Welcome To Major Credit Seminar

Shahnawaz ahmad bhat

M.V.Sc student

Div. of surgery & radiology

Prospects and Constraints

of

Veterinary Laparoscopic Surgery

overview

Introduction. Instrumentation.Uses of laparoscopy.Why to use laparoscopy?Current status.Prospects.Constraints.Conclusion.

laparoscopy

An endoscopic procedure designed for the visual examination, surgical procedures and biopsy of the peritoneal cavity & its organs using specialized instrument called laparoscope.

Also called Minimally invasive surgery, Key hole surgery 0r Band-Aid surgery.

Done under general anesthesia or sedation & local infiltration.Anesthetic induction need same procedures as in conventional surgery viz. fasting(24-48hrs), water holding(8-12hrs) , preanesthesia & fluid administration.Ketamine-diazepam or xylazine are recommended for G.A.Isoflurane for avian laparoscopy.

1-1.5cm incisions used.Veress needle used for pneumoperitoneum.Needle placement checked by;

Hiss test

Aspiration test

Flow test

External evaluation.

Pressure maintained automatically by insufflators.Should be less than 15mm Hg.

Goats/sheep 8-10mm Hg

Dogs 10-12mm Hg

Horses 12-15mm Hg.

Gas flow rate 2 L/minute.

Gas selection transparent, colorless, non-explosive, inert, readily available, less absorbed & readily eliminated by lungs.Gases - carbon dioxide, nitrous oxide, filtered room air, helium , nitrogen , xenon & argon.

Instrumentation

Laparoscope(small animals 2.7-5mm & large animals 10mm).Light source(xenon & halogen).Fibreoptic cable.Digital video camera.Video capturing systems with floppy & CD.Medical grade colour monitor.

Veress needle for creating pneumoperitoneumAutomatic Carbon dioxide insufflators.Gas inflation tubing.Trocar & canulas( 10-12mm & 5-8mm).Laparoscopic scissors & grasping forceps.Electrocoagulators.Irrigation & aspiration systems.Endoclip forceps, endoclips & staples.

Image documentation system

Medical grade monitor

Insufflator, veress needle & insufflation tube

*

Laparoscopic forceps

Laparoscopic forceps

Biopsy forceps

Disposable laproscopic forceps

Laparoscopic scissors

*

Uses of laparoscopy

Diagnosis of diseases;

by biopsy i.e. histopathology.

by direct visualization of body cavities

and organs.

Surgical treatment of diseases.

Why to use laparoscopy?

Less post-operative morbidity/pain.Shorter hospital stay & recovery period.GIT functions rapidly returned to normal.Few intra-abdominal adhesionsLess contamination of surgical fieldLess invasiveStress indicators increase less & return to base value rapidly indicating less stress to animal.

Current status

surgical procedures;

Exploratory laparoscopy.Ovariohysterectomy.Ovariectomy.Vasectomy.Cholecystectomy.Inguinal, femoral, umbilical hernia repair.

Gastrostomy, Gastropexy & partial gastrectomy.Complex procedures like pyloromyotomy

& fundoplication.

Feeding tube jejunostomy, enterotomy.Small intestinal anastomosis.Colopexy, rectopexy & cystopexy.Laparoscopic splenectomy.Laparoscopic adrenalectomy.

Intestinal intussusception diagnosis & treatment in a dogs.

S.K.maiti et al 2004

Intra-abdominal vasectomy in dogs.Lap. Assisted tube cystectomy in goats.

N. Kumar et al 2006

Diagnostics;

Infertility; uterine deformities, tubal defect, endometritis, ovarian cystsChronic abdominal pain due to adhesions, endometriosisEctopic pregnancy- diagnosis & treatmentUrinary tract diseases.Neoplasia of liver, spleenAbdominal cryptorchidism Normal & abnormal anatomy of organs.

Diagnosis of intra-abdominal pathologies in canines.Laparoscopic liver biopsies through cauterization in small animals.

S.K.Maiti et al 2004

Future prospects
in
laparoscopic surgery

Sterilization of small animals

Common clinical practice in western

countries.

Both single port & 2 port techniques used.

Post surgical activity measured by

accelerometer;

25% decrease in LapOVE.

62% decrease in OOVE.

William T.N.Culp et al 2009

Equine surgery in standing condition

Cryptorchid castration.Inguinal hernia repair.Standing flank ovariectomy.Standing flank tubal ligation.Standing flank oviductal insemination.Laparoscopically guided per-rectal examination for teaching students.

