Abstract
Minimally invasive surgery (MIS), or laparoscopic surgery has seen huge advances in both human and veterinary medicine. It has been shown to be associated with quicker healing times, less chance for infection and much less post operative discomfort. These improvements are particularly important in marine mammal medicine where tradition surgery is often unrealistic and diagnostic evaluations have had a variety of limitations. In 1998, the first laparoscopic surgery was performed in a cetacean. The procedure was part of a comprehensive diagnostic examination to investigate the cause of renal pathology in an older female bottlenose dolphin. The procedure was successfully completed with the animal under general anesthesia; the dolphin made a full recovery, without complications, and went on to live for years beyond the procedure.1 Despite this pioneering success, the procedure has not been attempted since. Why has the marine mammal community not embraced this new procedure? Is MIS considered to be a greater risk to the patient, than determining the animal's disease state? We clearly understand that the marine mammal medical community remains nearly optionless when it comes to surgical diseases or invasive diagnostic procedures in cetaceans. It is for this reason we are interested in exploring the use of MIS in dolphins to improve our diagnostic and treatment options.
To reignite the efforts started 12 years ago, and take a renewed first step towards establishing MIS in cetaceans as safe and rewarding, the authors, along with several IAAAM colleagues, participated in a dolphin MIS workshop. The goals of the workshop were to learn and practice general concepts and techniques in minimally invasive surgery, identify anatomy, approaches, and techniques specific to bottlenose dolphins, and to discuss the best equipment and all likely indications for MIS in cetaceans (direct visual exam of abdominal organs, tissue biopsy, reproductive manipulation, etc.)
Pervasive throughout the workshop was the general acknowledgment by all participants that for MIS to become widely applicable to cetacean medicine, procedural safety and success needs to be established. The advantages of MIS need to outweigh the risks (perceived and real) associated with general anesthesia and surgery. However, without a large caseload and dedicated veterinarians, the skill set necessary to improve outcome cannot be developed. To address this limitation, the group proposed to recreate the model of success demonstrated by Stetter et al.2, in their work with minimally invasive surgery in the elephant. In practical terms, means a team of clinicians, with MIS experience, funding, equipment, and availability would be established. This team would be able to travel for appropriate cases that will amass (from both rehabilitation facilities and zoological collections) to more quickly develop the necessary skill set and pattern of success. It is our intention to make marine mammal institutions aware of these efforts and that collaboratively we can make significant progress in applying this technology to enhancements in dolphin care.
Acknowledgements
We thank our co-participants from the workshop Drs Bill Van Bonn, Marty Haulena, Todd Schmitt, and Forrest Gomez, as well as the great staff at the Colorado State University Veterinary Teaching Hospital for hosting us in Fort Collins.
References
1. Dover S, Beusse D, Walsh MT, McBain JF, Ridgway S. Laparoscopic techniques for the bottlenose dolphin (Tursiops truncatus). Proc of the International Association for Aquatic Animal Medicine 1999: 147–148.
2. Stetter M, Hendrickson D, Zuba J, Stetter K, Briggs M, Groubler D, Small L, VanAltena J. Laparoscopic vasectomy in free ranging African elephants (Loxodonta Africana). Proceedings from the American Association of Zoo Veterinarians 2007: 185–188.