24 – Minimally Invasive Surgery Flashcards
**What are the advantages of minimally invasive surgery?
- Less tissue damage
- Short hospital stay
- Minimal post-operative pain
- Early return to work
- Low infection risk
- Better quality of observation
- Better cosmetics
**What are some disadvantages of minimally invasive surgery?
- Specialized institutions/referral hospitals
- Expensive equipment
- Laparoscopic training
- Increased operative time (learning curve)
Arthroscopy
- Replaced previous open arthrotomy techniques in horses
- Ex. osteochondral fractures (“chip fractures”)
- Ex. osteochondrosis (OCD)
- Ex. subchondral bone cysts (effusion in stifle)
- Ex. diagnostic exploratory
- Ex. assess fracture repair
Laparoscopy
- Provides alternatives to previous laparotomy techniques
- Standing or dorsal recumbency
Laparoscopy advantages
- Excellent quality of observation
- Insufflate abdomen with CO2 (pressure 8-16mmHg)
o Enter abdomen safely and allow proper visualization
Small intestinal surgery laparoscopy approach
- Standing RIGHT flank
- Neuroleptanalgesia
- 3 portal sites
Epiploic foramen
- Slit-like opening
- Marks omental bursa
- Located right dorsal abdomen
- Boarded by 2 organs (liver and pancreas)
- Boarded by 2 veins (vena cava and portal vein)
- *epiploic foramen entrapment
Disadvantages of dorsal recumbency
- Gotta go under GA
- Need to be in Trendelenburg position (30 degrees: head down position)
o Displaces viscera cranially (anesthesia does NOT like it)
What are some laparoscopic procedure examples?
- Cryptorchidetomy
- Ovariectomy
- Adhesiolysis
- Etc.
What are the approaches to equine cryptorchidism?
- Inguinal approach
- Parainguinal approach
- Paramedian approach
- Flank approach
Advantages of laparoscopy crytorchisim?
- Ease of location of testis
- Avoid paramedian incision or inguinal incisions
- Early return to exercise
When do you do a standing laparoscopic cryptorchidectomy?
- Unknown castration history
- Unilateral retained testis
- Bilateral retained testis
- *avoids GA: 12-24 hrs off feed (vs. 36hrs off feed with dorsal recumbency)
- *excellent visualization
- *minimal complications
What are NOT good candidates for a standing laparoscopic cryptorchidectomy?
- Foals
- Minatare horses
- Horses difficult to handle
Preoperative considerations for laparoscopic cryptorchidectomy?
- Palpation
- Ultrasound
- (anti-mullerian hormone test)
What are the indications for bilateral ovariectomy?
- Behavioural modification
- Sterilization
- Chronic visceral pain
What are the indications for unilateral ovariectomy?
- Ovarian tumor (granulosa cell tumor)
- Ovarian hematoma
- Ovarian abscess
What are the complications with traditional open approaches for ovariectomy?
- **Hemorrhage
- **Post-operative pain
- Incisional infections
- Incisional dehiscence
- Peritonitis
What are the advantages of standing laparoscopic ovariectomy?
- Excellent visibility
- Excellent access to ovaries
- Tension free laceration (‘hanging’)
- Secure hemostasis
- Avoid GA
Diagnostic laparoscopy: chronic and recurrent colic
- Can get serial intestinal biopsy
- Can do closure of nephrosplenic space
o Large dorsal colon entrapped: spleen, nephrosplenic ligament, left kidney
