Your fur kid will unfortunately require at least one surgery in their lifetime — for sterilisation purposes, if nothing else. Fortunately, there is a quick, virtually painless procedure which allows for speedy and comfortable recovery.
Endoscopy may or may not be a familiar term to you, but it has existed in human healthcare for decades with global manufacturers of endoscopic equipment like Karl Storz being founded back in 1945. Despite its known advantages when done on the human body, however, endoscopy is still a relatively new development in the veterinary industry.
Jonathan Chen, from the Singapore subsidiary of Karl Storz, shares, “I would say that veterinary endoscopy kicked off in Singapore about four years ago. Dr Eugene Lin, who is a senior veterinary surgeon from The Animal Ark, was one of the pioneers of veterinary endoscopy, and he started practising it in his clinic by the end of 2011.”
Dr Hsu Li Chieh, senior veterinary surgeon from The Animal Clinic, adds, “As it becomes more common in human healthcare, pet owners also started to look for it for their pets, as they become more aware of its benefits and its availability locally.”What is endoscopy?
Endoscopy is an umbrella term for the use of an endoscope — essentially an illuminated, slender, and miniaturised camera — to take a look at the internal organs by projecting the magnified images on a monitor.
Insertion of any endoscopic tools can be done via small incisions (typically 5mm to 10mm) or through natural orifices. By using a flexible or rigid endoscope, diagnostic procedures such as looking for foreign objects within the body, identifying tumours and taking a look at internal infections are made easier. Carbon dioxide insufflation into the cavity helps to create more space between each organ for better visibility and counteract space constrain.
Depending on the optical tools, 3D imaging is available as well.
“We’re working with 3D organs, but when we look at them through a 2D display, we don’t get the depth perception. With lots of experience, a vet can tell how big a lesion is or how deep to poke the needle in; however, 3D imaging still helps to make things easier by giving depth perception,” explains Dr Eugene Lin.
Even though its layman’s terms are “minimally invasive surgery” or “keyhole surgery”, endoscopic procedures do not necessarily involve surgeries. Components of a regular health check-up, such as a routine ear test, can also be improved with endoscopy.
“Without endoscopy, I have to try to explain what I see inside the ears to the pet owners, and they might not understand some of the more technical terms used. By using endoscopes, which display what previously only I could see, onto the screen for the owners to witness, I can point out exactly what I am referring to. It really helps them to better understand the situation,” says Dr Hsu.
While there are the various subsets of endoscopy, laparoscopic spaying (laparoscopy is endoscopy of the abdomen) is thus far the most common operation carried out on pets. Through only two small punctures, as little as 3mm, the animal’s ovaries are removed, leaving the uterus intact. This is following in the footsteps of the US’ and Europe’s veterinary industry, where the gold standard of sterilisation is moving towards ovariectomy. Sufficient studies have proven that there are no significance differences in chances of getting Pyometra from ovariectomy, as opposed to removing the entire uterus.Minimal pain and recovery time
The benefits of endoscopic surgery are numerous; with smaller cuts, the pain and discomfort caused to the body, as well as risks of unnecessary bleeding, are reduced.
“The delicate equipment actually allows the vet to have more control — we can do relatively fine work in tight spaces. With the magnified projection, we can see specific vessels and tissues so we know precisely where to dissect, where to coagulate, in order to minimise or stop bleeding,” Dr Hsu explains.
“The endoscope can be manoeuvred to have a look around the cavity — the abdomen, for instance, in the case of spays. With an open surgery, the vet is more or less ‘fishing things out’ without a proper look inside. There are risks like nicking the spleen, which will cause excessive bleeding. If the vet wants to be able to see the insides, the cut has to be even bigger. Being able to see more when using endoscopes also means that — especially in older pets — there is a chance that we can discover any pre-existing conditions that have been going on unnoticed.”
Endoscopic surgeries also allow for cauterisation, in which high frequency energy is used to “weld” tissues together, thereby sealing the blood vessel. In some cases, zero bleeding is possible. As nothing is being pulled or torn apart and everything is instead carefully and methodically dissected, the procedure is more forgiving and less traumatic to the body.
Post-operation, pets can enjoy a much quicker recovery as smaller incisions also mean less suturing is required, or even none if the wound can be left to heal on its own or if all endoscopic instruments were inserted through the body’s natural openings.
Dr Hsu recalls, “I once treated a puppy for incontinence. With the help of ultrasound, we found out that she had an ectopic ureter — the tube that brings the urine from the kidney to the bladder was positioned too far back. The traditional way to correct this is through an open surgery, where the vet cuts the ureter and transplants it back to the right position. One would have to stitch that tiny ureter securely yet leave enough space for the urine to still pass through.”
“Yet, through a cystoscope, we could look up the urethra to visualise the abnormal positioning of the urethral opening and laser it to the correct position, thus correcting the problem, all without opening up the abdomen. The results were almost immediate — the puppy stopped leaking urine the very next day and she acted absolutely normally as we didn’t have to make any cuts. It was almost like nothing happened.”
Further affirming the advantages of minimally invasive surgery, Dr Lin says, “Chances of infection and wound dehiscence are dramatically decreased. If you like to be extra cautious, you can clothe your pet to prevent them from picking at the wound, as well as to keep it away from dirty surfaces.”Concerns and complications
“The number one question among the pet owners I have met, whose pets have had to undergo surgery, is, ‘Will the anaesthetic be safe for my pet?’ The impression towards the use of anaesthesia on animals is that it is highly dangerous and that the animal may not wake up,” Dr Hsu shares. “I reassure them that nowadays, with newer anaesthetic drugs and better administration, it’s basically as safe as human anaesthesia. Of course, we can’t eliminate the risks completely, but chances are much lower and we will always inform and advise accordingly.”
As far as surgical complications go, Dr Lin explains that bleeding, despite the accuracy of the digital imaging, would be the most probable issue.
“There are devices such as bipolar sealers and vascular clips are ready to rectify the situation. In more dire circumstances, vets are trained and prepared to convert to an open surgery when necessary,” Dr Lin expresses.
While expenses for endoscopic surgeries can go up to twice or thrice more than conventional open surgeries, figures are ultimately secondary to pet owners’ concerns over the health and safety of their furry companions, who are regarded as a family member.
Dr Hsu also shares his insights: “You might spend more on the surgery itself, but you spend less post-surgery. For example, your pet may not need to be boarded in the clinic as the recovery process is faster and more manageable. You save time too; less stitch up time is required because the incisions are smaller, which also means less time on anaesthesia is required.”Gaining traction and recognition
Slowly but surely, endoscopy is catching on in terms of recognition and availability in the Singapore veterinary scene.
“Within four years, the number of registered vet clinics providing endoscopy went up to 10. This is 10 out of 80 clinics, located all around the island, and they are getting a steady flow of patients coming in for all sorts of endoscopic procedures,” Jonathan shares.
Dr Lin, who conducts endoscopy workshops himself, says, “The response within the Singapore veterinary profession is picking up excellently. When it first started, not many people had heard of it; even if they had, not many wanted to take the first step. Right now, though, almost everybody knows about it. They are aware that endoscopy is the way to go, so they are willing to learn.”
Aside from local sessions, Dr Lin has also been invited by Karl Storz to conduct seminars and workshops in Malaysia, Indonesia, Taiwan and Korea.