Veterinary Endoscopy for 

the Small
Animal Practitioner
 

Veterinary Endoscopy for the Small

Animal Practitioner

Second Edition

Edited by

Timothy C. McCarthy DVM PhD

Diplomate Emeritus, American College of Veterinary Surgeons,

ACVS Founding Fellow, Minimally Invasive Surgery (Small Animal Soft Tissue),
ACVS Founding Fellow, Minimally Invasive Surgery (Small Animal Orthopedics)
Veterinary Minimally Invasive Surgery Training (VetMIST), Beaverton, OR, USA
This edition first published 2021
© 2021 John Wiley & Sons, Inc.

Edition History
Elsevier (1e, 2004)

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Library of Congress Cataloging-in-Publication Data

Names: McCarthy, Timothy C. editor.

Title: Veterinary endoscopy for the small animal practitioner / edited by
  Timothy C McCarthy.
Description: Second edition. | Hoboken, NJ : Wiley-Blackwell, 2021. |
  Includes bibliographical references and index.
Identifiers: LCCN 2020026612 (print) | LCCN 2020026613 (ebook) | ISBN
  9781119155867 (cloth) | ISBN 9781119155881 (adobe pdf) | ISBN
  9781119155874 (epub)
Subjects: MESH: Endoscopy–veterinary | Endoscopy–methods |
  Endoscopes–veterinary | Animals, Domestic–surgery
Classification: LCC SF914.2 (print) | LCC SF914.2 (ebook) | NLM SF 914.2
  | DDC 636.089/705–dc23
LC record available at https://lccn.loc.gov/2020026612
LC ebook record available at https://lccn.loc.gov/2020026613

Cover Design: Wiley

Cover Image: Courtesy of Timothy C. McCarthy

Set in 9.5/12.5pt STIXTwoText by SPi Global, Pondicherry, India

10  9  8  7  6  5  4  3  2  1
I dedicate this book to all my patients.
Without their participation, this would not have been possible.
 vii

Contents

List of Contributors  xvii

Preface  xix
Acknowledgements  xxi
About the Companion website  xxiii

1 Introduction and History of Endoscopy  1

Timothy C. McCarthy
1.1 Introduction  1
1.2 The History of Endoscopy  1
1.3 Clinical Application in Veterinary Medicine  6
References  7

2 Instrumentation for Endoscopy  9
Timothy C. McCarthy
2.1 Endoscopy Room Setup and Organization  9
2.2 Instrumentation for Small Animal Endoscopy  10
2.2.1 The Endoscopy Video Tower  10
2.2.2 Video Cameras  10
2.2.3 Video Monitors  11
2.2.4 Light Source  12
2.2.5 Documentation Equipment  13
2.2.6 Power Equipment  14
2.2.6.1 Radio-Frequency Instrumentation  14
2.2.6.2 Vessel Sealing Devices  14
2.2.7 Irrigation Fluid Management Systems  16
2.2.7.1 Gravity Flow  16
2.2.7.2 Pressure-Assisted Flow  17
2.2.7.3 Mechanical Fluid Pumps  17
2.2.8 Operating Tables  17
2.2.9 Rigid Telescopes  17
2.2.10 Flexible Endoscopes  20
2.2.11 Sheaths, Cannulas, and Trocars  21
2.2.12 Diagnostic and Operative Instruments  24

3 Gastrointestinal Endoscopy  27
Reto Neiger and Christiane Stengel
3.1 Equipment  27
3.1.1 Flexible Endoscopy  27
3.1.2 Rigid Endoscopy  30
3.1.3 Ancillary Equipment  30
viii Contents

