1. Welcome To Major Credit
Seminar
Shahnawaz ahmad bhat
M.V.Sc student
Div. of surgery & radiology

2. Prospects and Constraints
of
Veterinary Laparoscopic Surgery

3. overview
• Introduction.
• Instrumentation.
• Uses of laparoscopy.
• Why to use laparoscopy?
• Current status.
• Prospects.
• Constraints.
• Conclusion.

4. laparoscopy
An endoscopic procedure designed for the
visual examination, surgical procedures
and biopsy of the peritoneal cavity & its
organs using specialized instrument called
laparoscope.
Also called Minimally invasive surgery, Key
hole surgery 0r Band-Aid surgery.

5. • Done under general anesthesia or
sedation & local infiltration.
• Anesthetic induction need same
procedures as in conventional surgery viz.
fasting(24-48hrs), water holding(8-12hrs) ,
preanesthesia & fluid administration.
• Ketamine-diazepam or xylazine are
recommended for G.A.
• Isoflurane for avian laparoscopy.

7. • 1-1.5cm incisions used.
• Veress needle used for
pneumoperitoneum.
• Needle placement checked by;
Hiss test
Aspiration test
Flow test
External evaluation.

8. • Pressure maintained automatically by
insufflators.
• Should be less than 15mm Hg.
Goats/sheep – 8-10mm Hg
Dogs – 10-12mm Hg
Horses – 12-15mm Hg.
Gas flow rate 2 L/minute.

9. • Gas selection – transparent, colorless,
non-explosive, inert, readily available, less
absorbed & readily eliminated by lungs.
• Gases - carbon dioxide, nitrous oxide,
filtered room air, helium , nitrogen , xenon
& argon.

10. Instrumentation
• Laparoscope(small animals 2.7-5mm &
large animals 10mm).
• Light source(xenon & halogen).
• Fibreoptic cable.
• Digital video camera.
• Video capturing systems with floppy & CD.
• Medical grade colour monitor.

11. • Veress needle for creating pneumoperitoneum
• Automatic Carbon dioxide insufflators.
• Gas inflation tubing.
• Trocar & canulas( 10-12mm & 5-8mm).
• Laparoscopic scissors & grasping forceps.
• Electrocoagulators.
• Irrigation & aspiration systems.
• Endoclip forceps, endoclips & staples.

16. Image documentation
system

18. Medical grade monitor

19. Insufflator, veress needle &
insufflation tube

20. Laparoscopic forceps

21. Laparoscopic forceps

22. Biopsy forceps

23. Disposable laproscopic forceps

24. Laparoscopic scissors

27. Uses of laparoscopy
Diagnosis of diseases;
by biopsy i.e. histopathology.
by direct visualization of body cavities
and organs.
Surgical treatment of diseases.

28. Why to use laparoscopy?
• Less post-operative morbidity/pain.
• Shorter hospital stay & recovery period.
• GIT functions rapidly returned to normal.
• Few intra-abdominal adhesions
• Less contamination of surgical field
• Less invasive
• Stress indicators increase less & return to
base value rapidly indicating less stress to
animal.

29. Current status
surgical procedures;
• Exploratory laparoscopy.
• Ovariohysterectomy.
• Ovariectomy.
• Vasectomy.
• Cholecystectomy.
• Inguinal, femoral, umbilical hernia repair.

30. • Gastrostomy, Gastropexy & partial
gastrectomy.
• Complex procedures like pyloromyotomy
& fundoplication.
• Feeding tube jejunostomy, enterotomy.
• Small intestinal anastomosis.
• Colopexy, rectopexy & cystopexy.
• Laparoscopic splenectomy.
• Laparoscopic adrenalectomy.

31. • Intestinal intussusception diagnosis &
treatment in a dogs.
S.K.maiti et al 2004
• Intra-abdominal vasectomy in dogs.
• Lap. Assisted tube cystectomy in goats.
N. Kumar et al 2006

32. Diagnostics;
• Infertility; uterine deformities, tubal defect,
endometritis, ovarian cysts
• Chronic abdominal pain due to adhesions,
endometriosis
• Ectopic pregnancy- diagnosis & treatment
• Urinary tract diseases.
• Neoplasia of liver, spleen
• Abdominal cryptorchidism
• Normal & abnormal anatomy of organs.

33. • Diagnosis of intra-abdominal pathologies
in canines.
• Laparoscopic liver biopsies through
cauterization in small animals.
S.K.Maiti et al 2004

34. Future prospects
in
laparoscopic surgery

35. Sterilization of small animals
 Common clinical practice in western
countries.
 Both single port & 2 port techniques used.
 Post surgical activity measured by
accelerometer;
25% decrease in LapOVE.
62% decrease in OOVE.
William T.N.Culp et al 2009

36. Equine surgery in standing condition

37. • Cryptorchid castration.
• Inguinal hernia repair.
• Standing flank ovariectomy.
• Standing flank tubal ligation.
• Standing flank oviductal insemination.
• Laparoscopically guided per-rectal
examination for teaching students.

