Referrals

Laparoscopic ovariectomy has several distinct advantages over tradition spay. The surgical time is typically decreased, there is less hemorrhage and risk of dropped pedicle, decreased postoperative pain, rapid return to preoperative activity, decreased postoperative ileus, and preserved immune function are among the benefits¹. 

Two small midline incisions are made, one for the camera, and the other for the instrumentation and removal of ovaries. These incisions are typically no longer than 1cm each and are closed with a resorbing intradermal suture. Only the ovaries are removed.

Animals who have had pyometra or uterine cancer are not ideal candidates for ovariectomy as they retain their risk for developing future uterine problems. Bitches that have not had these issues have no increased risk of developing them following the removal of the ovaries as hormones play a significant role in pyometra.

There are minor risks associated with laparoscopic OVE, with the main one being that if any bleeding is occurring within the visual field of the camera and cannot be identified and dealt with laparoscopically. In this case we will have to convert to an open procedure to ensure no major blood loss is occurring. This is very uncommon but should be discussed with clients prior to their appointment as a small possibility.

References:

1. Vet Res Forum. 2014 Summer; 5(3): 219–223.Comparison between two portal laparoscopy and open surgery for ovariectomy in dogs Elnaz Shariati,1 Jalal Bakhtiari,1,* Alireza Khalaj,2 and Amir Niasari-Naslaji1

Laparoscopic assisted gastropexy results in two small incisions (one on ventral midline caudal to umbilicus, and other oblique incision on right side caudal to last rib), as opposed to the larger midline incision required for traditional gastropexy.  This can be performed as an individual procedure or combined with an elective spay or neuter, both laparoscopic and traditional.

At Sackville Animal Hospital we are able to obtain laparoscopic biopsies of the liver and/or gross tumors within the abdominal cavity.  Biopsy of the liver is most common, and is an excellent way to obtain a large tissue sample with a minimally invasive technique.  This method is best to diagnose diffuse liver disease since a sample is taken from a caudal margin of a lobe, and if neoplasia within a lobe is suspected or was previously identified on ultrasound, then a core biopsy of that area is best.  We submit our liver samples to either Histovet for histological examination, or to Cornell University for full liver profiles analysis, including mineral analysis.

We are able to perform rhinoscopy for the purposes of image collection on cats and all sizes of dogs. Due to size limitations the scope used for small patients (approximately under 10kg) does not have a working channel that can accommodate the biopsy forceps, so our diagnostic capabilities are limited in these patients.

Indications

• Nasal discharge, unilateral or bilateral
• Suspicion of nasal/sinus tumor or polyps
• Sneezing
• Epistaxis

Procedure

We use a flexible endoscope to reach the caudal nasopharynx via the oral cavity. The majority of nasal/sinus tumors are present in this area and in larger patients we are able to biopsy these. Skull radiographs are an essential co-diagnostic tool when interpreting findings, and may be performed by the rDVM or done at our practice. In larger dogs we are also able to pass a small rigid scope into the nares, but due to the limited space and multiple chambers, this is often unrewarding, but can be useful in helping flush a particular area of the nasal cavity. 

We are able to use a combination of flushing to obtain culture and sensitivity or cytology samples, skull radiographs, direct visualization, and biopsy sampling, to reach a likely diagnosis in a large number of cases, but it should also be cautioned that in some cases the progression of disease is early and can yield unrewarding results. Occasionally these cases need several attempts throughout the disease progression in order to achieve a definitive diagnosis.

Contraindications/Complications

Patients with known bleeding disorders are not good candidates. A very common complication from rhinoscopy, and especially biopsy, is mild to moderate epistaxis for several days post-procedure. There is a small risk of patient asphyxiation on a blood clot post-procedure. Brachycephalic patients present the usual challenges, but can be especially difficult to image if their BAS is severe.

*We cannot perform gastrointestinal endoscopy on patients who have received barium and may have any residual barium within their GI tract as it is very damaging to the working channel of the scope

We use a flexible endoscope to retrieve esophageal and gastric foreign bodies in patients of all sizes.  We are unable to retrieve foreign bodies that have entered the duodenum or further into the GI tract.  A limitation of our cost estimation is that some foreign bodies can be difficult to remove and therefore require additional anesthetic time.  This can be very difficult to predict.  Patients should be fasted for 24 hours.