3.1.3.1 Biopsy Forceps  31

3.1.3.2 Foreign Body Retrieval Instruments  31
3.1.3.3 Others  31
3.2 Technique  32
3.2.1 Handling the Endoscope  32
3.2.2 Handling Accessory Instruments  32
3.2.3 Taking Biopsies and Brush Cytology  33
3.2.4 Patient Preparation  36
3.2.5 Anesthesia  37
3.2.6 Complications and Contraindications  37
3.2.7 Endoscopic Training  38
3.3 Esophagoscopy  39
3.3.1 Indications, Limitations  39
3.3.2 Procedure  39
3.3.3 Normal Findings  41
3.3.4 Abnormal Findings  41
3.4 Gastroscopy and Duodenoscopy  48
3.4.1 Indications, Limitations  48
3.4.2 Procedure  50
3.4.3 Normal Findings  55
3.4.4 Abnormal Findings  56
3.5 Colonoscopy/Ileoscopy  60
3.5.1 Indications, Limitations  60
3.5.2 Procedure  63
3.5.3 Normal Findings  68
3.5.4 Abnormal Findings  68
3.6 Therapeutic Flexible GI Endoscopy  71
3.6.1 Foreign Body Retrieval  71
3.6.1.1 Esophageal Foreign Body Removal  74
3.6.1.2 Duodenal Foreign Body Removal  77
3.6.1.3 Colonic and Rectal Foreign Body Removal  78
3.6.2 Feeding Tube Placement  78
3.6.2.1 Procedure  79
3.6.2.2 Tube Management  81
3.6.2.3 Replacement and Removal  83
3.6.3 Stricture Dilation  83
3.6.4 Stent Placement  86
3.6.5 Polyp Removal  87
3.7 Additional Techniques in GI Endoscopy  87
3.7.1 Capsule Endoscopy  87
3.7.2 Double Balloon Endoscopy  87
3.7.3 Confocal Endomicroscopy  88
3.7.4 Natural Orifice Transluminal Endoscopic Surgery  88
3.7.5 Endoscopic Retrograde Cholangiopancreatography  88
3.8 Care and Cleaning of GI Endoscopic Equipment  88
3.8.1 Pre-Cleaning  89
3.8.2 Manual Cleaning  90
3.8.3 Machine Cleaning  91
3.8.4 Storage  92
3.8.5 Sterilization or High-Level Disinfection  93
References  93
 Contents ix

4 Rhinoscopy  99
Timothy C. McCarthy
4.1 Introduction  99
4.2 Indications  100
4.3 Instrumentation  102
4.4 Preparation of the Patient  104
4.5 Technique  105
4.5.1 Radiographic Imaging  105
4.5.2 Culture Sample Collection  108
4.5.3 Rhinoscopy  108
4.5.4 Frontal Sinoscopy  112
4.6 Normal Nasal Cavity and Frontal Sinuses  113
4.7 Nasal Pathology  120
4.7.1 Nasal Neoplasia  120
4.7.2 Mycotic Rhinitis and Sinusitis  142
4.7.2.1 Aspergillosis  142
4.7.2.2 Cryptococcosis  152
4.7.3 Allergic Rhinitis  153
4.7.4 Nasal Foreign Bodies  157
4.7.5 Rhinitis Secondary to Dental Disease  159
4.7.6 Nasal Turbinate Infarction  161
4.7.7 Traumatic Rhinitis  164
4.7.8 Nasal Disease Secondary to Otic Diseases  165
4.7.9 Parasitic Rhinitis  169
4.7.10 Canenoid and Felenoid Diseases  171
4.7.11 Nasal Hamartomas  172
4.7.12 Viral Rhinitis  173
4.7.13 Bacterial Rhinitis  173
4.7.14 Nasal Vascular Dysplasia  174
4.7.15 Epistaxis  174
4.7.16 Rhinitis of Undetermined Origin  175
4.7.17 Brachiocephalic Nasal Airway Syndrome  179
4.7.18 Nasopharyngeal Stenosis  181
4.7.19 Nasal Lymphoid Hyperplasia  185
4.7.20 Nasal Angiofibroma  187
References  192

5 Bronchoscopy  195
Brendan C. McKiernan
5.1 Introduction  195
5.2 Equipment  195
5.2.1 Equipment Care and Cleaning  195
5.3 Indications and Contraindications of Bronchoscopy  196
5.4 Anesthesia for Bronchoscopy  196
5.4.1 Monitoring and Positioning the Patient for Bronchoscopy  198
5.5 Bronchoscopic Training  199
5.6 Bronchoscopic Procedure  199
5.7 Normal and Abnormal Bronchoscopic Findings  201
5.8 Sample Procurement and Handling  206
5.9 Summary  213
References  214
x Contents

