Interventional Endoscopy + Endoscopic Laser + Coblation Technology
About Interventional Endoscopy
Interventional Endoscopy is a term which describes a broad range of procedures which can be performed during an endoscopic examination. These can include foreign body removals, polypectomy, gastric feeding tube placement, nasal/sinus fungal debridement and anti-fugal soaks, laser and balloon dilatation of strictures, laser tumour debulking, laser ectopic ureters.
Interventional Endoscopic Procedures
Minimally invasive interventions:
A variety of instruments can be passed through the endoscope, allowing the veterinary endoscopist to treat a range of abnormalities with little or no discomfort to the patient. The endoscopist can remove swallowed objects (foreign bodies) using grasping forceps, baskets or snares, stretch narrowed areas (strictures) with a balloon catheter, remove polyps or treat upper GI bleeding. Endoscopy can also be used for the placement of feeding tubes that bypass the oesophagus and open directly into the stomach.
Minimally invasive interventions:
A variety of instruments can be passed through the endoscope, allowing the veterinary endoscopist to treat a range of abnormalities with little or no discomfort to the patient. The endoscopist can stretch narrowed areas (strictures) with a balloon catheter, remove polyps, treat (‘debulk’) tumours or even treat lower GI bleeding using a laser.
Minimally invasive interventions:
A variety of instruments can be passed through the rhinoscope, allowing the veterinary endoscopist to treat a range of abnormalities with little or no discomfort to the patient. The endoscopist can remove nasal foreign bodies (grass seeds, sticks), grass blades that have been vomited up over the soft palate in cats, fungal plaques (aspergillosis) and polyps, debulk tumours using special instruments placed through the operating port of the endoscope (e.g. lasers), debride dead turbinate tissue in cats with herpesvirus-induced rhinitis, stretch narrow areas at the back of the nose (nasopharyngeal stenosis) induced by chronic inflammatory conditions using a balloon catheter and/or laser, and use the fluid port on the endoscope for nasal/sinus flushing when continuous saline irrigation or antifungal treatment for aspergillosis is required.
Nasal Aspergillosis Treatment in cats and dogs involves endoscopic debridement combined with targeted antifungal soaks, eliminating the necessity for traditional sinus trephination. This method allows for direct visual access via transnasal routes, ensuring precise debridement and local antifungal application. The result is improved patient comfort, reduced recovery time, and enhanced treatment efficacy compared to conventional open surgical methods.
Minimally invasive interventions:
A variety of instruments can be passed through the endoscope, allowing the veterinary endoscopist to treat a range of abnormalities with little or no discomfort to the patient. The endoscopist can remove inhaled objects (foreign bodies) using grasping forceps, baskets or snares, stretch narrowed areas (strictures) with a balloon catheter, remove polyps and treat airway obstructions.
Minimally invasive interventions:
A variety of instruments can be passed through the endoscope, allowing the veterinary endoscopist to treat a range of abnormalities with little or no discomfort to the patient. The endoscopist can remove foreign bodies (e.g. grass awns) using grasping forceps, remove polyps or abnormal growths using snares or a surgical laser, treat cholesteatoma and instil depot medications deep in the ear to treat resistant infections (e.g. Pseudomonas).
Transcanal Endoscopic Ear Surgery (TEES) is a refined approach for treating middle ear conditions such as cholesteatoma and otitis media. By providing superior visualisation of the tympanic cavity, TEES reduces the need for external incisions and lowers surgical risks. The tympanomeatal flap technique enables precise cholesteatoma curettage, minimising trauma to surrounding structures and reducing recurrence rates. Additionally, endoscopic ventral bulla access in cats facilitates ventrolateral lavage and debridement, offering a safer, less invasive alternative to traditional open approaches while significantly lowering the risk of iatrogenic nerve damage.
Minimally invasive interventions:
A variety of instruments can be passed through the endoscope, allowing the veterinary endoscopist to treat a range of abnormalities with little or no discomfort to the patient. The endoscopist can remove bladder stones and foreign bodies (e.g. grass awns) using grasping forceps, baskets or snares, stretch narrowed areas (strictures) with a balloon catheter, remove polyps, debulk tumours using a laser, treat ectopic ureters with laser ablation and instil bulking agents into the urethra to ‘tighten’ the sphincter and help reduce sphincter mechanism incontinence. Laparoscopic cystoscopy may be performed as a minimally invasive alternative to open surgery in those cases where access to the bladder via the urethra is not possible (e.g. male cats) or where large stones need to be removed.
These interventions are particularly beneficial in cases where transurethral access is limited, such as in male cats, where small calculi can remain undetected despite flushing during open procedures. As highlighted in our FASAVA Congress ’24/Storz presentation, ‘Feline PCCL: Isn’t Just a Fancy Cystotomy?’, these techniques enhance surgical precision, reduce morbidity, and promote faster recovery. Furthermore, TCC laser ablation is available as a Minimally Invasive Palliation Procedure (MIPP), offering targeted tumour debulking to improve lower urinary tract function while minimising the risks associated with more invasive interventions.
