Endoscope and image-guided ventral bulla osteotomy in the dog: A cadaveric and patient study.

BACKGROUND: Surgery of the bulla in the dog can be difficult and associated with suboptimal resolution of disease and risk of complications, particularly in treatment of cholesteatoma. We explored use of image guidance and endoscopic assistance in ventral bulla osteotomy (VBO), initially with cadaveric studies and subsequently on dogs with cholesteatoma. METHODS: For surgical approach we used cone beam CT with an optical image navigation system. For endoscopic surgery we used 4 mm and 2.7 mm diameter endoscopes and a camera viewing system, with micro-instruments for dissection. RESULTS: Image guidance allowed us to accurately identify and approach the bulla in cadavers (n = 2) and patients (n = 2). The endoscope enabled us to define detailed endoscopic anatomy in cadaveric canine heads (n = 15), and in patients (n = 5) it enabled reliable and safe removal of pathological tissue. CONCLUSION: Image and endoscopic assistance could be a significant advance to the reliability and safety of VBO. Our techniques may be applicable to other indications and species.

Uso de cânula rígida com rosca e endoscópio flexível para videolaparoscopia de acesso único em equinos em estação / Use of threaded rigid cannula and flexible endoscope for single access video laparoscopy in standing horses

Com o objetivo de promover, por meio de acesso único e com o uso de endoscópio flexível, ampla exploração da cavidade peritoneal de equinos em estação, foi concebida uma cânula laparoscópica para dar sustentação ao endoscópio e possibilitar o acesso sob visualização. O procedimento foi realizado a partir da fossa paralombar. Após pequena incisão cutânea, o endoscópio foi inserido na cânula e os músculos e o peritônio foram divulsionados mediante rotação da cânula. Logo depois da perfuração do peritônio, foi realizada a exploração da cavidade e a identificação das estruturas. Em seguida à exploração do lado ipsilateral ao acesso, realizou-se a transposição do conjunto cânula/endoscópio ventralmente à porção caudal do cólon descendente, seguida de exploração do lado contralateral. Concluída a técnica, foi executado, para fins de comparação, o mesmo procedimento por meio da fossa paralombar contralateral. Foi possível a transposição do conjunto cânula/endoscópio para o lado contralateral ao acesso em todos os procedimentos. Também foi possível a identificação da maioria das estruturas abdominais tanto pelo acesso esquerdo quanto pelo direito. A abordagem por acesso único mostrou-se viável para a exploração ampla da cavidade peritoneal, demonstrando ser uma alternativa à técnica laparoscópica convencional.(AU)

A laparoscopic cannula was designed to support a single access approach with a flexible endoscope for the wide exploration of the peritoneal cavity of standing horses. It provides support to the endoscope and allows access to the peritoneal cavity with a visual aid. This procedure was performed through the paralumbar fossa. After a small cutaneous incision, the endoscope was inserted into the cannula, and the muscles and peritoneum were divulsed through the rotation of the cannula. After the peritoneal perforation, cavity exploration and identification of structures were performed. After the exploration of the ipsilateral side of the access, the cannula/endoscope was transposed ventrally to the caudal portion of the descending colon; this was followed by the exploration of the contralateral side. Once this process was completed, the same procedure was performed through the contralateral paralumbar fossa for comparison. It was possible to transpose the cannula/endoscope set to the contralateral access side in all procedures. Further, it was possible to identify most of the abdominal structures in both the left and right access. This single access approach proved to be feasible for the extensive exploration of the peritoneal cavity, thereby indicating it can be an alternative to the conventional laparoscopic technique.(AU)

Validation of a 2-mm videoendoscope for the evaluation of the paranasal sinuses with a minimally invasive technique.