Risks

Depending on the size, shape, position, and severity of blockage, there are several risks that should be discussed with clients.  Esophageal foreign bodies in particular pose a risk of damage to the esophagus and should be treated with urgency.  The client should be warned of the potential for post-operative esophageal stricture, which may require numerous subsequent procedures of balloon dilation.  The prognosis decreases relative to stricture severity.

There is also the potential for failure of retrieval, in which case progression to gastrotomy will be offered when possible.  It should be determined prior to endoscopy whether the rDVM would like the patient returned to them for surgery, or whether SAH can and will perform the necessary surgery.  This is uncommon when there is a known gastric foreign body that has not entered the small intestine, but is fairly common when the patient has ingested a large amount of material, there is food within the stomach, or the foreign body has entered into the small intestine.  Since the scope cannot pass into the small intestine while a foreign body is blocking it to visualize where the foreign body ends, the risk of applying traction is too great and therefore is not attempted.

*We cannot perform gastrointestinal endoscopy on patients who have received barium and may have any residual barium within their GI tract as it is very damaging to the working channel of the scope

We use a flexible endoscope to examine the esophagus, lower esophageal sphincter, stomach, pyloric sphincter, proximal duodenum, and/or colon up to the ileocecal junction and cecum. Biopsies of these areas and further into the small intestine are possible due to the length of the biopsy forceps. We will typically aim to obtain 5-7 biopsies of stomach, small intestine, and/or colon and we send these samples to Histovet for interpretation. A very thorough history summary is useful and appreciated in order for us to provide this for the pathologist. Patients should be fasted for 24 hours for upper GI scoping, and 48 hours with enemas (see attached preparation document) for Colonoscopy. Survey abdominal radiographs are strongly recommended prior to referral.

Indications for Upper Endoscopy

• Chronic or acute vomiting
• Chronic bruxism
• Dysphagia
• Regurgitation
• Hematemesis
• Small bowel diarrhea
• Anorexia
• Suspicion of upper GI disease

Indications for Colonoscopy

• Tenesmus
• Hematechesia
• Melena
• Diarrhea
• Rectal mass removal

Contraindications and Complications

Severely debilitated patients are not ideal candidates and every effort should be made to stabilize patients and/or warn owners of risks. Where we are bringing these patients in as surgical patients and are not set up as an emergency hospital capable of providing extensive medical care to very debilitated or complicated cases, we will recommend these patients return to their rDVM or Metro Animal Emergency Clinic for further care when necessary.

A very rare risk is gastrointestinal perforation, especially in cases of advanced gastric neoplasia. The prognosis if this occurs is extremely guarded and will require transfer to MAEC and critical care.

*Occasionally a patient will have indications of both upper and lower GI issues.  In these cases it is recommended to have both upper and lower GI scoping performed to increase the diagnostic potential; these procedures can be performed at the same time with the appropriate preparation.

We use a small rigid scope to examine the vaginal vault, cervix, urethra, bladder, and ureteral orifices of female dogs over 5kg. Small urethroliths may be retrieved with this method. We are also able to use a small flexible scope for male dogs over 25kg, but may or may not be able to reach the bladder with this method. We are also unable to pass an instrument into the working channel of our small scope, so for this reason we do not recommend pursuing this diagnostic method in male dogs. We are able to biopsy the bladder mucosa. We are unable to perform this on cats.

Indications (Females)

• Hematuria
• Dysuria
• Pollakiuria
• Suspected urethrolith

Contraindications/Complications

Risk of urethral tear or bladder perforation, especially if underlying etiology is neoplasia. Patients who have complete urethral blockage and suspected uroliths WITHIN the bladder should have cystotomy performed as the limitations posed by the small instrument size would make this method of treatment too time consuming.

Dr. Kristina Hughes is also able to perform a wide range of additional surgeries:

• Lumpectomies, including areas requiring surgical flaps
• Ear canal ablation (NOT bulla osteotomy)
• Enucleation
• Third eyelid flap
• Cherry eye repair
• Perineal urethrostomy
• Perineal, inguinal, or umbilical hernia repair
• Limb amputation
• Cruciate repair using lateral imbrication
• Splenectomy using Ligasure
• Routine gastropexy
• Surgery on higher risk pets, including those with cardiac disease, or surgery where referral to specialist is cost-limiting factor.
• Comprehensive Oral Health Assessment and Treatment*

 *We use digital dental radiography. We do not offer root canal/crown repair at this time.