Good evening everybody and welcome to Thursday Night members webinar. My name is Bruce Stevenson and I have the honour of chairing tonight's session. I don't think we've have any new members in tonight, so no need to do any housekeeping.
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But, just respond to those GDPR emails please, that it really is very, very important for us to keep bringing to you the wonderful service that is the webinar vet. Speaking of wonderful service, we are in for a treat tonight. John Chitti is presenting avian surgery for us.
And John is an RCVS advanced practitioner in zoological medicine. He qualified from the Royal Veterinary College in 1990 and he gained his RCVS certificate in zoo medicine in 2000. Co-director of a small animal and exotic practise in Andover.
With 100% avian exotic and small mammal case load. He does both referral and first opinion work. He consults for 5 zoological collections, commercial laboratory and the great bustard reintroduction project.
He's co-editor of two texts on avian medicine, one on rabbit surgery, and he's co-author of a textbook on tortoise medicine. He's also author of various book chapters and papers on a range of different species. John chairs, he's the chairman of the European Association of Avian Veterinarians.
Sorry, John. And on the editorial board of the Journal of Exotic Pet Medicine. John is the junior vice president of the British Small Animal Veterinary Association and this is all about birds and not aeroplanes.
John, sorry about that. Welcome to the webinar vet again and it's over to you. No worries, I think being an aviation vet sounds much more fun, but there we go.
That's a different story. Thank you very much indeed and welcome to this, webinar on avian surgery, . It's slightly ironic tonight, say, talking about surgery on the grounds that this weekend, well, I'm doing some kitchen work, I managed to slice up my thumb off with a kitchen knife.
So actually operating at the moment is highly difficult. I'm not doing very much. It does show one big poor interval where we with all surgery really, whether you're doing avian surgery or slicing your thumb off, is that basically, if your equipment isn't up to it.
In this case, a blunt knife, don't carry on. Stop, change it, start again. Don't just blindly carry on there because something will go wrong, as I found out.
So, you know, if you, if you don't set up on right footing, it's gonna go wrong. OK, so what are we going to cover tonight apart from my, my injuries? We can do some principles of a surgeons and bits and pieces, fundamentally why birds are different to mammals.
We can do some stuff on what you need, a lot of toys involved because that's what makes it fun. We're gonna do some techniques and step by steps and some illustrated, surgical techniques we've done on birds, and more common ones. And we're going to finish up with laparoscopy.
We do a lot of this and obviously a surgical route in there. It's our route for biopsies and stuff. And I thought it's probably worth including here because We don't just always operate for, curative reasons, but some for diagnostic reasons.
And that's where endoscopy really comes in useful in birds because air sacks they have like great viewing chambers. OK. So, People don't like operating on birds.
We get a lot of our referrals in space. We don't operate on them and things. And the fundamental reasons why is because for anaesthesia is tough, because it's small possibly, they can't lose much blood.
That's one of the big things they can't lose any blood from birds. And also it can be hard to prepare the patients. So these are big questions people always ask about or, or, or, or seem to consider when they don't want to operate on a bird.
So let's consider those questions. Yeah, anaesthesia is tough. Well, it can be.
Birds can be very unforgiving. Patients got very high metabolic rate. They've got very little residual, a reserve volume in, in their respiratory system.
So, and they can also be pretty ill at times, so they can be very tough anaesthetic patients. But they can be anaesthetized and so it can be remarkably easy to anaesthetize. What you need to have above everything else you need to be able to and this is not an anaesthetic lecture tonight.
Is you need to be able to intubate them so airway control. You need to be able to ventilate them. And this is really, really important aspect we found is that being able to ventilate our patients and that's not just the birds, that's the reptiles, the mammals, and also dogs and cats, we ventilate virtually everything there.
Getting that control over respiration makes a huge difference. And we've kept stuff alive, we wouldn't have done otherwise. Be able to monitor them properly, also really important to, so we're aware when vital signs start to fail early.
We haven't got much time, so any advanced warning we give ourselves great. And warming is really important as well. One of the biggest cause of death for birds under anaesthesia is hypothermia.
So keeping them warm, we have a very hot theatre, we use a lot of bear huggers and things, and those work really well. And above all else that too, even if you can operate and you've got those situations and you've got a good anaesthetic, if you can't hospitalise these patients afterwards and do the proper aftercare, it's not going to go right. So you have to be able to do that.
Another example, if you're doing rehabilitation work, you know, you have, you have a raptur in with a broken leg, you fix the leg beautifully. If you don't put it through the full rehab process, you might as well not have operated because the case is going to be a failure. So you need to have that view of the whole thing, the nursing, the care, not just the ability to cut and put things together.
OK, they're small. Well, you can't argue the fact the budget is about 30 grammes. They are small, some of them, but move on to a swan.
They're really very large indeed, and are large and obviously all the cats we operate on, a lot of the dogs we operate on, you know, it's not just size on those, but for most of the birds we operate on, we think about parrots, raptors, we're probably operating somewhere around the 400 gramme to to 1 kg mark. So yeah, they are fundamentally reasonably small patients and that, that does have some degree of intricacy. And difficulty.
So you need correct equipment. You do need magnification, . This is one of those things where when you're young, you say you don't need it.
I was, I probably could recite verbatim a lecture I heard when I, when I was about 25, 30, saying the same thing. And now I say it, that, you know, you don't feel you needs that you can see well enough without, you don't want to wear the loops and stuff because, you know, you're admitting you're old. Well, admit it.
It's great. I use loops a lot more time now. In fact, one of the best things I bought this year was a new set of loops to go over my prescription lenses.
And they make a world of difference. I can see a lot more. I can make 5 operating is easy.
You know, I should have said years ago. I'm not as young as I used to be. So magnification really helps a lot.
For some surgeries, you do need to be reasonably skillful. You know, they're small, they're fiddly, you don't. Yeah, I wouldn't recommend a beginner to go inside a bird's abdomen and start doing gut surgery and stuff in there because it's really unforgiving.
There's no momentum. It's particularly unforgiving area to operate in. But at the same time, these are all soft tissue surgeries.
And if you're a skillful small animal surgeon, you can do the vast majority of bird surgeries as well. And then we do some revision on anatomy and stuff along those lines. So you don't have to, in fact, in many ways people only operate on birds unless they do an awful, awful lot of them.
These abdominal surgery you don't always do very often. It's quite nice if you do have a mixed case load, so you're in other abdomens and stuff and keep your hands moving and keep that together. So the surgical skill is nonetheless pretty important.