OBJECTIVE: To describe the technique, experience, and limitations of using a 2-mm flexible endoscope to perform standing minimally invasive sinoscopy. STUDY DESIGN: In phases 1 and 2, we used cadaveric heads (ex vivo). In phase 3, we used unaffected horses (in vivo). ANIMALS: Five cadaveric equine skulls in phase 1 and 10 cadaveric equine skulls in phase 2. Six horses older than 5 years in phase 3. METHODS: In phase 1, the specimens were used to determine the suitability of the endoscope for sinoscopy and the ideal landmarks to approach the paranasal sinuses through minisinusotomies performed with a 14 gauge needle. In phase 2, a nonblinded evaluation of the visualization of the different sinus compartments was performed, and a score was attributed to each structure. Procedures were video recorded and compared with direct visualization of the sinuses after performing frontal and maxillary flaps. In phase 3, the technique was validated in healthy horses under sedation. RESULTS: The landmarks determined in phase 1 allowed a thorough exploration of the sinuses in phases 2 and 3. Sinoscopy findings were confirmed after direct visualization of the sinuses via frontal and maxillary bone flaps in phase 2. The procedure was well tolerated by all horses. CONCLUSION: Minimally invasive sinoscopy was readily performed without relevant complications in standing horses. A thorough evaluation of most sinus structures was obtained only using the frontal and the rostral maxillary portals. CLINICAL SIGNIFICANCE: Minimally invasive sinoscopy offers an alternative diagnostic tool to veterinarians. A specialized endoscope and appropriate training are required to perform this minimally invasive procedure.

Technological Advances in Endoscopic Equipment in Exotic Pet Medicine.

The aim of this article is to review some of the technological advances in endoscopy and endosurgery. The article focuses on a few key areas relevant to exotic pets, including advances in urolith management, visualization, and laparoscopic surgery.

Building an Oral Endoscope for Use in Equine Oral Examination and Treatment.

The use of oral endoscopy can be very beneficial in that it helps the clinician to perform a more thorough oral examination. However, due to the high cost, most commercially available equine oral endoscopy systems have been out of reach for clinicians who practice equine dentistry outside a large hospital setting. This article details how to set up an oral endoscopy system that can be used on equine patients either in an ambulatory practice or in a hospital setting. The system is more cost-effective than most other systems currently on the market without sacrificing functionality or image quality. The oral endoscope can be wirelessly integrated with a handheld tablet device or larger monitor for real-time viewing of images. It also has the ability to obtain high-resolution digital images and videos that can be easily incorporated into the patient's medical record. Incorporation of this system into equine practices has the potential to provide improved care for dental patients and to help overcome some of the inherent challenges of equine dentistry.

Evaluation of the economic and clinical feasibility of introducing rigid endoscopy and laparoscopy to a small animal general practice.

OBJECTIVE To evaluate the economic and clinical feasibility of introducing rigid endoscopy and laparoscopy to a small animal general practice. DESIGN Prospective study. SAMPLE A single 2-veterinarian small animal practice in southern California. PROCEDURES In early 2012, endoscopic equipment was purchased, and both veterinarians in the practice undertook training in rigid endoscopic and laparoscopic procedures. Subsequently, information for client-owned animals that underwent endoscopic and laparoscopic procedures during a 12-month period (2012 to 2013) was collected. Cost of equipment and training, revenue generated, specific procedures performed, surgery time, complications, and client satisfaction were evaluated. RESULTS 78 endoscopic procedures were performed in 73 patients, including 71 dogs, 1 cat, and 1 rabbit. Cost of endoscopic and laparoscopic equipment and training in the first year was $14,809.71; most equipment was financed through a 5-year lease at a total cost of $57,507.70 ($ 10,675.20/y). Total revenue generated in the first year was $50,423.63. The most common procedures performed were ovariectomy (OVE; n = 49), prophylactic gastropexy (6), and video otoscopy (12). Mean ± SD surgery times for OVE (n = 44) and for OVE with gastropexy (5) were 63.7 ± 19.7 minutes and 73.0 ± 33.5 minutes; respectively. Twelve of 54 patients undergoing laparoscopic procedures experienced minor intraoperative complications. Conversion to laparotomy was not required in any patient. There were no major complications. All 49 clients available for follow-up were satisfied. CONCLUSIONS AND CLINICAL RELEVANCE With appropriate training and equipment, incorporation of basic rigid endoscopy and laparoscopy may be feasible in small animal general practice. However, results of the present study are not applicable to all veterinarians and practice settings, and patient safety considerations should always be paramount.

Coelioscopic and Endoscope-Assisted Sterilization of Chelonians.

Elective sterilization is a safe and well-established surgical procedure performed in dogs and cats worldwide. Conversely, chelonian sterilization has been mostly performed therapeutically, because of the intricate anatomy and difficult access to the reproductive organs, and consequently, reproductive problems and diseases remain common. With the advance of veterinary endoscopy, novel techniques of soft tissue prefemoral coelioscopic and endoscope-assisted sterilization have been published, and preventative chelonian sterilization is now a reality. Nevertheless, extrapolations between species should be carefully considered, and further studies are warranted. This article summarizes and describes the current coelioscopic and coelioscope-assisted sterilization techniques for chelonia.

