss," he said.

Arthroscopic procedures explore the inside of a joint and can be used to treat problems in the shoulder, elbow and ankle joints, as well as for evaluation of knees that have cranial cruciate ligament ruptures. Dr. Jackie Davidson, small-animal surgeon, says that arthroscopy, as compared to the older technique, arthrotomy, gives a surgeon a more magnified, thorough view to better evaluate joint disease or damage.

"The animals seem to be more comfortable after arthroscopy as compared to arthrotomy, especially in the knee joint because an arthrotomy would involve more retraction of the joint tissues," she said.

Burba uses arthroscopy on horses to remove chip fractures and defective cartilage, and to evaluate soft-tissue injuries without the postoperative complications of the older techniques. Recent advancements using a vaporization unit are also being clinically tested at the school. The units help remove tissues that have enlarged or developed a mass, without cutting and damaging the joint.

Another advantage of endosurgery is the benefit it offers to the teaching process. One small animal surgery suite has recently been equipped with a TV monitor that projects the surgery from a camera incorporated into the surgical light. This allows students who are not able to participate in the surgery to view the procedure as if they were participating, and it allows the faculty to record the procedures to use as teaching tools. "These new capabilities allow for easier exchange of information because the students can see what is happening. More student interaction and involvement means more learning and better veterinarians," said Hedlund.

In addition to endosurgery, LSU surgeons also use laser capabilities for specialized surgeries, such as removing chronic lesions.