OK, we're losing too much blood. Well, actually, birds can lose a bigger proportion of circulating volume. The mammals can.
The studies show that they can actually lose over 50% of the circulating volume, and they'll still recover, which is a pretty big percentage. The circulating volume is around about 10% body weight, just the same as in mammals and stuff. So, you know, you can do the sums and stuff.
What it does mean, you know, you have got a relatively forgiving circulator system, but Of course, if you got a 300 budget, that's still not a large volume. 10% of that is, is a small percentage, so about 3 ms so you can't lose very much blood at all. So you have got to be very careful, with your lost some small birds.
Go to great paras, you know, you can lose some blood. It's not like you can't lose anything. Just be careful, just be aware of it and make sure you're particularly sharp on stopping even minor bleeds.
It's perfectly possible to get rent. How about preparing patients? Well, a lot of avian surgery is reactive.
We know that birds don't, don't show many clinical signs. They're often very ill when they come in and stuff. So yeah, a lot of these, techniques are reactive techniques.
For example, you're on laparoscopy, you're often do that diagnostically, you often do with sick patients and staff, especially respiratory cases. So that is can be very reactive indeed. However, a lot of the surgery gonna go through bit by bit.
Can wait for a day or two. So that means you can hospitalise them. You can give fluids and analgesia and antibiosis.
We actually bird blood isn't sterile, so bruising really does get colonised by circulating bacteria. So it be a little bit sharper on our antibiotics and use a little bit more than we would in mammal surgery. We can pay attention to the nutrition staff.
If you do operate on half starved creatures, they don't do well whatever species they are. So we can do that beforehand. We can stabilise them and that's great, that gives us some time to plan our surgeries.
And that means we've got time to prepare ourselves. And preparing yourself is the least important preparing your patient. If you go into things unready, it really is a good way of becoming a cropper where you're not actually familiar what you're going to go there, what you need, and, you know, maximise the time and we said it was not great.
So how do we prepare ourselves? What have you got ready for? You do need yourself obviously.
You need to have your nurse doing your anaesthetic and things and they have to be a dedicated anaesthetist. We've done the fact that bird anaesthetic can be tricky. You don't want your anestheist wandering off to find that rare set of retractors and stuff, in the drawer and taking half an hour.
So you're gonna need some assistance too. It can be very thirsty work on, on, on, on your staff because you need people to help you to get your staff to get the stuff to you and things. So often we'll have 2, some 3 people who've got student stuff around to help with the, with the, what seems like a basic surgery, but you don't want your estiswandering away.
And you want your equipment out and that's where the planning really comes in. I need to think your way through the, what you're going to need at all stages, so it's ready beforehand. We don't have to go and look it out.
They don't have to find stuff. It's far quicker getting more things out and then putting away afterwards if you don't use them than it is changing mind midway through and having to have it found and got for you or finding that pin wasn't sterilised, everything else that's have it already beforehand laid out as you want it, where it's going to be. And that makes life much, much simpler for everything.
In other words, minimise time spent anaesthetized. And that will really help your survival rates, really help things go there. I go well, and again, help reduce tissue trauma if you're not fiddling around, holding things open and that kind of thing.
So Above all, prepare yourself, plan the operation. You know, if you got to revise anatomy, revise the anatomy. If you got a revise technique, do that too.
Shouldn't really self advertise, but a new BSA, Avian practise Foundation manual with Debbie Monks and I've just finished. We've got step by step, operations in there so that you can help plan that up so you can see what you need to do when you need to be ready. It's also really important, the way you are doing a surgery and stuff, you've actually diagnosed what you're going to operate on if at all possible.
And they've done the correct imaging to see where things are, what you're going to do. So when you open up the animal, you know what you're gonna find. Sometimes you can't help but be surprised.
Sometimes you have to operate blind, but the fewer surprises you have, the better it's gonna go, the less stressful it's going to be and the more successful it'll be. For example, if it's a lump, You know, are you gonna diagnose what a lump is beforehand? So you done your biopsies, you know, it's an invasive lump or it's a benign one or, you know, it's just a reaction type of thing.
You get some idea on, on where it's spread to your imaging, with local or distant. You see the extent of the mass of it all possible. And again, of course, you're assessing how much skin is there and planning how you're going to close that wound or manage an open wound afterwards.
So it's important to be prepared totally just like you would for a dog or a cat. And so that's because you can be less familiar with these spaces, it can be a bit more difficult to do that, to take a bit more time, a bit more care to do that, make sure you're ready. OK, one arranisthetize.
Speed really helps. Don't rush. Precision is also important.
So quick, you must be precise, hence the emphasis on experience, surgery. Minimise that tissue handling, don't bruise things, don't that will help a lot. And again, minimise that time spent anaesthetized really will help a lot there too.
You can get away with a lot more if you're reasonably quick about it and more importantly, decisive. So again, being prepared, now we're gonna find really helps that decision making. Always pluck the feathers away, don't clip them.
The reason for that is that birds, the head, feathers don't grow like hair. They have discrete growth cycles. If you pluck your feathers out, they will regrow straight away because you torn the germ or cap.
If you clip them, they won't regrow until the next moult and that has big implication of thermal regulation, and sometimes for para things on, irritation and, and chewing and stuff like that too. Don't use spirit. They bears hypothermia can be an issue and cover them in surgical spirit can be a problem.
If a very small birds going to enclosed areas afterwards, kind of the fumes can be a problem as well. And as mentioned, can't mention too often, keep them warm, keep them warm, keep them warm. And we used to use lots of radiant heat sources.
We now have a well room and these bear huggers really are fantastic. I love them to bits. OK, so that's your basics.
Is your preparation stuff. What sort of equipment do you need? Well, The basics are things like drapes, of course.
I'm an old fashioned boy. I quite like my cloth drapes, but yeah, you got sort of adhesive ones, the transparent ones are really nice. It's what you like with that.
I do use a lot of sterilised cotton buds for moving stuff around. I like this a lot. I'm probably gonna have to rethink that, now that cotton buds are a big bad thing to have, and they're probably going to be prohibitively expensive.
So, but now there's something small like that you can, and, and, and soft, you can manoeuvre tissues around with really helps a lot. Mention magnification. Never get to you're doing micro stuff.
So, you know, seating's important, very appalling posture here on this bird I'm doing. So, it's a long time ago I was learning, . So seating is important because you often do like micro level, you need to sit down, support body weight, take Rest your arms and your elbows, so you're just moving your hands, and that's much more precise again, and again have the correct suture materials which we'll cover in a moment.