Training of upper respiratory endoscopy in the horse using preserved head and neck.

Endoscopy of the upper respiratory tract (URT) is one of the minimally invasive techniques used for diagnosis and treatment of diseases in horses. Training in the use of an endoscope follows an apprenticeship approach, with extensive practice needed to help achieve effective skills acquisition. The use of live animals for training presents the risk of injury to both the animal and the trainee. The increased number of students and practitioners, a shortage of facilities, and limited time available from expert clinicians add more challenges to the training process. In this work, we focused on the development of a preserved head and neck model that can be used as an effective training tool for training novices on the basics of upper respiratory endoscopy. The aim of the training is to become familiar with handling the endoscope and identification of the endoscopic depictions of normal anatomical structures encountered in the upper respiratory tract. Using the model, anatomical structures were clearly visible, recognized by their shape, architecture and topographical location. The model solved many of the aforementioned practical challenges, and has great potential as a replacement alternative to the use of live animals. There are opportunities for the application of such models intraining other clinical skills and for a variety of species.

Successful use of endoscopy for transcervical cannulation procedures in the goat.

Two methods for transcervical cannulation of the goat were evaluated during a contraception study in 15 adult female Nigerian dwarf and African pygmy goats. Twenty-four transcervical cannulation procedures were conducted in which seven females underwent the procedure 2-3 times. Initially, a rigid 4-mm stainless steel cannula and external light source were used in 19 procedures to introduce the contraceptive compound into the uterus. Placement of the cannula was directed by feel or depth assessment. Of seven females that were euthanized following this procedure, four evidenced complications including penetration of the cervix with the cannula and cervical damage. A 2-mm custom-made endoscope with a specially designed cannula was then used for the remaining five procedures. No complications were found. A single animal, that underwent the endoscopic procedure twice, was euthanized for study purposes and no abnormal findings of the reproductive tract were reported. The use of an endoscope resulted in better outcomes because the uterus could be visualized after traversing the cervix.

New techniques on the horizon: interventional radiology and interventional endoscopy of the urinary tract ('endourology').

PRACTICAL RELEVANCE: Interventional radiology and interventional endoscopy (IR/IE) uses contemporary imaging modalities, such as fluoroscopy and endoscopy, to perform diagnostic and therapeutic procedures in various body parts. The majority of IR/IE procedures currently undertaken in veterinary medicine pertain to the urinary tract, and this subspecialty has been termed 'endourology'. This technology treats diseases of the renal pelvis, ureter(s), bladder and urethra. In human medicine, endourology has overtaken traditional open urologic surgery in the past 20-30 years, and in veterinary medicine similar progress is occurring. AIM: This article presents a brief overview of some of the more common IR/IE procedures currently being performed for the treatment of urinary tract disease in veterinary patients. These techniques include percutaneous nephrolithotomy for lithotripsy of problematic nephrolithiasis, mesenchymal stem cell therapy for chronic kidney disease, sclerotherapy for the treatment of idiopathic renal hematuria, various diversion techniques for ureteral obstructions, laser lithotripsy for lower urinary tract stone disease, percutaneous cystolithotomy for removal of bladder stones, hydraulic occluder placement for refractory urinary incontinence, percutaneous cystostomy tube placement for bladder diversion, urethral stenting for benign and malignant urethral obstructions, and antegrade urethral catheterization for treatment of urethral tears. EVIDENCE BASE: The majority of the data presented in this article is solely the experience of the author, and some of this has only been published and/or presented in abstract form or small case series. For information on traditional surgical approaches to these ailments readers are encouraged to evaluate other sources.

Introduction to endoscopy in the cat: where to start? What to buy?

PRACTICAL RELEVANCE: For many years, endoscopy and minimally invasive surgery have been considered 'standard' in human healthcare. With the expansion of the used medical equipment market, and the falling cost of new equipment, veterinary practitioners are now starting to appreciate first-hand the benefits of performing endoscopic procedures: for example, vastly improved visualisation of the surgical site, reduced tissue trauma, minimal postoperative pain and faster recovery times, especially in feline patients. In addition, clients almost always choose a less invasive procedure if the capabilities are present, and will often consent to these procedures sooner than they would to conventional surgery. AIM: This article aims to guide the general feline practitioner towards a basic understanding of endoscopic and ancillary equipment, and in the direction of appropriate training required to perform routine endoscopic procedures. EVIDENCE BASE: The authors draw on information provided in a combination of published texts, articles, reviews and their own clinical experience to provide a practical information guide for the clinician interested in feline endoscopy.

