VCA South Shore Animal Hospital

Minimally invasive surgery using state of the art equipment

~ By Claudia Dolphin

Dr. Kechia Davis is a member of the surgical service at VCA South Shore Animal Hospital in South Weymouth, Massachusetts. She is a graduate of The Cornell University College of Veterinary Medicine, and received additional training at the University of Wisconsin and North Carolina State University. Her subspecialty is minimally invasive surgery, an alternative surgical approach that utilizes very small incisions and fiber optic instrumentation instead of the traditional large surgical incision. This type of surgery is appropriate for many conditions, and provides considerable benefits to the patient. We recently sat down for a discussion with Dr. Davis to learn more about minimally invasive surgery and how it might be the right choice for your pet. ~ssm

What exactly is minimally invasive surgery? How does it compare to the traditional open surgery? ssm
Minimally invasive surgery is a surgical technique whereby small incisions and surgical cameras are used to perform operations. Laparoscopy and arthroscopy are examples of minimally invasive surgery. Rather than having one single, large incision, minimally invasive surgery sometimes requires only two small one-inch openings. Having a large incision in the traditional surgical approach gives the surgeon the ability to have a wide viewing field of the surgical site. In minimally invasive surgery, surgical telescopes with video cameras, which magnify the view from inside the body, guide us. The magnification of the telescope actually improves our vision, so that we can now see the surgical field in the minutest detail. Abnormalities that we were missing before are now being noticed. This has really helped increase the understanding of some disease processes.

What are the benefits of minimally invasive surgery? Are there any additional risks beyond what is normally associated with traditional surgery? ssm
The benefits of minimally invasive surgery in animals are very similar to those experienced by humans. Perhaps the most important benefit is a reduction in post-operative pain. When there is less pain, there is less of a need for pain medication and ultimately the recovery time is faster. We are also able to perform some pretty complex procedures and reduce some complications that come with a large surgical incision.

Some dogs, for example, are at risk for a condition called pericardial effusion, a collection of fluid around their heart. This can be fatal if not treated. In traditional open surgery, a ten to fifteen inch incision would be made and the dog’s ribs would be spread, cutting through multiple layers of muscle and tissue. Some of those muscles support walking and can result in a post-operative limp if damaged. The recovery period for this type of procedure can be at least a two or three day stay in the hospital after surgery to manage pain. With minimally invasive surgery, the patient is usually able to go home the next day.

The risks of minimally invasive surgery are similar to open surgery: anesthesia, medication reactions and bleeding. Infection is also still a risk, albeit a lesser one than with a traditional approach. There are some cases where an unexpected complication is encountered, and the surgeon has to convert to traditional surgery. It isn’t usually a major problem if this has to be done, but it is one of the risks.

Describe how a minimally invasive procedure is actually done. Are there certain procedures that are more appropriate for minimally invasive surgery than others? ssm
When performing minimally invasive surgery, the surgeon makes two one-inch incisions in the body. The surgical camera is then placed into one of the openings, and it transmits live images to a larger monitor or screen. The camera guides the field of vision and helps us to see where we are and what we are doing. The second opening is where the instruments are placed and maneuvered. It is really very simple. Once the procedure is done, the scope and the instruments are removed and a few stitches are used to close the two incisions. Sometimes two to three openings are needed for additional instruments.

Many procedures that have traditionally been done as open procedures can be performed using minimally invasive surgery. In fact, there are some circumstances where it is preferable to do so. In deep-chested or large breed dogs like Great Danes, for example, using minimally invasive surgery to perform a gastropexy (tacking of the stomach to prevent bloat) provides a much better outcome because of less post-operative pain. This can be performed at the same time that a female dog is spayed laparo-scopically, or a male dog is neutered. This is routinely performed in military dogs (such as German Shepherds) that are at increased risk for bloating. In open surgery, the incision alone can reach 18 inches. The risk of serious incision complications (dehiscing, or incision “failure”) rises with the increased length of an incision. Doberman Pinchers are a unique breed of dog where minimally invasive surgery provides an excellent alternative to open surgery for some procedures. Dobermans are very prone to bleeding, which makes traditional open surgery more risky. Being able to mitigate this risk using laparoscopic vessel sealing equipment allows us to perform many surgical procedures with much less risk of bleeding.

It seems that minimally invasive surgery has been around for a while in human medicine. We all know people who have had arthroscopic surgery for orthopedic conditions like an anterior cruciate ligament (ACL) tear in the knee, for example. Is minimally invasive surgery “new” for veterinary medicine? ssm
Surgeons at a number of veterinary schools started developing minimally invasive surgical techniques in the early to mid 1990’s. In the last seven years, however, there has been an explosion in usage, particularly in treating cats and dogs. Despite this surge in popularity, it isn’t always easy to find a veterinarian who offers it. Performing minimally invasive surgery requires specialized training beyond the traditional surgical training, and an investment in the necessary tools and equipment. The overhead for this equipment is very high, so it is difficult for most veterinarians to commit to the time and costs. I am happy that VCA South Shore has made it possible for my colleagues and for me to be able to offer this option to our patients.

What are some of the animal species and conditions that are being treated using minimally invasive surgery? ssm
I primarily use minimally invasive surgery in dogs and cats. In orthopedic cases, I frequently use the scope to treat conditions involving the elbow and shoulder. Common soft tissue applications include removal of urinary bladder stones, liver biopsies, and gastropexies. Spaying, and neutering cryptorchids (dogs with undescended testicles) are procedures that are also well suited for minimally invasive surgery—especially in large dogs and adult dogs. There are also some limited procedures that can be performed on birds and reptiles.

How does the cost of minimally invasive surgery compare to traditional open surgery? ssm
It depends. As I mentioned earlier, the cost savings potential for performing cardiothoracic surgery using the scope can be quite high since the recovery time is much shorter. Also, studies have shown that performing preventive gastropexies in large breed dogs is very cost effective. This is especially true for Great Danes. For other procedures like spaying, the actual cost of surgery may be slightly higher, but the benefit to the animal with regards to pain reduction and a faster recovery may well outweigh the difference in cost.