So what do we use equipment wise? We have a basic small kit. I use obviously adds things Ain Olsen Hager, needle holders, mosquito forceps, to not iris scissors will be my basics in my kit.
We then have a few extras as well. I really like these sort of ring tip, forceps. They, they have a good grip on them.
They don't traumatise like rat tooths do. I also like playing with these. This is an accurate, and we, we actually import these I find very hard to get in the UK, but they're really great for scooping out pasts and things.
Avian abscesses are solid, so really good to have, have, have, have a solid scoop that's really good. And this is a strabismus hook, and again, very, very blunt rounded tip again, useful hooking things out of the way. So it's sort of retracting.
And for probing and what have you, really useful bit of gear, and those are relatively and easily available. And those, these bits of equipment are not expensive. I'd have fine tipped, mosquitoes, slightly, some of some slightly wider ones, but mainly, many fine tips, we should a very small precise areas and they're easy to get, get.
There's ring tip close up again you can see, they're exactly what they say they are. Now, when you're doing some really small stuff is, it's very tempting to get eye gear, because it's small, it's, it's cheaper. It's, it's again more readily available.
I instruments tend to be much shorter. The microsurgery gear is probably more preferable. It's longer, it's differently balanced, in the, it's very, very important if you're going to buy microsurgery equipment to actually go to a show and handle the equipment.
My wife has got much smaller hands than I have, and what she will use is very different to what I will use, because of the balance in your hand. You also notice you got these round bodies here. And this is really important.
I, surgical equipment doesn't have this, and yet, microsurgery does, and that enables you to roll the instrument in your hands. If you're suturing, you can roll the needle holders in your hand rather than pushing and using the whole hand to move through. So your movements are smaller, you move to more precise, and, and that's why microsurgery gear is so good.
And this is what we use. So these are needle holders, . Just the very basic, very small, very fine.
You have a locking part here. We have a pair of micro scissors, slightly curved ends, and again with these round body just for, for being able to rotate and handle. These some weird and wonderful things.
I found these right angle, cutting scissors which are really very useful when delving into dark places, inside birds with things like castrations and stuff. I also like these clamps. These are called Bennett clamps, and just the fact they've got this complete ability to encircle something, is really very useful.
Bizarrely, I think the main use I've used it for right adrenal removals in ferrets because they actually tend to be exactly right size to go round an adrenal, and clamp off of the vena cave around that as well. So, which is a different space and hopefully a different talk of the day. He mistakes are also very important as well.
And while you can ligate, of course, many of your surgeries, if once you're into the abdomen of things are down deep dark holes. It's very hard to get underneath stuff with, with, with suture material, it's very hard to ligate around, say, a broad-based testes, all around the base of the infantdibuum if you're doing hysterectomy. So we use a lot of these hema clips, and these are the wet ones.
And the reason I like the we particularly is because the, the applicators have this curve, and that lets you get, get underneath the equipment. It gets really nice clips. You can get them in stainless steel.
We use titanium, because it's less reactive, a little bit more expensive but less reactive, and they come in a range of sizes, and they're really good to use. We use them throughout small mammal surgery, reptile surgery, everything. Just because you understaff, it speeds the procedure, no end.
They are pretty non reactivists is a post-op picture, probably a week or two after, a spay operation, hysterectomy operation, and it's showing the, hemaclip on the end of the infant dibuum. And basically you can see there's really virtually no reaction at all around there. And those will sit in there for years and years and years.
And again, you don't tend to get any reactivity around, around the, around the clip. We love them to bits. Another aspect to hemostasis and having said that, you know, you can lose some blood, we want to minimise that for especially small stuff, is that when we're cutting through skin and things, is that we don't really want to use sharp surgery.
We, we, we don't want to have the haemorrhage from the ooze from a skin because that's blood loss we can, we can just lose. So we tend to use radiosurgery for entering body cavities, so cutting skin, cutting, muscle layers, also the cauterising small vessels as you go through. Radio is different to electrosurgeries, you can basically cutting radio waves.
So you get, less, collateral burning, and so you minimise the tissue damage and that increases the healing time. We use both monopolar, and bipolar. So monopolar is, it says you have a base plate and you have these, these instruments may be loops and maybe, wires.
Bipolar is where you actually cut between the tips of the forceps, and they're useful in different circumstances. They have a switching plate so you can move between it's really good. But this is a very basic dental, radiosurgery unit, which is much cheaper than the full ones, and it works beautifully.
And for, for a like a bird, it's got enough power to do that, that with ease. So we've, we've used this nice long lived bits of equipment, with other uses in the practise, which always good for, for avian surgery. OK, so we do suture, what do we use?
Reactivity studies have been done in birds, and they're very similar to those using in mammals and things. Certainly, I would avoid cat gutter and the really reactive sutures. I tend to use sort of, braided, materials, so like, Polysorb, virol, mainly because I find the handling is, is much better and it's less irritant afterwards.
And, and while the materials like PDS and things will have less reactivity and fewer problems, in that respect, they are also quite irri irritating to the bird, especially with skin and stuff. We get more picking problems afterwards. And I find them more difficult to tie as well.
So surgeon preference comes into this. So above all, do some reading, see the theoretical studies, work it with what you're familiar with using, what your favourite materials are because that helps an awful lot, and choose on that basis. Size is important too.
So we're very often, 30s my standard size for most ops, but we're down to 45, and for really fine surgery, 80 is not unknown. If you're down to your 80 50s, you really do need magnification to, to, to see those properly and things. Tend to use standard patterns.
It's very hard to intradermals in birds, but, you know, it's so simple interrupted, simple continuous tend to work very well. And so your basic mammal patterns should work absolutely fine in the bird. Picking suture can be a problem in parrots.
They're not as bad as, as they're often painted. We've had, touch wood, remarkably few problems with that. But like all things, we got one who does pick, then you've got a problem, and probably Harris hawks are the worst of a lot for that one.
And if you've got a bird that's going to pick stuff out of, say, a foot surgery, do it, we'll do it again and again and again, and that can be really quite, quite difficult to, to prevent. Some days you can bandage, of course, often they'll just eat the bandage as well, especially parrots. Obviously synthetic suturing methods will work very well.
You can use flash blocks. I think that's quite an important thing. We, we started doing a lot more now.
Be very aware of the toxic dose of these birds that's usually published and just check the volume of local block you're using is not going to exceed that. And, and don't get too carried away. We're putting everywhere.
And that does seem to help as well. But actually, they, they, they're not quite as, as bad as you think. We do very little colouring, of birds to prevent them picking.
