The editor

TIMOTHY C. MCCARTHY, DVM, PHD, Diplomate Emeritus, American College of Veterinary Surgeons, is an ACVS Founding Fellow in Minimally Invasive Surgery (Small Animal Soft Tissue and Small Animal Orthopedics) and owner of VetMIST, providing Veterinary Minimally Invasive Surgery Training, based in Beaverton, Oregon, USA.

List of Contributors xvii Preface xix Acknowledgements xxi About the Companion website xxiii 1 Introduction and History of Endoscopy 1Timothy C. McCarthy 1.1 Introduction 1 1.2 The History of Endoscopy 1 1.3 Clinical Application in Veterinary Medicine 6 References 7 2 Instrumentation for Endoscopy 9Timothy C. McCarthy 2.1 Endoscopy Room Setup and Organization 9 2.2 Instrumentation for Small Animal Endoscopy 10 2.2.1 The Endoscopy Video Tower 10 2.2.2 Video Cameras 10 2.2.3 Video Monitors 11 2.2.4 Light Source 12 2.2.5 Documentation Equipment 13 2.2.6 Power Equipment 14 2.2.6.1 Radio-Frequency Instrumentation 14 2.2.6.2 Vessel Sealing Devices 14 2.2.7 Irrigation Fluid Management Systems 16 2.2.7.1 Gravity Flow 16 2.2.7.2 Pressure-Assisted Flow 17 2.2.7.3 Mechanical Fluid Pumps 17 2.2.8 Operating Tables 17 2.2.9 Rigid Telescopes 17 2.2.10 Flexible Endoscopes 20 2.2.11 Sheaths, Cannulas, and Trocars 21 2.2.12 Diagnostic and Operative Instruments 24 3 Gastrointestinal Endoscopy 27Reto Neiger and Christiane Stengel 3.1 Equipment 27 3.1.1 Flexible Endoscopy 27 3.1.2 Rigid Endoscopy 30 3.1.3 Ancillary Equipment 30 3.1.3.1 Biopsy Forceps 31 3.1.3.2 Foreign Body Retrieval Instruments 31 3.1.3.3 Others 31 3.2 Technique 32 3.2.1 Handling the Endoscope 32 3.2.2 Handling Accessory Instruments 32 3.2.3 Taking Biopsies and Brush Cytology 33 3.2.4 Patient Preparation 36 3.2.5 Anesthesia 37 3.2.6 Complications and Contraindications 37 3.2.7 Endoscopic Training 38 3.3 Esophagoscopy 39 3.3.1 Indications, Limitations 39 3.3.2 Procedure 39 3.3.3 Normal Findings 41 3.3.4 Abnormal Findings 41 3.4 Gastroscopy and Duodenoscopy 48 3.4.1 Indications, Limitations 48 3.4.2 Procedure 50 3.4.3 Normal Findings 55 3.4.4 Abnormal Findings 56 3.5 Colonoscopy/Ileoscopy 60 3.5.1 Indications, Limitations 60 3.5.2 Procedure 63 3.5.3 Normal Findings 68 3.5.4 Abnormal Findings 68 3.6 Therapeutic Flexible GI Endoscopy 71 3.6.1 Foreign Body Retrieval 71 3.6.1.1 Esophageal Foreign Body Removal 74 3.6.1.2 Duodenal Foreign Body Removal 77 3.6.1.3 Colonic and Rectal Foreign Body Removal 78 3.6.2 Feeding Tube Placement 78 3.6.2.1 Procedure 79 3.6.2.2 Tube Management 81 3.6.2.3 Replacement and Removal 83 3.6.3 Stricture Dilation 83 3.6.4 Stent Placement 86 3.6.5 Polyp Removal 87 3.7 Additional Techniques in GI Endoscopy 87 3.7.1 Capsule Endoscopy 87 3.7.2 Double Balloon Endoscopy 87 3.7.3 Confocal Endomicroscopy 88 3.7.4 Natural Orifice Transluminal Endoscopic Surgery 88 3.7.5 Endoscopic Retrograde Cholangiopancreatography 88 3.8 Care and Cleaning of GI Endoscopic Equipment 88 3.8.1 Pre-Cleaning 89 3.8.2 Manual Cleaning 90 3.8.3 Machine Cleaning 91 3.8.4 Storage 92 3.8.5 Sterilization or High-Level Disinfection 93 References 93 4 Rhinoscopy 99Timothy C. McCarthy 4.1 Introduction 99 4.2 Indications 100 4.3 Instrumentation 102 4.4 Preparation of the Patient 104 4.5 Technique 105 4.5.1 Radiographic Imaging 105 4.5.2 Culture Sample Collection 108 4.5.3 Rhinoscopy 108 4.5.4 Frontal Sinoscopy 112 4.6 Normal Nasal Cavity and Frontal Sinuses 113 4.7 Nasal Pathology 120 4.7.1 Nasal Neoplasia 120 4.7.2 Mycotic