Laparoscopic surgery allows veterinarians to perform traditional open surgical procedures using minimally invasive techniques. Advantages to laparoscopic surgery include smaller incisions, decreased post-operative pain, shorter hospitalization time, quicker recovery, and better visualization through magnification. Laparoscopy is useful in identifying metastatic lesions that are small, such as peritoneal lesions that are less than 5 mm, and are often missed using other imaging techniques.

 

Procedures may be divided into 2 major categories: diagnostic & therapeutic. Most commonly, diagnostic procedures involve exploration of the abdomen, biopsies, and cancer staging. Therapeutic procedures may include pexy procedures, foreign body removal, mass excision and more. Some procedures are more technically challenging than others and require more careful case selection and significant surgical experience. Other procedures may still be in the process of fine-tuning in order to improve outcome.

 

The following is a list of situations you may encounter with your patients and potential laparoscopic techniques you may consider recommending for diagnosis and/or treatment of those conditions.

 

Hepatic & Pancreatic System

Examination and biopsy of the liver is indicated when abnormal liver values or imaging findings are identified. Laparoscopic liver biopsy can be useful when diagnosing hepatitis, copper-associated liver disease, neoplasia, or microvascular dysplasia. In addition, the visualization provided via laparoscopy is useful when diagnosing inflammatory biliary disease in cats, pancreatitis, and performing cholecystocentesis to obtain samples for culture. In selected situations when a gallbladder mucocele is observed without signs of pathology (inflammation of the wall, rupture, enlargement or biliary obstruction), a laparoscopic cholecystectomy may be pursued. Pancreatic biopsies may also be obtained when diagnosing chronic pancreatis, neoplasia, or cysts.

 

Gastrointestinal System

Laparoscopic and laparoscopic-assisted procedures are available for exploration of the gastrointestinal tract as well as obtaining full-thickness biopsies, performing preventative gastropexies, and removing foreign bodies or neoplastic masses. It may also be useful for enterostomy tube placement in anorexic patients and has recently been described for colopexy in patients with recurrent rectal prolapse

 

Urogenital System

Kidney biopsies may be indicated, after ruling out coagulopathies, to determine the cause of renal proteinuria, diagnose renal neoplasia or confirm congenital renal disease. Magnification may be useful when examining the urinary bladder for removal of urinary calculi or polyps. Cystopexy may be pursued laparoscopically in cases where the urinary bladder is retroflexed within a perineal hernia or for a suspension procedure in cases of spay-associated incontinence after failure of medical management. Patients with prostatomegaly or prostatic cysts may be examined and biopsy performed to differentiate between benign prostatic hyperplasia and prostatic neoplasia. In addition to the routine ovariectomy / ovariohysterectomy procedures, laparoscopy is a great alternative when diagnosing and treating cryptorchidism and ovarian remnant syndrome.

 

Spleen

Splenic biopsies may be obtained to determine the underlying cause of diffuse splenomegaly. Laparoscopic splenectomies may be considered in select cases where the patient is stable, not actively hemorrhaging, and does not have massive splenomegaly or large mass lesions.

 

Lymph Nodes

Biopsy of the lymph nodes is indicated in cases with lymphadenopathy or suspected metastatic neoplasia with non-diagnostic aspirates. The lymph nodes most commonly biopsied in the abdomen include the sublumbar, mesenteric and hepatic nodes.

 

Adrenal Glands

Adrenalectomy has been performed laparoscopically; however, open laparotomy is often preferred because the procedure is challenging laparoscopically, requiring very specific case selection (small mass < 6 cm, no evidence of vena cava involvement) and a surgeon highly experienced in the procedure. Twenty-five percent of adrenal neoplasms invade the vena cava or phrenicoabdominal veins, precluding laparoscopic adrenalectomy. CT or MRI is recommended prior to surgical planning.

 

Contraindications to laparoscopic surgery are few but include very small patients, sepsis, major mass resections that require significant exposure, and patients with unstable cardiopulmonary disease because of the effects of pneumoperitoneum as pressure is increased on the diaphragm impeding spontaneous breathing. Also, patients that have significant renal disease causing uncontrolled metabolic or acid-base disturbance are discouraged from having laparoscopic procedures performed. Coagulopathies may be considered a contraindication, though the argument exists that the amount of hemorrhage from a biopsy is minimal and can be easily detected and usually controlled. Therefore a stable patient with a controlled coagulopathy may benefit from a smaller incision.

 

Veterinary surgeons are continuing to find new methods to decrease morbidity in our patients each day. At Alameda East Animal Hospital, we are proud to offer laparoscopic surgery and other minimally invasive techniques to our patients and clients. If you have additional questions regarding whether laparoscopy is possible and indicated for your patient, please call and speak with one of our surgeons.