We find most birds get really stressed by that. And actually our big thing is after the surgery is try and reduce the stress, and, and, and obviously keep analgesia going, and, and try and reduce our problems that way rather than just put these big collars on and upset them, when they're in recovery phase. OK, we're gonna go on to some pictures and some techniques now and you'll see some pictures of the operating and stuff and You'll see that many pictures show I don't wear gloves, most of the time.
I was trained many years ago, as basically as a farmer to start with, and we didn't wear gloves very often then at all. And I do find I gloves really restrict my sensitivity. .
There are also very few, if any papers that really thoroughly show that wearing surgical gloves will reduce, surgical site infections. If you do, you need to double glove, you need to wear different colour gloves, and that does show has some impact, but, but not as much as good scrubbing up technique does. So that's probably more important.
The other danger too is doing sharp surgery with, with like orthopaedics and stuff. There is a danger that, People can become complacent. That has been illustrated as well.
So in short, if you do wear gloves, great, if you don't, be careful and make sure your gloving techniques correct, make sure you're still scrub and everything else there. If you don't wear gloves, then again, pay particular attention to your, your, your, scrubbing technique and of course monitor your surgical site infections, which we should be doing anyway. If you do wear them again, don't wear tout gloves.
That can be really very reactive inside birds and be careful. But this is why you're going to see where I don't always wear them. I do wear, wear gloves, I've got, you know, injuries to my hands.
I will also do it for radiosurgery many weeks it does tinkle like mad if you use it during radio surgery without wearing them. So self-interest and tight date. But just to explain why you're going to see pictures looking like they are.
OK. If you're doing abdominal surgery, the standard approach into a bird is a left-sided approach, left flank approach. And that's because a lot of this is based on reproductive system and that's where, it tends to sit, for certainly for female birds that they have a left of duct not a right.
So The approach obviously we have a bird on its right to have a wing stretch upwards, leg stretch back. And we'll then use a monopolar, . Radiosurgery just to cut through the skin, underneath the leg along that left flank.
So if you look at this grey parrot it's got having an aspergilloma removed. And we'll pluck. We try and pluck always the minimal area we get away with because with thermoregulation problems afterwards can be irritation problems.
So you got to pluck enough but not too much. And again, try and minimise the skin trauma if at all possible. We then prep the skin, and then we'll cut through and then we elevate the leg, and you always feel like you're dislocating the leg away from the body to make the space in onto the rib cage and onto the flank.
The big deal in this case, we're doing abdominal surgery is to have good retraction. And we use the Lone Star retractor a lot. We've always previously used to, cos, sterilise these.
Actually, now we've got gas sterilisation. They go through that beautifully, but they don't tend to water clay very well at all. And these are brilliant.
And so basically we put them around the, the lightweight too, which is great because you got rest on the bird. Again, bear in mind these, these, these animals are not big, so heavy instruments on top of them will cause problems. So lightweight retractor over the top is fantastic.
We then use these hooks just to pull everything out of the way. And he sees got really great visibility going into that the abdomen and things. And here's our bird with the aspergilloma, we can see the aspergilloma there.
We've got a really clear sight of that to help dissect that away. You'll note also if we go back a bit, is that To go into here, you've got to cut through 2 or 3 ribs, to access the abdomen, or access proper visibility, because the rib cage goes back such a long way. That's fine.
It's important. There's a blood vessel running along each rib just like there's other species, but before you cut the rib, you do need to cauterise that above and below your incision site. This is where the bipolar radiosurgery really comes in useful for that.
So we cauterise above the quarter below, then we cut through the middle of those cautry points and that reduces the haemorrhage from those areas, which is really useful. When they heal, by the way, we just put them back, we don't switch the ends together or repair the ends. As long as the ends of ribs are in close approximation, they will normally knitted back together beautifully within about 2 weeks.
So we do that, we put everything out of the way, then again, you can see a slightly different angle on, on the aspergilloma, and then we can dissect away. It's closing it up, again, we're basically once we've let everything go, we'll put a simple continuous layer of polysorb through the muscle, the ros to heal themselves, and then a simple continuous layer through the skin on top. So basically two layer closure, and again, we have good healing and very rarely get any interference or much swelling for that matter, which is surprising given how close it is to the leg.
Another I do like people to be aware of is this thing we see reasonably commonly, and young grey parrots in particular, where we see, chronic, nasal discharge, chronic sinusitis type things. And this is due to, A malformation of the kan of the drainage area from the nasal cavities. And the coalresia is reasonably common.
And whenever you get a chronic upper respiratory infection, a young bird or starting from a young bird, then I would suspect this, and it's quite important. Illustrates to the need to do proper imaging. Here we're doing positive contrast sonography in this grey parrot.
And what you can see is when you put the contrast into the nasal cavity, it's going nowhere. This should be draining down into the mouth, into, into the, into a trache and stuff and going somewhere you see it's just accumulating, and we've got nothing there. And you should be able to pick out a dependent point where it's trying to come through and that's where the coina should be forming.
It should be proper. That's important. That's telling you where you need to make your hole.
Now, that's basically what you need to do. You need to make that coa you to make that drainage hole and keep it open. Sounds complicated, it's remarkably easy.
The bird is intubated, we get a Steinman pin and we simply aim it towards that point from the nostril and drive it down through and make the hole. As you can see going into the mouth there penetrating through, through the area there. We then feed, some drainage tubing into that, and we repeat on the other side and draw it through, obviously changing the grey pattern to the core in the meantime.
And we draw the tube through both sides and sticking out there, and then we put a knot in the end here so the bird can't grab its feet and put it through, which they do try and do. You just try a couple of times. It feels uncomfortable, so they stop doing that.
And we leave that in place for about 6 weeks. And then removed. That's long enough for the tissue to granulate around the hole and form a new drainage angle.
So really simple surgery. It looks like a complicated condition. The diagnosis and the imaging is probably more complicated than the actual surgery.
So don't again, don't believe all a work is, is complex. One thing you will have to most vets have to do is crop surgery. And the main indication of that really is going to be where in primarily in chickens.
We do do some crop surgery in, in, in, parrots, especially for, even now for biopsy, looking for proventricular dilatation to these lesions, but it can occasionally have a foreign body in a raptor or, or a parrot. But more usually we're going into chickens now we got the static congested crops, often with large bundles of grass and stuff inside. And certainly it's much better practise to go in there and remove these things in total than it is to start turning a bit upside down and emptying things out with a high risk of inhalation pneumonia.