Diode laser endoscopic cyclophotocoagulation in the normal equine eye.

OBJECTIVE: To determine the clinical and histologic effects of diode endoscopic cyclophotocoagulation (ECP) in the phakic equine eye. ANIMALS STUDIED: Phase I: 10 equine cadaver eyes. Phase II: four normal adult horses. PROCEDURES: Phase I: ECP probe angle of reach (AR) was determined. Multiple ECP energy levels: 0.75, 0.90, 1.05, 1.20, 1.35, 1.50 J, and the resulting visible and histologic ciliary process changes were evaluated. Phase II: Ocular quadrants were treated with ECP at 0.90, 1.14, 1.38 J, and a control. The contralateral eye underwent a sham operation. Tissue changes (clinical and histologic) were evaluated. RESULTS: Phase I: Mean combined AR was 162 ± 29 degrees. Mean visible tissue scores: 2.60 ± 0.58 (0.75 J) to 5.04 ± 0.30 (1.50 J) from possible total of 6. Tissue 'popping' was observed at 1.50 J. Histologic ciliary tissue damage was present at all settings. Phase II: Mean visible tissue scores: 2.90 ± 0.48 (0.90 J), 3.61 ± 0.57 (1.14 J), and 4.52 ± 0.56 (1.38 J). Tissue 'popping' was observed at 1.38 J. Histologic ciliary tissue damage was present at all settings. Clinical effects included acute inflammation, intraocular pressure reduction, cataract formation, corneal edema, corneal ulceration, and postoperative ocular hypertension. CONCLUSIONS: Diode ECP between 0.90 and 1.14 J is a potential treatment option for glaucoma in horses based on visible tissue effects and target ciliary epithelium damage. Iatrogenic cataract development may limit the use of an anterior chamber approach in phakic horses. Supported in part by an ACVO VAF grant.

Evaluation of transcervical insemination using frozen semen by flexible endoscope in dogs.

We evaluated transcervical insemination (TCI) using frozen semen by flexible endoscopy in dogs. Eight female and eight male beagles were used in this study. A flexible endoscope and a washing tube were used for TCI. A tracheal tube was used as an alternative to the penis and was an auxiliary for inserting the flexible endoscope. The mean time required to insert the washing tube into the external os of the uterus after inserting the endoscope into the tracheal tube was 7.5 min. Slight or mild pain was observed in all bitches during TCI. However, TCI could be easily performed with retention in all bitches and without sedation anesthesia. The tracheal tube was useful to ensure the visual field using air sufflation. Clinical signs suspicious of infection were not observed in any bitches from the TCI to the pregnancy diagnosis. The conception rate was 87.5%, and the mean number of fetuses was 6.3. TCI using a flexible endoscope in bitches was performed quickly with minimal invasiveness. We present a new method of TCI in dogs. This method should be studied in small and large breeds to obtain more detailed results.

Avian diagnostic endoscopy.

Unlike most animals, birds are blessed by an air sac system that essentially provides the endoscopist with a preinsufflated patient. Thanks to this unique anatomy and the pioneering work of Greg Harrison, Michael Taylor, and other avian veterinarians, rigid endoscopy has enjoyed considerable popularity in avian practice over the past 30 years. Indeed, endoscopy now is considered an essential component of the avian investigation for many clinical presentations, and indeed few could argue that high-quality avian medicine is possible without rigid endoscopy. The ability to examine the internal viscera, respiratory, gastrointestinal, and reproductive tracts, and collect samples for definitive diagnosis continues to play a central role in avian practice, and this article summarizes the most common diagnostic endoscopic approaches likely to be undertaken in companion species.

Equipment and instrumentation in veterinary endoscopy.

Endoscopic procedures are minimally invasive in nature, and have been found to decrease the postoperative stress response and postoperative pain compared with similar procedures performed by an open approach. There is an ongoing effort to make minimally invasive surgery even less invasive through research and the development of new and improved medical devices. This article provides a general overview of the necessary equipment and instrumentation that will assist practitioners in making decisions for the incorporation of endoscopy/endoscopic surgery into their practice.

Diagnostic rigid endoscopy: otoscopy, rhinoscopy, and cystoscopy.

