We have all have heard of someone, a friend or a family member, who underwent a surgical procedure and had an extended stay in hospital. I recall some 25 years ago when my grandmother was struck with acutely painful belly pains.
Her self-prescribed remedy of tonic water and a heating pad did not resolve it. In the end, she had emergency surgery to have her gall bladder removed, and was hospitalized for some two weeks. She returned, tired but glad to be home. Frequent visits by home nurses helped her care for the ten inch long abdominal incision that caused her considerable pain for months afterwards.
Fast forward to three years ago, my father experienced similar symptoms. His self-prescribed remedy of benign neglect and ‘thinking himself well’ was no more successful than my grandmother’s methods. His gall bladder also needed removed, however, the course of his surgical treatment was quite different. His was performed with minimally invasive surgery (MIS). He returned home from the hospital the day after the procedure, and had four small incisions arrayed on his belly in the shape of an umbrella. His gall bladder was removed laparoscopically, meaning that the surgeons made small holes through the wall of his abdomen and used special instruments that were guided into his body to do the work inside while the surgeon’s hands were manipulating these tools outside the belly.
This was fascinating. The amount of trauma to his belly was minimized, as was his discomfort, healing time, and most important, his recovery time in the hospital. He was treated as an outpatient and discharged the following day.
Minimally invasive surgery (MIS) is precisely that: Using a “hands-out-of-body-with-tools-inside-body” approach through small incision(s) to accomplish the same surgical procedure as traditional methods, being a “hands-in” approach requiring a larger incision to permit manual access.
Laparoscopy utilizes special telescopic cameras and long surgical instruments to replace the traditional open abdominal “laparotomy”. Several ports or holes are placed to allow the surgeon to easily access the surgical site. The abdominal cavity is also inflated with safe carbon dioxide gas to stretch and raise the muscular wall like a canopy to allow the surgeon to locate internal organs. The same MIS principles are used for surgery in or on the chest cavity and joints, respectively.
MIS has become the preferred method in the human surgical realm for many reasons, including hastened patient recovery, decreased post-operative trauma and pain and shorter recuperation time and hospital stays. Surveys (Tams et al (2011)) taken in the United States of human patients given the choice between a traditional surgery at a cheaper cost as compared to a more expensive MIS, people routinely responded that they do not want the traditional and would insist on the MIS procedure.” All of these same tools and surgical techniques are available in the veterinary profession for our four-legged friends, offering them the same benefits.
Nearly all surgical procedures that are performed inside your pet’s chest or abdomen can be done laparoscopically. Animals enjoy the same benefit as humans as far as proven reduced postoperative discomfort and hospitalization stays.
Elective procedures such as dog spays and abdominal cryptorchid neuters (dogs whose testicles are still in their bellies) can also be done laparoscopically, and these patients enjoy much faster and more comfortable postoperative recovery. Another advantage of MIS is that a camera is inserted into the body which magnifies the area being worked on. This magnification allows the internal organs to be seen in greater detail than with the naked eye. This is very useful for detecting tiny abnormalities, like tiny tumours, and for removing stones and polyps from inside the urinary bladder.
We are seeing increased interest by owners of deep chested dogs such as Great Danes and Irish Wolfhounds to have their dogs’ preventive gastropexy (surgical tack-down of the stomach to the abdominal wall to aid in the prevention of ‘bloat’) performed laparoscopically. Two recent such surgeries were performed at our hospital on Ben and Gideon, two Great Danes, allowing the patients to recover faster and be discharged later the same day.
We use MIS routinely for diagnostic purposes such as abdominal organ exploration, cancer staging, and collecting organ biopsies. Sophie, a 10 year old Kerry Blue Terrier, had a preventive ultrasound performed and her entire liver appeared extremely abnormal. Instead of a large abdominal incision, three small 1cm incisions were all that were needed to collect a dozen liver samples quickly and safely.
MIS is not perfect; there are some downsides. The cost of the equipment and single-use items can be cost prohibitive, which is the reason that many hospitals may not offer this service. Some procedures cannot be performed laparoscopically, such as removing very large abdominal tumours or emergency surgeries requiring “all hands on deck”. Last, a surgeon preferring traditional operating methods would miss the tactile feel of organs in his hands.
Like most new technologies there is a learning curve, and this is one I embrace and utilize. I encourage you to view laparoscopic videos available on Youtube; the advances that have been made in human and veterinary medical technologies are fascinating. Consider asking your veterinarian about the potential for MIS for your pet.
I am amazed at the pace of innovation and improvement in medical technology, and I am grateful that I can enjoy it in a profession I love. It’s the people and pets that drive me and my fellow veterinarians to do the best we can for the furry family members, and for the people who love them.
Dr. Jonathan Mitelman is a partner at VETSToronto & Kingston Road Animal Hospital in Toronto’s Beach Neighbourhood. The 24/7 hospital performs minimally invasive surgery and offers general practice and emergency, referrals, and continuous care around the clock.
Contact us: firstname.lastname@example.org or 416-690-0625.