Rhinitis and Sinusitis 142 4.7.2.1 Aspergillosis 142 4.7.2.2 Cryptococcosis 152 4.7.3 Allergic Rhinitis 153 4.7.4 Nasal Foreign Bodies 157 4.7.5 Rhinitis Secondary to Dental Disease 159 4.7.6 Nasal Turbinate Infarction 161 4.7.7 Traumatic Rhinitis 164 4.7.8 Nasal Disease Secondary to Otic Diseases 165 4.7.9 Parasitic Rhinitis 169 4.7.10 Canenoid and Felenoid Diseases 171 4.7.11 Nasal Hamartomas 172 4.7.12 Viral Rhinitis 173 4.7.13 Bacterial Rhinitis 173 4.7.14 Nasal Vascular Dysplasia 174 4.7.15 Epistaxis 174 4.7.16 Rhinitis of Undetermined Origin 175 4.7.17 Brachiocephalic Nasal Airway Syndrome 179 4.7.18 Nasopharyngeal Stenosis 181 4.7.19 Nasal Lymphoid Hyperplasia 185 4.7.20 Nasal Angiofibroma 187 References 192 5 Bronchoscopy 195Brendan C. McKiernan 5.1 Introduction 195 5.2 Equipment 195 5.2.1 Equipment Care and Cleaning 195 5.3 Indications and Contraindications of Bronchoscopy 196 5.4 Anesthesia for Bronchoscopy 196 5.4.1 Monitoring and Positioning the Patient for Bronchoscopy 198 5.5 Bronchoscopic Training 199 5.6 Bronchoscopic Procedure 199 5.7 Normal and Abnormal Bronchoscopic Findings 201 5.8 Sample Procurement and Handling 206 5.9 Summary 213 References 214 6 Cystoscopy 217Timothy C. McCarthy 6.1 Introduction 217 6.2 Cystoscopy Indications 218 6.2.1 Chronic Cystitis 219 6.2.2 Hematuria 219 6.2.3 Tenesmus or Stranguria 219 6.2.4 Increased Frequency of Urination 219 6.2.5 Urinary Incontinence 219 6.2.6 Ureteroceles 220 6.2.7 Alteration of the Urinary Stream 220 6.2.8 Trauma 220 6.2.9 Cystic and Urethral Calculi 221 6.3 Instrumentation for Cystoscopy 221 6.3.1 Transurethral Cystoscopy in Female Dogs and Cats 222 6.3.2 Instrumentation for Transurethral Cystoscopy in Male Dogs 226 6.3.3 Instrumentation for Transurethral Cystoscopy in Male Cats 227 6.3.4 Instrumentation for Prepubic Percutaneous Cystoscopy 227 6.3.4.1 Telescopes 227 6.3.4.2 Sheaths 227 6.3.4.3 Sharp Trocars and Blunt Obturators 227 6.3.4.4 Second Puncture Cannulas 227 6.3.4.5 Operative Instrumentation 228 6.3.5 Instrumentation for Percutaneous Perineal Cystoscopy in Male Dogs 228 6.3.6 Instrumentation for Laparoscopic-Assisted Cystoscopy 228 6.3.6.1 Telescopes 228 6.3.6.2 Flexible Cystourethroscopes 228 6.3.6.3 Cannulas and Sheaths 228 6.3.6.4 Operative Instrumentation 229 6.3.7 Instrumentation for Lithotripsy 229 6.4 Techniques for Transurethral Cystoscopy 230 6.4.1 Patient Preparation 230 6.4.2 Transurethral Cystoscopy in Female Dogs and Cats 231 6.4.3 Transurethral Cystoscopy in Male Dogs 240 6.4.4 Transurethral Cystoscopy in Male Cats 244 6.4.5 Technique for Prepubic Percutaneous Cystoscopy 247 6.4.5.1 The Original Technique 247 6.4.5.2 Modified PPC Technique 250 6.4.5.3 Diagnostic Sample Collection 250 6.4.6 Technique for Laparoscopic-Assisted Cystoscopy 250 6.4.6.1 Diagnostic Sample Collection 257 6.4.7 Photodynamic Diagnostics with Cystoscopy 257 6.5 Normal Endoscopic Anatomy of the Lower Urinary Tract 257 6.5.1 Transurethral Cystoscopy in Female Dogs and Cats: Vagina 257 6.5.2 TUC in Female Dogs and Cats: Urethra and Bladder 262 6.5.3 Transurethral Cystoscopy in Male Dogs 267 6.5.4 Transurethral Cystoscopy in Male Cats 268 6.5.5 Normal Endoscopic Anatomy: LAC and PPC in the Dog and Cat 269 6.6 Diagnoses with Cystoscopy 269 6.6.1 Cystitis and Urethritis 269 6.6.1.1 Interstitial Cystitis 270 6.6.1.2 Follicular Cystitis 270 6.6.1.3 Polypoid Cystitis 273 6.6.1.4 Chronic Diffuse Cystitis 275 6.6.1.5 Urethral