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A Look Back and a Look Forward as NeedleView® Arthroscope Equine Turns 10

NeedleView System Lights Image

Year-end is traditionally a time to indulge in both reflection and prognostication. This year, rather than just looking back at these past 12 months, we’ve gone back a full decade to 2010. That’s when we first introduced the needleoscopy™ modality and our NeedleView® arthroscope for use in equines…and we’re proud that the pioneering veterinarians who were early adopters are still using it today.

The benefits that distinguished NeedleView® upon its introduction are the same ones responsible for its rise to prominence as the tool of choice for standing diagnostic arthroscopy.

NeedleView® Benefits for the Horse and the Owner
  • Because scoping with NeedleView® is minimally-invasive, recovery is faster. The scope has an outer diameter of only 1.2 millimeters. Accordingly, the site of the scope portal rarely requires sutures, is “healed and sealed” at a microscopic level within 48 hours, and the horse can resume normal exercise after 4-5 days of bandaging.
  • Because scoping with NeedleView® can be done with the horse standing, it’s less risky. The NeedleView® scope is the size of an 18-gauge needle. This allows the joint to be scoped with just a local block and sedation…avoiding all the attendant risks of general anesthesia.
  • Because scoping with NeedleView® can be done in the field and with the horse standing, it’s less expensive. Practitioners can perform diagnostic stifle exams with the NeedleView anywhere it’s possible to achieve and maintain sterility of the operative site. This can include not just your practice/facility, but even a barn or wash rack as well. Other diagnostic imaging approaches such as x-ray, CT, and MRI can require travel to special facilities. Not only can the travel be expensive, but so can the tests and the necessary general anesthesia–often $3,000 or more when all is said and done–and these imaging approaches can still leave you without a conclusive diagnosis.
NeedleView® Benefits for the Practitioner
  • Because scoping with NeedleView®requires no general anesthesia, no operating room or ventilator is needed. NeedleView® opens up a way for practitioners who see a lot of lameness but have more basic facilities to diagnose these cases.
  • Because scoping with NeedleView® has a short, comfortable learning curve, it’s accessible for general practitioners. The standing stifle diagnostic procedure with NeedleView® is easy to learn, and a practitioner needn’t be a surgeon or specialist to be able to use the tool effectively. As long as the practitioner is comfortable with joint anatomy and knowledgeable about how to be in a joint without damaging cartilage, he or she can learn the standing stifle diagnostic procedure in a wetlab or weekend workshop.
  • Because scoping with NeedleView® provides a definitive diagnosis, it simplifies the treatment decision for practitioners and clients alike. NeedleView® helps practitioners give clients the information they need to make good decisions about how to proceed with an injured horse. For example, if a horse has been treated with IRAP and doesn’t seem to be responding, NeedleView® provides a look to see what’s going on. Or if a horse has a meniscal tear, NeedleView® can help give the owner the information to decide to proceed with surgery, debride to speed healing, or–if the injury is so severe that the horse is still likely to be only 50/50 a year out–maybe not opt for the “Cadillac” level of treatment.

In this issue of Biovision Veterinary Endoscopy’s Views newsletter, we’re exploring how NeedleView® has been used since its introduction. We’ll also peek into the future to see what’s on the horizon for this still-exciting and innovative tool.

 

Audio Links

Audio clips from current clinical users and researchers regarding NeedleView®:

Jump to Individual Interviews

You  may use the following links to jump to a specific section or simply scroll to continue.

NeedleView® Then and Now:

The Future of NeedleView®:

 

® Then and Now: David Frisbie, DVM, PhD, DACVS, DACVSMR

Any discussion of NeedleView®’s history must start with Dr. David Frisbie. Dr. Frisbie is a professor of equine surgery at Colorado State University (CSU) College of Veterinary Medicine and Biosciences. As Dr. Frisbie recalls, “As Biovision moved into arthroscopy [in 2010], a colleague suggested that I be recruited to evaluate and develop potential equine applications for the NeedleView® scope. We knew we could probably find applications and develop techniques. I met with Biovision’s president John Small and we came up with a plan to look at NeedleView® in the field and see where the technology could make the biggest impact. Then we would conduct research and publish for solid science.”

David Frisbie, DVM, PhD, DACVS, DACVSMR
David Frisbie, DVM, PhD, DACVS, DACVSMR

The stifle was the logical best first place to look for applications, Frisbie noted at the time, because:

  • Stifle problems account for an estimated 40% or more of injuries in sport horses.
  • Definitive diagnosis of slight to moderate stifle pathology was limited.
  • Many practitioners are uncomfortable performing diagnostic anesthesia of the stifle.
  • Many lesions (particularly soft tissue lesions) go undetected with radiography.
  • Use of ultrasonography to examine cruciate ligaments remained difficult because of the orientation and deep anatomic location of these structures.
  • CT using contrast arthrography had been used to image the stifle, but limitations existed to its availability and the availability of MRI.

The outcome of that research was the development and refinement of the standing stifle diagnostic arthroscopy procedure as described in “Diagnostic stifle joint arthroscopy using a needle arthroscope in standing horses,” Vet Surg. 2014 Jan;43(1):12-8. doi: 10.1111/j.1532-950X.2013.12068.x. Epub 2013 Oct 31.

In the study, Frisbie and his colleagues were able to confirm that the 18-gauge NeedleView® arthroscope could be used to perform complete diagnostic examination of the three compartments of the stifle joint in standing horses. Further, they found that in some areas of the joint where space was limited, the small diameter of the scope was an advantage despite the smaller field of view.

In a 2014 video in which he demonstrated the standing stifle diagnostic exam, Dr. Frisbie noted, "The scope that we're using is the size of an 18-gauge needle. So when we go to treat a stifle joint, we use an 18-gauge needle. So we're really using the same size arthroscope as we do needle to treat them. So, i.e., it's very non-invasive. And as you can see, you know, it's, it's just like prepping it to treat or block a joint except you leave the needle in for four or five minutes as you're looking around to see what kind of a lesion that you have. So it's novel from another standpoint, in that the stifle is a very difficult place to image…meaning we can take x-rays of it [but] they're not horribly sensitive and not necessarily very specific for specific disease processes. Ultrasound helps us a little bit, but it misses a lot of the subtle things that keep our elite athletes from performing at their peak. We can go in and we can put local anesthetic in the joint and those horses go sound; we can treat them and they go sound for a couple of weeks, but then they return with this low-grade lameness. And up until now we've never been able to really look in there without doing, you know, general anesthesia and 'a big surgery.' So this [NeedleView®] allows us like in this horse to go in and look around and say, 'Look, there's a little bit of damage probably from a meniscal tear that is not accessible surgically. But we can treat it with other methods like stem cells.'”

 

"The scope that we're using is the size of an 18-gauge needle. So when we go to treat a stifle joint, we use an 18-gauge needle. So we're really using the same size arthroscope as we do needle to treat them. So, i.e., it's very non-invasive. And as you can see, you know, it's, it's just like prepping it to treat or block a joint except you leave the needle in for four or five minutes as you're looking around to see what kind of a lesion that you have. So it's novel from another standpoint, in that the stifle is a very difficult place to image…meaning we can take x-rays of it [but] they're not horribly sensitive and not necessarily very specific for specific disease processes. Ultrasound helps us a little bit, but it misses a lot of the subtle things that keep our elite athletes from performing at their peak. We can go in and we can put local anesthetic in the joint and those horses go sound; we can treat them and they go sound for a couple of weeks, but then they return with this low-grade lameness. And up until now we've never been able to really look in there without doing, you know, general anesthesia and 'a big surgery.' So this [NeedleView®] allows us like in this horse to go in and look around and say, 'Look, there's a little bit of damage probably from a meniscal tear that is not accessible surgically. But we can treat it with other methods like stem cells.'” –Dr. David Frisbie, Colorado State University College of Veterinary Medicine and Biosciences (Fort Collins, CO)

 

Upon the 5-year anniversary of NeedleView® in 2015, Dr. Frisbie said, “We’ve pretty much established what NeedleView® can do, and our experience will stand in any arena. We’ve used it to diagnose meniscal tears and lesions, cartilage damage, cruciate ligament tears and lesions, floating joint fragments, and subchondral bone cysts.”

We spoke with Dr. Frisbie recently to ask how his use of NeedleView® has evolved in the intervening years. Following are excerpts from that interview.

Biovision (BV): When you spoke of first exploring potential applications for NeedleView® a decade ago, you remarked about the limitations of various imaging modalities when it came to diagnosing stifle injuries. Do those limitations still exist? Have any of those modalities surpassed NeedleView® as a diagnostic tool?

David Frisbie (DF): In the last decade, there's been a lot more people trained in all of those modalities. So a decade ago, there weren't that many people that were really that skilled -- especially at stifles – so just the overall awareness and ability to do those things in the field has improved, there's no doubt about it. Likewise, the number of MRIs that are capable of handling a horse have increased, as have the number of MRIs with high field magnets. The quality of the imagery is certainly getting better, there's more of it out there, and people are better trained. Really, even with all those things said, it's not decreased the usefulness of the scope -- the definitive diagnosis can be had with the needle scope.

BV: How has your use of NeedleView® evolved over the last 10 years?

DF: It's evolved some. Most of the things that I do are related to the stifle, so in some respects I’m not the greatest litmus test [of evolving use]. But certainly we've scoped navicular bursas (which are really quite interesting), fetlocks front and back, and carpuses. We've also done a lot of experimental work or research scoping hocks with synovitis. With the size of the NeedleView® being so much smaller [than a standard arthroscope], it's easier to move around with that smaller scope in the navicular bursa, because it is such a limited space. So I can actually see myself doing some navicular bursa arthroscopy using the needle scope preferentially because of that.

 

"...we've scoped navicular bursas (which are really quite interesting), fetlocks front and back, and carpuses. We've also done a lot of experimental work or research scoping hocks with synovitis. With the size of the NeedleView® being so much smaller [than a standard arthroscope], it's easier to move around with that smaller scope in the navicular bursa, because it is such a limited space. So I can actually see myself doing some navicular bursa arthroscopy using the needle scope preferentially because of that." –Dr. David Frisbie, Colorado State University College of Veterinary Medicine and Biosciences (Fort Collins, CO)

 

DF (continued): When I was over in Sweden [demonstrating and training] they enjoyed the stifle piece, but they were even more keen about scoping the carpus. And I got feedback subsequent to it saying that was the thing that was a bit of a game changer for those guys, especially in those Standardbred horses. Again, the carpus is an area where the cartilage is thin so you can't really ultrasound very well and you don’t really know on x-ray, so there's no imaging modality that's going to give it to you. But when you stick the [needle] scope in there, it really almost instantaneously tells you if you've got a fair bit of cartilage damage.

BV: Have you done much with the NeedleView® and regenerative medicine?

DF: Quite a bit, actually. When we're scoping the stifles with the needle scope, about half of the horses go on to surgery and about half just get regenerative medicine. It’s economically really quite friendly to the consumer [to use the NeedleView® for evaluation vs. arthroscopy under general anesthesia] because now you've got $1,000 in to make the diagnosis instead of two to three times that, easily, for a diagnostic arthroscopy under general anesthesia. And you don't have the risk [of general anesthesia]. Now you can put that delta [difference] into the regenerative therapy instead of spending $2,000 to $3,000 on the arthroscopy only to learn that it was diagnostic in its benefit and you're going to do stem cells anyway.

BV: Any closing thoughts about NeedleView® on its 10-year anniversary?

DF: You know, the Biovision scope was the first to be described, it's been used the longest, and it certainly has had unique adaptations -- specifically the cannula -- to be better suited for use in horses. Those are all things that I think are unique pieces.

