Keyhole surgery: a world in miniature [H&H VIP]

  • Find out more about the latest advances in keyhole surgery from H&H's vet news expert, Peter Green MRCVS

    Keyhole surgery, or arthroscopy, is now the method of choice for removing bone chips from joints, sorting out osteochondrosis problems with joint cartilage and looking inside tendon sheaths.

    Although there have been a few brave attempts to perform keyhole joint surgery in standing horses under sedation, the vast majority is undertaken with the horse on the operating table under general anaesthesia.

    Compared with old-fashioned joint surgery, in which the surgeon made an incision big enough to open up the joint and look inside with the naked eye, our contemporary keyhole techniques are a revolution. The current standard keyhole instruments are about 2-4mm in diameter, the thickness of a medium-sized knitting needle.

    But even these are beginning to look dated as cameras and imaging equipment become smaller and smaller. Scientists have developed cameras small enough to stick on to tiny insects as they go about their daily life. Now, they have developed arthroscopy equipment no thicker than a hypodermic needle.

    Vets in Colorado, USA, have reported on the use of 18-gauge keyhole surgery equipment for operating on the stifles of standing horses. This needle gauge is only just over 1mm in thickness, just like the needles we routinely use to perform joint blocks as part of the lameness work-ups.

    The images obtained from this miniaturised equipment were just as good as those the standard 4mm camera could produce and the surgeons were able to operate on the stifles without sending the horses to the operating table.