So for our chickens with, impacted crops, again, bear in mind that you're going to want to hydrate them. First of all we're often quite dehydrated birds. The material is often quite dehydrated, so it's well worth not rushing in straight away, even if it's sour and you can smell the souring on its breath, then it's well worth hydrating that bird and preparing it before you go in.
And also, I would generally use antibiosis for these guys. These are penicillin because if you got some gramme negative or some and some anaerobes kicking around in there. So we want to do something about that.
So what do we do? I go back again. First of all, we basically incise over the crop is usually pretty easy to find.
Just skin incision over there, then I'll pick up the crop wall and, and make an incision through that. . Here we have our two layers.
You see the skin layer that we opened up the crop at this point here too. I would normally try and put some Alice Alice forceps on there to keep it open, and there's a matter of emptying out. And this is very typical where you get these mats of grass or straw, whatever else there with a lot of cereal, grain, really foul smelling material fermenting away inside.
And we'll empty it through that. Well then, once it's cleaned out, I'll then normally flush out and clean out. I'll often instil some penicillins into the crop straight afterwards, and One thing I should mustn't forget to say is before you flush that crop through and flush it out properly, if you do need to pack off the cranial part of that will raise the head so you're not putting a lot of fluid that's going to go up into the mouth, potentially being inhaled if the tube is not quite fitting correctly.
So pack that off first of all, then flush it through, clean the whole thing out properly, instil some antibiotics and and close. And with a crop, I'll generally do two layers of an inverting simple continuous suture. And then I'll close the skin with another simple continuous layer on top of that too.
And those usually heal beautifully. They heal like clockwork. And it's a very simple technique we use all the time.
It's a similar technique to what we do if we have a crop injury, say, in a pigeon. Where you got ruptured crop very commonly, or if you've got a crop burn in a young parrot. One thing I would say with the crop burns is again, one situation where you don't rush into those.
If you go in acutely when they even though they've got food dripping through there, then if you go in too quickly, you'll often find that your wound edges to his, you've got the same situation again in a few days' time. You actually leave them with a dripping crop with little often feeding to keep food going through the bird for 2 or 3 days. So that you can see clearly the unhealthy areas of crop tissue which demarcate out and you can dissect those way properly.
So that's quite important. If you're doing a biopsy, by the way, you break all the rules and you deliberately cut through a blood vessel and take a section with a blood vessel on it. And that's because you're looking for nerves, you're looking for the lesions in the nerve area too.
And of course, we all remember artery vein nerve run together and that's important in this situation. OK, I think they do very commonly, in chickens is to sinus surgery. We see a lot of birds with these, impacted, these large sinuses.
If it's liquid, we can often flush it. If it's, very, very reduced it for them go away by themselves. When you got hard material, and feel that hard material in the sinus, you've got no choice but to operate because it's not going to come through.
It's not you can consider a foreign body forever, even if you clear the infection. We have to be careful of, you will see tumours, as in this bird here. There's a lot of lymph tissue in this area and it's a very common site for lymphoma to occur.
So if you have got hard tissue, do do an FNA before you go in, before before you cut into it and find a nasty surprise at that point. So beware of tumours there. Before you, do anything with these sins, obviously, antibiosis is important to set up there because they're heavily infected areas.
So I do 2 or 3 days of antibiotic where I went in there. I'd also address any breathing concerns that might be going on there because it might be more extensive infection, might be more extensive problems extending to lower respiratory tracts sometimes. Very easy surgery too.
You generally cut over the area too, just almost dependent part. Scoop it out, here's where your ear curate comes in useful. This type of material gets out there, and then flush through, suture up simple continuous line.
Often there'll be a lot of bleeding because it's chronically inflamed and that, that, that, that will tend to work OK. What is important though too is you get a lot of debris. Have a sinus after the surgery.
And if you don't do post-surgical flushing, so we get the birds in once a week, and we flush the, sinuses when they're conscious, held upside down using, dilute F10, and we will flush those, sinus through once a week and just make sure that material doesn't build up and form another abscess. Occasional problem, but one which we seem to see in a few last year is nucleation with chronic long-term eye problems, some like sense of infection, sometimes, due to damage and stuff. But there are reasons why you may have to nucleate.
. The problems you have in a bird is it's a very large eye, especially compared to the head size and brain size. They've got very thin bone between the back of the eye and the brain with a very short optic nerve. So if you put too much pressure on that, it is possible to herniate part of the brain through following the nerves which can be very careful how you handle that.
There's also bone in the eye. I have a ring of of sclerosicles, which will complicate things and get right in the way. And again, they'll potentially haemorrhage quite a lot.
And they'll have, they also have a very powerful third eyelid. So don't think about suturing that or doing third eyelid flaps to these guys. They, they, they will just tear everything through because it's got such powerful muscling on there.
This is a, a wood partridge, that, obviously you can see a totally destroyed eye infection of the eye is actually full of puss. So, you know, there's no saving the eye, it's very uncomfortable. It's causing a lot of problem, and it's rubbing continuously.
So we decided we had to remove that. So birds and these eyes intubated as ever. We first step is actually just cut around the rim of the eye, so we cut around the eyelid and take a whole set of eyelids off there.
We're cutting around doing that there. And we'll then start to then dissect around the edge of the eye, cutting around in a circle, gently sort of blunt sharp dissecting, blunt dissecting around the eye just to free it off within the socket. What we then do is we start removing it piece by piece because it's so hard to get behind the eye without putting excess pressure on it, and because it's so large.
I found that basically you can't remove it as one big eye. So what we tend to do is actually, once we've freed it off, you start just cut into segments and remove it piece by piece. And I we usually leave a little bit of the sclera behind where it attaches to the optic nerve.
I'll try and take away the rest and stuff from there, but I very often leave that tiny bit of the back of the eye attached to blood supply it doesn't really seem to cause a problem. And we haven't seen any reactions because of it. And again, that minimising amount I have to pull on the optic nerve, and to cause problems from there.
Once we've removed the IP like that, then I'll go back and I'll remove the third eyelid in, in, in a single piece again. And that as a separate operation almost. And then at that stage then we simply close the whole thing up in a simple continuous pattern.
And we don't generally see too much wave haemorrhage, or, or problems from that. Another area we are very frequently asked to operate on and we came back to chicken medicine quite a lot too is, is prolapses. It is possible to have the cloaca or the oviduct or the gut prolapsing, in chickens it tends to be most commonly the oviduct, or cloaca, .
