The field of Veterinary Surgery is not stagnant. Veterinary surgeons are innovators and eager to learn new technologies. Below are the top 10 advances in Veterinary Surgery for 2024.

1) Minimally Invasive Surgery:

Minimally invasive surgery (MIS) is performed through small portals created by small incisions 5 to 20 mm long. Through these portals, scopes with cameras can be inserted to view the interior of body cavities. Advances in imaging technology, such as high-definition endoscopes and laparoscopes, as well as real-time 3D imaging, have improved the precision of MIS to provide for better visualization of internal structures. Additionally, small instruments can be inserted through the portals for dissection, suture, and removal of tissue. Of recent note, multiple instruments can be inserted through a single portal to significantly limit tissue trauma and postoperative pain. These procedures can be routinely performed on an outpatient basis since there is less tissue trauma, less postoperative pain, and faster recovery.

Minimally invasive surgery can now be used for multiple procedures that previously required a large open incision. MIS is tailor-made for procedures like arthroscopy, laparoscopy, thoracoscopy, cystotomy for bladder stones, pericardectomy, and prophylactic gastropexy, to name but a few. For example:

Prophylactic Gastropexy – Large breed dogs like Great Danes and Irish Wolfhounds are prone to developing a life-threatening condition called gastric dilation and volvulus (GDV), which requires emergency surgery. The stomach is secured to the abdominal wall through a small portal, assisted by cameras and MIS instruments.

Thoracoscopy for Pericardectomy- Pericardial effusion is a life-threatening condition in which cardiac output is significantly decreased with the patient at risk for sudden death. Emergency pericardial fluid drainage is required for survival. In a minimally invasive thoracoscopic pericardotomy or pericardectomy, 2 to 3 small portals are inserted into the thoracic wall for accommodation of camera and instruments. A drainage incision or a “window” of pericardial tissue is removed to allow for drainage of the impeding pericardial fluid. Thoracoscopy for this procedure makes for significantly less tissue trauma, less postoperative pain and a quicker recovery.

2) Robotic Surgery:

Robotic surgery in human medicine is now commonplace; however, in veterinary medicine, it remains futuristic and the purview of academic veterinary medicine. Texas A & M School of Veterinary Medicine & Biomedical Sciences veterinarians have found that the use of the da Vinci robotic surgery system offers the added benefits of circular wrist-like movements, allowing for much easier suturing and dissection. Additionally, the high-resolution 3D displays provide for improved visibility.

Robotic-assisted arms in orthopedic surgery can help stabilize a joint before inserting a screw, allowing for a smaller incision. Additionally, a robotic arm can move to a specified position to indicate the direction of screw implantation so that screw trajectories can be planned in axial, coronal, and sagittal views. During hip and knee arthroplasty, a robotic arm equipped with a burr or saw-cutting tool can guide the surgeon for precise bone resection. In some systems, robot-powered imaging can collect CT images, create 3D images, and capture fluoroscopic images to guide resection.

Robotic-assisted surgery in veterinary surgery currently remains an academic novelty. However, it is likely to follow the trend of human medicine and ultimately find its way to a veterinary hospital near you.

3) 3D Printing:

3D printing is not futuristic. It is one of the most practical advances in veterinary orthopedic surgery. 3D printing has hastened advancement in:

• Surgical planning- 3D models created by integration with CT and MRI scans can help a surgeon understand the patient’s precise anatomy and plan surgery. Vet3D, which specializes in 3D printed surgical guides, provides customized guides that can be printed to assist in precise reconstruction of angular limb deformities, fracture reduction, and vertebral screw placement. 
• Patient-specific implants- 3D printing creates patient-specific implants in orthopedic conditions like hip dysplasia, elbow dysplasia, and angular limb deformities. 3D printing, with the integration of CT and MRI scans, can create highly detailed models that precisely replicate the animal’s anatomy. VCA Northwest Veterinary Specialists utilize 3D printing technology to create precise, custom-fit implants and surgical guides tailored to each patient’s unique anatomy. This protocol provides for perfectly fitted implants with optimal functionality, improved accuracy of procedures, reduction in surgery times, and faster recovery times.

3D-printed models are increasingly used in veterinary student instruction. They improve students’ understanding of a patient’s anatomy and allow them to practice surgical techniques on realistic models before working on live patients.

3D printing can be done with a wide range of materials, including living cells. 3D printing is a powerful tool in veterinary surgery that can improve surgical performance, precision, and cost-effectiveness.

