Minimally Invasive | Common Procedures | Endoscopy-Assisted Gastropexy
  Exotics | Chronic Ear Disease| Laparoscopic Spaying

The endoscope is clearly one of the most important medical advances (among many) that came out of the twentieth century.  However, due to high equipment costs these devices have been virtually absent in veterinary hospitals until relatively recently.  As it has been doing for decades in human medicine, endoscopy and subsequently, endosurgery are beginning to transform the ways we diagnose and treat numerous disease conditions in our pets.

Endoscopy is the visualization of internal body structures through the use of an endoscope.  It enables veterinarians and physicians the ability to peer into body cavities and examine internal organs, joints, and spaces otherwise only accessible via more invasive surgery.  Endoscopes are instruments that use fiber optics and lens systems to provide lighting and visualization. They are usually connected to a camera that transmits the images to a monitor in the surgical suite.  There are seemingly countless types of endoscopes but they can all be separated into two broad categories: rigid and flexible.  Which to use depends on the medical procedure being performed.

The real take home message with endoscopy is that it is minimally invasive when compared to the traditional surgical approach. This means less post-operative discomfort and significantly shorter recovery times.  This approach typically carries far less risk then the comparable surgical option.  In addition, the risks are usually far outweighed by the diagnostic and therapeutic potential of the procedure.

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Endoscopy is also very useful in collecting samples for histopathology (biopsy testing) and can even guide in therapy and repair.  At Merrimack Veterinary Hospital we are fortunate to have several endoscopes which have applications in dogs, cats, and exotics.  Some of the procedures we are currently using them for include:

• Otoscopy: examination of the vertical and horizontal ear canals. This can include visualization of the middle ear (behind the eardrum) as well. Most commonly it is used to diagnose ear disease and to flush (under anesthesia) out difficult infections.  It also is used for the diagnosis and removal of tumors, polyps, and foreign bodies.

• Rhinoscopy: examination of the nasal passages to find the source of discharge or bleeding. Biopsies and cultures are usually taken with this procedure.

• Laryngoscopy: examination of the larynx (“voice” box at entrance to the trachea).  Common indications are for diagnosing laryngeal paralysis, tumors, and laryngitis.

• Tracheoscopy: examination of the trachea to reveal tracheal collapse, tracheitis (inflammation of the trachea), tumors and other growths, discharge, foreign bodies, and to collect samples for culture or biopsy.

• Esophagoscopy: visual examination of the esophagus to reveal hemorrhage, inflammation, ulcers, and foreign bodies.

• Laparoscopy: visualization of the stomach, liver, kidneys, bladder, pancreas, intestines and other abdominal structures including female reproductive organs and retained testicles. This is commonly done for both visualization of pathologic conditions and biopsy.

• Thoracoscopy: examination of the pleura (sac that covers the lungs), pleural spaces, mediastinum (space that separates both sides of chest), and pericardium (sac that covers the heart). Commonly we are looking for sources of chest fluid or air that is escaping the lungs, biopsy of tumors, and opening the pericardium (when it has filled with fluid).

• Vaginoscopy: direct visualization of the vagina and cervix to detect polyps, tumors, and inflammation.   

• Urethroscopy and Cystoscopy: examination of the urethra, bladder, and ureteral orifices to detect blockages, tumors, polyps, ectopic (abnormally connected) ureters (the tubes that go from the kidneys to the bladder). This is often indicated when pets are straining to urinate, passing bloody urine, getting frequent urinary tract infections, or are incontinent.

• Proctoscopy and Colonoscopy: examination of the inside of the rectum and end of colon to detect polyps, tumors, ulceration, inflammation, and discovery and removal of foreign bodies.

In addition to the above, endoscopes are assisting us in certain surgical procedures to increase the speed of the procedure and allow the procedure to be less invasive.  These are called endoscopic-assisted surgeries. One example is with dogs, cats, and rabbits that have retained testicles. These are testicles that never descended into the scrotum and are common causes of cancer later in the life of the pet. We are now using a “keyhole” incision to find the retained testicle using the endoscope and making a traditional surgical incision over it for removal. This is much faster and less invasive then having to search blindly for it, which often results in a lengthy incision and more post-operative discomfort.

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Another example of this is the endoscopic-assisted prophylactic gastropexy.  This is a procedure designed to prevent deadly stomach twisting (often referred to as “bloat”) in large breed dogs like Shepherds and Great Danes.  We use the endoscope to find the perfect location on the stomach, grab it with endoscopic forceps through a second “keyhole” incision, and bring it to the body wall for traditional suturing.  Again, substantially less invasive then the old approach.

In exotic species like rabbits, chinchillas, and guinea pigs we now use endoscopes to assist with trimming the normally difficult to visualize molar teeth.  These teeth often overgrow in these species when not supplied with enough roughage in their diet.  In birds, endoscopes allow for examining internal organs that would otherwise be almost impossible with regular surgery. We are even using this technology in reptiles (iguanas, monitors, turtles, snakes, etc) to diagnose and treat difficult to find disease conditions.

Arguably one of the most important uses of endoscopes in veterinary medicine is the endoscopic-assisted myringotomy.  A myringotomy is the surgical puncture of the eardrum. Why would we do this? The reason is that 89% of dogs that have had ear infections lasting longer then 6 months have middle ear infections. That is, the infection has moved behind the eardrum.  Thus, the middle ear must be flushed clean if the owner ever hopes to get control of these ear infections.  Without endoscopes the procedure is done blindly and is substantially more difficult with a much less certain outcome. With endoscopes we can actually visualize this middle ear area which improves our diagnostic abilities and allows for much greater therapeutic success.

When combined with cutting edge anesthesia and prudent pain control, endoscopy and endosurgery are as beneficial in veterinary medicine as they are in human medicine. Our goal at Merrimack Veterinary Hospital is to diagnose and treat disease with the minimum amount of pain and stress to our patients.  This technology is helping us do just that.

               Normal Ear                                  Abnormal Ear                             Diagnosing with Otoendoscope