 

"You know, the Biovision scope was the first to be described, it's been used the longest, and it certainly has had unique adaptations—specifically the cannula—to be better suited for use in horses. Those are all things that I think are unique pieces." –Dr. David Frisbie, Colorado State University College of Veterinary Medicine and Biosciences (Fort Collins, CO)

 

Josh Zacharias, DVM, MS, DACVS, DACVSMR
Josh Zacharias, DVM, MS, DACVS, DACVSMR

NeedleView® Then and Now: Josh Zacharias, DVM, MS, DACVS, DACVSMR

Dr. Josh Zacharias is another surgeon who can proudly claim status as one of the earliest adopters of NeedleView®. Dr. Zacharias is a large animal surgeon and clinician with Countryside Large Animal Veterinary Services, PLLC in Greeley, Colorado. His main interests are equine lameness and all aspects of large animal surgery. A referral practice, Countryside draws clients not only from Colorado but also from Kansas, Nebraska, Wyoming, Utah, New Mexico, Texas, and Oklahoma.

As guest editor of the newsletter issue commemorating NeedleView®’s first five years, Dr. Zacharias recounted his first exposure to the technology, saying, “I first encountered the NeedleView® scope at the American College of Veterinary Surgeons (ACVS) Surgery Summit in Seattle, Washington, in 2010, where Biovision was an exhibitor. I met John Small, the company’s president, and immediately was intrigued and excited by the potential of this new diagnostic tool. We got our hands on one in 2012 and began using it as a way to definitively diagnose stifle disease without the expense and risk of general anesthesia and surgery.” As Dr. Zacharias noted, “NeedleView® piqued my interest because it’s been my experience that it’s easy for private practitioners to get comfortable–and rusty–doing what they’ve always done. My goal is to always be learning and growing,” and needle arthroscopy provided that opportunity.

The standing stifle procedure developed by Dr. Frisbie “became our ‘bread and butter’ in regard to the NeedleView®,” said Dr. Zacharias. He added, “The system easily paid for itself. Keep in mind, our practice is in Colorado State University’s ‘back yard,’ and we’re not all that far from Littleton Equine Medical Center. But with the NeedleView®, we can compete with an academic institution and a large practice and more than hold our own treating Western performance horses.”

 

“…with the NeedleView®, we can compete with an academic institution and a large practice and more than hold our own treating Western performance horses.”–Dr. Josh Zacharias, Countryside Large Animal Veterinary Services (Greeley, CO)

 

We had a chance to catch up with Dr. Zacharias, and he reports that not much has changed for him in regard to his opinion or use of NeedleView® since 2015. He sees that as a good thing, though, because it means he has a “workhorse” of a diagnostic tool he can rely on to provide definitive diagnoses quickly and affordably, while additional uses—such as for examination of septic joints and as an aid to their lavage—just make the tool even more valuable and versatile.

NeedleView® Then and Now: Shane Miller, DVM, MS, DACVS, DACVSMR

Rounding out our stable (pun intended) of early NeedleView® adopters still using the technology today is Dr. Shane Miller of Comstock Equine Hospital in Reno, Nevada and Great Basin Equine Medicine and Surgery in Gardnerville, Nevada. Dr. Miller's professional interests lie in orthopedic and soft tissue surgeries with an emphasis in arthroscopy, laparoscopy, and regenerative medicine. He also has a large clinical interest in lameness and performance horse medicine. He has written articles in Veterinary Surgery Journal, Equine Veterinary Journal, Journal of the American Veterinary Medical Association, and many lay journals. Dr. Miller has also presented numerous surgical and lameness topics both nationally and internationally

Shane Miller, DVM, MS, DACVS, DACVSMR
Shane Miller, DVM, MS, DACVS, DACVSMR

Dr. Miller purchased his NeedleView® system in 2012 and it quickly proved its value helping him perform the many stifle diagnostics needed due to his practice’s population and caseload. And the tool soon proved its versatility. In a 2016 interview, Dr. Miller told us, “I also use it for exploration in areas like the tendon sheath, coffin, fetlock, and carpus. In addition, I use it in paranasal sinuses to help with diagnosis of masses and undetermined infections. One location that I really like its use is in the navicular bursa because of its small diameter. This is helpful in lameness diagnostics when localized to the bursa (via MRI results) or when there has been penetration of a foreign object and subsequent septic bursitis.”

Building on NeedleView®’s utility, Dr. Miller developed an additional use in horses that present with septic arthritis. As he noted in 2016, “The typical approach is to lay the horse down with general anesthesia and use a standard 4mm arthroscope to lavage or flush the joint.” In the recent interview he added, “With the NeedleView®, with the horse either standing sedated or under general anesthesia, I can flush the joint or sheath and it’s less labor intensive than an arthroscopic flush. Even if there is a lot of debris, we can still use instrumentation to help clear and remove using the NeedleView®.”

When we reached out to Dr. Miller for this 10-year anniversary newsletter issue, we found that he has added yet another procedure to his NeedleView® repertoire: bursoscopy. “I use it a lot for septic joints, especially for horses that step on nails and have septic navicular bursitis. I like using needle arthroscopy in that location for bursoscopy to take a peek in there. Again, it's much smaller diameter with less iatrogenic trauma. I can get a good evaluation inside the bursa in that location and a great lavage.”

Now, some eight years after first acquiring NeedleView® for his practice, the tool is still in regular use four to five times a month, says Dr. Miller. And for good reason: “I really like the system. It's super easy to use. You can see in the areas where you typically can't with a larger scope, and so I can get in some areas that I usually wouldn't be able to. So in that regard, just based on size alone, it allows us to see other aspects of the joint that you typically can't. I mean, other than that, it's, you know, the portability and ease of use, especially if you're used to doing arthroscopy. It's really simple.”

 

“I really like the system. It's super easy to use. You can see in the areas where you typically can't with a larger scope, and so I can get in some areas that I usually wouldn't be able to. So in that regard, just based on size alone, it allows us to see other aspects of the joint that you typically can't. I mean, other than that, it's, you know, the portability and ease of use, especially if you're used to doing arthroscopy. It's really simple.”–Dr. Shane Miller, Comstock Equine Hospital (Reno, NV)

 

Now let’s peer into the future to see what’s on the horizon for NeedleView® as we talk with researchers who are pushing the boundaries of the technology and exploring novel applications.

Marcos Perez-Nogues, LV, MSc, DACVS-LA
Marcos Perez-Nogues, LV, MSc, DACVS-LA

The Future of NeedleView®: Marcos Pérez-Nogués, LV, MSc, DACVS-LA

We’re excited to introduce you to Dr. Marcos Pérez-Nogués of the University of California-Davis. Dr. Pérez-Nogués obtained his veterinary degree from the School of Veterinary Medicine of Complutense University in Madrid, Spain. He then completed a 1.5-year equine internship at the School of Veterinary Medicine of Complutense University along with a master's degree in Veterinary Research. Dr. Pérez-Nogués then completed two equine surgery internships in private practice: Milton Equine Hospital in Ontario, Canada, and Hagyard Equine Medical Institute in Lexington, Kentucky. Upon completion of these internships, he joined and completed the equine surgery residency program at UC Davis. A Diplomate of the America College of Veterinary Surgeons, Dr. Pérez-Nogués is currently an equine surgeon with the UC Davis Veterinary Medical Teaching Hospital.

Dr. Pérez-Nogués is one of the researchers eager to expand the use of NeedleView® technology to–for lack of a better phrase–“go where no scope has gone before.” His recent area of research interest focused on equine caudal cervical articular process joints. Disorders of this area have been linked to spinal cord compression resulting in severe clinical signs such as ataxia, lameness, and weakness.

In Dr. Pérez-Nogués’s words, “The population of geriatric and retired horses, or simply late in their career that we see in our practice has increased. Mostly horses that have had a very good jumping, eventing, racing or other demanding physical activity usually develop some degree of arthritis problems. So we see like, almost ‘maintenance’ horses all the time…we will be checking them all the time because of arthritis.” He continued, “We see a lot of arthritis in the neck, too. And these horses with arthritis in the joints that we started scoping, they're very difficult to treat and assess because [of limitations in] the tools that we have now--the diagnostic imaging techniques that we have for horses. We have the radiology which is not that great; you can see that there's arthritis, but you cannot see the whole picture of what this arthritis is causing [in the spinal cord]. And then when we do an ultrasound of the neck, we just see the surface of the bone. And now they're developing some CT equipment that can fit a horse or do it standing. But we don't have it here [in our practice] yet. We're trying to get it. So the only diagnostic tools that we have is x-ray and ultrasound and they're not good enough."

 

“We see a lot of arthritis in the neck, too. And these horses with arthritis in the joints that we started scoping, they're very difficult to treat and assess because [of limitations in] the tools that we have now--the diagnostic imaging techniques that we have for horses. We have the radiology which is not that great; you can see that there's arthritis, but you cannot see the whole picture of what this arthritis is causing [in the spinal cord]. And then when we do an ultrasound of the neck, we just see the surface of the bone. And now they're developing some CT equipment that can fit a horse or do it standing. But we don't have it here [in our practice] yet. We're trying to get it. So the only diagnostic tools that we have is x-ray and ultrasound and they're not good enough.”–Dr. Marcos Pérez-Nogués, University of California-Davis

 

Others have tried to access these joints with standard arthroscopes. “There have been two or three cases published…people in Europe that tried [this procedure] with a big scope. They had to do a big surgery and cut very deep. Everything is really deep and if you damage something there, it’s going to be a big issue. So the needle scope comes in very handy.”

So Dr. Pérez-Nogués turned to needle arthroscopy. He particularly likes the insertion method available to him with NeedleView®. “We’ve tried different needle scopes over the years, too, and I think the [NeedleView®] insertion method with the trocar and the cannula separated from the camera is really good. It’s nice. It’s easy.”

 

“We’ve tried different needle scopes over the years, too, and I think the [NeedleView®] insertion method with the trocar and the cannula separated from the camera is really good. It’s nice. It’s easy.”–Dr. Marcos Pérez-Nogués, University of California-Davis

 

For his prospective experimental case series, Dr. Pérez-Nogués selected six adult horses. Leaving them standing and sedated in stocks (check out a video snippet here), he placed the trocar and cannula assembly under ultrasound guidance without joint distention and then introduced the NeedleView®. He explored bilateral C5-6 vertebral articular process joints in three of the horses; in the other three, he examined bilateral C6-7 joints. As he reports in his paper “Evaluation of the caudal cervical articular process joints by using a needle arthroscope in standing horses,”:

  • All 12 articular process joints were successfully explored.
  • Entering the joint on the first attempt was achieved in 10 of 12 joints.
  • A craniodorsal approach for arthroscope insertion allowed evaluation of the most cranial aspect of the articular cartilage surface.

As for limitations, he reported, “Triangulation with a spinal needle was determined to be difficult and resulted in a limited space for movement.”

He concluded that needle arthroscopy of the caudal cervical facet joints can be performed safely and efficiently in standing sedated horses. The clinical significance, then, is that “Standing cervical articular process needle arthroscopy is a minimal morbidity technique with the potential to be an advantageous technique for the diagnosis and treatment of cervical articular process pathology.”

As exciting as these findings are, Dr. Pérez-Nogués acknowledges they’re not yet sufficient to convince some of the vets who refer horses to the UC Davis Veterinary Medical Teaching Hospital. “The technique is very good, but it's still not very accepted by our ref vets,” he said. “Even though we lower the price [to perform the exam] and everything, the ref vet’s still ‘Well, we may have problems.’ It’s not usually a routine technique yet. So they are still backing up on sending horses that are more or less neurologic or ataxic with this problem to be scoped. And we still cannot say, ‘Oh, we're going to diagnose your horse with this technique’ yet.”

