Laparoscopy

Laparoscopy is the use of a rigid telescope for exploration or viewing of surgical procedures performed in the abdomen.

Laparoscopy is typically performed after “insufflation” of the abdominal cavity with carbon dioxide gas. This gas is used because it in non-flammable, non toxic and inexpensive. Insufflation allows displacement of the abdominal wall from the underlying viscera so that instruments may be manipulated without trauma to the abdominal organs. Cameras and instruments are then inserted through the skin through one or more small (5mm) incisions.

Indications for Laparoscopy

Indications to perform laparoscopy are almost unlimited, if appropriate planning and skills allow for conversion to an open approach when the indication arises. Preoperative decision-making, client communication and accurate diagnostic imaging using abdominal ultrasound are important pre-surgical steps before electing to perform MIS. The most obvious indications for laparoscopy are situations in which no mass lesions are identified on diagnostic imaging, but other clinical or laboratory abnormalities suggest intra-abdominal disease. Alternatively, laparoscopic biopsies of a known mass can be obtained as a method of “staging” neoplastic disease. In addition, a number of MIS elective procedures have been described, allowing some common surgical procedures to be performed through smaller incisions.

1) Full thickness intestinal biopsies:
Full thickness stomach and small intestinal biopsies are often required to obtain definitive diagnosis of several conditions, including inflammatory bowel disease, lymphoma and lymphangiectasia. These biopsies may be obtained with less pain and quicker recovery using laparoscopic assisted techniques.

2) Laparoscopic assisted gastropexy:
Recent publications suggest that large and giant breed dogs have a risk of 20-40% of developing a life-threatening condition known as “bloat”, a twisting and sudden distention of the stomach. Laparoscopic assisted gastropexy provides a reliable and rapid method of elective “tacking” the stomach in dogs that are at high risk of having gastric dilatation and volvulus (GDV or “bloat”) . We currently recommend this procedure to owners of giant breeds (Great Danes, St. Bernards, and Newfoundlands) and large breed dogs (German Shepherds, Labrador retrievers, and others). This technique is especially valuable in working dogs that have a high incidence of GDV, with the cost of prophylactic gastropexy being far less than the cost of treating GDV.

3) Laparoscopic assisted liver/kidney biopsy:
Organ biopsy in a pet with evidence of liver or kidney disease is one of the most common indications for MIS in small animal practice. Excellent biopsy samples may be obtained with minimal risk, improving the likelihood of obtaining a definitive diagnosis. Laparoscopic guided biopsies have been shown to provide more consistent results than ultrasound guided biopsies in dogs, because the organ can be directly visualized as the sample is acquired. MIS is often very appealing to owners that want a definitive diagnosis, but don’t want to subject their pets to open surgery.

4) Laparoscopic spay or neuter:
MIS techniques are readily applied in standard neutering procedures for dogs and cats. In female dogs, laparoscopic ovariohysterectomy (removal of the ovaries and uterus) has recently been replaced by simple ovariectomy (removal of the ovaries alone). Ovariectomy may be performed through small incisions and provides the same benefits as the traditional spay, preventing “heat cycles” pyometra and decreasing the risk of mammary cancer. Another use of MIS is in neutering of dogs with a retained testicle, a condition known as cryptorchidism. While standard open abdominal surgery allows removal of the testicle, the procedure may be performed through a much smaller incision using laparoscopic techniques.

5) Laparoscopic cystoscopy:
The availability of abdominal ultrasound has led to increased detection of transitional cell carcinoma (bladder cancer) and other abnormalities of the bladder wall. Unfortunately, ultrasound imaging does not allow definitive biopsy sampling to identify cancer and to guide treatment. When biopsy is required, a rigid cystoscope can be used obtain excellent images of the bladder, in addition to biopsy any lesions that are identified. This technique offers a minimally invasive method for biopsy of tumors or other processes that are identified in the bladder wall. In female dogs, the scope is inserted through the urethra without a need for any surgical incisions. In male dogs, the urethra is too long and narrow to allow the use of rigid cystoscopy. However, the bladder can also be accessed via an abdominal (laparoscopic) approach allowing visualization and biopsy of the bladder and prostatic urethra.

6) Urethroscopy and collagen injection:
Urinary incontinence is a common condition in female dogs, affecting between 10 and 20% of spayed females. Many dogs respond to medical therapy with alpha agonists (phenylpropanolamine) that increase urethral sphincter tone. The injection of cross-linked collagen into the region of the urethral sphincter allows for long-term control of incontinence in many dogs. An alternative to medical therapy is the use of collagen injections into the urethral lining to increase resistance to urine leakage. This procedure is available at VSES- please call VSES for more information on this procedure and to see if your dog is a candidate for this procedure.