Diagnostic examinations are markedly improved by using rigid endoscopy in the ear, nasal cavity, and urinary tract. This article presents the procedure, equipment, indications, and examples of abnormalities of rigid endoscopy in these areas. Textbooks, "hands-on" courses, and in-hospital training are methods for learning about these techniques and their applications. In addition to improving diagnostics, endoscopy can also be used for therapy in these three body areas.

Airway evaluation and flexible endoscopic procedures in dogs and cats: laryngoscopy, transtracheal wash, tracheobronchoscopy, and bronchoalveolar lavage.

Flexible endoscopy is a valuable diagnostic approach to the upper and lower respiratory tract, because it allows direct visualization and sample collection. Techniques requiring a range of specialized equipment and varying levels of experience have been developed to access and evaluate each anatomic region. Familiarity with appropriate indications for each procedure and normal appearance, cytology, and culture results from each region will enhance diagnostic success.

Dynamic respiratory endoscopy without treadmill in 68 performance Standardbred, Thoroughbred and saddle horses under natural training conditions.

REASONS FOR PERFORMING STUDY: High speed treadmill endoscopy provides a true assessment and diagnosis of the dynamic obstructions of the upper equine respiratory tract (DO-URT). However, treadmills do not always allow reproduction of the exact conditions of dynamic collapse of the URT. The availability of on-board endoscopes, which could be used without a treadmill, would make exercising endoscopy readily available to more equine practices. OBJECTIVES: To develop and validate an innovative endoscope which could be used for the examination of the URT at exercise in ridden and harnessed sport horses performing in natural conditions. METHODS: Authors worked closely with engineers of a company manufacturing veterinary endoscopes. Over a 2-year period several prototypes were tested on more than 20 cooperative horses performing either in trot, gallop, jumping or endurance. The final Dynamic Respiratory Scope (DRS) allows real-time visualisation of the URT and video recordings for post test reviewing and archiving. The DRS was then tested in 2 equine livery yards. Performance horses presented for investigation of abnormal respiratory noises at exercise and/or poor performance were subjected to exercising endoscopy. Endoscopic images of the URT were recorded and video recordings of the URT were reviewed post test. RESULTS: A total of 68 horses were examined: 39 harnessed Standardbred and 29 mounted horses (16 Thoroughbred and 13 saddle horses). Of these, 44 were diagnosed with a URT abnormality. Good quality videos were obtained even at maximum speed in all cases. The innovative insertion tube provided very stable images compared to those obtained with flexible video endoscopes on treadmills. CONCLUSIONS: This study validates the safety and the reliability of the DRS for imaging the equine URT during natural exercising conditions. POTENTIAL RELEVANCE: Most common causes of DO-URT can be diagnosed easily during any type of performance without a treadmill and the DRS offers a great potential for further URT clinical research.

Dynamic respiratory endoscopy in 67 Thoroughbred racehorses training under normal ridden exercise conditions.

REASONS FOR PERFORMING STUDY: There are potential advantages to imaging the upper portion of the respiratory tract (URT) of horses during ridden exercise. With the advent of a wireless endoscope, this is now possible. However, there has been no detailed validation of the technique and findings have not been compared to ridden speed. OBJECTIVES: To assess the combined use of a Dynamic Respiratory Scope (DRS) and global positioning system (GPS) receiver for examining the URT of a group of Thoroughbred racehorses randomly selected from a single flat racehorse training establishment. METHODS: Horses were selected randomly from a population of Thoroughbred horses in training at the same training yard. Endoscopic images of the URT were recorded during a ridden exercise test on an 'all-weather-gallop' and were reviewed post testing. Speed was measured using a wrist mounted GPS receiver. RESULTS: A total of 67 (34%) of the 195 horses in training were examined. Endoscopic findings included: normal URT function (44 cases); dorsal displacement of the soft palate (DDSP) (13 cases); laryngeal asymmetry (4 cases); and axial deviation of the aryepiglottic folds (3 cases). Maximum speed obtained by individual horses ranged from 41.8-56.3 km/h. Ridden speed was variably affected by DDSP. CONCLUSIONS: The DRS provides a safe effective system for imaging the equine URT during ridden exercise at speed. The abnormalities of the URT identified were similar to those observed during treadmill endoscopy studies reported in the literature. The effect of URT abnormalities on ridden speed requires further investigation. POTENTIAL RELEVANCE: This technique can be used to diagnose common causes of URT associated with poor performance in horses during normal training. This has substantial implications for future clinical diagnosis and treatment of URT pathology.