4) Regenerative Therapy:

Regenerative therapy has made significant advances in recent years and is a treatment modality most frequently utilized for the repair of joints, ligaments and cartilage. Treatment is provided in the following modalities:

Image from UCI

• Stem Cell Therapy - Stem cells are multipotential mesenchymal or embryonic cells capable of growing through cell division and differentiating into a multiplicity of tissues like blood vessels, bone, cardiac, ligament, cartilage, liver, muscle, nerve, and tendon. They serve as an internal repair system by replacing damaged or dead tissues by reproducing themselves and turning them into the needed tissue cells. Stem cells are harvested from the veterinary patient’s own adipose tissue or bone marrow. Stem cells are then separated from either the bone marrow or adipose tissue by a variety of sophisticated methods, such as Magnet-activated Cell Sorting, Density Gradient Centrifugation, and Fluorescence-activated Cell Sorting, to name a few. These separated stem cells are then injected into the affected area, such as a hip, elbow, or knee joint, as well as into tendons and ligaments to promote healing and regeneration of tissue.
• There are currently very unpredictable outcomes with the use of stem cell therapy in veterinary medicine. Some patients experience significant improvement after treatment, while other patients achieve a measure of symptom relief after several months. Stem cell treatment may cost $2000 to $3000 or higher, making it unaffordable for many pet owners.

• Platelet Rich Plasma – Platelet-rich plasma (PRP) is a biological treatment involving the injection of a patient’s own concentrated platelets into an injured area to initiate healing. PRP therapy is most often used in musculoskeletal conditions and soft tissue injuries. Blood is drawn from the patient; the blood is placed in a centrifuge to separate the blood components and concentrate the platelets. The PRP is then injected into the area of injury. PRP contains platelets, cytokines, and growth factors, which can help with tissue repair, pain relief, and regenerative processes.

• Tissue Engineering – Tissue engineering uses a combination of cells, biomaterials, and other factors to restore, replace, or improve biological tissues. Biomaterials are a central component of tissue engineering used in regenerating and treating multiple tissue types, including bone, cartilage, and skin. Advances in biomaterials have led to the development of scaffolds, which are temporary structures that support cells. These scaffolds can be combined with cells or growth factors to promote the regeneration of various tissues, including bone and cartilage.

• Regenerative Orthopedic Techniques – Regenerative Orthopedic techniques involve using the body’s natural healing processes to treat musculoskeletal injuries and degenerative conditions. Treatment usually consists of injections or arthroscopy to introduce regenerative materials like stem cells, platelet-rich plasma, and engineered tissue into the injured joint.

5) Laser Surgery: 

Laser surgery involves the use of focused light beams to cut, coagulate, and vaporize tissue. It is most frequently used in soft tissue surgery for tumor removal, skin lesions, and gingival procedures.

Laser surgery has the advantage of:

• Precision- more precise cutting with minimal damage to surrounding tissues.
• Reduced Bleeding: The laser’s heat coagulates blood vessels as you cut tissue, leading to less bleeding.
• Faster Recovery: Patients experience less pain and swelling because of minimal damage to surrounding tissues, which leads to faster recovery times.
• Less Infection Risk- the laser’s heat can help sterilize the surgical site, lowering the infection risk.

6) Improved Anesthetic Techniques:

Advances in anesthetic protocols and patient monitoring have provided significant enhancement in patient safety and pain control.

• Enhanced Monitoring Technologies- New patient monitors that track physiological parameters like heart rate, ECG, oxygen saturation, blood pressure, and end-tidal CO2, as well as neuromuscular monitoring of neuromuscular blocking agents, have significantly improved intraoperative patient safety. These parameters allow the anesthesia professional to tailor the anesthetic protocol to the patient’s intraoperative physiology.
• Innovative Anesthetic Agents—Several innovative anesthetic agents have emerged that have enhanced the safety and efficacy for various species.
  • Alfaxalone- a neuroactive steroid that provides rapid induction and recovery with minimal cardiovascular side effects.
  • Dexmedetomidine- an alpha-2 adrenergic agonist that provides sedation and analgesia whose effects can be reversed with atipamezole.
• Remifentanil- an ultra-short-acting opioid that allows for rapid anesthetic adjustments and is well suited for use in intravenous infusions.
• Buprenorphine- This is an opioid that has been used in human medicine for many years and is now used in veterinary medicine for its long duration of action and its effective use in postoperative pain management.
• Regional Anesthetic Techniques—There has been a surge of ultrasound-guided regional anesthesia, which allows veterinarians to perform nerve blocks more accurately and effectively, leading to better pain management. Regional anesthesia allows for the use of less volatile and intravenous anesthetic agents, with consequent faster recovery.
• Multimodal Anesthesia- The adoption of multimodal anesthesia protocols combines different classes of analgesics and volatile anesthetics to improve pain management and reduction of drug dosages and fewer side effects.
• Postoperative Pain Management- New protocols emphasize the early detection of pain and the use of non-steroidal anti-inflammatory drugs and opioids. Regional anesthesia has been indispensable in providing postoperative pain control