Being able to use the NeedleView® to get definitive diagnoses in this tricky area is what’s next on the research horizon for Dr. Pérez-Nogués. He notes, “It's a little bit early for us to say [we can do] that. Now what we have to do is [scope] the horses with problems and then correlate what we can see.” His next step is to look for such correlations in cadaver horses that have already died of the disease or that were euthanized because of the progression of the disease. “So far, I just have one horse that I've done. But yeah, I’m kind of hunting those cases down to see what we can learn.”

Dr. Pérez-Nogués sees great things ahead for NeedleView®. “I think the biggest advantage of this technique mainly is not [just] doing the horse standing but accessing joints that we've never routinely done…some joints that we’ve never been able to easily access without trouble: neck, hip, shoulder, etc.”

And that – “joints we’ve never been able to easily access without trouble” – leads to our final interview in this 10-year NeedleView® anniversary issue…

The Future of NeedleView®: Alvaro Garcia Bonilla, DMV, MSc, DACVS

We’re not aware of anybody recently who has stuck NeedleView® in so many new joints—and then published about the experiences—as Dr. Alvaro Garcia Bonilla, Assistant Professor of Equine Surgery at Université de Montréal in Saint-Hyacinthe, Quebec, Canada.

Dr. Bonilla received his DMV from the Universidad de Cordoba in Spain and completed two internships in medicine and equine surgery at the Universitat Autonoma de Barcelona in Spain and a private practice in Spain. Then, he moved to North America where he completed an internship at Milton Equine Hospital in Canada and an orthopedic fellowship at University of Pennsylvania. During his equine surgery residency at The Ohio State University, he earned his Master’s of Science and followed the residency with a one-year term as a Clinical Instructor in Equine Surgery and Emergency. After experience as an equine surgeon with the Université de Montréal, Charles Sturt University, and the University of Bristol, Dr. Bonilla joined the Université de Montréal as an Assistant Professor of Equine Surgery in 2016. A Diplomate of the American College of Veterinary Surgeons, Dr. Bonilla regularly conducts and publishes scholarly research focused on expanding the clinical applications of minimally-invasive approaches such as endoscopy and needle arthroscopy in equine diagnostics and treatment.

Alvaro Garcia Bonilla, DMV, MSc, DACVS
Alvaro Garcia Bonilla, DMV, MSc, DACVS

One of Dr. Bonilla’s first forays into research with NeedleView® was his 2020 paper titled “Validation of a 2-mm videoendoscope for the evaluation of the paranasal sinuses with a minimally invasive technique” (Vet. Surg. 2020 Jun;49 Suppl 1:O60-O70). Using the NeedleView® camera in conjunction with a 2mm flexible endoscope for standing, conscious evaluation of the paranasal sinus, he concluded, “Minimally invasive sinuscopy was readily performed without relevant complications in standing horses. A thorough evaluation of most sinus structures was obtained only using the frontal and the rostral maxillary portals."

When we asked him recently about the 2020 study, Dr. Bonilla noted, “Yes, it requires knowledge of the anatomy of the paranasal sinuses to do it, but once you have the knowledge, it doesn't require a lot of technical skills. So I think this is a procedure which is much simpler to perform. It’s very beneficial not only for a specialist; I think even practitioners could do it. Of course, it should be practitioners with good training and good knowledge of the anatomy of the paranasal sinuses and the pathologies. But it's a simple technique. It's very minimally invasive. The traditional technique makes around a 10-millimeter hole through the head. This one, we make it with a needle—two millimeters. You put the scope [in], look inside, and you have an idea about what is going on. And you can, in some locations, escape the need for advanced imaging, either because you don't need it or maybe because you don't have the money or the access to it.”

 

“That technique [evaluation of the paranasal sinuses with the NeedleView® camera and a flexible endoscope]…yes, it requires knowledge of the anatomy of the paranasal sinuses to do it, but once you have the knowledge, it doesn’t require a lot of technical skills. So I think this is a procedure which is much simpler to perform…You put the scope [in], look inside, and you have an idea about what is going on.”–Dr. Alvaro Bonilla, Université de Montréal

 

That experience sparked a desire in Dr. Bonilla to exploit the unique advantages of NeedleView® as a tool for diagnostic arthroscopy. We spoke to Dr. Bonilla recently in preparation for this newsletter issue. Following are excerpts from that interview.

Biovision (BV): From your perspective, how do you feel about this as a tool? And what sort of implications do you see it having?

Alvaro Bonilla (AB): So to me, the needle scope is a very valuable tool. And I think in the future, or progressively, we're going to give it a little bit of more therapeutic application, but the potential and the current use for me and others is diagnostics. So to me, it's a diagnostic or an alternative diagnostic tool. Many of us, when we work in academia, we have CT, we have MRI, we have a lot of toys…but many people [outside academia] are left still with radiography and ultrasound to get their diagnosis. It's not that we need the needle scope for every case, but in selected cases, radiography and ultrasound don't give us a definitive diagnosis. And we need to go beyond that. And that's specifically why it was created for the stifle. So the way I see it, we have kind of two limitations for diagnostics in horses. On one side is that advanced imaging: CT and MRI are cost prohibitive for many, and it's not accessible to many people. And the other limitation is that even if it is accessible, there are certain regions in the horse, especially the upper limb--like the shoulder [or] the stifle--where you pretty much cannot do any advanced imaging. So there are still, in our field, certain limitations regarding traditional diagnostics, and that's where the needle scope is a valuable tool…having another diagnostic tool that can help you to get a diagnosis more precisely when you don't have it with basic imaging.

 

“So there are still, in our field, certain limitations regarding traditional diagnostics, and that’s where the needle scope is a valuable tool…having another diagnostic tool that can help you to get a diagnosis more precisely when you don’t have it with basic imaging.” –Dr. Alvaro Bonilla, Université de Montréal

 

 BV: Can you talk a little bit about NeedleView® and the information that you get from it versus something like an MRI or a CT or an X ray? How much of an advantage is that?

AB:  It's a great advantage. So arthroscopy remains the gold standard to diagnose multiple pathologies. MRI progressively is getting better and better for diagnosis of cartilage lesions. But [with] some of them, our eyes are better than others and some sequences are better than others. Many times you need to put the horse under general anesthesia to get an appropriate diagnosis. So it's always an advantage to be able to put your eyes inside a joint to look at the cartilage, look at the soft tissues within the joint, to look at some fragments that you may be suspicious of or that may be silent on other imaging modalities.

And, you know, surgeons…sometimes we are a little simplistic, so having our eyes on something and being able to see it really helps us to determine exactly what's going on. So that's for sure a value.

 

“It's a great advantage. So arthroscopy remains the gold standard to diagnose multiple pathologies. MRI progressively is getting better and better for diagnosis of cartilage lesions. But [with] some of them, our eyes are better than others and some sequences are better than others. Many times you need to put the horse under general anesthesia to get an appropriate diagnosis. So it's always an advantage to be able to put your eyes inside a joint to look at the cartilage, look at the soft tissues within the joint, to look at some fragments that you may be suspicious of or that may be silent on other imaging modalities.”–Dr. Alvaro Bonilla, Université de Montréal

 

Dr. Bonilla has since gone on to co-author four more papers involving NeedleView® in just this year alone. We provide a brief overview of each study below, along with links to the published papers. (Note: journal subscription is required to view the full content.)

Diagnostic needle arthroscopy of the tarsocrural joint in standing sedated horses. Kadic DTN, Bonilla AG. Vet Surg. 2020 Apr;49(3):445-454. doi: 10.1111/vsu.13375. Epub 2020 Jan 13.

In this experimental study, Dr. Bonilla and his coauthors used cadaveric hind limbs in Phase 1 and six healthy horses in Phase 2, examining each tarsocrural joint (TCj) with the NeedleView® scope and the use of a custom-made splint and base to maintain joint flexion during the procedure. As reported in the paper, “Thorough evaluation of the dorsal intra-articular structures of the TCj via dorsomedial and dorsolateral approaches was possible in both phases. The procedure was feasible, quickly performed, and well tolerated by all horses. Complications consisted of moderate movement (2/6 horses) and hemarthrosis (3/6 horses).” Dr. Bonilla and his coauthors concluded that “Diagnostic standing needle arthroscopy of the TCj allowed thorough evaluation of the dorsal aspect of the joint while avoiding the cost and risks associated with general anesthesia,” and “Needle arthroscopy of the TCj offers an alternative diagnostic tool when traditional imaging techniques (radiography and ultrasonography) are unrewarding or nondiagnostic.”

Diagnostic tenoscopy of the carpal sheath with a needle arthroscope in standing sedated horses. Miagkoff L, Bonilla AG. Vet Surg. 2020 Jun;49 Suppl 1:O38-O44. doi: 10.1111/vsu.13381. Epub 2020 Jan 25.

Dr. Bonilla and his coauthors took a similar approach with this experimental study, again choosing to use six cadaveric limbs (forelimbs this time) in Phase 1 and six healthy horses in Phase 2. In Phase 1, the researchers performed carpal sheath tenoscopy with NeedleView® using both the 65mm and 100mm scopes. This was followed by tenoscopy with a 4-mm arthroscope through a standard proximolateral approach. In Phase 2, they performed unilateral standing carpal sheath tenoscopy in six healthy sedated horses with the 65mm NeedleView® scope, maintaining the limbs in flexion with a custom-made splint and base. As reported in the paper, “Visibility at the most distal aspect of the sheath was absent for the needle arthroscopes vs a standard arthroscope. The maneuverability with a 65-mm needle arthroscope was excellent and allowed exhaustive visualization of the proximal region of the carpal sheath in cadaveric limbs and standing horses (six of six). However, visualization of the intertendinous recess was partial in most horses (four of six) vs cadavers (complete in six of six) because of remaining flexor tendon tension in standing horses. No major complications were encountered.” The researchers concluded, “Standing carpal sheath tenoscopy allowed a safe and thorough evaluation of most structures in the proximal region of the sheath and offers an alternative diagnostic technique,” and “Horses with unrewarding results after traditional imaging or that require an accurate diagnosis before treatment may benefit from this alternative procedure.”

Needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses. Kadic DTN, Miagkoff L, Bonilla AG. Vet Surg. 2020 Jul;49(5):894-904. doi: 10.1111/vsu.13430. Epub 2020 Apr 25. PMID: 32333682

Replicating the methods of the preceding two studies, Dr. Bonilla and his coauthors used NeedleView® in cadaveric forelimbs as well as in healthy sedated standing horses to evaluate the radiocarpal and middle carpal joints. In Phase 1 (cadaveric), they were able to thoroughly evaluate the dorsal and palmar recesses of both joints with NeedleView®. In phase 2 (standing sedated healthy horses), “…joint evaluation was also thorough but only dorsal approaches were performed. All horses underwent radiocarpal joint arthroscopy, whereas the middle carpal joint was evaluated in only three of six horses because of limb movement.” The researchers noted, “The technique was quickly performed and well tolerated by all horses. Complications included moderate movement, mild iatrogenic cartilage damage, and mild hemarthrosis.” They concluded, “Standing needle arthroscopy allowed thorough evaluation of the dorsal aspect of both joints, although only three of six middle carpal joints were assessed because of movement limitations,” and “The proposed technique offers an alternative diagnostic tool for radiographically silent intra-articular lesions of the carpus while initially avoiding the cost and risks associated with general anesthesia. Arthroscopy of a single joint is recommended to minimize risks associated with movement during the procedure.”

Diagnostic needle arthroscopy of the scapulohumeral joint in standing sedated horses. Pouyet M, Bonilla AG. Vet Surg. 2020 Oct 19. doi: 10.1111/vsu.13529. Online ahead of print.