Endoscopic Laser Surgery
The marriage of endoscopy and surgical lasers has offered veterinary endoscopists the opportunity to perform minimally invasive interventions in circumstances which were traditionally treated by more invasive surgical approaches.
At EVR, we use an 810nm:980nm dual-wavelength diode laser which provides us with the advantages of both wavelengths (vessel ablation and tissue debulking) whilst reducing risk of collateral tissue damage due to thermal spread.
Endoscopic Diode Laser Procedures
Respiratory Tract
The use of lasers, together with endoscopy, allow for a range of respiratory conditions to be treated in a curative, or palliative manner. Laser endoscopy is indicated for congenital conditions, tumours, as well as vaporisation of polyps, stenosis (nasopharyngeal, laryngeal, tracheal) and granulomas.
Primary intranasal tumours represent approximately 1% of all neoplasms in dogs and cats (mainly carcinomas, sarcomas and lymphoma). They have progressive local invasion and a low metastatic rate. It is for this reason, and because of the high recurrence rate, that local treatment has great importance. Radiotherapy is the treatment of choice, but chemotherapy or non-steroidal anti-inflammatory drugs (NSAIDs), or a combination, can be used with differing degrees of effectiveness. It is unclear whether adjuvant cytoreduction (laser rhinoscopy or open surgery) decreases recurrence or increases median survival time. Empirically, local clinical signs appear decreased, especially if access to radiotherapy is not possible. With laser turbinectomy, there is an evident reduction in the clinical signs associated with nasal masses (e.g. epistaxis, mucus and sneezing) which can buy relatively good quality of life for those patients where radiotherapy and/or chemotherapy have been declined or not available to the patient. The main palliative benefit is through increasing the airway space for improved breathing for the patient.
The procedure of choice for nasopharyngeal stenosis is balloon dilation and nasopharyngeal stent placement. However, in cases where the stenosis is located in a caudal position, and the stenotic wall is very thin and therefor the use of laser endoscopy may be sufficient alone. In cats especially, making 2 lateral cuts fron the stenotic opening allows a more controlled balloon dilation and preserves the edges of the wound to allow epithelialisation. The laser can also be used to control haemorrhage post dilation. Stents in cats are less successful as they tend to get hair wrapped around them.
Urinary Tract
Endoscopic Urinary Procedures encompass percutaneous cystotomy, cystolithotomy, laser polypectomy, and transitional cell carcinoma (TCC) laser debulking, providing minimally invasive alternatives to traditional open surgeries.
Ectopic ureters are classified as either intramural (tunnel through the caudal bladder; approximately 85% of ectopic ureters in dogs) or extramural (do not tunnel through the caudal bladder; typical in cats). This distinction allows the practitioner to select therapies best suited for the patient. Surgical correction methods are available for both classifications; however, only ectopic ureters travelling intramurally can be managed using diode laser ablation. Cystoscopy usually the easiest and the most accurate method of diagnosis of ectopic ureters. However, fluoroscopic-aided contrast urography, CT with contrast urography, or cystoscopic-assisted retrograde contrast ureteropyleography with fluoroscopy permit identification of a transmural orientation of intramural ectopic ureters.
Vestibulovaginal septal remnants can distort or block the vaginal and urethral openings. Their clinical significance is variable, but some are associated with urinary tract infection or interference with parturition. Most remnants are narrow and easily broken digitally. Those that are more difficult to detach can be freed from their dorsal and ventral attachments using a laser.
Coblation Technology
Interventional endoscopy continues to expand the boundaries of minimally invasive veterinary surgery, offering advanced techniques for managing conditions affecting the nose, tonsils, larynx, and oral cavity. Second-generation Coblation technology plays a key role in this field by utilising low-temperature plasma energy to achieve precise tissue ablation, haemostasis, and debulking while minimising collateral damage. Its integration into endoscopic nasal, pharyngeal, and laryngeal procedures enhances precision, reduces postoperative discomfort, and improves patient recovery. By integrating Coblation technology into interventional endoscopic protocols, veterinary clinicians can expand their minimally invasive surgical capabilities, achieving superior outcomes with reduced morbidity. As advancements in veterinary endoscopy continue, Coblation remains a crucial tool in providing precise, effective, and patient-friendly interventions for upper airway and oral conditions.
Coblation Technology Procedures
In nasal procedures, Coblation can be used endoscopically for tumour debulking and haemostasis, facilitating the management of obstructive or bleeding nasal masses with minimal trauma. The ability to control bleeding while preserving surrounding structures is particularly beneficial in maintaining airway patency.
For laryngeal interventions, Coblation offers a minimally invasive option for arytenoidectomy in patients with non-resectable laryngeal tumours as a Minimally Invasive Palliation Procedure (‘MIPP’). The precision of plasma energy enables targeted tissue removal while preserving essential airway function, making it a valuable tool for conditions where maintaining normal respiration is critical.