6 Cystoscopy  217
Timothy C. McCarthy
6.1 Introduction  217
6.2 Cystoscopy Indications  218
6.2.1 Chronic Cystitis  219
6.2.2 Hematuria  219
6.2.3 Tenesmus or Stranguria  219
6.2.4 Increased Frequency of Urination  219
6.2.5 Urinary Incontinence  219
6.2.6 Ureteroceles  220
6.2.7 Alteration of the Urinary Stream  220
6.2.8 Trauma  220
6.2.9 Cystic and Urethral Calculi  221
6.3 Instrumentation for Cystoscopy  221
6.3.1 Transurethral Cystoscopy in Female Dogs and Cats  222
6.3.2 Instrumentation for Transurethral Cystoscopy in Male Dogs  226
6.3.3 Instrumentation for Transurethral Cystoscopy in Male Cats  227
6.3.4 Instrumentation for Prepubic Percutaneous Cystoscopy  227
6.3.4.1 Telescopes  227
6.3.4.2 Sheaths  227
6.3.4.3 Sharp Trocars and Blunt Obturators  227
6.3.4.4 Second Puncture Cannulas  227
6.3.4.5 Operative Instrumentation  228
6.3.5 Instrumentation for Percutaneous Perineal Cystoscopy in Male Dogs  228
6.3.6 Instrumentation for Laparoscopic-Assisted Cystoscopy  228
6.3.6.1 Telescopes  228
6.3.6.2 Flexible Cystourethroscopes  228
6.3.6.3 Cannulas and Sheaths  228
6.3.6.4 Operative Instrumentation  229
6.3.7 Instrumentation for Lithotripsy  229
6.4 Techniques for Transurethral Cystoscopy  230
6.4.1 Patient Preparation  230
6.4.2 Transurethral Cystoscopy in Female Dogs and Cats  231
6.4.3 Transurethral Cystoscopy in Male Dogs  240
6.4.4 Transurethral Cystoscopy in Male Cats  244
6.4.5 Technique for Prepubic Percutaneous Cystoscopy  247
6.4.5.1 The Original Technique  247
6.4.5.2 Modified PPC Technique  250
6.4.5.3 Diagnostic Sample Collection  250
6.4.6 Technique for Laparoscopic-Assisted Cystoscopy  250
6.4.6.1 Diagnostic Sample Collection  257
6.4.7 Photodynamic Diagnostics with Cystoscopy  257
6.5 Normal Endoscopic Anatomy of the Lower Urinary Tract  257
6.5.1 Transurethral Cystoscopy in Female Dogs and Cats: Vagina  257
6.5.2 TUC in Female Dogs and Cats: Urethra and Bladder  262
6.5.3 Transurethral Cystoscopy in Male Dogs  267
6.5.4 Transurethral Cystoscopy in Male Cats  268
6.5.5 Normal Endoscopic Anatomy: LAC and PPC in the Dog and Cat  269
6.6 Diagnoses with Cystoscopy  269
6.6.1 Cystitis and Urethritis  269
6.6.1.1 Interstitial Cystitis  270
6.6.1.2 Follicular Cystitis  270
6.6.1.3 Polypoid Cystitis  273
 Contents xi

6.6.1.4 Chronic Diffuse Cystitis  275

6.6.1.5 Urethral Strictures  280
6.6.1.6 Urethrocutaneous Fistula  282
6.6.1.7 Prostatitis  282
6.6.2 Neoplasia of the Lower Urinary Tract  284
6.6.2.1 Transitional Cell Carcinomas  284
6.6.2.2 Other Tumors of the Lower Urinary Tract  294
6.6.2.3 Vaginal Tumors and Masses  294
6.6.3 Cystic and Urethral Calculi  300
6.6.3.1 Oxalate Calculi  301
6.6.3.2 Struvite Calculi  301
6.6.3.3 Urate Calculi  302
6.6.3.4 Silica Calculi  302
6.6.4 Anatomic Abnormalities  307
6.6.4.1 Vaginal Anatomic Abnormalities  307
6.6.4.2 Ectopic Ureters and Ureteroceles  308
6.6.4.3 Ureteroceles  313
6.6.4.4 Ectopic Ureters in Male Dogs  315
6.6.4.5 Bladder Diverticula  317
6.6.4.6 Vascular Dysplasia  320
6.6.5 Urinary Tract Trauma  320
6.6.6 Renal Hematuria  325
6.7 Interventional and Operative Cystoscopy  326
6.7.1 Minimally Invasive Management of Inflammatory Disease  326
6.7.2 Minimally Invasive Management of Neoplasia  328
6.7.2.1 Transitional Cell Carcinoma Management  328
6.7.2.2 Management of Other Tumor Types  338
6.7.3 Minimally Invasive Urolithiasis Management  338
6.7.3.1 Hydropropulsion  339
6.7.3.2 Transurethral Cystoscopy  340
6.7.3.3 Laparoscopic-Assisted Cystoscopy  341
6.7.3.4 Minimally Invasive Management of Urethral Calculi in Male Dogs  343
6.7.4 Minimally Invasive Management of Anatomic Abnormalities  344
6.7.4.1 Ectopic Ureters  344
6.7.4.2 Laparoscopic-Assisted Ectopic Ureter Correction in Male Dogs  352
6.7.4.3 Minimally Invasive Vaginal Web and Septum Transection  353
6.7.4.4 Minimally Invasive Management of Urachal Diverticula  355
6.7.5 Minimally Invasive Management of Urinary Incontinence  357
References  359