Strictures 280 6.6.1.6 Urethrocutaneous Fistula 282 6.6.1.7 Prostatitis 282 6.6.2 Neoplasia of the Lower Urinary Tract 284 6.6.2.1 Transitional Cell Carcinomas 284 6.6.2.2 Other Tumors of the Lower Urinary Tract 294 6.6.2.3 Vaginal Tumors and Masses 294 6.6.3 Cystic and Urethral Calculi 300 6.6.3.1 Oxalate Calculi 301 6.6.3.2 Struvite Calculi 301 6.6.3.3 Urate Calculi 302 6.6.3.4 Silica Calculi 302 6.6.4 Anatomic Abnormalities 307 6.6.4.1 Vaginal Anatomic Abnormalities 307 6.6.4.2 Ectopic Ureters and Ureteroceles 308 6.6.4.3 Ureteroceles 313 6.6.4.4 Ectopic Ureters in Male Dogs 315 6.6.4.5 Bladder Diverticula 317 6.6.4.6 Vascular Dysplasia 320 6.6.5 Urinary Tract Trauma 320 6.6.6 Renal Hematuria 325 6.7 Interventional and Operative Cystoscopy 326 6.7.1 Minimally Invasive Management of Inflammatory Disease 326 6.7.2 Minimally Invasive Management of Neoplasia 328 6.7.2.1 Transitional Cell Carcinoma Management 328 6.7.2.2 Management of Other Tumor Types 338 6.7.3 Minimally Invasive Urolithiasis Management 338 6.7.3.1 Hydropropulsion 339 6.7.3.2 Transurethral Cystoscopy 340 6.7.3.3 Laparoscopic-Assisted Cystoscopy 341 6.7.3.4 Minimally Invasive Management of Urethral Calculi in Male Dogs 343 6.7.4 Minimally Invasive Management of Anatomic Abnormalities 344 6.7.4.1 Ectopic Ureters 344 6.7.4.2 Laparoscopic-Assisted Ectopic Ureter Correction in Male Dogs 352 6.7.4.3 Minimally Invasive Vaginal Web and Septum Transection 353 6.7.4.4 Minimally Invasive Management of Urachal Diverticula 355 6.7.5 Minimally Invasive Management of Urinary Incontinence 357 References 359 7 Vaginal Endoscopy in the Bitch 363Cindy Maenhoudt and Natalia Ribeiro dos Santos 7.1 Canine Vaginal Anatomy 363 7.2 Instrumentation 363 7.3 Cleaning and Sterilization of Equipment 365 7.4 Procedures in the Bitch 366 7.4.1 Transcervical Insemination (TCI) 366 7.4.1.1 Introduction of the Endoscope and Catheterization of the Cervix 366 7.4.1.2 Insemination 369 7.4.2 Observation of the Vaginal Changes Throughout the Estrous Cycle 370 7.4.2.1 Proestrus 370 7.4.2.2 Estrus 370 7.4.2.3 Diestrus and Anestrus 371 7.4.3 Diagnostic Vaginoscopy 371 7.4.3.1 Anomalies Related to the Paramesonephric Ducts 372 7.4.3.2 Vaginitis, Vaginal Mass, and Foreign Body 373 7.4.4 Other Uterine Procedures 373 7.4.4.1 Hysteroscopy 374 7.4.4.2 Endometrial Biopsy 375 7.4.4.3 Uterine Cytology and Culture 376 7.4.4.4 Uterine Lavage 376 7.4.4.5 Other Usages 377 7.4.5 Complications and Limitations 377 7.4.6 Tips and General Comments 378 7.5 Conclusion 379 References 379 8 Laparoscopy 383Timothy C. McCarthy 8.1 Introduction 383 8.2 Indications for Laparoscopy 385 8.2.1 Indications for Diagnostic Laparoscopy 385 8.2.2 Indications for Operative Laparoscopy 386 8.3 Instrumentation for Small Animal Laparoscopy 388 8.3.1 Insufflator 388 8.3.2 Laparoscopes 389 8.3.3 Trocar-Cannulas 391 8.3.4 Operative Instruments 392 8.3.5 Hemostasis 395 8.3.6 Single Incision Laparoscopic Surgery (SILS) Instruments 398 8.3.7 Single Incision Wound Protectors/Retractors for MIS 399 8.4 Laparoscopy Technique 399 8.4.1 Portal Placement and Insufflation 399 8.4.2 Laparoscopic-Assisted Technique 407 8.4.3 Anesthesia for Laparoscopy 407 8.5 Normal Laparoscopic Anatomy 408 8.5.1 The Abdominal Wall, Diaphragm, and Falciform Ligament 408 8.5.2 Normal Liver and Gall Bladder 414 8.5.3 Normal Kidneys 415 8.5.4 Normal Pancreas 416 8.5.5 Normal Spleen 416 8.5.6 Normal Urinary Bladder and Ureters 417...