In his most recent and arguably most ambitious study with the technology, Dr. Bonilla and his coauthors sought to describe the technique for using NeedleView® to perform diagnostic standing scapulohumeral joint needle arthroscopy in horses. Using eight cadaveric thoracic limbs in Phase 1, they assessed the feasibility of the technique by using a craniolateral arthroscopic approach, performing an evaluation of the visible structures of the scapulohumeral joint with both the needle scope and a 4-mm arthroscope. In Phase 2, they performed the technique in six healthy sedated standing horses. As reported in the paper, “In phase 1, joint evaluation was similar between arthroscopes and allowed complete evaluation of approximately the lateral half of the humeral head and the lateral glenoid rim. In phase 2, all joints were successfully accessed, and fluid extravasation was mild. Arthroscopic visualization was complete for the centrolateral aspect of the joint in all horses and either complete (3/6) or partial (3/6) for the craniolateral and caudolateral structures, respectively. The procedure was rapidly performed and well tolerated, and no postoperative complications occurred.” The researchers concluded “The described technique was simple and allowed direct inspection of the scapulohumeral joint. Nonetheless, the standing nature of the technique prevents evaluation of the medial aspect of the humeral head and most of the glenoid cavity.” They added, “Needle arthroscopy of the scapulohumeral joint is feasible in horses and offers a diagnostic technique that may improve the surgeon's diagnostic ability for certain shoulder pathologies.”

 

BONUS: Watch Dr. Bonilla's AAEP Presentation on Standing Diagnostic Arthroscopy Beyond the Stifle

Watch Dr. Bonilla’s presentation – “How to Perform Standing Needle Arthroscopy Beyond the Stifle” – on demand via the American Association of Equine Practitioners’ 2020 Virtual Convention. To watch Dr. Bonilla's session, you must be registered for the convention. Once you have your login credentials, you will be able to access his presentation by using this link:  https://aaep.digitellinc.com/aaep/sessions/5156/view. Dr. Bonilla’s presentation is available now and will remain accessible through June 30, 2021.

 

Thanks for Reading!

It has been our pleasure to bring you this “look back and look forward” to commemorate the 10-year anniversary of NeedleView®’s introduction for equine use. We hope you’ve enjoyed it and that it has set the wheels turning in your mind as to the value this versatile diagnostic tool could have for you in your practice.

To See NeedleView® in Action…

We miss being able to demonstrate NeedleView® at conferences and conduct continuing education wetlabs with the technology. You can still see the tool in action by checking out some of our featured videos:

This is a Perfect Time to Add NeedleView® to Your Diagnostic Toolbox

Now is a perfect time to add NeedleView® to your diagnostic toolbox so you can begin offering minimally-invasive standing joint diagnostics in the new year. Favorable financing offers are available, and your purchase may qualify for special tax treatment. Contact us at 303-225-0960 Monday-Friday between 9:00 a.m. and 5:00 p.m. Mountain time or send an email to .

 

URL: https://biovisionvet.com/views-newsletter/look-back-forward-needleview-arthroscope-turns-10/
Updated: 2023-03-31

Can I Use the Section 179 Tax Deduction on Biovision Equipment?

For practices and hospitals subject to taxation by the U.S. Internal Revenue Service, the Section 179 deduction for fixed assets is pretty close to magic. That's because it lets you deduct the full purchase price of qualifying equipment purchased or financed during the tax year rather than capitalizing and depreciating it over time.

In a nutshell, this provision of the tax code allows you to write off up to $1,040,000 in tax benefit on qualifying assets costing up to $2,590,000. Most tangible goods used by American businesses qualify -- including Biovision's EndoDiagnostic+Surgical Suite EDSS and NeedleView Arthroscope Suite.

The Section 179 deduction is one way the government encourages businesses to buy equipment and rewards them for investing in themselves. These immediate deductions can free up valuable cash for expansion, growth and self-investment. (Want to know more about the deduction, how it works, and what qualifies? Check out Section 179.org.)

Applying the Section 179 Tax Credit to Biovision Equipment Suites

NeedleView® Arthroscope Suite
    • Tax year 2020
    • Tax bracket of 35%
    • Equipment purchased and put into use prior to December 31, 2020
    • $5,232 in tax savings (calculated as $14,950 purchase price x 0.35)
    • Takes effective cost down to $9,717
    • The typical NeedleView® customer bills each NeedleView procedure at $1,000 and performs 2-4 procedures per month...resulting in a potential first-year ROI of 247% (click here for a full ROI calculation)
EndoDiagnostic+Surgical Suite (EDSS)
    • Tax year 2020
    • Tax bracket of 35%
    • Equipment purchased and put into use prior to December 31, 2020
    • $13,632 in tax savings (calculated as $38,950 purchase price x 0.35)
    • Takes effective cost down to $25,318
    • The typical EDSS customer bills each EDSS procedure at $500 and performs 4 procedures per month...resulting in a potential first-year ROI of 92% (click here for a full ROI calculation)

Purchase Considerations

It's important to plan any capital expenditure — such as the purchase of endoscopic/laparoscopic and/or arthroscopic equipment suites — wisely. You'll want to factor in:

  • Current and future practice needs
  • Price
  • Return on investment
  • Useful life/depreciation
  • Tax deductibility

If old equipment needs to be replaced to sustain a currently-offered service, the determination is relatively simple.

Don’t limit your vision, though! Take time to consider how new equipment or technology could:

  • Help expand your service lines
  • Add to your skills
  • Reignite excitement for your work
  • Set your practice apart from competitors for being innovative or offering the highest standard of care

Important Deadlines and Requirements

It’s crucial that you place your new equipment into service by December 31, 2020 if you wish to take the Section 179 deduction for the 2020 tax year. Orders should be placed ASAP to allow sufficient time for processing, shipping, delivery/set-up and integration into your practice by December 31.

 

Biovision NeedleView Camera and Scopes Now Deployable with Vetel’s Metron Image Software

Biovision Veterinary Endoscopy and Vetel Diagnostics are excited to announce as of October 2019 that Biovision’s NeedleView® camera and scopes for arthroscopy are fully deployable for use with Vetel’s exclusive image acquisition and picture archiving communication system (PACS) software, Metron.

Veterinarians need quality products that are efficient in operation and seamlessly integrate into their practices. That is why Vetel and Biovision are working together to provide technological solutions that meet the current and projected needs of today’s veterinarians.

Vetel has been an industry innovator for 20 years, selling diagnostic modalities such as digital radiography, ultrasound, thermal imaging and endoscopy products. Vetel’s Metron software allows for the entirety of a veterinarian’s imaging library to be easily accessed via a centralized PACS database. The inclusion of Biovision’s NeedleView® camera and arthroscopes allows for Metron to be an all-inclusive, one stop shop for image acquisition, processing and storage.

John Small, CEO of Biovision Veterinary Endoscopy LLC, remarked, “We are excited to enable Vetel’s Metron™ software users the ability to add our 18-gauge NeedleView® arthroscope technology to their tool set to perform micro-arthroscopic and sinoscopic diagnostic procedures along with some biologic visual injections. This value-added element will definitely enhance [Vetel’s] service offering.”

Dr. James Waldsmith, president of Vetel, is looking forward to the new opportunities that customers will have with this development. “We are thrilled with the addition of the Biovision line to our product offering,” Waldsmith said. “The integration brings our Metron users a fantastic value in their ability to grow their practices in adding arthroscopy and sinoscopy services.”

About Biovision Veterinary Endoscopy LLC and Vetel Diagnostics

Biovision Veterinary Endoscopy LLC provides veterinary practitioners with quality, innovative products that are cost effective and enable better patient care. Biovision’s product line is composed of technologically advanced, ultra-portable systems and accessories tailored for cutting-edge visualization applications. For more information about Biovision, visit the home page.

Born from the need to bring quality and value to veterinary diagnostics, Vetel maintains a perpetual drive to harness the digital world for the veterinarian. Combining the state of the art in imaging technology with the Metron™ AI enhanced software platform, and dedicated to providing unsurpassed customer support, Vetel delivers simplicity, reliability and precision to the daily lives of the veterinary practitioner. For more information about Vetel, visit its website.

 

VOS 2019 NeedleView Wetlab Demonstrates Value in Canine Care

For many years, small animal veterinarians had only a few options for canine musculoskeletal diagnostic imaging – namely, x-ray and first-generation ultrasound. The advent of magnetic resonance imaging (MRI) technology and improved ultrasound machines made things better…but still not great. Because these imaging modalities show very little soft tissue, they give an incomplete diagnostic picture. The 1.2mm O.D. NeedleView® arthroscope allows vets to document intraarticular findings and obtain a definitive diagnosis in full color and real time…so they can determine the appropriate treatment plan.

More than a dozen small animal vets had the opportunity to use the NeedleView® arthroscope in a wetlab setting at the 2019 convention of the Veterinary Orthopedic Society (VOS). The purpose of the wetlab was to familiarize veterinarians with the ease of maneuvering the 1.2mm (18-gauge) needle arthroscope in a joint, processing autologous point-of-care devices, and applying autologous protein solution under visualization. The lab focused on performing joint lameness diagnostics, blood processing through a newly available point-of-care device, and arthroscopic guided administration under visualization on canine cadavers.

 

View a video with feedback from 2019 VOS NeedleView® Wetlab Participants

 

Instructors for the wetlab were Chad Devitt, DVM, MS, DACVS – VRCC Veterinary Specialty & Emergency Hospital (Englewood, CO); Kristin Kirkby Shaw, DVM, MS, PhD, DACVS, DACVSMR – Animal Surgical Clinic of Seattle (Seattle, WA); and Sam Franklin, MS, DVM, PhD, DACVS, DACVSMR – Colorado Canine Orthopedics & Rehab (Colorado Springs, CO). Dr. Devitt is a NeedleView® pioneer, with many years of experience using it for diagnostics in dogs that present with lameness, stiffness, or other symptoms of arthritis.

Feedback from the wetlab participants was uniformly positive. “There’s a lot of applications for me with [NeedleView®] – shoulders, elbows, and knees,” said James Simcock, BVSc (Hons), MANZCVS, of Southpaws Specialty and Referral Hospital in Moorabbin, Victoria, Australia. “It seems like a very user-friendly system, and I would definitely use it when I’m out in practice after my residency,” added Amanda Rollins, MVB, a final-year surgery resident at the Animal Medical Center in New York, NY.

New NeedleView Equine Research

Recently-published research highlights novel applications for Biovision Veterinary Endoscopy’s 1.2mm O.D. NeedleView® arthroscope in the diagnosis and treatment of equine sinus and fetlock problems.

The use of the NeedleView® arthroscope has been documented in research and in practice since 2014 to allow equine practitioners to perform conscious, standing exams of the stifle.1,2 Ensuing research has proven its value in the evaluation of the navicular bursa as well.3 Two recently-published studies have found novel applications.

  • Paranasal sinus: A 2018 study4 explored the use of Biovision’s NeedleView® camera in conjunction with a 2mm flexible endoscope for standing, conscious evaluation of the paranasal sinus. The conclusion: “Minimally invasive sinoscopy was readily performed without relevant complications in standing horses. A thorough evaluation of most sinus structures was obtained only using the frontal and the rostral maxillary portals.”
  • Fetlock: A 2019 prospective clinical study2 described the technique, experience and outcome of standing, conscious arthroscopic removal of dorsal osteochondral fragmentation of the metacarpophalangeal and metatarsophalangeal joint using Biovision’s 1.2-mm NeedleView® arthroscope. The conclusion: “All fragments were successfully removed and needle arthroscopy allowed a thorough evaluation of the dorsal aspect of the joint. The technique offers an alternative for standing fetlock arthroscopy for surgeons concerned about equipment damage or portability.”

NeedleView Equine Clinical Research References

1 Frisbie DD, Barrett MF, McIlwraith CW, and Ullmer J. Diagnostic stifle joint arthroscopy using a needle arthroscope in standing horses. Vet Surg. 2014 Jan;43(1):12-8. doi: 10.1111/j.1532-950X.2013.12068.x. Epub 2013 Oct 31.