38. Laparoscopic mesh incisional hernioplasty
in horses
 8-16% horses affected after median celiotomy.
 Open hernioplasty-seroma,wound or mesh
infection, fistula & recurrence.
 Laparoscopic mesh incisional hernioplasty
Less soft tissue trauma
Lower recurence rates
Good cosmetic result
J.P.Caron 2009

39. Laparoscopic embryo transfer
 For genetically superior animals
 Mares in athletic performance or unable to
maintain pregnancy.
 Done with a specially designed embryo transfer
catheter.
 Non-surgical method-50-60% success rate
 Laparoscopic method-80-90% success rate.
Squires EL et al 1999

40. Laparoscope with a specialized embryo transfer
catheter.

41. Laparoscopic ovum pick-up(LOPU)
 For obtaining invitro fertilized zygotes in the
production of transgenic goats or reproductive
rescue of aged goats of high genetic value.
 As a source of cytoplasm in nuclear transfer (NT)
procedures.
Baldassarre H 2007

42. Prepubertal propagation of superior
animals & transgenic cloned goats.
The pregnancy and transgenesis rates
similar to the rates obtained when using in
vivo-produced zygotes
Baldassarre H et al 2003

43. Gasless Laparoscopy in bovines
Diagnosis of traumatic reticuloperitonitis.
Diaphragmatic hernia.
Abomasopexy.
PIERRE-YVESMULON 2006

44. Laparoscopic artificial insemination
70-80 % success rate

45. Laparoscopic ultrasound(LUS)

46. • Primary advantage of LUS - ability to image
beyond tissue boundaries.
• Additionally, the ability to place the transducer
directly against an organ allows the use of
higher frequency devices which provide better
resolution.
• Used for staging of neoplasm

47. LUS of normal liver
LUS of gall bladder

48. Laparoscopy in radiology
• Contrast radiographic studies of biliary
tract (cholecystocholangiography) & urinary tract
have become common technique.
• Contrast agent (Iohexol , Meglumine
iodipamide) directly injected into gall
bladder or urinary bladder under
laparoscopic guidance.

49. Laparoscopic fetal surgery(fetoscopy)
• Corrective procedures on fetus at a much
earlier age when the wounds heal without
scars.
• Fetuses treated for congenital conditions
like cleft lips, obstructive uropathy, severe
congenital diaphragmatic hernia etc.
• Successful operations performed in
bitches, sows & ewes.
Roman M Sydorak 2001

50. MR-compatible laparoscope
• In traditional procedures the surgeon exposes
the whole operative site in order to interpret its
broader anatomical context.
• video-guided MIS - lack of a wide field of
view(FoV).
• Many Surgeons doubt that patient safety can be
warranted using only a key hole perspective.

51. MR-compatible laparoscopy

52. • Provides a wide FoV image of moderate
resolution.
• In addition, the method provides high soft
tissue contrast.
P.Gross et al 2001

53. Laparoscopic Surgical Robot (laprobot)
Lanfranco AR-2004

56. • Robotic surgery has been touted as a solution to
underdeveloped nations, whereby a single
central hospital can operate several remote
machines at distant locations.
• The potential for robotic surgery has strong
military interest, providing mobile medical care
while keeping trained doctors safe from battle.

57. Augmented reality technology

60. • Allows a physician to see directly inside a
patient, using augmented reality (AR).
• AR combines computer graphics with images
of the real world. This uses laparoscopic
range imaging, a video see-through head-
mounted display (HMD), and a high-
performance graphics computer to create live
images that combine computer-generated
imagery with the live video image of a patient.

61. CAPSULE ENDOSCOPY

63. Constraints
In
Laparoscopic surgery

64. Technical constraints
• Anesthesia –hypercapnia & acidosis.
• Veres needle & Trocar injury.
• Insufflation- subcut., periperitoneal, &
subfacial emphysema.
Pnuemothorax, pnuemomediastinum &
pnuemopericardium.

65. • Gas embolism.
• Incisional hernias.
• Tumor implantation at trocar sites.
• Lack of tactile feedback.
• Loss of depth perception due to 2
dimensional view on monitor.
• Restricted range of motion & FoV.
• Electrosurgical burns.
• Time consuming.

66. Non-technical constraints.
• Cost of equipment.
• Long procedural learning curve.
• High skill level needed.
• Lack of skilled assistance.
• Cumbersome maintenance of equipments.
• Lack of will from surgeons to use the
technique.

67. Conclusion

68. With the development of skills,
research and advancement in
technology time is not far when
laparoscopic surgery will replace many
of the traditional surgical procedures in
veterinary sciences as well like human
field

69. "Someday in the future, people will look
back at a regular surgical incision as
something archaic and barbaric’’
Dr. Paul A. Wetter,
Chairman of the
Society of Laparoendoscopic Surgeons
USA