And it's very important to bear in mind with this case is what people are after with it. So, we found from experience that the bears very little way of controlling over a ductal prolapse without actually doing a full hysterectomy on the bird. And that's some abdominal surgery, so it's expensive, it's reasonably tricky.
And of course the bird's never going to lay an egg again. So if it's a bird's primary purpose is laying eggs, then we have, an issue with that afterwards. If the, bird is a pet bird and they minds about the eggs, absolutely fine.
People can go into that quite happily. And that, that's great. So, and then what we do with these guys, we tend to take the prolapse in quickly.
So to keep the tissue vital. Then a few days later on we stabilise the birds, we'll go in, and we'll do a left flank approach as before, and perform hysterectomy. Don't tend to remove the ovary.
It is really difficult to dissect off some really serious blood vessels, and it's quite extensive and hard to move in total, and there's a really high risk of complication from that. Generally, if you just remove the, the, the overdose, that's, that's, that's sufficient. The other advantage to once you pull the obviduct inside, of course, you can then hexi and stabilise the cloaca, and the oppiductal stump into the wound as you close up.
It's very important too when you go into a prolapse and know what the tissue is and how vital it is too. For example, this peregrine here, this is a cloacal prolapse. And the thing see is nice and pink, it's very fresh.
The prognosis prolapse is really quite good. Again, we can take that inside. We probably is we do a midline incision.
Pull everything back inside and thenexi the cloaca into that midline incision, and that tends to be fine. You do need to investigate what the problem was in this case, it was actually just a cloa infection, but the systemic metabolic disturbances, you need to stabilise those. This Harris Hawker has got, a gut prolapse.
This is an inception, the gut by definition has to intercept to go through. You see, it's dried, it's deists, it's purple, it's lost vitality. So firstly, a gut prolapse has a much worse outlook because the surgery is much more difficult.
We're going to have to remove a section of gut there and that's automatically putting a prognosis much, much worse. We can't tuck it back there. We can't just retract and pexing it.
We like to have some gut breakdown inside. And that's when we start having to warn the owner that this could be quite, difficult situation. This could be a situation of the poor, poor, poor prognosis.
Having mentioned hysterectomy for our for our oviductal prolapses, again, we were, as I said, we don't tend to very hysterectomy just plain hysterectomy. This is often linked to the books to a cessation, obviously, obviously bigle because I think you come out through, but actually of ovarian activity as well. And to a large extent that's true, that they will have much reduced ovarian activity due to no feedback from the end fundibuum.
However, ovarian activity will continue to some extent and A lot of these birds will have a constant low grade egg peritonitis afterwards as the egg yolks tend to go into the abdomen. Now most birds cope that fine. In fact, many of them have a low grade one anyway and so chickens.
So, but it is likely every once in a while that will flare up and cause a clinical problem. So they can have have problem issues afterwards again, worth warning owners about that, but in those situations, it's generally a life saving operation. Big deal with prolapses is don't just tuck them back in the days of just putting a prolapse back in the hole, putting a purse string around it.
Yeah, that might be useful for a very short period of time while you stabilise and keep tissue vital inside mucous membranes. It is not very often curative. You have got to be fairly like you have a very mild tracheal prolapse about to be the case.
Generally, you can have to go back in and do some more advanced surgery at some point. OK, we're going to just discuss a little bit about bumblefoot this is again a common situation. I'm really thinking about bumble foot in raptors, in waterfowl and chickens, it tends to be slightly different and parrots do with more based on pressure sores and and relieving perch and pressure and things.
In birds of prey, yep, it's bacterial infection of feet. They have more complex causes and very often related to blood flow changes at the end of a flying season. And change in diet and excise rates and metabolic change, in many ways more like say navicular or, or a laminitis in a horse with peripheral blood flow changes.
But blood is not sterile, therefore, blood flow changes can easily result in build up of bacteria and abscessation from those pooled areas of blood. We'll class it in three different ways. This is type one where you can see this general flattening of the papilla slight reddening, smoothing off her feet.
And these ones are generally not surgical cases. They don't have a past buildups and stuff and we can do something about that by addressing underlying causes. Type 2, this is when we start to have to operate.
This is 2A, we've got mild inflammation, mild, scabbing and build up and more chronic issues to be, and type 3 where we've got the really extensive information when we have osteomyelitis, she tendon sheath infections, joint infections, and these often actually have such poor prognosis, we often be considering euthanasia of a bird unless it's a very valuable bird indeed. Our approach to bumble foot operation again. It's about finding what you're going into, what's going on.
It's a whole bird thing. If you have on 1 ft, actually pay a lot more attention to the unaffected leg, because very often that's got a lesion in it, which is causing a bird to put more weight on the foot, which has got the the bumble foot, is putting pressure on that because everything's going there. If you don't address that underlying cause, your surgery is not going to have any success at all.
We start preemptive antibiotics, are you saying that you like a potential penicillin. Just a broad range before we go in to prepare things to type 2 or type 3 bumble foot would tend to be operating and then putting dressings on or padded perchings to protect the foot. And this is what we tend to do.
It's very simple. We'll actually lift away the scab, make a hole, flush it through, clean it out. I often take swabs and stuff deep within that, even though we're on antibiotics to see, make sure I'm on the right thing, especially I'm considering maybe putting an implant in place.
But generally open up, flush out, clean out that treated like an abscess, which in effect is what it is. Once we've done that, we can then say someone's put beat in releasing antibiotic, or we can close it and do something about that. Now, you often this is straightforward.
It's a small wound, we just simply close it with simple interrupt the sutures. Sometimes we might want to keep it open for better drainage in some situations. Sometimes it's so swollen, we're taking so much skin away, we can't actually close that so might use granulating dressings to help.
Healed by a second intention. And in really severe cases, we may use this technique where we actually sacrifice digit 4 to harvest a skin graft to close the wound across from there. That, that's a situation we may do that.
We'll certainly do padded dressings where I use this, swimming noodle. I cut a sort of foot shape in there, sit the foot inside the dressing, so that the, lesion is underneath that means that the falconer can then, treat the lesion, put creams and stuff on it and protect it afterwards. OK, we can do a bit about orthopaedics now too, and birds have their own problems with orthopaedics too.
They've got bones of very thin cortices, they can't take much away implants, very wide medulla, and pneumatized cavity inside. So that's really difficult because, you know, you might, you feel you might want to put a pin in there to fill that. And again, caution that too, they actually heal by end osteo.
Blood supply. So if you do feel that that neti cavity or medullary cavity, first of all, you often putting a very heavy implant in place, but also putting pressure on the blood supply that's bringing the nutrients to the healing bone. So don't, the general rule is no wider than a third of that cavity, as an implant inside the bone.