2 Adrian AM, Barrett MF, Werpy NM, et al. A comparison of arthroscopy to ultrasonography for identification of pathology of the equine stifle. Equine Vet J. 2015 Nov 18. doi: 10.1111/evj.12541. [Epub ahead of print]

3 Mahlmann K, Koch C, and Bodo G. Diagnostic endoscopy of the navicular bursa using a needle endoscope by direct or transthecal approach: a comparative cadaver study. Vet Surg. 2015;44:816-824.

4 Pouyet M and Bonilla A. Validation of a 2-mm videoendoscope for the evaluation of the paranasal sinuses with a minimally invasive technique. Vet Surg. 2019;1-11.

5 Bonilla, Alvaro G. Standing Needle Arthroscopy of the Metacarpophalangeal and Metatarsophalangeal Joint for Removal of Dorsal Osteochondral Fragmentation in 21 Horses. Veterinary and Comparative Orthopaedics and Traumatology, 2019, doi:10.1055/s-0039-1688984.

 

The Magic of the Section 179 Tax Deduction

General business tax practices call for any fixed asset placed in service to be capitalized and depreciated over a set period of time (typically five to seven years) until its book value is zero. Qualified Section 179 deductions, however, allow the entire cost—with certain stipulations—to be taken immediately in the year the asset is placed in service. Such immediate deductions can be valuable as they free up cash for expansion, growth and self-investment.

For a veterinarian in a U.S. practice in a 35% tax bracket, the typical Section 179 deduction/tax savings for each Biovision suite is:

  • NeedleView® Arthroscope Suite
    • $5,232 in tax savings (calculated as $14,950 purchase price x 0.35)
    • Takes effective cost down to $8,417
    • The typical NeedleView customer bills each NeedleView procedure at $1,000 and performs 2-4 procedures per month
  • EndoDiagnostic+Surgical Suite (EDSS)
    • $12,582 in tax savings (calculated as $35,950 purchase price x 0.35)
    • Takes effective cost down to $23,367
    • The typical EDSS customer bills each EDSS procedure at $500 and
    • performs 4 procedures per month

Plan capital expenditures — such as the purchase of endoscopic/laparoscopic and/or arthroscopic equipment suites — wisely, factoring in current and future practice needs, price, return on investment, useful life/depreciation and tax deductibility. If old equipment needs to be replaced to sustain a currently-offered service, the determination is relatively simple. Don’t limit your vision, though! Take time to consider how new equipment or technology could help expand your service lines, add to your skills (even re-igniting your passion for your work), and set your practice apart from the competition for being innovative or offering the highest standard of care.

It’s crucial that you place your new equipment into service by December 31, 2016 if you wish to take the Section 179 deduction for the 2016 tax year. Orders should be placed ASAP to allow sufficient time for processing, shipping, delivery/set-up and integration into your practice by December 31.

Laparoscopy/Endoscopy CE Course Reviews: July 2016 Session

“THE COURSE WAS SO WELL DONE THAT IF I HAD THE EQUIPMENT TOMORROW,
I’D FEEL COMFORTABLE STARTING TO PERFORM PROCEDURES.”
Garth Waddoups, DVM,
Mountain River Veterinary Hospital (Rigby, ID)

“HAVING HAD A GREAT EXPERIENCE WITH LAPAROSCOPIC SURGERY MYSELF,
I KNEW THIS WAS SOMETHING WE WANTED TO EXPLORE FOR OUR CLINIC.”
Kevin Lamczyk, DVM,  and Jo Lynn Lamczyk, DVM,
Lamczyk Veterinary Clinic (Mount Vernon, IL)

If you’re on the fence about attending “Practical Single-Port Laparoscopy for the General Practitioner” hosted by Biovision’s partner the Center for the Advancement of Rigid Endoscopy (C.A.R.E.) in Littleton, CO on November 10, 2016, the experience of three recent attendees may help you decide.

Garth Waddoups, DVM, operates a mixed practice at Mountain River Veterinary Hospital in Rigby, ID. There really is no “typical day” in the practice. Dr. Waddoups and his team might be repairing a torn cranial cruciate ligament on a Labrador retriever, performing artificial insemination on a horse, and checking the health of a herd of beef cattle.

“There’s a clinic in southwest Idaho — the other side of the state — that performs laparoscopic spays, and that’s how I first learned about the modality,” said Dr. Waddoups. “I then did some web searches about it. I teach laser surgery, and I happened to be instructing out at Deer Creek Animal Hospital in Littleton, Colorado. That’s the practice of Dr. Ray Cox, who teaches the Practical Single-Port Laparoscopic Procedures CE course along with Dr. Markee Kuschel. I knew this was something I wanted to check out, so I signed up for the July session.”

“The first half of the day, the course covered the advantages of laparoscopy over conventional surgery. We also learned how to market laparoscopic services and how to ensure we could be profitable with the equipment. The second half of the day was the hands-on wetlab. Both parts together just validated everything I thought about laparoscopy as the way to go. The course was so well done that if I had the equipment tomorrow, I’d feel comfortable starting to perform procedures.”

“Taking the course was sure worthwhile. After 26 years in practice, I still do new things every week, and courses like this allow me to grow and offer a better level of service to my clients and patients.”

Jo Lynn Lamczyk, DVM and Kevin Lamczyk, DVM operate Lamczyk Veterinary Clinic, a mixed practice in Mount Vernon, IL, caring for the smallest exotic pets up to the largest horses with services ranging from acupuncture to surgery to physical therapy and more.

“I first became interested in the laparoscopic modality a few years ago when I saw it at a veterinary convention” said Dr. Kevin. “Not too long after, I had laparoscopic surgery on myself. There was so much less pain. Having had a great experience with laparoscopic surgery myself, I knew this was something we wanted to explore for our clinic. We’re not aware of any vets in our area who offer the laparoscopic modality, so we think this is something that can really set our clinic apart.”

Both Dr. Jo Lynn and Dr. Kevin enjoyed the low student-to-instructor ratio of the course, which allows for in-depth, personal teaching. “We each performed two lap spays and a prophylactic gastropexy for GDV,” said Dr. Kevin. “I really enjoyed the GDV surgery and can see how this can be a valuable part of our practice. We also appreciated that this truly was a learning experience. We never felt pressured to buy, and we could tell that the instructors genuinely wanted to show us the modality and its advantages, then have us make up our own minds.”

Register today for the November 10 session!

Explore the Laparoscopic Modality in Beautiful Colorado this November!

Practical Single-Port Laparoscopy for the General Practitioner

Nov. 10, 2016 from 8 a.m. to 6:00 p.m.
Center for the Advancement of Rigid Endoscopy, Littleton, CO

“Pursue it. You won’t regret it.” —
Dr. Kimberly May, Arvada Veterinary Hospital, Arvada, CO

According to Biovision customers who have successfully implemented laparoscopic and laparoscopic-assisted procedures into their practices, more than 70% of veterinary clients will choose laparoscopy for their animal if it is available and if they are given the choice–even if the cost is higher.

This fall, explore the laparoscopic modality for yourself at a full-day, hands-on CE course in breathtaking Colorado!

Taught by Dr. Ray Cox and Dr. Markee Kuschel, who pioneered single-port techniques, the class will introduce you to techniques necessary for incorporating rigid endoscopy into your everyday practice. Procedures are practical, easy to learn, and profitable, allowing you to utilize them right away in practice.

The course will:

  • Demonstrate the varied applications of laparoscopy
  • Allow each practitioner to participate in at least two single-port ovariohysterectomies
  • Allow each practitioner to participate in performing a laparoscopic assisted gastropexy
  • Discuss incorporating rigid endoscopy into private practice, including:
    • Benefits to the patient
    • Best practices
    • Profitability

All teaching surgeries are performed with live animals (who are then adopted into homes). Labs are taught using one instructor per one or two attendees, allowing for in-depth personal teaching.

Come and experience laparoscopy’s short, comfortable learning curve for yourself on user-friendly equipment doing everyday procedures and learning from instructors who pioneered single-port techniques and have taught them across the country.

Early registration is $895; registration within two weeks of a class increases to $995. Space is limited to ensure a quality experience.

Still not sure? Read course reviews here from Drs. Kevin and Jo Lynn Lamczyk and Dr. Garth Waddoups, each of whom attended the July 2016 session.

CLICK HERE TO REGISTER
RESERVE YOUR SPACE TODAY!

Questions? Call CARE at 303-296-3000. We look forward to welcoming you in November!

Issue 3, Q4 2016

Our final newsletter of the year brings you important information about:

  • An under-utilized U.S. income tax deduction that helps make capital equipment more affordable (and therefore more profitable);
  • Participant feedback on the value and applicability of exploring the laparoscopic modality through CE at the Center for the Advancement of Rigid Endoscopy (C.A.R.E.); and
  • The opportunity to register to attend the final C.A.R.E. CE session of 2016 — “Practical Single-Port Laparoscopy for the General Practitioner” on November 10 in Littleton, CO.

As always, please feel free to contact us with any questions. We can put you in contact with peers who can share their experiences with the modalities and help you determine if it’s a good fit for your practice. Call us any time at 303-225-0960 or send an email to .

Featured Practitioner: Aris Atakem, DVM

Who doesn’t love to hear a story? We love to tell the stories of the veterinarians who use our equipment to provide gold-standard care to their clients and patients. In this issue, we feature a Colorado veterinarian who overcame incredible odds to succeed. This is his story:

Location of Chad on African Continent
Location of Chad on African Continent

A French-speaking boy grows up in the war-torn African nation of Chad. He’s bright and eager. He wants to become a doctor. Even with parents who earned master’s degrees, there’s simply no money for college — and there’s no such thing as student loans in Chad. But he won’t give up.

He applies for 50 scholarships at colleges and universities around the world. He gets no offers. But he won’t give up.

He comes to realize that the challenge of being a veterinarian suits him better. There are two scholarships available in his entire country to go to vet school. He applies and wins one. The vet school is in Senegal — more than 2,000 miles away. But he won’t give up.

Location of Senegal on the African Continent
Location of Senegal on the African Continent

He moves away from his family, studies diligently, and earns his degree. His dream now is to emigrate to the United States and build a veterinary practice there. He has an uncle who lives in Colorado. That’s more than 5,000 miles away. But he won’t give up.

He emigrates to the United States and arrives speaking only French. He moves in with his uncle. The uncle runs a gas station and wants the young man to work for him for $300 a month. When the young man tells his uncle he is determined to follow his dream, his uncle tells him he’s doomed to fail and will never amount to anything. He has to move out if he wants to pursue his dream. But he won’t give up.

He cannot take the veterinary licensing exams until he can read and write English well enough. He takes the English competency test and is unable to pass all of the sections the first time. And the second time. And the third time. But he won’t give up.

Ray Cox, DVM — Deer Creek Animal Hospital
Ray Cox, DVM — Deer Creek Animal Hospital

He connects with Ray Cox, DVM, a distinguished veterinarian and co-founder of Deer Creek Animal Hospital in Littleton. Dr. Cox is so impressed by the young man, he takes him under his wing. Not only does Dr. Cox provide him with an externship and a place to live, he also co-signs the young man’s student loan to solidify his skills at Kansas State University…and lends him $20,000 from his own pocket.Then, he trains him to become an expert in performing single-port, minimally-invasive, laparoscopic surgical procedures that are clinically proven to provide for smaller incisions, less pain, increased intra-operative safety, superior intra-operative visualization, and faster recovery.

The young man passed the English exam. And the veterinary licensing exam. And he’s already paid back his student loan. Because he never gave up.

