Keyhole or laparoscopic surgery is now a standard and common technique used in the field of human surgery and is starting to become increasingly popular within the world of veterinary medicine. Some of our clients now expect to be offered routine laparoscopy as a service, and with last week’s speaker Jon Hall performing laparoscopic spays at a flat rate of £350, I completely understand why many owners would rather opt for this procedure given the benefits this technique offers.

Jon discussed these benefits in last week’s platinum member’s webinar which covered the use of keyhole surgery within our veterinary patients. Jon explained that this technique leads to a smaller increase in inflammatory mediators compared to open surgery allowing for a faster recovery and a much quicker return to normal activity for our patients. Usually Jon’s laparoscopic bitch spays will return to their normal exercise routine just one day after having surgery. Jon also advised that laparoscopic techniques are thought to reduce post-operative pain and could reduce a patient’s hospitalisation time.

There are of course some challenges which need to be overcome, the most difficult of which is to create enough working space within the abdomen. This is most commonly achieved by insufflating the abdomen with CO2, thereby creating a capnoperitoneum. Manipulation of the viscera can also be difficult and usually requires the use of specialist instrumentation to move viscera to an appropriate position. Placing a patient on a tilting table can also be useful, as gravity allows the viscera to slide away from an area trying to be visualised. Knot tying is an obvious challenge and can be achieved either within the abdomen or outside of the abdomen where the knot is tied on the exterior and then slid down into position.

The techniques used in laparoscopic surgery take a lot of practice and Jon advised it should come a little easier to those of us who are frequent and expert gamers. Practice is essential and the use of box trainers can be very useful with Jon using his own makeshift cardboard box together with portholes, a mobile phone and tablet, all of which was explained in more detail within the webinar.

A significant part of this webinar centred around Jon’s videos demonstrating many of the techniques utilised for performing laparoscopic surgery including laparoscopic bitch spays, gastropexies and biopsies of the liver, pancreatic and a variety of tumours. Less common procedures such as cholecystotomy and adrenalectomy were also discussed. These videos can only really be appreciated by logging into this webinar and watching them (their accompanying background music is also rather amusing and should not be missed!). Jon also demonstrated the use of sealing instrumentation used to cauterise and seal vessels with ease. Their use is so straightforward and effective, that Jon now often uses them when performing open surgery as well as laparoscopic surgery.

Jon ended this webinar by discussing the future of both veterinary and human laparoscopy with advances continually being made in the world of robotics. These advances should help reduce the risk of human error and also make difficult techniques such as knot tying much simpler thereby making it more accessible to surgeons with a wider range of abilities. Near infrared fluorescence is another technique which is being used at the cutting edge of this field and involves the use of Indocyanine green (ICG) which fluoresces within certain areas of the body once injected. ICG fluorescence can be used to assess vascular perfusion and identify areas of inflammation, neoplasia, and draining lymphatics. This could prove invaluable when trying to differentiate between viable and non-viable tissue and for staging a variety of tumours.

Jon’s webinar was a visual feast of surgical laparoscopic techniques which as stated previously can only be appreciated by taking an hour of your time to sit and watch some amazing footage. I must admit I cannot see myself performing laparoscopic surgery but as clients become more demanding and educated about their options, it is important we understand these techniques and are able to offer either referral or an in-house option where ‘keyhole’ surgery is readily available for our clients and a real opportunity for vets.