Veterinary Endoscopy for the Small Animal Practitioner

The editorTIMOTHY C. McCARTHY, DVM, PHD, Diplomate Emeritus, American College of Veterinary Surgeons, is an ACVS Founding Fellow in Minimally Invasive Surgery (Small Animal Soft Tissue and Small Animal Orthopedics) and owner of VetMIST, providing Veterinary Minimally Invasive Surgery Training, based in Beaverton, Oregon, USA.

• List of Contributors xviiPreface xixAcknowledgements xxiAbout the Companion website xxiii1 Introduction and History of Endoscopy 1Timothy C. McCarthy1.1 Introduction 11.2 The History of Endoscopy 11.3 Clinical Application in Veterinary Medicine 6References 72 Instrumentation for Endoscopy 9Timothy C. McCarthy2.1 Endoscopy Room Setup and Organization 92.2 Instrumentation for Small Animal Endoscopy 102.2.1 The Endoscopy Video Tower 102.2.2 Video Cameras 102.2.3 Video Monitors 112.2.4 Light Source 122.2.5 Documentation Equipment 132.2.6 Power Equipment 142.2.6.1 Radio-Frequency Instrumentation 142.2.6.2 Vessel Sealing Devices 142.2.7 Irrigation Fluid Management Systems 162.2.7.1 Gravity Flow 162.2.7.2 Pressure-Assisted Flow 172.2.7.3 Mechanical Fluid Pumps 172.2.8 Operating Tables 172.2.9 Rigid Telescopes 172.2.10 Flexible Endoscopes 202.2.11 Sheaths, Cannulas, and Trocars 212.2.12 Diagnostic and Operative Instruments 243 Gastrointestinal Endoscopy 27Reto Neiger and Christiane Stengel3.1 Equipment 273.1.1 Flexible Endoscopy 273.1.2 Rigid Endoscopy 303.1.3 Ancillary Equipment 303.1.3.1 Biopsy Forceps 313.1.3.2 Foreign Body Retrieval Instruments 313.1.3.3 Others 313.2 Technique 323.2.1 Handling the Endoscope 323.2.2 Handling Accessory Instruments 323.2.3 Taking Biopsies and Brush Cytology 333.2.4 Patient Preparation 363.2.5 Anesthesia 373.2.6 Complications and Contraindications 373.2.7 Endoscopic Training 383.3 Esophagoscopy 393.3.1 Indications, Limitations 393.3.2 Procedure 393.3.3 Normal Findings 413.3.4 Abnormal Findings 413.4 Gastroscopy and Duodenoscopy 483.4.1 Indications, Limitations 483.4.2 Procedure 503.4.3 Normal Findings 553.4.4 Abnormal Findings 563.5 Colonoscopy/Ileoscopy 603.5.1 Indications, Limitations 603.5.2 Procedure 633.5.3 Normal Findings 683.5.4 Abnormal Findings 683.6 Therapeutic Flexible GI Endoscopy 713.6.1 Foreign Body Retrieval 713.6.1.1 Esophageal Foreign Body Removal 743.6.1.2 Duodenal Foreign Body Removal 773.6.1.3 Colonic and Rectal Foreign Body Removal 783.6.2 Feeding Tube Placement 783.6.2.1 Procedure 793.6.2.2 Tube Management 813.6.2.3 Replacement and Removal 833.6.3 Stricture Dilation 833.6.4 Stent Placement 863.6.5 Polyp Removal 873.7 Additional Techniques in GI Endoscopy 873.7.1 Capsule Endoscopy 873.7.2 Double Balloon Endoscopy 873.7.3 Confocal Endomicroscopy 883.7.4 Natural Orifice Transluminal Endoscopic Surgery 883.7.5 Endoscopic Retrograde Cholangiopancreatography 883.8 Care and Cleaning of GI Endoscopic Equipment 883.8.1 Pre-Cleaning 893.8.2 Manual Cleaning 903.8.3 Machine Cleaning 913.8.4 Storage 923.8.5 Sterilization or High-Level Disinfection 93References 934 Rhinoscopy 99Timothy C. McCarthy4.1 Introduction 994.2 Indications 1004.3 Instrumentation 1024.4 