Aris Atakem, DVM — Liberty Animal Hospital
Aris Atakem, DVM — Liberty Animal Hospital

That young man is Aristophane Atakem. He just opened Liberty Animal Hospital in Westminster, Colorado, providing everything from routine wellness and dental care to emergency services and surgeries of all kinds. Dr. Atakem particularly enjoys performing laparoscopic procedures using Biovision’s EndoDiagnostic+Surgical Suite (EDSS). We at Biovision could not be more pleased and proud to be associated with him, and wish him the brightest of futures.

Featured Product: Next-Generation NeedleView Arthroscope Suite

HUGE CAPABILITIES IN AN ULTRA-COMPACT SYSTEM

SMALL ANIMAL: Elbow — Hip — Knee — Shoulder
LARGE ANIMAL: Carpus — Coffin — Fetlock — Hock — Navicular Bursa — Shoulder — Stifle

The Biovision 1.2mm NeedleView™ system is a breakthrough technology that offers a visualization tool the size of an 18-gauge needle! You can perform diagnostic and therapeutic arthroscopic procedures that bring a “value added element” to your equine/large animal or small/companion animal practice. The system combines several essential surgical and diagnostic features into a single compact and portable all-digital visualization platform.

When Biovision introduced the NeedleView Arthroscope Suite in 2010, it was the only system that allowed veterinarians to perform conscious/standing micro-arthroscopy. That’s still true in 2016 — but updates have made our next-generation suite more remarkable. In this issue, we review the suite in depth, pointing out not just what it can do, but what it can now do even better.

Key Benefits

• Easy to Learn – You don’t necessarily need to be a surgeon to be able to use the NeedleView Arthroscope Suite effectively. You do need to be comfortable with joint anatomy and know how to be in a joint without damaging cartilage; this can be taught in a wetlab or weekend workshop. But the actual technique is easily taught if you’re in joints frequently (for example, using PRP, stem cells, IRAP, or other therapeutic agents).

• Minimally Invasive – At 1.2mm, the NeedleView scope is the size of an 18-gauge needle. You can scope with just a local block and sedation. If you don’t have a surgery room or ventilator, NeedleView opens up a way to diagnose cases in a treatment room, trailer, or wash rack.

• Meaningful Information – NeedleView helps you give clients the information they need to make good decisions about how to proceed with their animal. It helps you know what paths to consider. For example, if the animal has been treated with biologic agents or regenerative therapies and doesn’t seem to be responding, NeedleView lets you easily take a look to see what’s going on. NeedleView can also help you give the owner the information and options – for example, to proceed with surgery, debride to speed healing, or – if the injury is too severe, particularly with working or sport horses – to choose the right next step.

It’s Better Medicine: Capabilities Proven by Both Research and Practice

In a seminal peer-reviewed study¹ published in 2014, researchers confirmed:

  • The 18-gauge NeedleView arthroscope can be used to perform complete diagnostic examination of the three compartments of the stifle joint in standing horses.
  • In areas of the joint where space was limited, the small diameter of the scope was an advantage despite the smaller field of view.

One of the study’s lead authors (David Frisbie, DVM, PhD, MS, DACVS, DACVSMR, Professor of Equine Surgery, Colorado State University, Fort Collins, CO) has successfully used the NeedleView arthroscope to diagnose injuries in more than 100 stifles, including:

  • Meniscal tears and lesions
  • Cartilage damage
  • Cruciate ligament tears and lesions
  • Floating joint fragments
  • Subchondral bone cysts

Needle arthroscopy can also be used to confirm the presence of a lesion identified by either x-rays or ultrasound and confirm that no additional lesions are present.

Another study² concluded:

  • “When combined, arthroscopy and ultrasound can provide a more global assessment of pathological changes within the equine stifle.”

And it’s not limited to the stifle. A 2015 study³ explored direct and transthecal approaches to the navicular bursa using Biovision’s NeedleView scope. Among its conclusions:

  • “Needle endoscopy offers a reliable technique to evaluate the navicular bursa and may complement or replace other diagnostic modalities in horses with lameness localized to the navicular region.”

Leading veterinary schools and forward-thinking practices across the United States and around the world are beginning to perform and teach standing equine diagnostics using the NeedleView Arthroscope suite.

Institutions adopting the technology include:

  • Colorado State University College of Veterinary Medicine and Biosciences
  • University of Florida College of Veterinary Medicine
  • Oklahoma State University Veterinary Teaching Hospital
  • VetSuisse Faculty (University of Bern and University of Zurich)
  • University of Montreal
  • University of Melbourne Veterinary Clinic

Practices adopting NeedleView can be found from coast to coast in the United States and around the world:

  • Veterinary Specialists of the Southeast (Savannah, GA)
  • Premier Equine Veterinary Services (Whitesboro, TX)
  • Pferdeklinik Burg Müggenhausen (Müggenhausen, Germany)
  • Comstock Equine Hospital (Reno, NV)
  • Littleton Equine Medical Center (Littleton, CO)
  • Veterinary Specialty Center (Buffalo Grove, IL)
  • VRCC Veterinary Specialty & Emergency Hospital (Englewood, CO)

References

1 Frisbie DD, Barrett MF, McIlwraith CW, and Ullmer J. Diagnostic stifle joint arthroscopy using a needle arthroscope in standing horses. Vet Surg. 2014 Jan;43(1):12-8. doi: 10.1111/j.1532-950X.2013.12068.x. Epub 2013 Oct 31.

2 Adrian AM, Barrett MF, Werpy NM, et al. A comparison of arthroscopy to ultrasonography for identification of pathology of the equine stifle. Equine Vet J. 2015 Nov 18. doi: 10.1111/evj.12541. [Epub ahead of print]

3 Mahlmann K, Koch C, and Bodo G. Diagnostic endoscopy of the navicular bursa using a needle endoscope by direct or transthecal approach: a comparative cadaver study. Vet Surg. 2015;44:816-824.

It’s Profitable: Equine/Large Animal

ESTIMATING CONSERVATIVELY

  • 2 procedures per month
  • $1,000-$1,200/procedure from diagnostic first looks
  • Additional $500-$850/procedure from post-treatment, confirmatory second looks
  • Income from therapy and/or surgery from your own clients or referrals

ROI EXAMPLE

  • 247% Year One cash-on-cash return
  • Assumptions:
    • 5-year loan
    • 6% simple interest
    • 35% marginal U.S. tax rate
    • Use of Section 179 deduction (U.S. only)

CALCULATE THE ROI FOR YOURSELF

This interactive financing calculator from Bank of America lets you model “what if?” scenarios for loan length, interest rate, and more; use $14,950 as the equipment price for the NeedleView™ Arthroscope Suite.

CASE SCENARIOS

  • Case 1 — Diagnostic
    • Acute 4/5 lameness
    • 3/4+ MFT effusion, with >80% response to anesthesia
    • Radiographs within normal limits
    • Ultrasound — suspect meniscal involvement
  • Case 2 — Lack of Response
    • 2 previous MFT arthroscopies
    • Unable to return to work
    • Known meniscal damage
    • No other diagnostic changes

Click on the image for full size spreadsheet.

Biovision Needleview Arthroscope Suite Equine Large Animal Return on Investment Calculation 2019

It’s Profitable: Small/Companion Animal

ESTIMATING CONSERVATIVELY

  • 2 procedures per month
  • $300-$500/procedure from diagnostic first looks
  • Additional $250-$300/procedure from post-treatment, confirmatory second looks
  • Income from therapy and/or surgery from your own clients or referrals
  • ROI Example
    • 99% Year One cash-on-cash return
    • Assumptions:
      • 5-year loan
      • 6% simple interest
      • 35% marginal U.S. tax rate
      • Use of Section 179 deduction (U.S. only)

CALCULATE THE ROI FOR YOURSELF

CASE SCENARIOS

  • Case 1 — Diagnostic
    • 5 year-old female canine presents with stiffness and other symptoms of arthritis
    • X-ray and CT inconclusive — suspect fragmented medial coronoid process
  • Case 2 — Therapeutic
    • 9 year-old male canine presents with lameness, periarticular enlargement, joint effusion, loss of range of motion, and pain, laxity, and crepitus upon joint manipulation
    • X-ray and arthrocentesis reveal loss of and degraded quality of synovial fluid

Click on the image for full size spreadsheet.

Biovision Needleview Arthroscope Suite Small Companion Animal Return on Investment Calculation 2019

Included Equipment

Click the image below for a printable PDF overview of Biovision Veterinary Endoscopy’s NeedleView Arthroscope Suite, including a list of all suite components.

Needleview System PDf

You Can Do It: See for Yourself

Check out the videos below demonstrating the use and discussing the learning curve of the NeedleView™ 1.2mm O.D. arthroscope for diagnostic and therapeutic use in both large animals and small animals.

Make 2017 the Year You Learn Laparoscopy

According to Biovision customers who have successfully implemented laparoscopic and laparoscopic-assisted procedures into their practices, more than 70% of veterinary clients will choose laparoscopy for their animal if it is available and if they are given the choice–even if the cost is higher.

MINIMALLY INVASIVE
Biopsy • Cryptorchid • Cystoscopy • Foreign Body • Ovariectomy/Ovariohysterectomy
Prophylactic Gastropexy • Video Otoscopy • Thoracoscopy • More

With the doctor’s help, clients come to understand that laparoscopic surgeries offer the following advantages:

  • Less painful — A groundbreaking study published in 2005- (J Am Vet Med Assoc.2005 Sep 15;227(6):921-7) showed that dogs who underwent laparoscopic-assisted ovariohysterectomy (LAOHE) had lower pain scores than dogs who underwent traditional OHEs. Nine of 10 dogs in the OHE group required additional pain medication on the basis of pain scores, whereas none of the dogs in the LAOHE group did.
  • Less stressful — In the same study, blood glucose concentrations were significantly increased from preoperative concentrations in both groups at 1 hour postoperatively; however, blood glucose concentrations remained elevated only in the OHE group, and remained elevated at 2, 4, and 6 hours postoperatively. Cortisol concentrations were significantly increased at 1 and 2 hours postoperatively only in the OHE group.
  • Faster recovery — In most cases of routine laparoscopic-assisted procedures such as spay, cryptorchid neuter, gastropexy, and biopsy, the animal is able to return home the same day.
  • Smaller incision with smaller resulting scar — In many cases, the incision for a laparoscopic-assisted procedure is as small across as a dime. Accordingly, preoperative shaving usually involves a much smaller area.

Register Button

SEE FOR YOURSELF

Click on a link to view a brief procedure video

FULL-DAY HANDS-ON CONTINUING EDUCATION COURSE:

“Practical Single-Port Laparoscopy for the General Practitioner”
November 2, 2017
Littleton, CO

Come and experience laparoscopy’s short, comfortable learning curve for yourself on user-friendly equipment doing everyday procedures and learning from instructors who pioneered single-port techniques and have taught them across the country. Early registration is $895; registration within two weeks of a class increases to $995. Space is extremely limited; only 6 participants per session — click to REGISTER TODAY!

Issue 2, Q3 2016

2525 15th Street
Suite 1A
Denver, CO 80211

Our phone and fax numbers remain unchanged:

Phone: 303-225-0960
Fax: 720-259-5235

Click for map and directions

Next-Generation Suites Are Ready to Ship!

From Biovision’s Views Newsletter, Issue 1, Q1 2016

When Biovision introduced the EndoDiagnostic+Surgical Suite (EDSS) in 2003, it was a game-changer, giving veterinarians a way to perform highly profitable procedures such as spays, cryptorchid neuters, biopsies, and more through a single port and with faster recovery and less pain, stress, and scarring for their patients.

When the NeedleView Arthroscope Suite debuted in 2011, it revolutionized joint diagnostics, allowing many procedures to be performed without general anesthesia and its attendant risks.