7) Telemedicine for Surgical Planning:

Virtual consultations have become more streamlined, allowing surgical specialists to consult with general practitioners. Telemedicine platforms now integrate advanced imaging techniques like 3D imaging, videos, X-rays, CT and MRI scans, and augmented reality.

Artificial intelligence (AI) has improved the diagnostic accuracy of X-rays and CT scans and provides diagnoses from large databases to provide improved anatomic evaluation for surgical planning.

Wearable technology for pets is increasingly used to monitor health metrics pre-and postoperatively. With this data, the surgeon can improve surgical plans and postoperative care.

8) Advanced Imaging:

In 2024, multiple exciting advances in imaging have produced more precise diagnoses, leading to improved surgical outcomes.

1. Enhanced MRI Techniques- New developments in MRI technology have reduced scan times and improved resolution for better visualization of animal soft tissue.
2. AI Integration- Artificial intelligence (AI) draws on large imaging databases to assist veterinarians in diagnosing conditions more accurately and efficiently. AI algorithms can help identify subtle abnormalities that the human eye can miss.
3. Portable Imaging Devices- Portable ultrasound and radiography innovations have made imaging more user-friendly in field settings, enabling veterinarians to obtain diagnostic imaging in rural areas and emergencies. 
4. 3D Imaging and Printing- 3D imaging advances have facilitated the creation of detailed models of anatomical structures essential for surgical planning and educational purposes.
5. Functional Imaging- PET scans are increasingly used for cancer diagnosis and cancer monitoring, as well as obtaining valuable metabolic information and assistance in treatment planning.

Functional MRI (jMRI), although still in early stages in veterinary medicine, it is being explored for understanding brain activity in animals which can aid in diagnosing neurological disorders and assessing pain.

9) Surgical Education Technologies:

High-fidelity simulators provide life-like models of animals, allowing students to practice surgical techniques before embarking on a procedure on a live animal. Virtual reality technology immerses students in a 3D environment, enabling them to practice procedures in a realistic setting to improve spatial awareness and procedural skills. Augmented reality applications overlay digital information onto the physical world, providing guidance during surgeries and showing anatomical structures or step-by-step instructions. Many veterinary schools are incorporating interactive learning modules, allowing students to explore anatomy and surgical techniques in an engaging manner. All these technologies work together to provide students with educational experiences that were never possible before.

10) Innovative Patient Warming:

Patient warming to date has consisted of forced air warming with a perforated disposable blanket placed over the nonsurgical portion of the patient with frequently inadequate patient warming results. Some facilities utilize electric warming pads with a history of patient burns and expiring warming pads.

Watch this video to learn more about patient warming

VetORSolutions has developed the game-changing HoverHeat Patient Warming System. It is the only forced air warming system that provides true underbody warming. The HoverHeat allows for low resistance warm air flow underneath the patient by its two internal patient levitating components. The entire undersurface of the body can now be warmed, which was previously not possible with forced air warming. Additionally, a second HoverHeat can be connected in series so that the animal's underside and top side can be warmed with one warm air blower. The HoverHeat accommodates any warm air blower on the market and increases the warming capacity of any warm air blower by 50 to 75 percent.

VetORSolutions has recently developed patent-pending technology whereby the temperature of the HoverHeat itself or any convective warm air disposable blanket that contacts the patient can be measured. This allows the anesthesia provider to compare three temperatures: the patient temperature, the warm air blower temperature, and the temperature of the convective unit (HoverHeat or convective blanket), which is contacting the patient. This “temperature trifecta” allows incremental temperature adjustments to be made, leading to precise patient warming.

Watch this video on how the HoverHeat impacts the patient experience.

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