Minimally Invasive Surgery and Diagnostics/Interventional Radiology and Endocopy
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.
Interventional Radiology (IR)
Interventional radiology (IR) involves the use of fluoroscopy to gain access to different structures in order to deliver materials for therapeutic purposes. These minimally invasive techniques are currently being investigated in veterinary medicine and have the potential to provide alternatives for our patients in whom conventional therapies are declined, not indicated, or associated with excessive morbidity or mortality. IR can be applied to any body system in patients of all sizes and therefore will likely have very broad applications in our veterinary population.
Following the description of percutaneous arterial catheterization by Seldinger in the 1950’s, angiography developed into a widely-utilized and essential diagnostic tool in human medicine. Technological advances have since helped transform this diagnostic modality into a sub-specialization with enormous therapeutic potential. Interventional radiology (IR) involves the use of contemporary imaging techniques such as fluoroscopy and specialized equipment such as catheters, guidewires, and stents for therapeutic purposes. The field has grown considerably over the past 20 years and IR techniques are considered the gold standard to treat a variety of conditions in humans.
Despite applications in veterinary medicine, IR techniques have not been widely adopted. Examples in the veterinary literature include coil embolization to treat patent ductus arteriosus, stenting for tracheal collapse, coil embolization of the carotid and maxillary arteries for treatment of hemorrhage from guttural pouch mycosis in horses, and coil embolization of canine intrahepatic portosystemic shunts.
Interventional Endoscopy (IE)
Interventional Endoscopy (IE) involves the use of endoscopic equipment with other contemporary imaging modalities, such as fluoroscopy and/or ultrasound, to perform diagnostic and therapeutic procedures in virtually any part of the body accessed endoscopically (gastrointestinal, biliary, respiratory, urinary tract, etc).
Currently, an expanding investigation of the use of some novel techniques in veterinary medicine has been undertaken. The combination of endosocpy and fluoroscopy allows for one to visualize and gain access into small orifices that would otherwise require more invasive surgical technique. A good example of this is the placement of a biliary stent into the common bile duct via the major duodenal papilla with endoscopic and fluoroscopic guidance. Many of these interventional procedures are considered the standard-of-care in human medicine, and are currently being investigated in veterinary medicine. The use of these techniques are expanding as these modalities are becoming more widely available.
The invasiveness and morbidity associated with some traditional surgical techniques (i.e. biliary re-routing surgery, ureterotomy for ureteral obstructions, or nasopharyngeal surgery for nasopharyngeal stenosis) makes the use of minimally invasive alternatives using IE appealing. The advantages of such procedures are the minimally invasive nature, the lower morbidity, shorter hospital stays, and sometimes even the lack of alternative options. The disadvantages are that these procedures are technically challenges, require specialized equipment, and require specialized training.
A large number of the procedures we are currently performing are in the urinary tract (ureteral stenting, laser lithotripsy, urethral stenting, urethral bulking agent injections for incontinence, etc).