Transorbital postcaruncular endoscopic surgery as an alternative to orbital exploratory surgery: A cadaveric study and case report in a dog with an orbital sarcoma

Abstract

Objective: To describe a postcaruncular approach for transorbital endoscopy as an alternative, minimally invasive technique to access the orbital apex. Study design: Ex vivo and prospective clinical case report. Animals: A 12-year-old male castrated cocker spaniel and three cadaver heads (one large breed dolichocephalic, one medium-sized breed mesocephalic, and one small breed brachycephalic). Methods: Transorbital endoscopy was performed to obtain biopsies of an orbital apex mass by using a postcaruncular approach. A 2.7-mm 30 rigid endoscope fitted with a cystoscope working sheath was used with the aid of a blunt suction-dissector and fluid ingress. This procedure was first performed on three cadavers to assess feasibility and later performed in a clinical case. Results: By using a transorbital postcaruncular approach, it was possible to visualize and obtain biopsies from structures within the orbital apex with minimal perioperative morbidity. Dissection and expansion of the working space was facilitated with the aid of fluid ingress; however, judicious use of fluids is recommended because secondary orbital edema and chemosis can occur. Conclusion: Transorbital endoscopy via a postcaruncular approach is feasible. Clinical significance: This technique should be considered in cases in which a histological diagnosis is required prior to definitive treatment as a method to obtain biopsy samples of the orbital apex region without major surgical dissection.

Minimally invasive video‐assisted parathyroidectomy in dogs: Technique description and feasibility study

“…This was quickly abandoned as it caused the adventitia of the neck to become edematous thereby obscuring visualization and dissection. This experience is similar to what was found when performing transorbital video‐assisted surgery 25 . Although insufflation with CO 2 tends to improve visualization, careful retraction allows adequate operating space to perform the procedure when using an endoscope in potential spaces such as these 24…”

“…For the endoscopic surgeon, one of the biggest adjustments when performing MIVAP is the use of a potential space, rather than the natural body cavity of the abdomen or thorax. Other examples of scoping in a potential space include transorbital endoscopy 25 and third space endoscopy, which is performed in humans 27 . When approaching the thyroid/parathyroid complex, blunt dissection and retraction are utilized to create a working space for the scope.…”

Endoscopic diagnostic and surgical orbital approach in canines

“…White et al (1984) and, more recently, Strom et al (2018) investigated the use of the endoscope to resolve nasolacrimal obstruction in dogs. Recently, Espinheira Gomes et al (2020) has described a transcaruncular endoscopic orbital approach for visualisation and biopsy specimen collection in a dog with orbital sarcoma, introducing orbital endoscopy into veterinary medicine as a potential method for use in obtaining histopathology orbital specimens, and potentially for minimally invasive orbital surgery.…”