Soft Tissue Surgery
Introduction
The Soft Tissue Team at the Royal Veterinary College Equine Referral Hospital is led by Thomas Witte and Justin Perkins.
We accept the full spectrum of general surgery cases referred by Equine Practitioners. In addition, the service plays a pivotal role in the management of cases admitted via other services within the Equine Referral Hospital. This integration of the specialist services is reinforced by daily hospital rounds, which are attended by Senior Clinicians and Senior Clinical Training Scholars from all services. This approach ensures the highest possible standards of management of all cases.
Soft tissue surgery is a varied discipline and includes the majority of surgical procedures not falling under the remit of Orthopaedic Surgery. We apply the latest developments in surgery, as well as the latest approaches to sedation and anaesthesia. This means we are now able to perform many soft tissue procedures in the standing position under sedation and local anaesthesia. Obviously, general anaesthesia is still warranted in many cases, and our anaesthesia team ensures surgery can be performed as safely as possible, whether in the standing position or under general anaesthesia.
Specific areas of expertise
Abdominal Surgery
As well as abdominal surgery for life-threatening colic, the soft tissue surgery service also specialises in minimally invasive procedures of the abdomen, also known as keyhole surgery or laparoscopy. This approach means much smaller incisions for common procedures such as ovary removal (ovariectomy), rig surgery (cryptorchidectomy, photo below) or for the investigation of chronic or recurrent colic. Smaller incisions often mean less risk of post-operative complications and a faster recovery and return to work. In addition to traditional keyhole surgery, we also have extensive experience with hand-assisted laparoscopic (HALS) procedures, including closure of the nephrosplenic space for recurrent nephrosplenic entrapment and kidney removal (nephrectomy).
Ophthalmic Surgery
Unfortunately, in some cases of ocular trauma and end stage corneal ulceration or uveitis, the eye must be removed. The Soft Tissue Surgery Team at the RVC ERH have pioneered an approach to eye removal (enucleation) performed in the standing position under sedation and local anaesthesia, and all cases are now performed in this way. This minimises the risk of bleeding during surgery, a common complication when this procedure is performed under general anaesthesia. In less severe cases, a variety of corneal and conjunctival grafts can be performed and in early cases of recurrent uveitis cyclosporine implants may be appropriate.
Respiratory Tract Surgery
With extensive experience in the diagnosis and treatment of upper respiratory (wind) disorders in horses, the Soft Tissue Surgery Team is able to deal with the full array of possible conditions.
A particular area of expertise is the application of Dynamic Respiratory Endoscopy to diagnose obstructions that only occur during exercise. We have also undertaken and published studies assessing the success rates and potential complications of surgical treatments and have developed several new surgical approaches. We have many years experience with the full range of laryngeal surgery and palatal surgery, and depending upon the diagnosis many treatments can now be performed using minimally-invasive approaches such as endoscope-guided laser surgery. The latter approach avoids the risks and expense of general anaesthesia and often leads to a more rapid return to athletic work post operatively.
In addition to the performance-related respiratory problems described, the Soft Tissue Surgery Team is also responsible for the evaluation and treatment of horses with sino-nasal diseases. Again, we have been publishing in this field for some time, and have developed minimally invasive approaches to the sinuses. These approaches, in addition of our standing computed tomography (CT), have revolutionised our ability to diagnose and specifically treat both dental disease with resulting sinus pathology, and primary sinus disease such as cysts, ethmoidal haematomas and fungal disease.
General Surgery
The Soft Tissue Surgery Team also operate on horses with a variety of lumps and bumps, including sarcoids, foreign bodies and abscesses.