Laparoscopic mesh incisional hernioplasty

in horses

8-16% horses affected after median celiotomy.

Open hernioplasty-seroma,wound or mesh infection, fistula & recurrence.

Laparoscopic mesh incisional hernioplasty

Less soft tissue trauma

Lower recurence rates

Good cosmetic result

J.P.Caron 2009

Laparoscopic embryo transfer

For genetically superior animals

Mares in athletic performance or unable to maintain pregnancy.

Done with a specially designed embryo transfer catheter.

Non-surgical method-50-60% success rate

Laparoscopic method-80-90% success rate.

Squires EL et al 1999

Laparoscope with a specialized embryo transfer catheter.

Laparoscopic ovum pick-up(LOPU)

For obtaining invitro fertilized zygotes in the production of transgenic goats or reproductive rescue of aged goats of high genetic value.

As a source of cytoplasm in nuclear transfer (NT) procedures.

Baldassarre H 2007

Prepubertal propagation of superior animals & transgenic cloned goats.

The pregnancy and transgenesis rates similar to the rates obtained when using in vivo-produced zygotes

Baldassarre H et al 2003

Gasless Laparoscopy in bovines

Diagnosis of traumatic reticuloperitonitis.

Diaphragmatic hernia.

Abomasopexy.

PIERRE-YVESMULON 2006

Laparoscopic artificial insemination

70-80 % success rate

Laparoscopic ultrasound(LUS)

Primary advantage of LUS - ability to image beyond tissue boundaries. Additionally, the ability to place the transducer directly against an organ allows the use of higher frequency devices which provide better resolution.Used for staging of neoplasm

LUS of normal liverLUS of gall bladder

Laparoscopy in radiology

Contrast radiographic studies of biliary tract (cholecystocholangiography) & urinary tract have become common technique.Contrast agent (Iohexol , Meglumine iodipamide) directly injected into gall bladder or urinary bladder under laparoscopic guidance.

Laparoscopic fetal surgery(fetoscopy)

Corrective procedures on fetus at a much earlier age when the wounds heal without scars.Fetuses treated for congenital conditions like cleft lips, obstructive uropathy, severe congenital diaphragmatic hernia etc.Successful operations performed in bitches, sows & ewes.

Roman M Sydorak 2001

MR-compatible laparoscope

In traditional procedures the surgeon exposes the whole operative site in order to interpret its broader anatomical context. video-guided MIS - lack of a wide field of view(FoV). Many Surgeons doubt that patient safety can be warranted using only a key hole perspective.

MR-compatible laparoscopy

Provides a wide FoV image of moderate

resolution.

In addition, the method provides high soft tissue contrast.

P.Gross et al 2001

Laparoscopic Surgical Robot (laprobot)

Lanfranco AR-2004

Robotic surgery has been touted as a solution to underdeveloped nations, whereby a single

central hospital can operate several remote machines at distant locations.

The potential for robotic surgery has strong military interest, providing mobile medical care while keeping trained doctors safe from battle.

Augmented reality technology

Allows a physician to see directly inside a patient, using augmented reality (AR). AR combines computer graphics with images of the real world. This uses laparoscopic range imaging, a video see-through head-mounted display (HMD), and a high-performance graphics computer to create live images that combine computer-generated imagery with the live video image of a patient.

CAPSULE ENDOSCOPY

Constraints

In

Laparoscopic surgery

Technical constraints

Anesthesia hypercapnia & acidosis.Veres needle & Trocar injury.Insufflation- subcut., periperitoneal, & subfacial emphysema.

Pnuemothorax, pnuemomediastinum & pnuemopericardium.

Gas embolism.Incisional hernias.Tumor implantation at trocar sites.Lack of tactile feedback.Loss of depth perception due to 2 dimensional view on monitor.Restricted range of motion & FoV.Electrosurgical burns.Time consuming.

Non-technical constraints.

Cost of equipment.Long procedural learning curve.High skill level needed.Lack of skilled assistance.Cumbersome maintenance of equipments.Lack of will from surgeons to use the technique.

Conclusion

With the development of skills, research and advancement in technology time is not far when laparoscopic surgery will replace many of the traditional surgical procedures in veterinary sciences as well like human field

"Someday in the future, people will look back at a regular surgical incision as something archaic and barbaric

Dr. Paul A. Wetter,

Chairman of the

Society of Laparoendoscopic Surgeons

USA