For the budding enthusiast getting started in endoscopy can seem quite daunting. Practical training in a wet lab environment is essential in order to understand your own capabilities and the potential value of the equipment in your practice. Endoscopy is a very practical skill that cannot be learned from textbooks or lectures alone. Operating and using instruments in a two-dimensional environment requires training and considerable practice. Adequate time and funding should be put aside to ensure high-quality training is available prior to embarking on live surgical cases.

Selecting the correct equipment at an affordable cost is the next most important factor and this information can often be refined during a practical course or from experts in the field who can give unbiased advice.

Endoscopy and endosurgery are disciplines that have increased in popularity in recent years and continue to do so, not least because of public demand. Many procedures in people are now carried out using minimally invasive techniques and our clients are well aware of this, appreciate the benefits of rapid recovery and reduced pain and want the same for their pets. What many veterinary surgeons fail to appreciate is that the benefits are not all in favour of the patient, important though that is. Improved visualisation, through a high quality magnified and well illuminated image, coupled with access to otherwise inaccessible sites, enable the surgeon to perform procedures that are otherwise extremely difficult or impossible. High-quality, targeted biopsy specimens can be obtained and surgical procedures carried out with precision and minimal trauma.

Practice requirements will vary according to caseloads and individual interests and specialisation. If your interest lies in gastroenterology or respiratory medicine, then you may wish to start with flexible endoscopy. If you have more of a surgical bent then rigid endoscopy may be of more practical use to you. In fact there is considerable overlap as rigid endoscopes are useful for rhinoscopy and tracheoscopy as well as some cases of lower gastrointestinal disorders. Flexible endoscopes are also used in rhinos-copy for retroflexed views of the choana and in urethrocystoscopy in male dogs. Whichever avenue you choose to pursue it is helpful to acquire equipment that can be upgraded or added to when your requirements change rather than having to exchange equipment or buy duplicate units for different instruments. A camera system and monitor are essential for all forms of endoscopy. Although it is physically possible to peer down the oculus of rigid endoscopes and fibreoptic flexible endoscopes, the image obtained is rarely adequate for diagnosis and renders surgical endoscopy impossible. Many camera systems can be adapted to fit both rigid and flexible fibreoptic endoscopes and even video endoscopes, and this will increase your diagnostic and surgical capabilities enormously, as well as enabling you to capture images for the benefit of clients and to accompany pathological samples for laboratory analysis. Many image-capture devices are available on the high street and are considerably less expensive than bespoke medical devices. They can also be used to capture ultrasound images if required.

A suitable light source can also be used for both flexible and rigid endoscopy. It is best to choose a xenon or metal halide light source sufficiently powerful for the largest patients you are likely to see. Light is significantly absorbed in large open spaces such as the stomach or abdominal cavity of giant breeds of dog, so whilst output is less of a problem for rhinoscopy or cystoscopy, if you plan to do any laparoscopy or upper gastrointestinal endoscopy then a powerful light source is essential. Halogen light sources are not generally suitable. Ensure that the light source can be adapted to fit both the flexible endoscope and the light guide cable of the rigid endoscope.

The choice of flexible endoscope will depend on your area of interest and patient demographics and caseload. No single flexible endoscope will suit all cases and usually a compromise has to be struck. For most clinics a gastroduodenoscope of around 7.8–8 mm diameter will provide a good start as this will pass through the pylorus of small dogs and cats but must be offset against the smaller biopsy channel - usually around 2 mm as against 2.8 mm in larger endoscopes. Smaller biopsy samples can be more difficult for pathologists to interpret. The endoscope should have four-way tip deflection (at least 180 degrees in one direction), automatic air/water insufflation, a biopsy/suction channel and a working length of at least 100 cm. For large breeds a working length of 130–150 cm is essential to examine the small intestine and caecum. A 7.8–8-mm duodenoscope can also double as a bronchoscope for medium to large-breed dogs, increasing its versatility. However, for cats and small dogs a bronchoscope is essential for examining the respiratory tree. Bronchoscopes should have two-way tip deflection of at least 100 degrees in each direction, and preferably 180 degrees in one direction to allow retroflexion over the soft palate. Suction will also be required together with a biopsy/working channel and a working length of at least 80 cm. An outer diameter of 3.5–5 mm is ideal for all adult dogs and cats.

For rigid endoscopy the same camera system, monitor, capture system, suction device and light source can be used. If laparoscopy is contemplated then an electronic carbon dioxide insufflator is essential to create a pneumoperitoneum. The most versatile rigid endoscope to purchase is the 2.7-mm 30-degree 18-cm telescope. This can be used for arthroscopy, rhinoscopy, urethrocystoscopy in bitches and large cats and otoscopy as well as laparoscopy and thoracoscopy in cats and small dogs. It is also used extensively in exotics. For laparoscopy and thoracoscopy in medium to large dogs a 5-mm 0-degree endoscope is most commonly used.

Buying equipment new and from a single source is useful as compatibility should be guaranteed and the suppliers will often provide valuable training to the clinic on care and cleaning of the equipment which should prolong its life and reduce expensive breakages.

References

1.  Chamness C. Endoscopic instrumentation and documentation for flexible and rigid endoscopy. In: Tams TR, Rawlings CA, eds. Small Animal Endoscopy. 3rd ed. St Louis, Missouri; Elsevier Mosby, 2011:3–26.

2.  Chamness C. Instrumentation. In: Lhermette P, Sobel D, eds. BSAVA Manual of Endoscopy and Endosurgery in the Dog and Cat. Gloucester: British Small Animal Veterinary Association, 2008:11–30.

3.  Freeman L, Rawlings C. Psychomotor training and virtual reality. In: Tams TR, Rawlings CA, eds. Small Animal Endoscopy. 3rd ed. St Louis, Missouri; Elsevier Mosby, 2011; 393–396.

4.  Hall E. Flexible endoscopy: basic technique. In: Lhermette P, Sobel D, eds. BSAVA Manual of Endoscopy and Endosurgery in the Dog and Cat. Gloucester: British Small Animal Veterinary Association, 2008:31–41.

5.  Lhermette P, Sobel D. Rigid endoscopy and endosurgery: principles. In: Lhermette P, Sobel D, eds. BSAVA Manual of Endoscopy and Endosurgery in the Dog and Cat. Gloucester: British Small Animal Veterinary Association, 2008:97–108.