Laparoscopic cystotomy has a number of advantages which include
- less patient pain
- shorter recovery time
- shorter healing time
- complete examination of bladder for other diseases greatly
- reduced risk that stones will be left in the bladder after surgery
What is is involved with a laparoscopic cystotomy?
Cystotomy is a surgically procedure that has been traditionally performed with a sizeable incision to remove stones from the bladder. With the advancement of minimally invasive surgery for dogs and cats, a very small incision can be made to remove stones from the bladder. In males dogs, a 1 cm incision is made just in front of the prepuce. In female dogs (depending on the size of the patient) the 1 cm incision is made about 7 to 10 cm in front of the pelvic bone on the abdomen. The bladder is identified, pulled up to a small abdominal incision, and is tacked to the skin to keep it in place and prevent leakage of urine and spillage of stones into the abdomen. A small incision is made in the exposed bladder and a 30 degree, 4 mm scope is placed into the bladder. The 30 degree scope helps look at all areas of the bladder more easily. The bladder is examined through the scope and the stones identified. Alligator or other forceps are passed parallel to the scope so that the tip of the forceps can be seen during retrieval of stones. See video right which shows removal of stones and blood clots that are engulfing stones.
The photo left shows the small incision, between the 2 black dots through which the laparoscopic cystotomy has been performed.
This next case is was referred to me from another veterinary hospital after stones were removed from the bladder. The dog developed distention of the abdomen with fluid. The fluid was found to be urine based on biochemical testing. The dog was taken to surgery and the bladder was found to be moderately distended and leaking urine into the abdomen. A scope was used to look inside of the bladder and also into the urethra (tube that drains the bladder to the outside). From this examination it was determined that a stone was lodged in the urethra which resulted in urinary obstruction. Watch the video below to see the retrieval of the stone with the assistance of an endoscope.