7 Vaginal Endoscopy in the Bitch  363

Cindy Maenhoudt and Natalia Ribeiro dos Santos
7.1 Canine Vaginal Anatomy  363
7.2 Instrumentation  363
7.3 Cleaning and Sterilization of Equipment  365
7.4 Procedures in the Bitch  366
7.4.1 Transcervical Insemination (TCI)  366
7.4.1.1 Introduction of the Endoscope and Catheterization of the Cervix  366
7.4.1.2 Insemination  369
7.4.2 Observation of the Vaginal Changes Throughout the Estrous Cycle  370
7.4.2.1 Proestrus  370
7.4.2.2 Estrus  370
7.4.2.3 Diestrus and Anestrus  371
xii Contents

7.4.3
Diagnostic Vaginoscopy  371
7.4.3.1 Anomalies Related to the Paramesonephric Ducts  372
7.4.3.2 Vaginitis, Vaginal Mass, and Foreign Body  373
7.4.4 Other Uterine Procedures  373
7.4.4.1 Hysteroscopy  374
7.4.4.2 Endometrial Biopsy  375
7.4.4.3 Uterine Cytology and Culture  376
7.4.4.4 Uterine Lavage  376
7.4.4.5 Other Usages  377
7.4.5 Complications and Limitations  377
7.4.6 Tips and General Comments  378
7.5 Conclusion  379
References  379

8 Laparoscopy  383
Timothy C. McCarthy
8.1 Introduction  383
8.2 Indications for Laparoscopy  385
8.2.1 Indications for Diagnostic Laparoscopy  385
8.2.2 Indications for Operative Laparoscopy  386
8.3 Instrumentation for Small Animal Laparoscopy  388
8.3.1 Insufflator  388
8.3.2 Laparoscopes  389
8.3.3 Trocar-Cannulas  391
8.3.4 Operative Instruments  392
8.3.5 Hemostasis  395
8.3.6 Single Incision Laparoscopic Surgery (SILS) Instruments  398
8.3.7 Single Incision Wound Protectors/Retractors for MIS  399
8.4 Laparoscopy Technique  399
8.4.1 Portal Placement and Insufflation  399
8.4.2 Laparoscopic-Assisted Technique  407
8.4.3 Anesthesia for Laparoscopy  407
8.5 Normal Laparoscopic Anatomy  408
8.5.1 The Abdominal Wall, Diaphragm, and Falciform Ligament  408
8.5.2 Normal Liver and Gall Bladder  414
8.5.3 Normal Kidneys  415
8.5.4 Normal Pancreas  416
8.5.5 Normal Spleen  416
8.5.6 Normal Urinary Bladder and Ureters  417
8.5.7 Normal Gastrointestinal Tract  418
8.5.8 Normal Ovaries and Uterus  422
8.5.9 Normal Adrenal Glands  424
8.5.10 Normal Blood Vessels  425
8.6 Laparoscopic Abdominal Abnormalities  426
8.6.1 Abdominal Wall Abnormalities  427
8.6.2 Diaphragmatic Abnormalities  431
8.6.3 Fat Abnormalities  432
8.6.4 Free Abdominal Foreign Bodies  433
8.6.5 Liver Abnormalities  434
8.6.6 Gall Bladder Abnormalities  444
8.6.7 Extra-Hepatic Bile Duct Abnormalities  447
8.6.8 Kidney Abnormalities  447
 Contents xiii

