The Role Of Outreach In Honing Endoscopy Skills

Dr. Markee Kuschel does a laparoscopic spay. A study found that minimally invasive laparoscopic spays were up to 65 percent less painful than were conventional spays. Photo courtesy of BioVision Technologies

Like every other form of new technology, endoscopy is only as good as the practitioner using it. For some, a lack of experience with the equipment can build a roadblock to success.

In the relatively short history of the technology in veterinary medicine, some general practitioners have been known to go weeks or even months between chances to use their rigid endoscopy equipment. Those who have used it only for procedures such as lung lobe removals or liver biopsies might have gone as long as six months between surgeries.

“If you’re going six months without performing a procedure, it’s easy to lose confidence in your ability,” says Raymond Cox, DVM, founding partner of Deer Creek Animal Hospital in Littleton, Colo.

The solution championed by Dr. Cox and several colleagues is to make endoscopy an indispensible tool of their everyday practice. Aided by a study that established a pain advantage, they started using laparoscopic equipment to perform spays.

They also took a big step to close the gap on experience and confidence. By reaching out to shelters and rescue groups with an offer to perform procedures for free or at a greatly reduced cost, the veterinary colleagues created a model of mutual benefits that continues to grow.

A key to the success of that model is their study, the results of which were published in the Journal of the American Veterinary Medical Assn. in September 2005. Cox collaborated on the research report with Chad M. Devitt, DVM, MS, Dipl. ACVS, of the Veterinary Referral Center of Colorado, and with Jim Hailey, DVM, of the Redstone Animal Hospital in Littleton.

The three compared the complications, stress and pain of open ovariohysterectomy with that of laparoscopic-assisted ovariohysterectomy in dogs. The study found that the minimally invasive laparoscopic spays were up to 65 percent less painful than were conventional spays.

“The study allowed us to pass on the perception of value to clients and staff,”Cox said.

“That study is the bible of why laparoscopy is so viable as a tool of the general veterinary practice,” says John K. Small, vice president of BioVision Technologies of Golden, Colo.

BioVision sells veterinary endoscopy equipment and helps provide surgical training by supporting the Center for the Advancement of Rigid Endoscopy. It’s through CARE that Cox, Dr. Hailey and Cox’s Deer Creek colleague, Markee Kuschel, DVM, teach the techniques that have helped turn laparoscopy from a specialty-only tool to one generalists can love.

Over the years, Cox and his fellow proponents of the lap-assisted spay have refined the procedure from three ports to two, then finally to a single port, which they say further minimizes risk, pain, complications and recovery time.

But those risks are reduced only if the practitioner has experience and a level of comfort with the technology. That’s where the community outreach model comes in.

“Until we developed our skills, we didn’t want to take the risk with owned pets,” Cox said. “So we started calling shelters and then rescue groups. We’re able to perform procedures they wouldn’t be able to afford otherwise. It’s a win-win.”

The group launched the shelter model in 2003, and Cox performed about 20 procedures over a three-month period before he felt comfortable working on paying clients’ pets.

“Once I found my success rate was as good or better than that of a specialist, I didn’t feel bad about charging the appropriate rate to perform the procedure,” he said.

In the meantime, he made many new friends among rescue group volunteers.

“In a world where we’re always looking to increase our clientele, these are good friends to have,” Cox said. “When they find a home for that dog, they’re going to tell the new owner, ‘Here’s where you want to take your dog.’”

These days, all of Deer Creek’s spays are lap-assisted. The 12-doctor hospital charges $1,200, plus the cost of blood work, and will perform 600 to 800 procedures this year, Cox said. With refinements in technique, he averages 20 minutes per spay.

Everyone from board-certified practitioners to veterinary school students is eager to learn the single-port approach, and CARE now works with 26 rescue organizations, Cox said.

The $150 price charged for rescue dogs includes blood work, procedures and post-op pain medications.

In addition to the spays, CARE offers training in laparoscopic-assisted surgeries such as liver biopsies and retained testicles. Plus, Cox said he still finds benefit in the shelter/rescue group model as a means for continuing to stretch his skill set.

 For instance, a rescue group asked him if he could perform laparoscopic surgery on a Boston terrier who was dribbling urine. Though he had never tried the procedure before, Cox was able to attach the ureter to the bladder, helping the pooch regain continence.

Of course, that was nothing compared to the time the Colorado Division of Wildlife asked him to help a cormorant that had a fish hook in its esophagus.

“I was able to go in through the mouth, find the fishing line, pull the hook into the working channel and slide the esophagus off the needle,” Cox said.

Performing surgery on a rescued wild bird isn’t exactly the niche procedure on which Cox can build his practice. But the fact that the surgery succeeded illustrates how much confidence he has in his laparoscopic skills these days.

It’s the kind of self-assurance that comes from consistent work with equipment he now knows like the back of his hand.  

With the right training, he adds, “I have yet to find a clinic that isn’t able to justify the expense of the equipment.” <HOME>

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