May/June 2004

Modern Advances in Veterinary Surgery

This month guest columnist Stephen H. Levine, DVM, MS presents the second in his series of articles on surgery.

Introduction
The past few decades have witnessed an exponential
leap in the sophistication and variety of surgical care available to companion animals. There is probably a veterinary
counterpart to almost every procedure currently performed
in human patients.
Total hip replacements are now routine procedures for
many veterinary surgeons. One institution is now offering
total elbow replacements for canine patients suffering from
debilitating arthritis of the elbow joint. While dogs tend
not to suffer from coronary artery disease, there are now
many cardiovascular surgeries performed on veterinary
patients including open heart procedures such as valve
replacements and septal defect repairs (holes in the heart)
and closed heart procedures such as pacemaker implantation, patent ductus arteriosus (PDA) repair, and heart base
tumor removals.
Highly technical procedures are now available to correct anomalies of the urinary system, the digestive system,
the nervous system, the respiratory system, the musculoskeletal system and virtually all others.
Tremendous progress has been achieved in the surgical
battle against all forms of cancer in companion animals
from limb-sparing techniques for the treatment of
osteosarcoma to computer guided surgery for the removal
of brain tumors.
Kidney transplants are now performed on felines in
several hospitals throughout the world. These patients are
generally older cats in some form of renal (kidney) failure.
The owners choosing a transplant must adopt a compatible
donor cat which has been slated for euthanasia from a shelter and then agree to provide a home to the donor cat for
the rest of its life. After transplantation the recipient cat is
placed on anti-rejection drugs as in humans. Many of these
patients survive several years with a good quality of life.
Kidney transplants are possible in dogs but very few
have been performed clinically. It is much more difficult to
immunosuppress the rejection response in dogs even when
donors are closely matched or related. The technology for
heart and liver transplants in dogs also exists. In fact,
canines have served as the model for the development of
these procedures in man. They are not performed clinically in dogs because of donor controversy. Both procedures
require the death of the donor, and suitable brain-dead
donors are rare in veterinary medicine.

Modern diagnostic equipment such as ultrasound

imaging equipment, CAT (computer-assisted tomography)
scanning equipment, and MRIs (magnetic resonance imaging machines) are now available through many veterinary
centers to assist in establishing a diagnosis and monitoring
the progression of diseases and/or their treatments.
Virtually any surgical procedure now available to
humans could theoretically be offered to feline and canine
patients. In many cases, however, cost is the limiting factor.
It would be well beyond the scope of this article to discuss the many specific surgical procedures now available in
small animal practices. Indeed, multi-volume textbooks
are devoted to just that. However two general areas of veterinary surgery that have become quite common deserve
further discussion. They are laser surgery and minimally
invasive surgery.

Laser Surgery
Veterinary surgical lasers have become very popular
over the past several years. Medical use of the laser began
in the early 1960s. The first units were costly, nonportable, and had huge maintenance and operational problems. Improvements in laser development in the military
and industry benefited the biomedical lasers which soon
became more user friendly.
Laser is an acronym for Light Amplified by
Stimulated Emission of Radiation. Very basically, a laser
beam is created by passing light through a lasing medium.
The lasing medium is a solid crystal, a liquid, or most commonly a gas such as carbon dioxide (CO2). Atoms in the
lasing medium are then excited and gain energy after which
they pass through a partially reflective mirror at one end of
the laser chamber as a highly concentrated, precise beam of
light. This beam is capable of vaporizing tissues.
Use of laser energy for surgery has many proposed
advantages. Hemostasis (control of bleeding) is excellent
with laser surgery. While blood loss is generally not a problem in most procedures, having a clear and dry surgical
field is desirable for visualization. The vaporization of tissues at the incision site seals nerve endings and blood vessels and might result in less post-operative pain and
swelling although this has not been fully documented in
veterinary patients.
Research studies have proven that laser-created wounds
tend to heal somewhat slower and are slightly more susceptible to infections than scalpel created wounds. When an