Shrinking Surgeries: The Advantages of Minimally Invasive Endoscopic Procedures

Endoscopy is a fantastic, minimally invasive tool that is now widely used throughout the veterinary field, both in small- and large animal medicine. You may or may not have access to endoscopy in your current veterinary clinic but even so, it is really handy to know when to reach or refer for this modality!

What is endoscopy?

Let’s begin by reviewing how endoscopy actually works. Endoscopes are often described as “cameras'' which are used to view internal organs.

In reality, of course, we do not routinely place a camera into the patient; instead, we use an optical waveguide, typically in the form of fiber optics, which transmits light from the insertion tube and umbilical cord into the patient. The reflected light is sent back to the processor for image visualization

These optical devices rely on the principle of total internal reflection, a phenomenon whereby light can be reflected continually along an optical fiber or rod lens. The image can then either be viewed directly or projected onto a camera and displayed on a screen (as is increasingly common). 

There are two major types of endoscope: rigid vs flexible

These are selected based on the area of interest. For example, if you wanted to examine the colon, bronchioles, oesophagus, or stomach then you would opt to use the flexible endoscope.

Flexible endoscopes are made up of moveable and easy-to-manipulate insertion tubes, containing one or more bundles of optical fibers.

Whereas fixed rigid endoscopes are better suited to procedures such as arthroscopy and laparoscopy, and comprise a steel sheath containing delicate rod lenses.

In either case, the insertion tube must be connected to an umbilical cord, which supplies light (it’s dark inside a patient, remember!), distilled water (for cleaning the lens), and in many cases the camera mount and other mechanisms.

In the case of flexible endoscopes, there will usually also be a handpiece on the end of the insertion tube that mounts the control wheels, for lateral and vertical flexion and extension of the scope. In many scopes, there is an instrument channel through which instruments can be passed such as surgical instruments, biopsy forceps, or grasping instruments.

The benefits:

There are many benefits of endoscopy in small animal procedures in particular which can enhance your clinical practice, improve patient outcomes, and reduce the requirements for referral to alternative or secondary providers.

Diagnostics:

Endoscopy is now a well-recognized diagnostic tool in the management of gastrointestinal disorders in dogs and cats (Rychlik and Kaczmar, 2020). Endoscopy and endoscopically guided biopsy have a high sensitivity to diagnosing mucosal disorders within the gastrointestinal tract.

Additionally, the endoscopic biopsy of the intestine is regarded as the gold standard in the diagnosis of IBD in dogs and cats in veterinary hospitals (Rychlik et al, 2007).

As well as gastrointestinal diseases being explored via endoscopy, the respiratory system can also be explored in this way too.

Rhinoscopy, bronchoscopy, and tracheostomy can all be performed to investigate pathology associated with these areas. Focusing on rhinoscopy, this technique allows direct visualization of the nasal mucosa, allowing samples to be obtained in a less traumatic way than direct surgery.

This is particularly relevant when nasal masses are present and require diagnosis (neoplasm or mycosis, for example)  or where tumors require staging with minimal destruction of the overlying bony structures. 

Minimally invasive surgery:

Whatever it is used for, endoscopy is always described as ‘minimally invasive.’ This is due to the small incision size and minimal exposure of the body cavity.

Consequently, because of the smaller surgical wounds with endoscopy compared to conventional surgical approaches, the healing process is quicker than with traditional surgical wounds.

Quicker healing times are of particular importance in dogs with working, competition or service duties, because of their rapid return to normal function. 

Many clinics are now offering laparoscopic (keyhole) ovariohysterectomies or ovariectomies as an alternative to the traditional ventral median celiotomy technique.

As stated above, this spay technique is not only less invasive but it has also been associated with fewer postoperative complications (William et al, 2009).

Post-operative pain scores in dogs were found to be significantly higher in cases using the traditional technique versus the laparoscopic technique (Devitt et al, 2005). Other surgeries which can now be performed via endoscopy include gastropexy, cryptorchidectomy, and abdominal organ biopsy. 

Foreign bodies:

Unfortunately, as we are all well aware, foreign bodies are common presentations in small animal practices. Whether endoscopy can be offered is dependent on the nature of the foreign body and its location within the gastrointestinal tract.

Endoscopy is currently the superior treatment of choice for the majority of gastric or oesophageal foreign bodies (Poggiani et al, 2020). Without the aid of endoscopy, in most circumstances, the alternative option is invasive surgery to physically remove the foreign object.

Endoscopy is greatly beneficial in the majority of these cases because it offers a less invasive and less costly option to the pet owner.

Additionally, endoscopy is associated with a much shorter hospitalization time which is beneficial for the patient. 

To summarise, endoscopy has many benefits in small animal Veterinary medicine.

Whether you’re already a pro at endoscopy or a budding novice endoscopist, the movement is happening, and it is becoming widely available within the veterinary field worldwide. 

Advancing Veterinary surgery: Exploring the benefits of endoscopes in small animal procedures

References

Devitt, C, M. Cox, R, E. Hailey, J, J. 2005. Duration, complications, stress and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs. Journal of American Veterinary Medicine Association. 227: 921- 927. 

Rychlik, A. Kaczmar, E. 2020. Endoscopic biopsies and histopathological findings in diagnosing chronic gastrointestinal disorders in dogs and cats. Vet Med Int. 9. Rychlik and Kaczmar

Rychlik, A. Nieradka, R. Kander, M. Depta, A. Nowicki, M. Sarti, K. 2007. Usefulness of endoscopic examination for the diagnosis of inflammatory bowel disease in the dog. Polish Journal of Veterinary Sciences. 10: 113-118. 

Poggiani, F, M. Duarte, R, P. Santana, M, S. Galera, P, D. 2020. Endoscopic removal of foreign body in upper gastrointestinal tract in dogs: Success rate and complications. Sci Vet. 48: 1735.

William, T, N, C. Mayhew, P, D. Brown, D, C. 2009. The effect of laparoscopic versus open ovariectomy on postsurgical activity in small dogs. Veterinary Surgeon. 38: 811-817.