8.6.9 Pancreatic Abnormalities  449

8.6.10 Splenic Abnormalities  450
8.6.11 Adrenal Gland Abnormalities  454
8.6.12 Bladder and Ureteral Abnormalities  455
8.6.13 Abnormalities of the Gastrointestinal Tract  458
8.6.14 Ovarian Abnormalities  461
8.6.15 Abnormalities of the Uterus  463
8.6.16 Testicular Abnormalities  463
8.6.17 Blood Vessel and Lymphatic Abnormalities  464
8.6.18 Abdominal Fluid, Ascites, and Bleeding  464
8.6.19 Abdominal Masses and Cancer Staging  468
8.7 Diagnostic Laparoscopy and Biopsy Techniques  469
8.7.1 Exploratory Laparoscopy  469
8.7.2 Liver Biopsy  469
8.7.3 Cholecystocentesis  474
8.7.4 Pancreatic Biopsy  474
8.7.5 Kidney Biopsy  475
8.7.6 Gastrointestinal Biopsy  478
8.7.7 Biopsy of the Spleen  483
8.7.8 Biopsy Techniques for Additional Organs and Tissues  484
8.7.9 Cancer Staging  484
8.8 Minimally Invasive Abdominal Surgery  485
8.8.1 Laparoscopic Ovariectomy  485
8.8.1.1 Single-Port Technique  486
8.8.1.2 Two-Port Techniques  492
8.8.1.3 Three-Port Technique  495
8.8.2 Laparoscopic Ovariohysterectomy  497
8.8.3 Ovarian Remnant Removal  500
8.8.4 Cryptorchid Castration  501
8.8.5 Laparoscopic Vasectomy  506
8.8.6 Prophylactic Gastropexy  506
8.8.6.1 Laparoscopic-Assisted Gastropexy  506
8.8.6.2 Laparoscopic Gastropexy  513
8.8.7 Laparoscopic-Assisted Gastrotomy  514
8.8.8 Laparoscopic Pyloroplasty  516
8.8.9 Laparoscopic-Assisted Enterotomy and Intestinal Resection with Anastomosis  516
8.8.10 Laparoscopic-Assisted Cecectomy  517
8.8.11 Laparoscopic Cholecystectomy  517
8.8.12 Laparoscopic Partial Pancreatectomy  522
8.8.13 Pancreatic Cyst Ablation  525
8.8.14 Laparoscopic Nephrectomy  526
8.8.15 Laparoscopic Adrenalectomy  528
8.8.16 Laparoscopic Portosystemic Shunt Occlusion  533
8.8.17 Laparoscopic Splenectomy  535
8.8.18 Laparoscopic Herniorrhaphy  536
8.8.19 Laparoscopic Urethral Occluder Implantation  537
8.8.20 Laparoscopic-Assisted Cystoscopy  541
8.8.21 Laparoscopic-Assisted Cystopexy  545
8.8.22 Laparoscopic-Assisted Intestinal Feeding Tube Placement  546
8.8.23 Laparoscopic-Assisted Gastrostomy Feeding Tube Placement  547
8.8.24 Additional Minimally Invasive Abdominal Surgical Procedures  547
References  547
xiv Contents

