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.Thoracoscopy is a general term for minimally invasive procedures of the chest cavity. Thoracoscopic procedures are usually performed in specialist centers as they often require an advanced level of knowledge and expertise in specialized anesthetic techniques. These might include techniques such as one-lung ventilation that might be required in order to create enough working space in the chest to perform certain surgical procedures.
Thoracoscopic procedures are performed through keyhole incisions created under the breastbone or in between the ribs through which cannulae (small plastic or metal tubes) are placed. These ports provide unimpeded access for repeated insertion of a telescope or surgical instruments. As soon as the first cannula has been placed, a telescope is inserted into the chest to visualize the lungs, heart and other thoracic organs of interest. After placement of the first cannula, 2-4 further ports are created to allow placement of surgical instruments that will allow completion of the procedure.
A large variety of thoracoscopic procedures have been described including lung lobectomy (removal of lung lobes), pericardectomy (removal of the sac around the heart), treatment of chylous effusion, biopsy of thoracic organs and removal of tumors in the chest not associated with the lungs as well as several others.
Advantages of thoracoscopy include less post-operative pain because of avoidance of the need to spread the ribs or breastbone apart. Thoracoscopy also provides excellent magnification of the surgical site which is especially useful for procedures such as thoracic duct ligation in which very small ducts are visualized and ligated. Disadvantages include the anesthetic challenges involved and the fact that not all procedures can be approached using minimally invasive techniques. Just as in laparoscopy (minimally invasive surgery in the abdomen), selection of appropriate cases is critical. Small dogs and cats are more challenging for thoracoscopic surgery as the amount of working space is very limited in these patients. Diseases that are advanced in nature may present a challenge for thoracoscopy if the extent of disease has gone beyond what can be reasonably approached using these techniques. In these situations, an open thoracotomy or median sternotomy may be a more appropriate choice for the patient. Pet owners should thoroughly discuss all of these factors with their surgeon in order to reach a decision regarding the appropriateness of a thoracoscopic approach for treatment of their pet’s condition.
