Minimally Invasive Surgery and Diagnostics
Laparoscopy/Thoracoscopy
Introduction
The development of minimally invasive surgery in people has revolutionized human medicine over the last 25 years. There are currently minimally invasive alternatives for most procedures that were previously performed in an “open” manner. Two forms of minimally invasive surgery are laparoscopy and thoracoscopy where very small, keyhole, incisions are used to place a camera and instruments inside either the chest (thoracoscopy) or abdomen (laparoscopy). The surgeon can visualize a magnified picture of the interior of these body cavities and organs on a special medical-grade monitor. In veterinary medicine we are now able to offer pets many of the advantages of minimally invasive surgery that exist today in human medicine.
Advantages
Laparoscopy and thoracoscopy allow many procedures to be performed with minimal post-operative pain compared to “open” surgical procedures. Post-operative complications that can be associated with large surgical incisions are also minimized. In older and debilitated animals minimally invasive surgery is also likely to reduce other post-surgical complications. Improved cosmesis is another advantage compared to large scars from open incisions.
Disadvantages
Not all procedures can be performed using laparoscopic or thoracoscopic means although the list of operations that we can perform this way is ever growing. In all cases, owners of pets who are undergoing laparoscopic or thoracoscopic procedures must be aware that there is a small chance that conversion to an “open” approach may be necessary if that is deemed to be safer. Feel free to discuss with your veterinarian whether laparoscopic or thoracoscopic options exist for your pets problem or contact Dr. Philipp Mayhew at Penn Vet to discuss whether your pet might be a good candidate (215 898 7982).
What procedures can we perform using laparoscopy/thoracoscopy?
In human medicine there is now a minimally invasive alternative for almost all procedures in the chest and abdomen that used to be performed with a large open incision. As these procedures are experienced routinely by the owners of pets and their family members there has quite naturally been an increased interest from pet owners to have procedures performed in a minimally invasive fashion when their pets require surgery. In response to this the Penn Vet Center for Minimally Invasive Procedures has pioneered the development of laparoscopic and thoracoscopic procedures to offer options to pet owners that will minimize post-operative pain and discomfort and reduce incision related complications.
The following is a list of the procedures that can be performed using laparoscopy:
- Ovariectomy/ovariohysterectomy in dogs
For routine sterilization (spay) or reproductive tract neoplasia or ovarian remnant syndrome
- Cryptorchidectomy in dogs/cats
Removal of retained testicle(s)
- Laparoscopic-assisted cystotomy in dogs/cats
For removal of bladder stones or biopsy of bladder cancer
- Laparoscopic-assisted gastropexy in dogs
For preventative treatment of gastric dilation and volvulus (twisted stomach or GDV) syndrome
- Biopsies of the following: Gastrointestinal tract, liver, spleen, pancreas, kidney, abdominal masses in dogs and cats
- Ureteronephrectomy
Removal of the kidney and ureter for chronic pyelonephritis/abcess, neoplasia, dysplasia of the kidney
- Adrenalectomy
Removal of the adrenal gland for modestly sized adrenal cortical tumor/pheochromocytoma (especially left sided) or incidentally discovered adrenal masses
- Liver lobe resection/partial resection
For liver biopsy or modestly-sized peripherally located liver tumor resection
- Insulinoma Resection
Partial pancreatectomy for insulinoma removal
- Cholecystectomy
Gall bladder removal in the case of unruptured gall bladder without bile peritonitis. Primarily for stable dogs with biliary mucocele or gall stone disease.
- Laparoscopic Biliary Stent placement or cholecystostomy tube placement
For blockages of the bile duct (extra-hepatic biliary tract obstruction or EHBO)
The following is a list of the procedures that can be performed using thoracoscopy:
- Pericardectomy
Removal of the pericardium (the sac around the heart) for palliation of idiopathic or cancer-associated bleeding into the pericardial sac, constrictive pericarditis, pericardial biopsy or as an adjunct to treatment of idiopathic chylothorax
- Lung biopsy or lung lobe removal
For neoplastic/inflammatory lung conditions. Lung lobectomy is possible for modestly sized peripherally located primary lung tumors or metastatic lesions if single. Some cases of spontaneous pneumothorax may also be treated by partial or complete lung lobectomy.
- Cranial mediastinal mass biopsy or mass resection
For thymoma removal when tumor is not too large. Other masses can be biopsied under thoracoscopic guidance.
- Thoracic duct ligation
For management of idiopathic chylothorax