9 Thoracoscopy  553
Timothy C. McCarthy
9.1 Introduction  553
9.2 Indications  553
9.3 Thoracoscopy Instrumentation  555
9.3.1 Telescopes  555
9.3.2 Cannulas  557
9.3.3 Operative and Sample Collection Instruments  558
9.4 Thoracoscopy General Technique  559
9.4.1 Patient Preparation  559
9.4.2 Technique Anesthesia and Pneumothorax  559
9.4.3 Telescope Portal Placement  562
9.4.3.1 Paraxiphoid Telescope Portal  562
9.4.3.2 Lateral Telescope Portal Placement  563
9.4.4 Operative Portal Placement  566
9.4.5 Portal Closure and Pleural Space Management  566
9.4.6 Postoperative Recovery  569
9.5 Thoracoscopy: Normal Thoracic Anatomy  569
9.6 Thoracic Pathology  572
9.6.1 Pleural and Pericardial Fluid  573
9.6.2 Chest Wall Abnormalities  575
9.6.3 Abnormalities of the Diaphragm  577
9.6.4 Mediastinal Abnormalities  580
9.6.5 Thoracic Foreign Bodies  581
9.6.6 Lung Pathology  583
9.6.6.1 Neoplasia  584
9.6.6.2 Pneumothorax  585
9.6.6.3 Spontaneous Pneumothorax  585
9.6.6.4 Primary Pulmonary Disease  589
9.6.6.5 Lung Lobe Torsion  591
9.6.7 Pleural Effusion  592
9.6.8 Chylothorax  593
9.6.9 Pericardial Effusion  595
9.7 Diagnostic Thoracoscopy Procedures  601
9.7.1 Pleural, Hilar Lymph Node, Mediastinal, Pericardial, and Chest Wall Mass Biopsy  602
9.7.2 Lung Biopsy  603
9.8 Thoracic Operative Procedures  606
9.8.1 Pericardial Window  606
9.8.2 Right Atrial Mass Resection  609
9.8.3 Subtotal Pericardiectomy  612
9.8.4 Partial Lung Lobectomy  615
9.8.5 Lung Lobectomy  617
9.8.6 Thoracic Duct Occlusion  622
9.8.7 Patent Ductus Arteriosus Occlusion  624
9.8.8 PRAA Correction  624
9.8.9 Mediastinal Mass Removal  626
9.8.10 Thoracic Foreign Body Removal  627
9.9 Contraindications for Thoracoscopy  628
9.10 Complications of Thoracoscopy  630
9.11 Conclusions  630
References  631
 Contents xv

10 Video Otoscopy  637

Rod Rosychuk
10.1 Normal Anatomy of the Ear as Seen Through the Video Otoscope  637
10.2 Pathophysiology of the Ear as Seen Through the Video Otoscope  643
10.3 Video Otoscopes  645
10.4 Video Otoscope Instrumentation  648
10.5 Video Otoscopy as a Diagnostic Aid – “In Examination Room” Use  649
10.6 Video Otoscopy Procedures  650
10.6.1 Deep Ear Cleaning of the Ear Canals  652
10.6.2 Deep Ear Cleaning of the Middle Ear  653
10.6.3 Intralesional Glucocorticoid Injections  654
10.6.4 Laser Surgery  655
10.6.5 Myringotomy  655
10.6.6 Management of Primary Secretory Otitis Media  656
10.6.7 Biopsies and Mass Removals  656
10.6.8 Feline Aural Polyp Removal  657
10.6.9 Visualization of the Tympanic Cavity and Bulla  658
Suggested Reading  659

11 Otheroscopies 661
Timothy C. McCarthy
11.1 Introduction  661
11.2 Instrumentation for Otheroscopy in Small Animals  661
11.3 Transabdominal Nephroscopy and Ureteroscopy  661
11.4 Transabdominal Cholecystodocoscopy  665
11.5 Transabdominal Gastrointestinal Endoscopy  668
11.6 Prepuceoscopy  671
11.7 Laceroscopy  673
11.8 Drain Retrieval  675
11.9 Fistuloscopy  677
11.10 Oculoscopy  677
11.11 Oncoscopy  679
11.12 Oraloscopy  680
11.12.1 Dentaloscopy  680
11.12.2 Tonsiloscopy  680
11.12.3 Pharyngoscopy  681
11.13 Laryngoscopy  684
11.14 Dermoscopy  691
11.15 Analsacoscopy  693
References  693