We are thrilled to announce that following extensive development and refinement, the next-generation EDSS and NeedleView suites are ready to ship!

Both suites have:

  • Improved cameras that allow you to see in greater detail (HD camera in the EDSS; CCD camera in the NeedleView);
  • Brighter-than-ever illumination so you can see more, period (xenon arc in the EDSS; LED in the NeedleView); and
  • Intelligent LCD touch screens with integrated media capture that allow you to enter patient data, capture still and video images, and generate comprehensive visit reports (LCD monitor in the EDSS; 10.1” terminal in the NeedleView).

“WOW! The detail and HD resolution are outstanding and the colour is more saturated. The illumination is also much brighter.” — Paul Hodges, DVM (Toronto, ON), long-time EDSS owner who recently purchased the next-generation EDSS

Pricing remains extremely competitive, even in light of the suites’ enhanced capabilities – which means ROI remains high, as well. Existing customers may be eligible for trade-in discounts or special upgrade pricing (call to inquire).

Contact Biovision directly at 303-225-0960 or stop by the Biovision booth at any upcoming conference.

Get Hands-On with Biovision’s Next-Generation Endoscopy and Arthroscopy Suites at WVC

From Biovision’s Views Newsletter, Issue 1, Q1 2016

Are you one of the 15,000+ veterinary professionals planning to attend the Western Veterinary Conference’s 88th Annual Conference from March 6-10, 2016 at the Mandalay Bay Convention Center in Las Vegas, NV? If so, be sure to include a visit to Booth 2739! That’s where you will find Biovision and have a chance to see and try the next-generation EndoDiagnostic+Surgery Suite (EDSS) and NeedleViewTM Arthroscope Suite for yourself. We look forward to meeting you and showing you how EDSS and NeedleView can integrate quickly, easily, and – most important – profitably into your practice.

Learn Profitable Lap-Assisted Procedures in Beautiful Colorado — May 5, 2016

From Biovision’s Views Newsletter, Issue 1, Q1 2016

More than 70% of veterinary clients will choose laparoscopy for their animal if it is available and if they are given the choice–-even if the cost is higher. 

That’s been the experience of Biovision customers who have successfully implemented laparoscopic and laparoscopic-assisted procedures into their practices.

With the doctor’s help, clients come to understand that laparoscopic surgeries offer the following advantages:

  • Less painful — A groundbreaking study published in 2005 (J Am Vet Med Assoc. 2005 Sep 15;227(6):921-7) showed that dogs who underwent laparoscopic-assisted ovariohysterectomy (LAOHE) had lower pain scores than dogs who underwent traditional OHEs. Nine of 10 dogs in the OHE group required additional pain medication on the basis of pain scores, whereas none of the dogs in the LAOHE group did.
  • Less stressful — In the same study, blood glucose concentrations were significantly increased from preoperative concentrations in both groups at 1 hour postoperatively; however, blood glucose concentrations remained elevated only in the OHE group, and remained elevated at 2, 4, and 6 hours postoperatively. Cortisol concentrations were significantly increased at 1 and 2 hours postoperatively only in the OHE group.
  • Faster recovery — In most cases of routine laparoscopic-assisted procedures such as spay, cryptorchid neuter, gastropexy, and biopsy, the animal is able to return home the same day.
  • Smaller incision with smaller resulting scar— In many cases, the incision for a laparoscopic-assisted procedure is as small across as a dime. Accordingly, preoperative shaving usually involves a much smaller area.

Now you can learn practical, profitable lap-assisted procedures in a full-day, hands-on CE course in beautiful Colorado! In partnership with the Center for the Advancement of Rigid Endoscopy (C.A.R.E.), Biovision is hosting this popular course on May 5, 2016 in Littleton, Colorado (a suburb approximately 10 miles southwest of Denver).

Come and experience laparoscopy’s short, comfortable learning curve for yourself on user-friendly equipment doing everyday procedures and learning from instructors who pioneered single-port techniques and have taught them across the country.

Early registration is $895; registration within two weeks of a class increases to $995. Space is extremely limited; register today!

New NeedleView Procedure: Lavage of Septic Joints

From Biovision’s Views Newsletter, Issue 1, Q1 2016

Every day, all around the world, veterinarians are using Biovision’s 1.2mm NeedleView® arthroscope to provide a higher standard of care for animals both large and small. Many are investigating or developing new procedures for the technology (see Views newsletter, Issue 2, 2nd quarter 2015 at https://biovisionvet.com/about-us/news-events/archived-news/ for details).

Recently, we learned that Shane Miller, DVM, DACVS of Comstock Equine Hospital in Reno, NV has been using NeedleView® in the diagnosis and treatment of septic arthritis in horses. We caught up with him on the phone to learn more.

Biovision (BV): How long have you been using Biovision’s NeedleView® arthroscope in your practice?
Shane Miller (SM): I purchased the NeedleView® Arthroscope Suite in October, 2012, so a little more than three years.

BV: How do you use the NeedleView® most days?
SM: I do a lot of stifle diagnostics, primarily because of my practice’s population and caseload. I also use it for exploration in areas like the tendon sheath, coffin, fetlock, and carpus. I even use it for sinuses to see masses, tumors, and fluid. I think I like it best in the navicular bursa when there has been penetration of a foreign object – although I don’t do those cases with the horse standing.

BV: Was it difficult for you to learn to use the NeedleView® and incorporate it into your practice?
SM: It was really simple for me, because I had already done a lot of surgery and arthroscopy. Once you are comfortable with the anatomy of whatever space you’re in, using the NeedleView becomes a lateral move to a tool that gives you enhanced access and allows you to do more procedures with the animal standing and conscious.

BV: Tell us about the new way you’re using the NeedleView®.
SM: I recently started using the NeedleView® on horses that present with septic arthritis. [Editor’s note: septic arthritis is inflammation of a joint caused by bacteria or other micro-organisms.]  The typical approach is to lay the horse down with general anesthesia and use a standard 4mm arthroscope to lavage or flush the joint. With the NeedleView®, I can leave the horse standing and conscious but sedated, I can flush the joint, and I can generally get further into the joint than with a 4mm scope. If I see lots of fibrin deposition, I can put an instrument in from the other side – using the NeedleView® to guide me – and pull it out.

BV: How have clients responded to your use of the NeedleView®?
SM: Whenever I can do an effective procedure without laying a horse down, it’s a win for the animal, the client, and me. When there’s no general anesthesia, there’s typically less morbidity and it’s almost always more cost-effective for the client. I’ve found that clients are more willing to move forward with the procedures – even if they are more expensive – if it means the horse can remain standing and conscious.

 

Editor’s Comment from Guest Editor Josh Zacharias, DVM, MS, DACVS, DACVSMR

From Biovision’s Views Newsletter, Issue 2, May 2015

Josh Zacharias

Vet: Josh Zacharias, DVM, MS, DACVS, DACVSMR
Affiliation: Countryside Large Animal Veterinary Services, PLLC
Position: Full-time surgeon
Focus: Equine, livestock, food production animals
Location: Greeley, CO
Contact:
URL: http://www.csidevet.com

I am pleased to write the Editor’s Comment for this issue of Biovision’s “Views” newsletter. I’ve been an equine vet since 2003 and am the full-time surgeon in a four-vet practice – Countryside Large Animal Veterinary Services, PLLC – in Greeley, a town of approximately 100,000 people on the eastern plains 50 miles north-northeast of Denver, Colorado. Our services for livestock and large animals include surgery, lameness, equine treadmill, equine dentistry, and vaccinations and total health care for individuals and herds/flocks of food animals and production livestock.

This issue of the newsletter focuses exclusively on Biovision’s NeedleView® Arthroscope Suite, recapping its development, documenting its growing worldwide adoption, and looking ahead to potential new applications. Biovision asked me to write the Editor’s Comment specifically because of my experience with the product.

I first encountered the NeedleView® scope at the American College of Veterinary Surgeons (ACVS) Surgery Summit in Seattle, Washington, in 2010, where Biovision was an exhibitor. I met John Small, the company’s president, and immediately was intrigued and excited by the potential of this new diagnostic tool. We got our hands on one in 2012 and began using it as a way to definitively diagnose stifle disease without the expense and risk of general anesthesia and surgery. NeedleView® piqued my interest because it’s been my experience that it’s easy for private practitioners to get comfortable – and rusty – doing what they’ve always done. My goal is to always be learning and growing.

The standing stifle procedure developed by Dr. David Frisbie of Colorado State University became our “bread and butter” in regard to the NeedleView®, and it easily paid for itself. Keep in mind, our practice is in Colorado State University’s “back yard,” and we’re not all that far from Littleton Equine Medical Center. But with the NeedleView®, we can compete with an academic institution and a large practice and more than hold our own treating Western performance horses (rodeo horses, barrel racers, cutters, etc.). Now, three years in to having the NeedleView®, we pull clients from as far away as Colorado’s western slope, Wyoming, Nebraska, Kansas, and even Montana.

We’re able to compete and distinguish our practice because of NeedleView®’s unique advantages:

  1. Easy to learn – You don’t necessarily need to be a surgeon to be able to use the NeedleView® Arthroscope Suite effectively. You do need to be comfortable with joint anatomy and know how to be in a joint without damaging cartilage; this can be taught in a wetlab or weekend workshop. But the actual technique is easily taught it you’re in joints frequently (for example, using IRAP or other therapeutic agents).
  2. Minimally-invasive – The NeedleView scope is the size of an 18-gauge needle. You can scope with just a local block and sedation. If you see a lot of lameness cases but don’t have a surgery room or ventilator, NeedleView® opens up a way to diagnose these cases.
  3. Meaningful information – NeedleView® helps us give clients the information they need to make good decisions about how to proceed with an injured horse. It helps us know what paths to consider. For example, if a horse has been treated with IRAP and doesn’t seem to be responding, NeedleView lets us easily take a look to see what’s going on. Or if a horse has a meniscal tear, NeedleView® can help us give the owner the information to decide to proceed with surgery, debride to speed healing, or – if the injury is so severe that the horse is still likely to be only 50/50 a year out – maybe not opt for the “Cadillac” level of treatment.

The profiles in this issue will give you insight into NeedleView®’s early history in horses (Dr. Frisbie) and small animals (Dr. Devitt), its current applications (Dr. Frisbie and Dr. Robbins), and its growing worldwide adoption and research into potential future applications (Dr. Grant, Dr. Koch, and Dr. Canapp).

I hope the profiles get you excited about NeedleView® and its potential. I’m proof that you can use this versatile tool to enable better medicine at your practice and simultaneously create a new profit center; I challenge you to consider how you can do the same.

NeedleView Pioneer: Dr. Chad Devitt

From Biovision’s Views Newsletter, Issue 2, May 2015

Cha Devitt

Vet: Chad Devitt
Affiliation: VRCC Veterinary Specialty and Emergency Hospital
Position: One of the owners of Veterinary Surgical Services at VRCC
Focus: Small/companion animals
Location: Englewood, CO
Contact: 
URL: http://www.vrcc.com

I first became involved with Biovision around 2004. Dr. Jim Hailey, now of Alpine Vet Clinic of Fraser, CO, called me about developing equipment and technology to perform laparoscopically-assisted ovariohysterectomies in dogs. Along with Dr. Ray Cox of Deer Creek Animal Hospital of Littleton, CO, we conducted a research study to describe a simple method of laparoscopic-assisted ovariohysterectomy (LAOHE) and compare duration of surgery, complications, measures of surgical stress, and postoperative pain with open ovariohysterectomy (OHE) in dogs. We used Biovision’s EndoDiagnostic & Surgical Suite (EDSS) product to perform the procedures. Our results, published in the Journal of the American Veterinary Medical Association (J Am Vet Med Assoc. 2005 Sep 15;227(6):921-7), showed that LAOHE caused less pain and surgical stress than OHE and could be appropriate for an outpatient setting.

