Endoscopic Surgery
Laser Surgery for Dogs and Cats
The Best Surgery for Your Dog's Knee Tibial Tuberosity Advancement (TTA Surgery)

Endoscopic Surgery

The use of small cameras to perform diagnostics and surgery has been the standard of care for 10 to 15 years in human medicine and is now available for animals also! Arthroscopic (most commonly knee, shoulder, and elbow joints), laparoscopic (abdomen such as gall bladder removal in people), and thorascopic (chest and lung) surgery are all now possible at Lake Geneva Animal Hospital.

Benefits

	Small incisions - Usually 1/4 to 1/2  inch
	Less Pain - Small incisions are less painful and heal easier
	Better Visualization - Images are magnified and projected onto a monitor for easier viewing. Angled optics allow for looking around corners and into crevices that may not be visualized with traditional surgery.
	"A picture is worth a thousand words" - Seeing structures like the liver or kidney allow biopsies to be taken from specific areas of interest that may not be visualized on x-ray or ultrasound.

Common Indications for Endoscopic Surgery

	OCD (Cartilage Flap) of the shoulder, elbow, or knee (stifle).
	Biceps Tendonitis
	Gastropexy in breeds likely to bloat (deep-chested breeds such as Great Danes, Dobermans, Rottweilers, Labradors, Retrievers, etc.). Prophylactic gastropexy (permanently suturing the stomach to the body wall) is used to prevent gastric volvulus; a life threatening condition where the stomach rotates on itself leading to bloating and death within hours.
	Bladder evaluation for urinary problems, persistent infections or removal of stones.
	Lung Mass Removal
	Biopsies - Liver, Kidney, Pancreatic, etc.
	Cancer Staging - Staging of cancer to determine treatment options - Many cancers are very treatable with surgery or other modalities. Veterinarians and owners often do not want to put an animal through a major surgery to remove a cancerous growth if the cancer has spread to other regions. Spread often indicates the need for chemotherapy or radiation. It may also mean that the surgery will not extend the animal's quality of life. Those animals can be checked first with the endoscope through a very small incision to determine if major surgery will be helpful and/or get biopsies for a definitive diagnosis. This avoids a potentially long recovery from major surgery allowing the animal to go home quickly.

 
“Cowboy” had his stomach tied down to prevent twisting (GDV)

Bloat

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Laser Surgery Available At Lake Geneva Animal Hospital

Advantages

	Less bleeding - the laser cauterizes as it cuts.
	Less Pain- the nerves are sealed as they are cut so no raw nerve endings.  Thus, there is much less pain.
	Sterile- Any organisms (bacteria, viruses, etc.) are vaporized by the laser.  Plus, the laser never touches the surface as it cuts resulting in less swelling.
	Precise - the beam can be directed to exact spots and the power adjusted to vary the depth of cut.  This allows very precise cuts.  Also, because of a feature called super-pulse on this laser, there is minimal thermal damage to surrounding tissue.  The heat produced by the super-pulse laser does not spread to other tissues and to surrounding tissue.  This is not the case with all lasers. Some do not have the super-pulse feature or use a different form of laser energy (diode lasers for example) and result in significant tissue damage not apparent at the time of surgery. This can lead to healing problems and even sloughing of tissue days after surgery.  The carbon-dioxide, super-pulse laser that we employ eliminates these issues.

Disadvantages

These are few but the laser is not used in all surgeries.  Because of the lack of bleeding and swelling, incisions can take slightly longer to fully heal (14-21 days versus 10-14 days with a scalpel). Though this is not noticeable for most surgeries, we do not use the laser when it is essential for rapid healing (such as intestinal surgery).  The doctor will determine if laser surgery is a good option for each case.

Cost
Use of the laser adds anywhere from $40 (spays, neuters) to $150 (large mass removals or toenail lasering).

Procedures that benefit from laser surgery

	Declaws - The procedure used to be very painful for the cats. Now, the cats usually are walking and playing the next day. Even older or heavy cats can now be done humanely.  Because of the significant reduction in the post-operative pain level for this procedure, the use of the laser is mandatory.  We no longer perform declaws without the laser.
	Short-Nosed Animals - Pugs, Pekinese, Bulldogs, Persian cats, etc - Animals with "pushed in noses" commonly have "Brachyocephalic Syndrome". They breathe loudly, snore, and often times do not exercise much. Though this is a "normal conformation" for these breeds, it is not healthy.The nostrils are typically just slits rather than open holes, and the soft palate is too long. The result is noisy breathing, snoring, and decreased exercise.  Over time, the continual vacuum created by these problems causes the larynx (voice box) and trachea (windpipe) to collapse further limiting air movement. Once this happens, the dog begins to cough and breathe even harder. There is no treatment at this stage of disease. Now, laser surgery can be done, prior to permanent damage, to open the nostrils and reduce the soft palate. This alleviates much of the noisy breathing and the effort required. The animals can move air more easily and can live a more normal life lessening the chance of tracheal collapse later in life. After very promising results with the first patients, we are recommending this procedure on many of these pushed-in-face dogs.
	Mass removal -Small masses (warts) are often vaporized away with just a local anesthetic. Larger masses are removed with less bleeding and cleaner edges since there is no scalpel to possibly drag tumor cells to new areas when cutting.
	Spays/Neuters - the majority of the post-operative pain comes from the incision.  Since the laser seals the nerves, it is much less painful.
	Many, many more...

This cat was spayed and declawed 12 hrs ago		This is a 4 yr. old cat declawed 12 hrs ago

Laparoscopic/arthroscopic Surgery

	Spays
	Stomach tacking to prevent Gastric Dilation-Volvulus (GDV)
	Bladder stone removal
	Osteochondrosis Desicans (OCD) Surgery

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The Best Surgery for Your Dog's Knee (Tibial Tuberosity Advancement (TTA SURGERY)

The most common knee injury in the dog is rupture of the Cranial Cruciate Ligament (CCL), also frequently called the Anterior Cruciate Ligament (ACL). This injury can occur at any age and in any breed, but most frequently occurs in middle aged, overweight, medium to large breed dogs. This ligament frequently can suffer a partial tear, leading to slight instability of the knee. If this damage goes untreated, it most commonly leads to complete rupture and possibly damage to the medial meniscus of the knee. The meniscus acts as a cushion in the knee. Complete rupture results in front-to-back instability, commonly called Tibial Thrust, and internal rotation of the lower leg, commonly called Pivot Shift. Untreated legs usually become very arthritic and painful from the instability.

An injured Cruciate Ligament can only be corrected by surgery. There are numerous surgical corrections currently being performed. The most common are 1) External Capsular Repair, 2) Tibial Plateau Leveling Operation (TPLO), and 3) Tibial Tuberosity Advancement (TTA). This article will focus on the TTA, which is the newest procedure, and probably the best repair for most dogs. The forces within the knee are very complicated and change as the knee is rotated through its range of motion. In a normal standing position there is a tendancy for the lower end of the Femur to slide backwards on the tilted Tibial Plateau, this is called Tibial Thrust. This force can be corrected by either cutting the Tibial Plateau and rotating it into a more flat position (TPLO) or by counteracting this force by changing the angle of pull of the very strong Patellar Tendon by advancing the Tibial Tuberosity (TTA). It has been shown that the TPLO procedure can still allow rotational instability (Pivot Shift) and this may lead to the progression of arthritis as the dog ages. This Pivot Shift does not seem to be a problem with the TTA procedure because it results in more control of rotation by the large quadriceps muscle which pulls on the Patellar Tendon. The difference in the physics have been worked out quite well by the researchers. Anyone interested in the details can easily find them by doing an internet search on "TTA vs. TPLO".