What is a Diplomate?
The term "ACVS Diplomate" refers to a veterinarian who has been board certified in veterinary surgery. Only veterinarians who have successfully completed the certification requirements of the ACVS are Diplomates of the American College of Veterinary Surgeons and have earned the right to be called specialists in veterinary surgery.Laparoscopy is a general term used to describe surgical procedures in the abdominal cavity that are performed through small keyhole incisions. Another term that is often used to describe this form of procedure is minimally invasive surgery, an umbrella term, of which laparoscopy is one form. Laparoscopic procedures are usually performed by placement of surgical instruments through cannulae which are small plastic or metal tubes. Cannulae are placed through small 0.5-1cm incisions in the skin and muscle of the abdominal wall. A typical procedure might require the placement of one to four cannulae.
To initiate a laparoscopic procedure, a working space has to be established. That space is necessary in order to visualize organs and perform procedures and is usually created by formation of what is known as a pneumoperitoneum. To create a pneumoperitoneum carbon dioxide gas is insufflated into the abdomen to create working space. After creation of the pneumoperitoneum and placement of the first cannula, a small telescope (or laparoscope) with a camera attached is placed through the cannula and gives a view of the contents of the abdominal cavity. The image obtained by the camera is displayed on a monitor from which the surgeon and the surgical assistants work. After placement of the telescope into the first cannula the remainder of the cannulae required to complete the procedure are placed. As the telescope is now positioned in the abdominal cavity, these “instrument” cannulae can be placed under direct visualization. Once all instrument ports are positioned the procedure can proceed.
Many different laparoscopic procedures have been described in veterinary medicine from relatively uncomplicated procedures like organ biopsy and ovariectomy/ovariohysterectomy through to potentially complex procedures like adrenalectomy (resection of the adrenal gland) and abdominal tumor removal. In every case where a laparoscopic procedure is being considered, it is important to select cases very carefully as some cases are appropriate for this minimally invasive approach whereas others may be better approached through a traditional celiotomy (open) incision.
The advantages of laparoscopy include the creation of smaller incisions, a more rapid return to function and diminished post-operative pain. Other advantages may include fewer post-operative complications for certain procedures but in all cases owners should thoroughly discuss with their surgeon the advantages and disadvantages for the specific procedure that is being considered. The appropriateness of a laparoscopic approach will also vary depending on the disease process and the disease severity present.