A few years after that, John [Small] asked me to try out the NeedleView® system and give him feedback about what it enabled us to see and how it affected our clinical decision-making. Since then, we use the NeedleView an average of 2-3 times per month, depending on our caseload.

I’ve used it primarily for diagnostics in dogs that present with lameness, stiffness, or other symptoms of arthritis. X-ray and CT may not demonstrate findings – for example, in cases of fragmented medial coronoid process. The NeedleView® scope is helpful to decide if the dog would benefit from debridement.

Key benefit(s) of the NeedleView modality: The benefits to NeedleView® include that it’s less costly to perform than full-blown arthroscopy. We can generally do it with heavy sedation and a local block, so we avoid the risks and costs of general anesthesia. We also like that we can perform NeedleView® diagnostic procedures on a prep table; this removes the need for OR time and its associated costs, plus it means that clients can usually watch the procedure.

For what practitioner/practice is NeedleView® best suited? I wouldn’t say NeedleView® arthoscopy is easier than conventional arthroscopy; you need to be experienced with arthroscopy techniques to get the full benefit from NeedleView. While it won’t replace a full conventional arthroscopy kit, NeedleView® is plenty useful.

NeedleView Pioneer: Dr. David Frisbie

From Biovision’s Views Newsletter, Issue 2, May 2015

David Frisbie

Vet: David Frisbie, DVM, PhD, MS, DACVS, DACVSMR
Affiliation: CO State University Equine Orthopedic Research Center
Position: Professor of Equine Surgery
Focus: Equine
Location: Fort Collins, CO
Contact: 
URL: https://tmi.colostate.edu/about/

I specialize in orthopaedic research, intra-articular therapeutics, new methods of cartilage repair, equine lameness, orthopaedic surgery and biologics for the treatment of musculoskeletal injuries with an emphasis on stem cells, gene therapy, and sports medicine. I’ve worked on projects with Chad Devitt since residency, primarily in canine orthopaedics. As Biovision moved into arthroscopy, Chad suggested John Small should get me involved in evaluating and developing potential equine applications for the NeedleView® scope.

With Chad’s recommendation, we knew we could probably find applications and develop techniques. I met with John Small, and we came up with a plan to look at NeedleView® in the field and see where the technology could make the biggest impact. Then we would conduct research and publish for solid science. The outcome of that research was the standing stifle diagnostic arthroscopy procedure.

Definitive diagnosis of slight to moderate stifle pathology has been limited. Many practitioners are uncomfortable performing diagnostic anesthesia of the stifle. Many lesions (particularly soft tissue lesions) go undetected with radiography. Ultrasonography has helped, but use of this modality to examine cruciate ligaments remains difficult because of the orientation and deep anatomic location of these structures. CT using contrast arthrography has been used to image the stifle, but limitations exist to its availability and the availability of MRI. The NeedleView® scope’s field of view is smaller than that of a standard 4mm arthroscope, but we feel it provides a better exploratory of the stifle joint than we get with a 2.7mm arthroscope.

In our study (“Diagnostic stifle joint arthroscopy using a needle arthroscope in standing horses,” Vet Surg. 2014 Jan;43(1):12-8. doi: 10.1111/j.1532-950X.2013.12068.x. Epub 2013 Oct 31.), we were able to confirm that the 18-gauge NeedleView® arthroscope could be used to perform complete diagnostic examination of the three compartments of the stifle joint in standing horses. Further, we found that in some areas of the joint where space was limited, the small diameter of the scope was an advantage despite the smaller field of view.

I presented the standing stifle diagnostic procedure at the American Association of Equine Practitioners (AAEP) Annual Conference in 2013, in conjunction with Dr. Josh Zacharias of Countryside Large Animal Clinic of Greeley, CO. Combined, we’ve performed the procedure on more than 100 joints. Additionally, my colleagues and I have demonstrated and/or taught the procedure worldwide — two CE courses in Fort Collins (2013 and 2014, with another coming up in September 2015); two at Newmarket Equine Hospital in the United Kingdom; and one each in Germany, Switzerland, and Canada.

We’ve pretty much established what NeedleView® can do, and our experience will stand in any arena. I’m now looking at using NeedleView® in the navicular bursa and tendon sheaths, following essentially the same plan to prove its efficacy as we did for stifle diagnostics.

Key benefit(s) of NeedleView® modality: Because of the NeedleView® scope’s small size, we can “drive it around” the stifle and image everything. No other technology gives us that ability. Traditional imaging modalities typically require transporting the animal and then putting it under general anesthesia and handling the subsequent recovery…all of which can be costly and may require significant lead time. The NeedleView® Arthroscope Suite is so small and portable, we can perform diagnostic arthroscopy in our trailer at equine events. It truly lets us get an instant answer anywhere. We like that NeedleView gives us a way to diagnose mild to moderate stifle disease earlier in the process, before it has progressed too far to be amenable to treatment.

For what practitioner/practice is NeedleView® best suited? The people who will experience the best ease of use with NeedleView® are those who already use arthroscopy and know the anatomy. Surgeons who feel a need to reinvent themselves in a hard economy have had success using it to perform diagnostics and preventive procedures. That said, it should be kept in mind that NeedleView® is a diagnostic tool; if a vet sees something with that indicates the animal needs surgery, he or she can refer it out if they are not trained for orthopaedic surgery. Similarly, NeedleView® can help with the clinical decision to use a regenerative medicine approach.

Current NeedleView User: Dr. Mitch Robbins

From Biovision’s Views Newsletter, Issue 2, May 2015

Vet: Mitch Robbins, DVM, DACVS
Affiliation: Veterinary Specialty Center
Position: Director of Surgery and Anesthesia/Pain Management
Focus: Small/companion animals
Location: Buffalo Grove, IL
Contact: 
URL: http://www.vetspecialty.com

I was introduced to the NeedleView® modality during a presentation at an ACVS meeting. The simplicity of the diagnostic arthroscopy tool drew my attention. Following the meeting, I contacted John [Small] regarding some basic questions about cost and usefulness of the needle arthroscope. John came out to visit Veterinary Specialty Center to demonstrate the unit to our surgical service. This was our first experience with NeedleView®. When our six surgeons observed the efficiency of use compared to traditional arthroscopy, we decided to purchase the unit to use for our clinical cases.

My hope for the NeedleView® modality was that it would provide us a resource for the rapid evaluation of joints arthroscopically. Disorders such as elbow fragmented medial coronoid process, medial shoulder instability, cranial cruciate and meniscal injury can be frustrating and expensive to rule in and out of our differential diagnosis list. We were hoping that by increasing efficiency and decreasing time, we could provide superior diagnostics for a lower cost.

Veterinary Specialty Center is always looking towards innovation and technology to help us provide extraordinary care to our patients and their families. The NeedleView® is an excellent tool in this tool box.

The scope is very useful in our practice. We can perform diagnostic arthroscopy on a multitude of patients with ease and efficiency. Our expectations certainly have been met. I use the scope an average of one time per day for all of the above techniques. We also own the attachment and the insufflator that allows us to use our regular scope for laparoscopy, thoracoscopy, and therapeutic arthroscopy [Editor’s note – Dr. Robbins is referring to the SurgAssist Insufflator and Electrosurgical Generator, which together with the SurgView Xenon Imaging System included as part of the NeedleView® Arthroscope Suite, can be used with an operating laparoscope for single-port laparoscopic and laparoscopic-assisted procedures].

Key benefit(s) of the NeedleView® modality: Simplicity of use and small size are very big advantages. The other is that the scope is very durable.

For what practitioner/practice is NeedleView® best suited? I think the NeedleView® scope has more value for busy specialty practices than for general practitioners.

NeedleView Researcher: Dr. Christoph Koch

From Biovision’s Views Newsletter, Issue 2, May 2015

Vet: Christoph Koch, Dr. Med. Vet., DACVS, DECVS
Affiliation: ISME –Swiss Institute of Equine Medicine
Position: Clinical Lecturer in Surgery and Deputy Head of ISME-Clinic Bern
Focus: Equine
Location: Bern, Switzerland
Contact: 
URL: http://ismequine.ch

Use: Currently performing clinical research into feasibility of needle arthroscope bursoscopy in standing horses

My colleague Dr. Gabor Bodo was attending an equine stifle arthroscopy course at Cornell (Ithaca, NY) in 2011. There, Dr. Wayne McIlwraith, one of the course instructors, reported on Dr. David Frisbie’s work using the NeedleView® scope for diagnostic [stifle] procedures in standing sedated horses. Following the course, Dr. Bodo contacted Dr. Frisbie to get more information about this particular procedure.

We soon gained some experience with the equipment and felt that the dimensions of the cannula and the field of view of the NeedleView equipment were also perfect for applications in either small joints or bursae of the horse. In particular, the region of the navicular bursa of the horse is a common source of lameness in horses. However, conventional, and even advanced imaging techniques like low-field MR, cannot provide sufficient information to explain the exact nature of the underlying pathology localized to that area. A well described approach to improve the diagnostic yield of this field is bursoscopy using standard rigid arthroscopic equipment in the anesthetized, recumbent patient. Seeing the possibility of a truly minimally-invasive diagnostic procedure that could potentially be performed in the standing, sedated patient (with regional anesthesia only), we performed a cadaver study to investigate the feasibility, diagnostic potential and best technique/approach to explore the navicular bursa using the needle-view equipment. This study has been accepted for publication in a peer-reviewed journal.

Currently, we are working on a subsequent proof-of-principle study to investigate the feasibility of needle arthroscope bursoscopy in standing horses. Having successfully performed the procedure in nearly 20 bursae, we feel confident that it can be performed in a clinical setting. However, more experience, refinements in technique and possibly adaptions regarding the equipment are required to make it a valuable diagnostic procedure in the hands of equine practitioners. Nonetheless, the recent developments are encouraging, and we feel that for selected indications, the NeedleView will find its place in equine veterinary medicine.

Key benefit(s) of the NeedleView® modality: The small dimension and easy set-up to generate images of diagnostic quality.

For what practitioner/practice is NeedleView® best suited? Anyone facing a situation with incomplete diagnoses regarding particularly the stifle and navicular region in horses. The NeedleView® modality can provide them and their clients with a minimally invasive procedure at hand that carries the potential to overcome this unsatisfying situation.

Needleview Researcher: Dr. Barrie Grant

From Biovision’s Views Newsletter, Issue 2, May 2015

Vet: Barrie D. Grant, DVM, MS, DACVS, MRCVS
Affiliation: Barrie Grant Equine Consultant
Position: Consultant in private practice
Focus: Equine
Location: Bonsall, CA
Contact: 
URL: http://equinewobblers.com

Use: Currently performing clinical research into the feasibility and safety of implanting mesenchymal stem cells underneath the pia mater using the NeedleView® scope with a ventral cervical intervertebral approach between C3-C4 and C4-C5 in healthy horses

I first became aware of Biovision when they exhibited at the American College of Veterinary Surgeons (ACVS) Surgery Summit in Chicago in 2011. I had been looking for an approach to image the spinal cord that was not too invasive. I talked to John [Small, Biovision’s president] as well as to other vets. Soon after that, I went to South Africa and encountered Dr. Olivier Lepage, who was on sabbatical from the University of Lyon. He was looking for a project but had no funding. When I got back home, I connected with Dr. Elaine Carpenter at Cave Creek Equine Surgical and Diagnostic Imaging Center in Phoenix, AZ. She has assisted me in the past with spinal surgeries, and Cave Creek has been using Biovision’s NeedleView® Arthroscope Suite since early 2012. Cave Creek soon had a case; they got great video and we were able to share it with Dr. Lepage. