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Dr. Jim Perry, oncologist

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February 2011, Issue 28

What's New at AMVSWe are pleased to announce that our first Continuing Education (CE) class of 2011 (The Orthopedic Exam: A Hands on Experience) was quite a success!

Not only was there a great turn out, but everyone involved enjoyed the material presented and the interactive lab that followed.

Please join us for our next CE on Thursday March 3 at AMVS (104 S. Main St., Longmont),presented by our oncologist, Dr. Jim Perry. The topic is Lymphoma: Current Management Protocols.

Registration, appetizers and drinks are at 6:30 p.m. with thelecture following from 7-8 p.m.

Space is limited and reserved for veterinarians only. Technicianspecific topics will be announced at a later time.

Please R.S.V.P. by Monday, Feb. 28 to 303-678-8844.

We look forward to seeing you there!

Laparoscopy: Benefits and when it can be used

In This Issue

What's New at AMVS

Laparoscopy

Archives of our past newsletters

containing timely and useful medical information are on

our website.

In addition to our regular ER hours,

AMVS is providing emergency and

critical care services

to your patients:

of 4News from Aspen Meadow Veterinary Specialists

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Dr. Trent Gall

by Trent Gall, DVM, Orthopedic SurgeonLaparoscopy is a minimally-invasive way to perform diagnostics and some abdominalprocedures. Laparoscopy can be used to perform prophylactic gastropexies, performovariohysterectomy and ovariectomy, cryptorchidsurgery and assist in feeding tube placement and assist in cystotomies. It can also be used for more advanced procedures such as adrenalectomies and cholecystecomies. Laparoscopy can be used to obtain liver biopsies, pancreatic biopsies, kidney biopsies, lymph node

biopsies and assist in obtaining intestinal biopsies and can aid in staging neoplasia. Laparoscopic biopsies have ahigher diagnostic accuracy than percutaneous fine needle aspirates. Patients recover from laparoscopy quicker thanlaparotomies.

Laparoscopy is a minimally invasive technique to view the internal organs and struct-res in the abdominal cavity and perform many diagnostic and therapeutic procedures in our small animal patients. The procedure involvesdistending the abdominal cavity with a gas (the most commonly used gas is carbon dioxide). Next, a rigid scope (laparoscope) is inserted into portals that are placed in various regions of the abdominal wall. The procedure(s) of choice is then performed using various instruments such as biopsy forceps or other surgical instruments through theportals.

Some of the more common laparoscopic surgeries that can be performed are: laparoscopic gastropexies or laparoscopic assisted gastropexies, ovariohysterectomies, ovariectomies, and cryptorchid surgery. Laparoscopic assisted gastropexies are more common than truelaparoscopic gastropexies. These procedures are easy to perform, have minimal complications and are minimally invasive. Prophylactic gastropexies can be performed in tandem with a spay or neuter procedures. Another surgical procedure in which laparoscopy can used is when placing a gastrotomy or jejunostomy feeding tube. When doing multiple laparoscopic procedures, this should be the lastprocedure performed because it results in the abdominal cavity becoming deflated. Other surgical techniques that are becoming more widely practiced are laparoscopic adrenalectomies in select cases as well as cholecystectomies in select cases.

One of the most utilized procedures using laparoscopy is performing biopsies. The biopsy samples obtained via this

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method can be larger than those obtained via percutaneous fine needle aspirates. Additionally, one can visualize normal and abnormal tissue sections from which to sample. The diagnostic accuracy of laparoscopic biopsies is greater than that of fine needle aspirates. Liver biopsies are obtained using a 5-mm oval cup biopsy forcep. It is recommended to obtain 3-5 samples from both normal and abnormal sections of the liver. Once the biopsy samples are taken, the sites are observed for bleeding. Thebleeding can be stopped with direct pressure by using a palpation probe or by placing a piece of saline-soaked Gel Foam (a hemostatic agent) directly on the biopsy site using laparoscopic forceps. Other biopsy samples that can be taken via laparoscopy include: pancreatic biopsies,kidney Tru-Cut biopsies, lymph node biopsies, andcholecystocentesis (for cytology and culture). The benefits of performing these biopsies using laparoscopy include direct visualization (thereby avoiding vascular areas), the capability to sample normal and abnormal tissues, achieving diagnostic accuracy by obtaining larger samples, and by having a direct means of controlling hemorrhage.

nother biopsy technique is laparoscopic assisted intestinal biopsies. As when placing a gastrotomy or jejunostomy feeding tube, this must be performed as the last laparoscopic procedure due to deflation of the abdomen. Atraumatic forceps are used to isolate aloop of intestine and then the incision by the portal is lengthened and that loop of bowel is exteriorized. Then full thickness intestinalbiopsies can be obtained and then closed in a routine fashion. Again, there is more diagnostic accuracy by obtaining full thickness biopsies as compared to partial thickness biopsies that are obtained via endoscopy.

Laparoscopy is also very useful for staging neoplasia. Small abdominal wall, other organ, or diaphragmatic metastases (0.5 cm or less) can be seen since the scope has magnification capabilities. Other modalities, such as ultrasound imaging, might miss these small lesions, potentially leading to a less favorable prognosis. Another benefit of laparoscopy is that tumor biopsies and suspect metastasis can be obtained more easily.

Several recent studies have compared traditionalovariohysterectomies versus ovariectomies (which have been performed in Europe for many years). According to



these studies there was no difference in complication rate, incidence of stump pyometra, metritis, or neoplasia between the two groups. The studies concluded that there was no difference between the surgical procedures when the uterus looked grossly normal.

Laparoscopy carries a very low complication rate, less than 2%, which is less than that of laparotomies. The potentialcomplications include: anesthesia related problems, vascular injury to abdominal wall or organs, subcutaneous emphysema, peritoneal tenting, pneumothorax, gas embolism, operative complications, bleeding, tissue injury, technical problems, lack of experience and equipmentproblems. Other contraindications for laparoscopy include ascites and abnormal bleeding times.

Laparoscopy is a minimally-invasive technique of obtaining surgical biopsies and performing select surgical procedures. Once the basic technique is mastered, laparoscopy is a very useful tool that can be used to help diagnose and treat our small animal patients.

Thank you for your continued support. -Aspen Meadow Veterinary Specialists

104 S. Main StreetLongmont, CO 80501303-678-8844 (p)303-678-8855 (f)

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