Minimally Invasive Surgery in Small Animal Practice: Laparoscopy and Thoracoscopy

MIS=Minimally Invasive Surgery revolutionizes small animal surgical practice via reduced tissue trauma, analgesia requirements, and recovery time vs. traditional open procedures. Core techniques: laparoscopy (abdominal cavity access) and thoracoscopy (thoracic cavity access). Both rely on rigid endoscopic systems, insufflation (pneumoperitoneum/pneumothorax), video imaging, and specialized long-shaft instruments. Equipment: 2.7–5mm laparoscopes/thoracoscopes, HD camera systems, insufflator (CO2 preferred), trocars (5–12mm), graspers, dissectors, ligating devices (e.g., Hem-o-lok, LigaSure), energy modalities (bipolar, ultrasonic). Patient prep: pre-op imaging (US/CT) to exclude metastasis,禁食12h, urinary catheterization in females, dorsal recumbency (laparoscopy), lateral recumbency (thoracoscopy). Port placement critical: laparoscopy: 3–4 ports (1x camera, 2–3x working); standard: umbilical (camera), left caudal (assistant), right mid-abdominal (primary working). Thoracoscopy: 2–3 intercostal ports (7th–9th ICS), camera caudal, working cranial/caudal. Insufflation: IAP=Intra-Abdominal Pressure 8–15mmHg (dog), 6–10mmHg (cat); ITP=Intra-Thoracic Pressure 6–10mmHg; rate 2–4L/min; monitor ETCO2, BP, SpO2. Key procedures: laparoscopic ovariectomy (OVE), ovariohysterectomy (OHE), cryptorchid castration, gastropexy (prophylactic in GDV-prone breeds), liver/kidney biopsy, gastrointestinal resection. Thoracoscopic: lung lobectomy, pericardectomy, mediastinal mass biopsy, PDA ligation, sympathectomy. Advantages: magnified visualization, reduced surgical site infection (SSI), faster return to function, improved cosmetic outcomes. Limitations: steep learning curve, equipment cost, limited tactile feedback, technical complexity in obese or adhesion-heavy patients. Complications: CO2 embolism (rare), subcutaneous emphysema, port-site hemorrhage, visceral injury (enterotomy, ureter damage), incomplete resection. Safety: Veress needle vs. open Hasson for initial access—Hasson preferred in small animals due to precision. Two-dimensional vision limits depth perception; training via box simulators, cadaver labs, mentored cases. Current SOTA: single-incision laparoscopy (SILS), robotic-assisted systems (e.g., da Vinci SP) emerging but cost-prohibitive in general practice. Training programs: ACVS/ESVS offer MIS modules; proficiency requires 20–50 supervised cases. Evidence: OVE non-inferior to open OHE in morbidity/mortality; laparoscopic gastropexy gold standard for GDV prevention in at-risk breeds. Thoracoscopic lung lobectomy offers superior pain control vs. thoracotomy. Pitfalls: inadequate insufflation, poor triangulation, improper port spacing, instrument crowding, inexperienced assistant. Ergonomics: surgeon positioning critical to avoid fatigue; camera operator must maintain horizon and focus. Instrument care: regular leak testing, proper cleaning to prevent biofilm. Future: integration with AR=Augmented Reality, AI-guided navigation, smart trocars with haptic feedback. Economic: ROI achievable via increased case load and client demand for advanced care. MIS now standard in referral centers; increasing adoption in general practice with modular training. Essential skills: camera navigation, tissue manipulation, hemostasis under laparoscopic view, knot tying (extracorporeal or pre-tied), complication recognition. Patient selection: ideal candidates are ASA I–II, non-obese, no prior abdominal/thoracic surgery. Use of stay sutures for organ retraction (liver, spleen). Bipolar electrocautery preferred over monopolar to reduce stray current injury. Energy device selection based on vessel size: ultrasonic for ≤7mm, bipolar for ≤5mm. Hem-o-lok clips safe for vessels ≤7mm. CO2 absorption enhanced by warm, humidified gas to reduce peritoneal irritation. Post-op: multimodal analgesia (local blocks, opioids, NSAIDs), early ambulation. Discharge: 24–48h post-op for OVE/OHE. Monitoring: incisional pain, respiratory effort (thoracoscopy), abdominal distension. MIS improves surgical precision and client satisfaction; represents evolution toward evidence-based, high-acuity veterinary surgical care.