Preparation of the Patient 1044.5 Technique 1054.5.1 Radiographic Imaging 1054.5.2 Culture Sample Collection 1084.5.3 Rhinoscopy 1084.5.4 Frontal Sinoscopy 1124.6 Normal Nasal Cavity and Frontal Sinuses 1134.7 Nasal Pathology 1204.7.1 Nasal Neoplasia 1204.7.2 Mycotic Rhinitis and Sinusitis 1424.7.2.1 Aspergillosis 1424.7.2.2 Cryptococcosis 1524.7.3 Allergic Rhinitis 1534.7.4 Nasal Foreign Bodies 1574.7.5 Rhinitis Secondary to Dental Disease 1594.7.6 Nasal Turbinate Infarction 1614.7.7 Traumatic Rhinitis 1644.7.8 Nasal Disease Secondary to Otic Diseases 1654.7.9 Parasitic Rhinitis 1694.7.10 Canenoid and Felenoid Diseases 1714.7.11 Nasal Hamartomas 1724.7.12 Viral Rhinitis 1734.7.13 Bacterial Rhinitis 1734.7.14 Nasal Vascular Dysplasia 1744.7.15 Epistaxis 1744.7.16 Rhinitis of Undetermined Origin 1754.7.17 Brachiocephalic Nasal Airway Syndrome 1794.7.18 Nasopharyngeal Stenosis 1814.7.19 Nasal Lymphoid Hyperplasia 1854.7.20 Nasal Angiofibroma 187References 1925 Bronchoscopy 195Brendan C. McKiernan5.1 Introduction 1955.2 Equipment 1955.2.1 Equipment Care and Cleaning 1955.3 Indications and Contraindications of Bronchoscopy 1965.4 Anesthesia for Bronchoscopy 1965.4.1 Monitoring and Positioning the Patient for Bronchoscopy 1985.5 Bronchoscopic Training 1995.6 Bronchoscopic Procedure 1995.7 Normal and Abnormal Bronchoscopic Findings 2015.8 Sample Procurement and Handling 2065.9 Summary 213References 2146 Cystoscopy 217Timothy C. McCarthy6.1 Introduction 2176.2 Cystoscopy Indications 2186.2.1 Chronic Cystitis 2196.2.2 Hematuria 2196.2.3 Tenesmus or Stranguria 2196.2.4 Increased Frequency of Urination 2196.2.5 Urinary Incontinence 2196.2.6 Ureteroceles 2206.2.7 Alteration of the Urinary Stream 2206.2.8 Trauma 2206.2.9 Cystic and Urethral Calculi 2216.3 Instrumentation for Cystoscopy 2216.3.1 Transurethral Cystoscopy in Female Dogs and Cats 2226.3.2 Instrumentation for Transurethral Cystoscopy in Male Dogs 2266.3.3 Instrumentation for Transurethral Cystoscopy in Male Cats 2276.3.4 Instrumentation for Prepubic Percutaneous Cystoscopy 2276.3.4.1 Telescopes 2276.3.4.2 Sheaths 2276.3.4.3 Sharp Trocars and Blunt Obturators 2276.3.4.4 Second Puncture Cannulas 2276.3.4.5 Operative Instrumentation 2286.3.5 Instrumentation for Percutaneous Perineal Cystoscopy in Male Dogs 2286.3.6 Instrumentation for Laparoscopic-Assisted Cystoscopy 2286.3.6.1 Telescopes 2286.3.6.2 Flexible Cystourethroscopes 2286.3.6.3 Cannulas and Sheaths 2286.3.6.4 Operative Instrumentation 2296.3.7 Instrumentation for Lithotripsy 2296.4 Techniques for Transurethral Cystoscopy 2306.4.1 Patient Preparation 2306.4.2 Transurethral Cystoscopy in Female Dogs and Cats 2316.4.3 Transurethral Cystoscopy in Male Dogs 2406.4.4 Transurethral Cystoscopy in Male Cats 2446.4.5 Technique for Prepubic Percutaneous Cystoscopy 2476.4.5.1 The Original Technique 2476.4.5.2 Modified PPC Technique 2506.4.5.3 Diagnostic Sample Collection 2506.4.6 Technique for Laparoscopic-Assisted Cystoscopy 2506.4.6.1 Diagnostic Sample Collection 2576.4.7 Photodynamic Diagnostics with Cystoscopy 2576.5 Normal Endoscopic Anatomy of the Lower Urinary Tract 2576.5.1 Transurethral Cystoscopy in Female Dogs and Cats: Vagina 2576.5.2 TUC in Female Dogs and Cats: Urethra and Bladder 2626.5.3 Transurethral Cystoscopy in Male Dogs 2676.5.4 Transurethral Cystoscopy in Male Cats 2686.5.5 Normal Endoscopic Anatomy: LAC and PPC in the Dog and Cat 2696.6 Diagnoses with Cystoscopy 2696.6.1 Cystitis and Urethritis 2696.6.1.1 Interstitial Cystitis 2706.6.1.2 Follicular Cystitis 2706.6.1.3 Polypoid Cystitis 2736.6.1.4 Chronic Diffuse Cystitis 2756.6.1.5 Urethral Strictures 2806.6.1.6 Urethrocutaneous Fistula 2826.6.1.7 Prostatitis 2826.6.2 Neoplasia of the Lower Urinary Tract 2846.6.2.1 Transitional Cell Carcinomas 2846.6.2.2 Other Tumors of the Lower Urinary Tract 2946.6.2.3 Vaginal Tumors and Masses 2946.6.3 Cystic and Urethral Calculi 3006.6.3.1 Oxalate Calculi 3016.6.3.2 Struvite Calculi 3016.6.3.3 Urate Calculi 3026.6.3.4 Silica Calculi 3026.6.4 Anatomic Abnormalities 3076.6.4.1 Vaginal Anatomic Abnormalities 3076.6.4.2 Ectopic Ureters and Ureteroceles 3086.6.4.3 Ureteroceles 3136.6.4.4 Ectopic Ureters in Male Dogs 3156.6.4.5 Bladder Diverticula 3176.6.4.6 Vascular Dysplasia 3206.6.5 Urinary Tract Trauma 3206.6.6 Renal Hematuria 3256.7 Interventional and Operative Cystoscopy 3266.7.1 Minimally Invasive Management of Inflammatory Disease 3266.7.2 Minimally Invasive Management of Neoplasia 3286.7.2.1 Transitional Cell Carcinoma Management 3286.7.2.2 Management of Other Tumor Types 3386.7.3 Minimally Invasive Urolithiasis Management 3386.7.3.1 Hydropropulsion 3396.7.3.2 Transurethral Cystoscopy 3406.7.3.3 Laparoscopic-Assisted Cystoscopy 3416.7.3.4 Minimally Invasive Management of Urethral Calculi in Male Dogs 3436.7.4 Minimally Invasive Management of Anatomic Abnormalities 3446.7.4.1 Ectopic Ureters 3446.7.4.2 Laparoscopic-Assisted Ectopic Ureter Correction in Male Dogs 3526.7.4.3 Minimally Invasive Vaginal Web and Septum Transection 3536.7.4.4 Minimally Invasive Management of Urachal Diverticula 3556.7.5 Minimally Invasive Management of Urinary Incontinence 357References 3597 Vaginal Endoscopy in the Bitch 363Cindy Maenhoudt and Natalia Ribeiro dos Santos7.1 Canine Vaginal Anatomy 3637.2 Instrumentation 3637.3 Cleaning and Sterilization of Equipment 3657.4 Procedures in the Bitch 3667.4.1 Transcervical Insemination (TCI) 3667.4.1.1 Introduction of the Endoscope and Catheterization of the Cervix 3667.4.1.2 Insemination 3697.4.2 Observation of the Vaginal Changes Throughout the Estrous Cycle 3707.4.2.1 Proestrus 3707.4.2.2 Estrus 3707.4.2.3 Diestrus and Anestrus 3717.4.3 Diagnostic Vaginoscopy 3717.4.3.1 Anomalies Related to the Paramesonephric Ducts 3727.4.3.2 Vaginitis, Vaginal Mass, and Foreign Body 3737.4.4 Other Uterine Procedures 3737.4.4.1 Hysteroscopy 3747.4.4.2 Endometrial Biopsy 3757.4.4.3 Uterine Cytology and Culture 3767.4.4.4 Uterine Lavage 3767.4.4.5 Other Usages 3777.4.5 Complications and Limitations 3777.4.6 Tips and General Comments 3787.5 Conclusion 379References 3798 Laparoscopy 383Timothy C. McCarthy8.1 Introduction 3838.2 Indications for Laparoscopy 3858.2.1 Indications for Diagnostic Laparoscopy 3858.2.2 Indications for Operative Laparoscopy 3868.3 Instrumentation for Small Animal Laparoscopy 3888.3.1 Insufflator 3888.3.2 Laparoscopes 3898.3.3 Trocar-Cannulas 3918.3.4 Operative Instruments 3928.3.5 Hemostasis 3958.3.6 Single Incision Laparoscopic Surgery (SILS) Instruments 3988.3.7 Single Incision Wound Protectors/Retractors for MIS 3998.4 Laparoscopy Technique 3998.4.1 Portal Placement and Insufflation 3998.4.2 Laparoscopic-Assisted Technique 4078.4.3 Anesthesia for Laparoscopy 4078.5 Normal Laparoscopic Anatomy 4088.5.1 The Abdominal Wall, Diaphragm, and Falciform Ligament 4088.5.2 Normal Liver and Gall Bladder 4148.5.3 Normal Kidneys 4158.5.4 Normal Pancreas 4168.5.5 Normal Spleen 4168.5.6 Normal Urinary Bladder and Ureters 4178.5.7 Normal Gastrointestinal Tract 4188.5.8 Normal Ovaries and Uterus 4228.5.9 Normal Adrenal Glands 4248.5.10 Normal Blood Vessels 4258.6 Laparoscopic Abdominal Abnormalities 4268.6.1 Abdominal Wall Abnormalities 4278.6.2 Diaphragmatic Abnormalities 4318.6.3 Fat Abnormalities 4328.6.4 Free Abdominal Foreign Bodies 4338.6.5 Liver Abnormalities 4348.6.6 Gall Bladder Abnormalities 4448.6.7 Extra-Hepatic Bile Duct Abnormalities 4478.6.8 Kidney Abnormalities 4478.6.9 Pancreatic Abnormalities 4498.6.10 Splenic Abnormalities 4508.6.11 Adrenal Gland Abnormalities 4548.6.12 Bladder and Ureteral Abnormalities 4558.6.13 Abnormalities of the Gastrointestinal Tract 4588.6.14 Ovarian Abnormalities 4618.6.15 Abnormalities of the Uterus 4638.6.16 Testicular Abnormalities 4638.6.17 Blood Vessel and Lymphatic Abnormalities 4648.6.18 Abdominal Fluid, Ascites, and Bleeding 4648.6.19 Abdominal Masses and Cancer Staging 4688.7 Diagnostic Laparoscopy and Biopsy Techniques 4698.7.1 Exploratory Laparoscopy 4698.7.2 Liver Biopsy 4698.7.3 Cholecystocentesis 4748.7.4 Pancreatic Biopsy 4748.7.5 Kidney Biopsy 4758.7.6 Gastrointestinal Biopsy 4788.7.7 Biopsy of the Spleen 4838.7.8 Biopsy Techniques for Additional Organs and Tissues 4848.7.9 Cancer Staging 4848.8 Minimally Invasive Abdominal Surgery 4858.8.1 Laparoscopic Ovariectomy 4858.8.1.1 Single-Port Technique 4868.8.1.2 Two-Port Techniques 4928.8.1.3 Three-Port Technique 4958.8.2 Laparoscopic Ovariohysterectomy 4978.8.3 Ovarian Remnant Removal 5008.8.4 Cryptorchid Castration 5018.8.5 Laparoscopic Vasectomy 5068.8.6 Prophylactic Gastropexy 5068.8.6.1 Laparoscopic-Assisted Gastropexy 5068.8.6.2 Laparoscopic Gastropexy 5138.8.7 Laparoscopic-Assisted Gastrotomy 5148.8.8 Laparoscopic Pyloroplasty 5168.8.9 Laparoscopic-Assisted Enterotomy and Intestinal Resection with Anastomosis 5168.8.10 Laparoscopic-Assisted Cecectomy 5178.8.11 Laparoscopic Cholecystectomy 5178.8.12 Laparoscopic Partial Pancreatectomy 5228.8.13 Pancreatic Cyst Ablation 5258.8.14 Laparoscopic Nephrectomy 5268.8.15 Laparoscopic Adrenalectomy 5288.8.16 Laparoscopic Portosystemic Shunt Occlusion 5338.8.17 Laparoscopic Splenectomy 5358.8.18 Laparoscopic Herniorrhaphy 5368.8.19 Laparoscopic Urethral Occluder Implantation 5378.8.20 Laparoscopic-Assisted Cystoscopy 5418.8.21 Laparoscopic-Assisted Cystopexy 5458.8.22 Laparoscopic-Assisted Intestinal Feeding Tube Placement 5468.8.23 Laparoscopic-Assisted Gastrostomy Feeding Tube Placement 5478.8.24 Additional Minimally Invasive Abdominal Surgical Procedures 547References 5479 Thoracoscopy 553Timothy C. McCarthy9.1 Introduction 5539.2 Indications 5539.3 Thoracoscopy Instrumentation 5559.3.1 Telescopes 5559.3.2 Cannulas 5579.3.3 Operative and Sample Collection Instruments 5589.4 Thoracoscopy General Technique 5599.4.1 Patient Preparation 5599.4.2 Technique Anesthesia and Pneumothorax 5599.4.3 Telescope Portal Placement 5629.4.3.1 Paraxiphoid Telescope Portal 5629.4.3.2 Lateral Telescope Portal Placement 5639.4.4 Operative Portal Placement 5669.4.5 Portal Closure and Pleural Space Management 5669.4.6 Postoperative Recovery 5699.5 Thoracoscopy: Normal Thoracic Anatomy 5699.6 Thoracic Pathology 5729.6.1 Pleural and Pericardial Fluid 5739.6.2 Chest Wall Abnormalities 5759.6.3 Abnormalities of the Diaphragm 5779.6.4 Mediastinal Abnormalities 5809.6.5 Thoracic Foreign Bodies 5819.6.6 Lung Pathology 5839.6.6.1 Neoplasia 5849.6.6.2 Pneumothorax 5859.6.6.3 Spontaneous Pneumothorax 5859.6.6.4 Primary Pulmonary Disease 5899.6.6.5 Lung Lobe Torsion 5919.6.7 Pleural Effusion 5929.6.8 Chylothorax 5939.6.9 Pericardial Effusion 5959.7 Diagnostic Thoracoscopy Procedures 6019.7.1 Pleural, Hilar Lymph Node, Mediastinal, Pericardial, and Chest Wall Mass Biopsy 6029.7.2 Lung Biopsy 6039.8 Thoracic Operative Procedures 6069.8.1 Pericardial Window 6069.8.2 Right Atrial Mass Resection 6099.8.3 Subtotal Pericardiectomy 6129.8.4 Partial Lung Lobectomy 6159.8.5 Lung Lobectomy 6179.8.6 Thoracic Duct Occlusion 6229.8.7 Patent Ductus Arteriosus Occlusion 6249.8.8 PRAA Correction 6249.8.9 Mediastinal Mass Removal 6269.8.10 Thoracic Foreign Body Removal 6279.9 Contraindications for Thoracoscopy 6289.10 Complications of Thoracoscopy 6309.11 Conclusions 630References 63110 Video Otoscopy 637Rod Rosychuk10.1 Normal Anatomy of the Ear as Seen Through the Video Otoscope 63710.2 Pathophysiology of the Ear as Seen Through the Video Otoscope 64310.3 Video Otoscopes 64510.4 Video Otoscope Instrumentation 64810.5 Video Otoscopy as a Diagnostic Aid – “In Examination Room” Use 64910.6 Video Otoscopy Procedures 65010.6.1 Deep Ear Cleaning of the Ear Canals 65210.6.2 Deep Ear Cleaning of the Middle Ear 65310.6.3 Intralesional Glucocorticoid Injections 65410.6.4 Laser Surgery 65510.6.5 Myringotomy 65510.6.6 Management of Primary Secretory Otitis Media 65610.6.7 Biopsies and Mass Removals 65610.6.8 Feline Aural Polyp Removal 65710.6.9 Visualization of the Tympanic Cavity and Bulla 658Suggested Reading 65911 Otheroscopies 661Timothy C. McCarthy11.1 Introduction 66111.2 Instrumentation for Otheroscopy in Small Animals 66111.3 Transabdominal Nephroscopy and Ureteroscopy 66111.4 Transabdominal Cholecystodocoscopy 66511.5 Transabdominal Gastrointestinal Endoscopy 66811.6 Prepuceoscopy 67111.7 Laceroscopy 67311.8 Drain Retrieval 67511.9 Fistuloscopy 67711.10 Oculoscopy 67711.11 Oncoscopy 67911.12 Oraloscopy 68011.12.1 Dentaloscopy 68011.12.2 Tonsiloscopy 68011.12.3 Pharyngoscopy 68111.13 Laryngoscopy 68411.14 Dermoscopy 69111.15 Analsacoscopy 693References 693Index 695