Recent advancements in veterinary medicine have led to the development of many different minimally invasive surgical techniques. These exciting and innovative approaches offer significant advantages for veterinary practitioners and their patients. Minimally invasive surgeries (MIS) are being used more frequently in both human and veterinary operating theatres. Laparoscopy and arthroscopy in particular have become increasingly popular over the last decade. MIS is a rapidly evolving field of veterinary medicine.
This article will explore the benefits of MIS and the challenges faced by veterinary professionals. It will also discuss the common procedures performed and what the future may hold for this approach in small animal surgery.
What are the benefits of minimally invasive techniques?
MIS has many benefits compared to traditional open surgical approaches. There are advantages for both patients and veterinary staff. These include:
- Reduction in pain: smaller incisions mean there is usually less disruption of tissue and less discomfort in the post-operative period
- Quicker recovery times: MIS procedures usually result in faster healing times and a shorter stay in hospital, which, in turn, can lower stress for patients
- Minimise tissue disruption: less invasive operating procedures tend to minimise the disruption and damage to healthy tissue around the surgical site
- Less scarring: MIS techniques usually involve smaller incisions and less scarring of tissues internally and on the surface of the skin
- Improved visualisation: MIS techniques often allow for better visualisation with a magnified, well-lit view of the surgical site, which can enhance precision
- Reduction in surgical complications: the use of state-of-the-art equipment can decrease the incidence of bleeding and other complications, therefore making surgery safer
What challenges are presented by minimally invasive surgery?
While MIS techniques boast many benefits, there are also some disadvantages and things that need to be considered. For example, MIS techniques require specialist training and equipment, both of which are costly. This can be a significant investment for veterinary practices and clients alike.
In some cases, using MIS techniques can mean longer operating times as some complicated procedures may take longer than their traditional open surgery alternatives. Further, surgeons must always be prepared to convert an MIS operation into an open surgery should any complications arise. Therefore, owners must be briefed appropriately beforehand and understand the risks involved.
Because the skills required for MIS procedures necessitate a very specific skill set to ensure successful outcomes, all members of staff involved in the surgeries must be well trained in using the specialised equipment
Depending on the size of the animal, MIS may not be suitable. If there is not enough space for the camera and instruments to be inserted, traditional surgical techniques may be considered safer. Also, a high level of surgical skill and knowledge of anatomy is required to practise these techniques. The smaller working space may present challenges with the manipulation of instruments and visualisation. Magnification of the internal structures can cause confusion, and the use of MIS instruments means there is a lack of tactile feedback, which may reduce the accuracy of tissue recognition. Because the skills required for MIS procedures necessitate a very specific skill set to ensure successful outcomes, all members of staff involved in the surgeries must be well trained in using the specialised equipment.
Common minimally invasive procedures performed in veterinary medicine
There are various different soft tissue procedures that are being carried out more frequently. These include laparoscopy, thoracoscopy, cystoscopy and arthroscopy.
Laparoscopy
Laparoscopy is a minimally invasive surgery that offers an alternative approach to open surgery of the abdomen. Usually, several small incisions are made to allow for the insertion of the camera and instruments into the abdominal cavity. This allows the surgeon to visualise and manipulate internal organs to perform procedures and complete surgeries with exceptional detail.
Surgeries such as neutering female dogs, which are being carried out more frequently using laparoscopy, and prophylactic gastropexy procedures can be performed. Other uses include exploratory surgery to diagnose internal issues, obtaining biopsy samples for histological examination, removal of masses and removal of the gall bladder (cholecystectomy).
Thoracoscopy
Thoracoscopy is used for procedures in the chest cavity. Small incisions are made in the chest wall, which allow the surgeon to visualise inside the chest cavity, diagnose issues and perform surgical procedures.
Thoracotomy is frequently used for the diagnosis and treatment of pericardial disease and can be used for thoracic duct ligation. A commonly seen condition that can be treated with MIS is pericardial effusion. Traditionally, treatment of this condition involves a large incision through the breastbone to access the thoracic cavity and remove part of the pericardium. Thoracoscopy provides a much less invasive option for this procedure.
Cystoscopy
Cystoscopy is usually used as a diagnostic tool. It allows for evaluation and visualisation of the genital and lower urinary tracts. It can be helpful to screen for certain conditions and diseases. Often, certain conditions that cannot be detected or are missed on X-rays or ultrasound scans can be picked up during a cystoscopy exam. It is particularly useful in the work-up of recurrent urinary infections in dogs. In some circumstances, it can also be used to administer treatment.
Arthroscopy
Arthroscopy is used for the diagnosis and treatment of joint problems. It allows for close-up visualisation of the joint, making diagnosis more accurate for a variety of different conditions.
Arthroscopy is particularly useful for diagnosing and treating elbow and shoulder disease. A traditional approach to exposing these joints often involves cutting various tendons and muscles; arthroscopy offers a significant advantage as it enables better access and evaluation of the joint. It causes minimal discomfort compared to more traditional techniques and facilitates a much faster recovery time.
In the shoulder joint, conditions such as osteochondritis dissecans (OCD) and bicep tenosynovitis can be diagnosed and treated. Arthroscopy is also a valuable tool for taking biopsy samples of abnormal tissue within the shoulder joint. In the elbow joint, issues such as an ununited anconeal process, OCD of the medial humeral condyle, and fragmented medial coronoid process can be diagnosed and treated.
What factors influence the use of minimally invasive surgery?
More general practitioner vets are starting to get to grips with MIS. This rise is being driven by a few different things, including:
- An increase in demand for MIS from pet owners: nowadays, owners are more aware of the options available for their pets and want the best for their companions
- Training and CPD options: there is a growing availability of different training courses and CPD programmes for vets and other veterinary staff to embark on. The RCVS and other professional bodies actively promote the development and adoption of MIS techniques. The knock-on effect is that educating veterinary staff will enable them to carry out more MIS surgeries
- Continuing development: lots of exciting research studies continually exploring new applications of MIS for different procedures are being carried out by institutions worldwide. This will further expand its reach in small animal surgery
- More affordable and accessible equipment: as the techniques are used more widely, there is more opportunity for affordable and accessible equipment, for example second-hand instruments, meaning the cost may be reduced
Final thoughts
Minimally invasive surgery is transforming the landscape of small animal soft tissue surgery in a positive way. These innovative approaches offer significant advantages for both veterinary practitioners and their patients, paving the way for wider adoption and future advancements.
With the increased availability of training programmes and ongoing technological breakthroughs, MIS techniques are expected to be applicable to a much broader range of procedures
With the increased availability of training programmes and ongoing technological breakthroughs, MIS techniques are expected to be applicable to a much broader range of procedures. This will undoubtedly improve surgical outcomes for pets, enhance their overall well-being and usher in a new era of refined surgical practices in veterinary medicine.