Index  695
 xvii

List of Contributors

Cindy Maenhoudt DVM Reto Neiger Dr. Med. Vet PhD

Diplomate, European College of Animal Reproduction
Diplomate, American College of Theriogenology
Ecole Nationale Vétérinaire d’Alfort, Centre d’études en
reproduction des Carnivores
Maisons-Alfort, France
Timothy C. McCarthy DVM PhD
Diplomate Emeritus, American College of Veterinary
Surgeons
ACVS Founding Fellow, Minimally Invasive Surgery
(Small Animal Soft Tissue)
ACVS Founding Fellow, Minimally Invasive Surgery
(Small Animal Orthopedics)
Veterinary Minimally Invasive Surgery Training
(VetMIST)
Beaverton, OR, USA
Branden C. McKiernen DVM (Retired)
Diplomate, American College of Veterinary Internal
Medicine (SAIM), Watkinsville, GA;
Department of Veterinary Clinical Medicine
University of Illinois
Urbana, IL, USA
Diplomate, American College of Veterinary Internal
Medicine (SAIM)
Diplomate, European College of Veterinary Internal
Medicine-CA (Internal Medicine)
Clinical Medical Director IVC Evidensia DACH, Germany
Munich, Germany
Rod Rosychuk DVM
American College of Veterinary Internal Medicine (SAIM)
Colorado State University CVMBS
Ft. Collins, CO, USA
Natalia Ribeiro dos Santos
American College of Theriogenology
Ecole Nationale Vétérinaire d’Alfort, Unité de Médecine
de l’Elevage et du Sport
Maisons-Alfort, France
Christiane Stengel Dr. Med. Vet
Diplomate, European College of Veterinary Internal
Medicine-CA (Internal Medicine)
www.zweitmeinung-tierarzt.de
Giessen, Germany

Preface
While writing this book, my 50 year anniversary of gradua-
tion from Veterinary School occurred. Fifty years! This has
been an incredible journey! Beyond my wildest dreams. I
never thought that I would be where I am today and would
have done the things that I have done. I never dreamed that
the first edition of this book would be translated into
Russian or that I would be invited to Russia to launch its
sale and teach Russian Veterinarians. I never dreamed that
I would travel to teach in 14 countries and 23 states. That I
would publish books about my professional work.
It is amazing that I was even able to become a
Veterinarian. I am so dyslexic that I struggled to learn to
read. When I started the fifth grade, I was reading at a
­second-grade level. Spelling was impossible. In the third
grade, I was able to get 49 out of 50 words WRONG on a
review spelling test even after spending uncountable hours
with my parents trying to learn spelling using flash cards.
People with really bad handwriting are probably dyslexic
and with really bad handwriting no one can tell how the
word was spelled. I think that I got into Veterinary School
with the lowest grades in the history of Veterinary
Medicine, but Baxter Black and I debate who’s was worst.
If it were not for Dr Don Bailey, I would not have been
accepted. He worked for Dr Davis who was head of the
admission committee all through Veterinary School and
graduated at the top of this class. I managed to not flunk
out and graduated at the bottom of the class, again Baxter
Black and I argue about who was really “last in class.” And
they call the person who graduates last in class “Dr.”
It was obvious in my first job out of school that I wanted
to do surgery. Residency programs for advanced training
were a new entity 50 years ago and they were few and far
between. Then how does someone with grades barely
above 2.0 get into a residency program? NOT! I finally
thought that I needed to try CSU, my “amalater.” They did
not have a residency program but there was the graduate
program at the Surgery Lab. I interviewed with the head of
the program and during the interview it was obvious that if
I applied for the master’s degree program, there was no
xix
chance that I would be accepted but if I applied for the PhD
program, I was guaranteed to be accepted. Interesting, but
it worked. Six years later, I passed the ACVS examination
and became a board-certified surgeon and in a few years
later won my PhD. ACVS recently initiated fellowship
training in minimally invasive surgery and I was selected
as a founding fellow in this program for both small animal
soft tissue surgery and small animal orthopedics, the only
veterinarian to qualify for both categories.
At my 25 year class reunion, I was informed that at a
­previous time I had been unanimously selected as the
classmate least likely to go back to school AND they were
“Stunned” that I was board-certified. My reply was that no
one is more stunned than I.
Getting into endoscopy happened totally by chance. I got
a call from a local veterinarian asking if I wanted to buy a
used gastroscope that he had. As a surgeon, I had never
really thought about doing GI endoscopy but thought, “hey
why not” since no one in the area had one. I did not buy
that endoscope but bought another one that was in better
shape for $550 with a light source and all the instruments
that I needed. A little later, I bought a laparoscope to do
liver biopsies and then an arthroscope. I never thought that
I would pay for this equipment, but I thought it would be
fun, I might be able to practice better medicine, and I could
afford the expense.
I started putting endoscopes everywhere and added to
the list of procedures that could be performed by trying
new things on my patients. Many of the endoscopic first-
ever procedures were performed on patients with clinical
problems. Using the axiom of “Above all do no harm” and
combining endoscopy with transition to traditional
approaches, there were an unbelievingly low number of
problems or complications. Very few firsts were planned or
thought about ahead of time and many were spur of the
moment events added to an already ongoing procedure or
immediately prior to surgery by asking the question, can I
do this with a scope? In cases where the question was asked
before surgery, the discussion with the client was, I would
xx Preface

like to try this with minimally invasive technique, I have spend that time breaking down my resistance. We went
never done this before or this has never been done before, from there. I am a much happier person, I have eliminated
if I cannot do this with minimally invasive technique I will my anger issues, and I am much more resilient to the
do it the traditional old way, and the cost will by the same stresses in life.
how matter how it gets done. I never had a client say no to Early in this saga I made the statement in my lectures:
this plan. Sure, I had to eat some of the cost on many early “Endoscopy is a quantum leap forward in our diagnostic
cases, but this is the easiest, most effective, cheapest con- and therapeutic armamentarium.” This was and still is
tinuing education I have ever gotten and has benefitted the true. Now I say “A patient comes into every veterinary
patients, clients, my practice, my happiness, plus my pock- practice every day who would benefit from a minimally
etbook thousands of times over the cost. Sixty endoscopes invasive procedure.” This is also true or when I get pushy:
and over 7000 procedures later I am writing the second edi- “Every patient who comes into every veterinary practice
tion of this book. every day would benefit from a minimally invasive proce-
I know that I am different and do not follow the book. I dure” and this is almost true.
am so dyslexic that I cannot read about what I am not sup- Enjoy your endoscopes. They are the best burnout pro-
posed to be able to do. I also never learned to come in out tection that you can buy.
of the rain because my mother took me out in the rain. In
the first grade when we had art class all the class got color-
ing books, but the teacher did not give me one. Being a
typical first grader I was devastated and did not understand
why I did not get a coloring book. The teacher then brought
me a large blank piece of paper and told me that my mother
did not want me to have a coloring book but wanted me to
make my own drawings. So, I never learned to color
between the lines. In fact, I never learned that there were
lines. When someone says something about thinking out-
side the box, my question is, what is a box?
As I said at the beginning, my career has been an incred-
ible journey. But it has not all been easy or fun. There have
been times of miserable struggle. I belong to the face book
group; “Not one more vet,” because I am a suicide survivor.
Twice in my life I have been at the edge. Fortunately, I
never acted on my thoughts of suicide and am here to tell
about the experience. If I can through this, so can you. I
looked for and got help from my friends and great help
from some great Psychologists. I also have to admit that I
am really stubborn and was not going to let the b’s win. If
you are in trouble, get help! Working with a psychologist
has changed my life. It does not mean that if you see a
Psychologist that there is something wrong with you. Get
over this mental block. Unburden yourself to them, that is,
what they are there for. At my first visit with my first
Psychologist, I unloaded everything that was bothering me,
things that I never thought I would ever tell anyone, at the
end of the session she said that I saved about nine months
of therapy because I was ready and she did not have to

Acknowledgments
This work would not have been possible without a great
number of people and animals who collectively made this
attainable. I simply put it to paper.
First to my parents for bringing me into this world and
for their unending support, encouragement, and love.
To Dr. Don and Betty Bailey for introducing me to
Veterinary Medicine, for getting me into Veterinary School,
and for their continued support throughout my career.
To all my teachers and professors, from my first-grade
teacher Mrs. Mathews, through high school and college for
their efforts to educate and stimulate me but especially to
Drs. Jim Creed, Glenn Severin, Pat Chase, Harry Gorman,
and Henry Swan.
To my colleagues who referred the cases that provided
me with the material for learning these techniques. And to
the clients who entrusted me with their beloved pets.
xxi
To Mr. Karl Storz, his daughter Ms. Sible Storz, and his
grandson Dr. Karl-Christian Storz for their interest in
Veterinary Medicine and support of our profession. To all
the staff of the Veterinary Division of the Karl Storz
Endoscope Company for their educational endeavors and
instrumentation development for our profession. Especially
to Dr. Christopher Chamness for his support, encourage-
ment, and friendship.
To all the younger veterinarians who have picked up the
reins and are driving all aspects of endoscopy forward at an
ever-increasing rate. I am thrilled that I now only see
smoke and taillights. It is a thrill to watch.
And most importantly to my wife and son for their
patience and for allowing me the time to complete this
project.
 xxiii

­About the Companion Website

This book is accompanied by a website at:

www.wiley.com/go/mccarthy/endoscopy

The website includes:

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