Laparoscopic surgery: cutting edge: smaller incisions mean less pain and a shorter recovery time for your dog.
In the past, this was the typical scenario for all exploratory surgeries in the abdominal region of a dog's body. Today, with advances in veterinary medicine, veterinarians have access to a revolutionary surgical technique called laparoscopy--a minimally invasive medical procedure that is being used with increasing frequency for a variety of diagnostic and surgical purposes.
The technology is a giant step forward for the veterinary surgical field, according to James Flanders, DVM, an associate professor of surgery at Cornell University's College of Veterinary Medicine. "Traditionally, veterinarians would perform an "open" surgery, where we make a large, mid-line incision in the abdomen in order to look inside and do whatever we need to do, whether it's to take a biopsy of the liver or to remove bladder stones. Now, with the laparoscope, we only need to a few small incisions (each one about 1/2-inch in length). Because the incisions are so tiny, the animal experiences far less post-operative pain and recovers faster."
Tools of the Trade
The laparoscope--which literally means "in the lap"--consists of a tube and an attached camera that allows a surgeon a detailed interior view of a dog's body. The images of the abdominal cavity are projected onto a television monitor, which is positioned next to the operating table.
In addition to the tube and monitor, several other instruments are used and each one is threaded through a separate port (incision). The xenon light, for instance, is a powerful cold light source that illuminates the area under inspection, while a variety of specialized tools such as laparoscopic scissors, clamps, and a suction device allow the surgeon to perform a multitude of procedures. Another necessary tool for laparoscopy is carbon dioxide gas, which is used to insufflate the abdominal cavity.
"If we didn't inflate the abdomen," notes Dr. Flanders, "we really wouldn't be able to see much at all because the organs normally push right up against the abdominal wall. Laparoscopists realized long ago that it was necessary to inflate the abdomen and it turns out that carbon dioxide, a non-toxic and inexpensive gas, worked well for their purposes."
The laparoscope is commonly used to perform liver biopsies and to detect abdominal abnormalities such as tumors or cancerous growths. The instrument also can be used to spay a female animal, remove bladder stones or a diseased gallbladder, or to prevent gastric dilatation volvulus (GDV) or "bloat." Many giant breed dogs such as the Newfoundland and Great Dane are predisposed to GDV, which is a painful and life-threatening twisting of the stomach caused when the stomach fills up with air and puts pressure on the other organs and diaphragm.
"Bloat is usually treated by what is called a gastropexy procedure, where a surgeon makes a large incision and then anchors the stomach within the abdomen so it can no longer twist," says Dr. Flanders.
Gastropexy is considered a serious surgery, but, as Dr. Flanders points out, the procedure can be performed laparoscopically. "Many veterinarians are now recommending that giant breed dogs undergo a prophylactic (preventative) laparoscopic gastroplexy procedure, so the dog is never at risk for the condition," he says. The procedure can be performed at the time a dog is spayed, or at any time."
Low Risk Procedure
Laparoscopic procedures are considered very safe and pose little risk to the patient. It should be noted, however, that all animals that undergo a laparoscopic surgery are placed on a ventilator. The reason? When the abdomen is inflated with carbon dioxide, it pushes on the diaphragm--a layer of muscles responsible for respiration--and an animal cannot breathe on his own. A ventilator will do all the breathing for the animal during surgery. When the procedure is complete, the surgeon opens up one of the ports and discharges the gas, much like the air is released from a balloon.
Although it's uncommon for complications to develop during a laparoscopic surgery, surgeons must always be prepared for something unexpected to occur.
"We are always cognizant of the fact that we might have to go in and open up the abdomen to take care of a problem," cautions Dr. Flanders. "For instance, a dog may begin bleeding, although that's unusual. We have cauterizing ports to stem the flow of blood as well as grasping forceps and clips, so we can normally stop the flow before it becomes a big problem."
Although laparoscopy is not as widely used in veterinary medicine as it is in human medicine, it is gaining in popularity among veterinary surgeons--especially board-certified surgical specialists. Dr. Flanders estimates that, today, at least 50 percent of veterinary surgical specialty practices are performing laparoscopic procedures, although the percentage is lower among general practitioners. One reason is the expense of the equipment. Depending on the number of add-on devices purchased, a laparoscopic machine can cost upwards of $30,000, which is out of reach for many small veterinary practices.
With that said, Dr. Flanders estimates that more and more veterinarians will begin using the laparoscope in the coming years. "Laparoscopic surgery will be driven by client requests," he says. "If more and more clients request this type of procedure for their dog, then veterinarians will have to comply or risk losing business. The future of this technology is still unfolding. In the next five to 10 years, I'm sure we'll see big, big changes."