Page 286 - Clinical Manual of Small Animal Endosurgery

274 Clinical Manual of Small Animal Endosurgery

plated lizard may overlie and obscure underlying coelomic pathology on
radiographs. All these lesions are readily evident with the aid of lapar-
oscopy (Fig. 10.1). Furthermore, although speculums can be used to
visualise the oral cavities of rodents and rabbits to evaluate the extent
of dental disease, rigid endoscopy provides ease of access, and a well-
illuminated and magnified view even at the back of the mouth (Fig. 10.2).
Images may also later be shown to owners, in a bid to help them under-
stand the disease process.
This chapter will attempt to give a very broad overview of some of
the most common applications for conditions encountered in exotic
pet species in general practice, but clearly there are many more applica-
tions for rigid-endoscopic techniques not covered here. Endoscopes can
be used to visualise any anatomical space, or any potential space that
can be created via distention with fluid, air or carbon dioxide, and can
also be used in surgically created spaces. While outside the scope of this
chapter, endosurgery has been described in amphibians such as frogs
(Cook, 1999), fish endosurgery is surprisingly well developed thanks
to recent research (Divers, 2010), and endoscopy has even been used
for examination of the pulmonary cavity in giant African land snails
(Pizzi, 2010).
Although minimally invasive in nature, the majority of endoscopic pro-
cedures in exotic pet animals do need anaesthesia for safe restraint, as well
as analgesia in surgical applications, just as for all surgical procedures.

Equipment

A 2.7 mm-diameter, 30° endoscope and associated operating sheath,
originating as a human paediatric cystoscope, has traditionally been the
mainstay of exotic pet endoscopy, and is commonly referred to as the
‘universal’ endoscope. This endoscope may also be used in other applica-
tions such as canine rhinoscopy. When choosing endoscopes, one will
always be forced to compromise between the diameter of the endoscope
and the light-transmission capability and related image size and quality.
While the minimally invasive nature of endosurgery is always empha-
sised as the main benefit in veterinary patients, the other notable advan-
tage is the excellent visualisation that is possible, as well as illumination,
and access to the regions of the body such as the cranial and caudal
abdomen not easily visualised by open surgery. Unfortunately emphasis
on incision size and number has led to some veterinarians believing that
the smallest number of smallest ports is always best. A reduction in 2 mm
port-site wound size is likely to have minimal effects on postoperative
pain and healing, yet the reduction in endoscope size may cause a notable
decrease in illumination from the same light source and yields a smaller,
poorer-quality image. The ultimate aim of minimally invasive surgery is
safer, more physiological surgery, and this is best accomplished with
good visualisation. It is up to the individual clinician to decide the best