This all had low body mass, so it's great if you want to put, half a pound of of metalwork on top on a budgie, it's fine, but it's probably not going to move until that's healed. It's probably quite difficult. And we all see other problems too, lots of old parrots, steoporosis, young birds are mess.
Bone diseases and very importantly, in the exercising raptors, they may well have dehydration or electrolyte disturbances in the immediate period after exercising immediate period after the injury, which you've got to stabilise and get those right before birds fit for surgery. So preoperatively, we stabilising fluids, analgesia, antibiosis. We may do an immediate stabilisation if it's a very, wax fracture, if it's, likely to cause more damage to itself, before we're going to, repair it.
And that might mean bandaging, or it might even just be a period of confinement in the falconer's box or something like that or a cage or something, as long as there's not standing on a wing or something like that. We then form our plan. We do the imaging, we need to see what the fracture is.
That's gonna tell us what equipment we're gonna need, work our approach, and obviously also the desired result. You've got a falcon, a hunting falcon, that bird to performance athlete. It's got to have a perfect repair to be able to go back to that.
If you got a parrot in a cage, which doesn't fly much, and we don't really want to flying that much anyway, we bring every year for a wing trim or whatever, you know, that bird doesn't have to have a really great repair, because Actually, it may save it coming in once a year for, for it's, for, for, for its wing trim. The important thing is it has a wing we can use to balance. It can get about in the cage or wherever and that it's not in pain afterwards.
That's the important thing rather than pure flying ability. So we use. Well, we use very thin pins and Kres as a large power range from dully pinning.
We'll use this I use this very nice, aluminium, self tightening, pin driver. It's very light, it's very easy to drive things through. We use lightweight bone holders, and then we use, positive profile pins for doing our external fixators, because they tend to, be able to self tap into the bone.
That's really good. And we often link things with some patty and things. I'll show you different technique we use well at the moment.
And this is a very basic repair. The most common fracture of the raptors is a tibiatarsal fracture, typically about quarter to halfway down the leg, and it's a really simple repair. Try not to open up bird fractures.
They don't like it. They, there's a way of introducing infection stuff and minimal handling is fantastic. So wherever possible you normal grade a pin.
And here what we've done is with normal grade in podalary pin, down the tibiottarsus, we've then put a couple of, I usually put a few more than this. But 2 to 4 external fixation pins just, self tap through from, from the lateral surface, and we bend the invalid pin around and just form a fixator bar, as a time fixator. And that's a very simple repair that can take about 10 minutes to put in there and you get really good success with those.
Probably way we do more often now is we actually use this fea gear, and this is the French army finger fracture repair gear. These are aluminium bars. They're very, very lightweight.
They're fantastic to use. And the real joy I find is, yes, we put the pinned down in the same way, preferly normal grade, if not retrograded. We then bend it in and we'll put the essa bar on top of that.
What I love about it is that I'm no great orthopaedic surgeon. I do avian orthopaedic do quite well, but it's not my first love by any stretch of foundation. And if I'm left to my own devices, I put my external fixation pins in all kinds of places.
I then got to try and link them up. Beauty of this is I've got guide holes to tell me where to put them, so they do end up in a straight line. I find that really, really useful.
We then use little hexagonal screws to head screws to, to, to tighten those up there. And these are great. So if you're doing parrots and stuff, they just can't get them out.
And that makes a world of difference in not having your fixated bars, damaged. Quick, quick step step through. This is a duck with a fractured humerus initial X-ray shows we got this mid-shaft fractured, a little bit complicated.
We don't worry too much about these fragments because the bird bone heals beautifully drags into them, no problem at all. You don't have to do much about that. I will then normal grade the, the, the, the, the, the intermediary pin from the distal humerus, guiding it into the proximal humerus pass the fracture.
Once you done that, we bend it, put the feser bar on top, and then start putting our pins, usually one or two above a fracture site. And then we have a finished result, and this is nice, quick, easy surgery, and orthopaedics can be very, very simple indeed, and nice lightweight repair. And this is a post-op picture we see everything's aligned.
Yes, we got some fracture point, but that again, it doesn't matter too much. That will repair quite, quite well without worrying about it. From time to time, we, we amputate again, if we got a bird that doesn't need to fly, we can think about removing a wing.
There's a really complicated fracture, open fractures, really, really complicated situation, often don't heal so well, so you might think about it then. Occasionally you might amputate a leg, only in a very, very small bird, and again, attention to perch management thereafter just to make sure we don't get bumble foot in the remaining foot. So amputation is relatively rare occasion.
We do try and repair first of all. I'm going to finish up on endoscopy and it's not a true surgical thing. We have a surgical approach, often used in place of certainly for diagnostics.
We can use endoscopy with anywhere, anywhere they've got cavity we put a scope into, but we can also tend to use it a lot during laparoscopy where we go into the flank and have a look at the air sack and look at our abdominal organs, look at the breathing system from there. Where you can't use it is in this situation here, which is AITs. This is a cockatoo, it's acetic, whatever you do, you never put this is an indication of ultrasound, never put your scope into aITS.
The bird will drown in front of your eyes, and it's not very nice. Equipment we use this our standard, our standard scope is a 2.7 millimetre, 30 degree scope.
That's our work or scope and 30 degrees great rotate and get a great field of view. We'll keep that sterilised all the time, ready for use in cold sterilising or gas sterilising, so we can go straight in and it's really just use to have a scope on the on the spots and go straight in there. Where do we go in?
We go in, this is triangle for the both of its right flank here, left wing pull that up, left leg pull backwards. This is the lines of the spine. This is the caal rib.
This is the the leg, and there's this little triangle of softer tissue proximal to the leg where you can just go in. And it's very simple. You incise the skin and then I tend to push and pop artery forceps or hemostats through the muscle layers and let the scope in that way.
A slight different view on that, so it's the spine, last rib, and the leg. Then push a scope in there and we can have a look around this manoeuvre from there. Now one big indication was was for surgical sexing.
We tend to do a lot more DNA sexing these days, but still we use it if, we got, an infertility case. I want to look and see what the going out of vital or not. And sometimes if we've got, we want to have immediate results with both identified on the spot, or released if it's a case.
Of water fountain stuff. They want to know the answer straight away, whereas with always delay with the DNA sex thing. One important thing is always to starve the birds property beforehand.
And if it's parrot sized boating, generally do that overnight. Otherwise, you tend to get great view very fully intestine, and that's really hard to work around and see if we can and see everything else. Just fancy it's obviously invasive for sexing and caused anaesthetic, and the great advantage of doing this is it's actually quick results.
And of course, you can identify the bird on the spot and you got all this information about what's going on in there. So this is the sort of thing you see, these are very stage of ovary. We can see sort of this is a fairly quiescent ovary, with obviously a fully active ovary, and very active from there.
This is a female bird, become the left side, we see generally only have a left ovary. Odd things you will see this is the macaw top end of, of, of, of your ovary here. It's over a ductal cyst and carrying further cordially as the rest of the cyst there.
So again, this is no surprise this bird is not fertile. It's got a cyst there and this type of thing endoscopy will show you which we say DNA sexting would not. We can see testes too.
They do have 2 testes. They can be pigmented and this great bastard. And occasionally we will but generally we smooth, elongate structures where we got this parrot here, this is an infertility case again.
We can see the the test is, is shrunken. It's it's in irregular shape. It's got blood vessels coming up.
It's quite inflamed, and it should, and we can biopsy those relatively simply and this showed they had an orchitis and that's why this bird was infertile. So a lot of information you can get in these breeding cases. Our primary use is in respiratory cases.
It's probably most common reason why we scope, have a good look around, we can see into the lungs. We've got the ostium here. Let's put a scope into the lungs.
We can even biopsy the lungs from there. And we can have a look around and there's a lot of this detail, which you're not going to get from X-rays and stuff, and you wouldn't want to say the open surgery to find out. Just show a quick tour around, hope this video is going to come through.
Obviously, there's a cranial part of the, slamic cavity going past the heart, going up in towards the neck. In theory, you can actually reach the thyroid from here and actually biopsy thyroid if you're feeling really excitable. Here we got some, you can see some thickening around here got some adhesions in the, in the air sacs there.
It's nice adhesions there. Looking at the lungs look OK. Now we're going to the osteium.
We're going into the body of the lungs. Takes 2 or 3 days. I I'm having a bad driving day.
And we have a look inside there. This is a great place actually going right through into there we can actually can reach up towards a bronchi there. And, the biopsy is fairly simple at this point.
Looking further back at the back of the abdomen again, we see some lesions on on the airsite walls there by the way, and we're looking here at the testes, . And Looking fairly abnormal there as well. So there's a lot you can see in there too.
Now one extension from this is air sack cannulation, and the reason why it's essential is is actually using the same approach. You put an endoscope into the air sacks, you can also put a cannula into there. And this is great to enables a bird to breathe bypassing the, the trachea and the synx very useful if you've got to say a syringe aspergilloma, it's a lump of fungus growing in synx blocking breathing is you now have a route where you can bypass that.
So same sort of approach into that section there, which we get, we just put this tube, this is specially designed, air sack tube, lots of side holes and stuff and put it into there. That bird can now breathe through that area or through that tube there, and that enables it to sustain. I the bird before we go ahead and do some surgery and that if we just show this video here, I'm sorry, it's very, very old video, since that is looking like it does.
If you look at this cockatiel, this is a bit drip t as we modified, and had a seed stuck down its trachea. If we watch here, hopefully you can see the inhale exhaled air going up and down the tube and see how well they breathe through that. And that's really useful for stabilising a bird before you want to operate or for keeping it with a patent airway after you have operated.
And again for an aesthetic, we can just reg on, a T piece on there, have a low flow, continuous flow through the bird, and that keeps asleep. And this is us operating on a syringe aspergilloma in in a Harris Hawk. And it's great.
It's been in this house from back in there. It's perfectly asleep. We don't have to keep coming in and out.
We can operate continuously. The only disadvantage of course we got a flow of isofluorine gas coming into my face here, so I get sleepy quite a bit and have to take a break every now and then. But we can live with that.
We see other organs too. So here's the kidneys, interesting te like shapes there some communicate gout we can see that too. This is the adrenal and obviously the test is there.
We can see the spleen poking out from behind the stomach here. And this is the, liver, slightly rounded edge, so slightly abnormal liver. And these are great because once you've done that, we can have more fun with them.
We take biopsies and stuff, retrieve something we find a foreign body too, with more gear. This is standard operating sheet. It's called the tailor sheath.
It's actually a urethral sheath. It's got inflowaxo flash, which we don't use in birds, but we do in other places, and it's got an instrument port on the top. And we just lock in with 2.7 30 millimetre scope so we be edge fits beautifully and then we can, we can put instruments through there and typically we're using retrieval grips or we might use a bis little biopsy cups and sometimes set of scissors for performing biopsy and a standard biopsy technique we just take a pinch biopsy to his edge of the liver, and we just put.
Force it down they grip onto it and just pull away and take our section out. Or if you want to go into the parentchima, we might insert the scissors point first, open them slightly within that just open the capsule and then put our biopsy forceps into the parentine of the liver and take out a section from the middle of it, depending where we want things to. It all sounds very dramatic.
This is a immediate post-op picture of a of a kidney biopsy, and you can see there's a little bit of blood, but really remarkably little and I think, well, you know, it's all everybody's concerned when they start doing this. Oh my God, I have a major haemorrhage. It's highly unlikely.
And we don't see very many problems at all postoperatively. So that's why I put endo endoscopy in here because it's a great technique to move on to. It's a great technique to use, particularly for diagnostic purposes, where, where you might be considering an open surgical approach to take out organ biopsies instead of doing that.
And whereas in mammals, we might want to use ultrasound and a fine needle, biopsy, very difficult birds because the air sacs really bouncy ultrasound everywhere. So basically in summary, avian surgery can be tricky, and they're not the easiest patients, and preparation can be nearly impossible, but if you use a lot of care, you got some basic gear and some advanced gear, and you're a skillful surgeon, then you can do quite a lot of this. And there's a lot of these techniques are perfectly possible in any sports one practise.
Thank you. John, that was absolutely fascinating and I, I cannot remember when last I sat so still for an hour. So thank you for sharing the amazing work that you do with birds.
It, it, it really is incredible to see. Thank you. We don't have any questions.
I think everybody like me has been sitting, absolutely spellbound and hanging on every word that you've said. So, I'm not sure I'm brave enough to be jumping in and doing all these things that you are. So, I'm very grateful to have people like you around that I can refer them to.
Thank you. Always welcome. Folks, that's it for tonight.
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John, once again, thank you for your time. We so look forward to having you on the webinar vet again. Thank you.
And from my side, it's good night to everybody. Thank you to Stuart in the background for all the controlling. Good night folks.