Hampshire & West Sussex

Laparoscopic, or “key hole”, surgery is seen as gold standard in human medicine and is now making the transition to the veterinary world. It is well documented that it causes fewer complications and less post-operative pain in people, compared to traditional surgery, and we are now seeing data in animals which supports this.

Laparoscopic procedures have the advantage of:

• Reduced tissue handling
• Greater precision
• Less trauma
• Haemorrhage (bleeding) is often reduced and more easily controlled
• The whole abdomen can be examined to ensure there is no unexpected disease evident
• Procedure time may be reduced

This procedure can offer a quicker recovery time often allowing dogs off the lead and running around three days after surgery. The wounds are also smaller meaning your pet is less likely to lick them and cause complications.

The procedure is performed by a small needle being placed into the abdomen which is then used to inflate the patient with carbon dioxide. This creates a space for the camera to be placed and gives the surgeon room to move instruments around. Three small tubes are then placed into the abdomen which act as ports for instruments to pass down and through which the ovaries can be removed. The wounds are small and are closed without external stitches.

Traditionally in the UK we have performed ovariohysterectomy where the ovaries and the whole of the uterus are removed. In mainland Europe and the US ovariectomy has always been used whereby the ovaries are removed but the uterus is left in place. The rationale in the UK for removing everything was to eliminate risk of pyometra, an infection in the uterus. This has now been disproven, as pyometra does not occur when the ovaries are removed and this data shows that we only need to perform an ovariectomy. Therefore in laparoscopic surgery only the ovaries are removed which further reduces tissue handling and trauma to the patient.

The procedure is highly successful with great results following surgery however as with all procedures there are risks and potential complications. If at any point the surgeon is unhappy with how the procedure is going, i.e. due to equipment failure, abnormal bleeding etc, the decision may be made to convert to an ‘open’ surgery. This decision would always be made with the safety of the patient in mind.

Endoscopy is a process of using small cameras to examine the internal structure of certain hollow body parts. This non-invasive technique can allow visualisation or areas that would require, in some cases, radical surgery to access otherwise. The cameras can be used to examine and record the appearance of structures, to obtain samples via biopsy or washes or to remove foreign bodies. 

Endoscopy takes a lot of time and patience to learn but can be a hugely rewarding and vital diagnostic tool. Most endoscopy work is performed at our Emsworth clinic. Here we have 3 flexible cameras which can but manipulated through areas of the body and 3 rigid cameras for use in more external areas. With our full range of equipment, we can examine;

• Upper and lower airway, including nose and lungs
• Upper gastrointestinal tract (stomach, duodenum)
• Lower gastrointestinal tract (rectum and colon)
• Bladder (in female dogs and a certain size)

We now offer arthroscopy (allowing visualisation of a joint without surgery to open it) and also laparoscopic surgery whereby body cavities (such as the abdomen) can be examined and surgery performed through ‘key hole’ incisions.

With the range of exotic species we see, it is not unusual for our exotic vet Dean to be using the cameras in some unusual animals! 

Ultrasound is a non-invasive (and therefore non-painful) way of imaging which we find invaluable in the work-up of a lot of medical and surgical cases. We have had many years' experience with ultrasound at the Bognor Regis surgery (Annette Moyart has 10 years' experience). We find it a very useful tool to obtain definitive diagnoses and prognoses in a wide range of cases. Ultrasound ensures that we get the most information possible, with the least risk to the patient and guides prompt treatment. We provide pain relief if the patient is uncomfortable but they remain conscious throughout the procedure. The patient lies on a nice comfortable bed and is held gently by nurses. We clip some hair over the region we are imaging and to improve contact of the ultrasound probe with the skin, gel is applied to the skin.

CRITICAL CASES

These cases are often very unstable (weak and collapsed or having breathing difficulty), so ultrasound has the advantage of being non-invasive, allows rapid assessment and it doesn’t necessitate anaesthesia which could be dangerous in these individuals.

Such cases include:

• To investigate the cause of internal haemorrhage in an elderly dog with a splenic tumour and then to check for metastasis to liver and heart, prior to performing surgery
• Diagnosis of pyometra
• Confirmation whether a cat in acute respiratory distress has fluid around its lungs or heart failure

MEDICAL CASES

These cases are often of a more chronic nature; such as weight loss, vomiting, diarrhoea, abdominal masses, abnormal urination or ongoing discomfort. They have often been unresponsive to standard treatment eg a course of antibacterials of bacterial cystitis in a dog. There has often been prior investigations such as blood or urine tests and radiographs, but a definitive diagnosis or prognosis has not been reached. We have a lot of experience in the investigation of a wide range of medical cases involving internal organs such as liver, spleen, pancreas, gut and urinary system including prostate disease. We routinely perform ultrasound-guided biopsies, cystocentesis, thoracocentesis and abdominocentesis. The fine needle aspirates are often submitted to a specialist cytologist to obtain a definitive diagnosis.

WIDE VARIETY OF CASES

Ultrasound can also be used in a wide variety of other cases; including assessment of skin masses or, hernias and for the presence of free fluid in a body cavity. Please contact us if you are unsure if a case could benefit from ultrasound imaging.

DVG’s orthopaedic service is run at the Emsworth surgery by Fabio Cabriolu and Gus Nieves. We offer a wide range of services including TTA and lateral suture for cruciate ligament repair, luxating patella surgery, lameness work-up, fracture repairs and arthrodesis.

We also do arthroscopy, where by small cameras can be placed into joints to help diagnose and treat certain conditions.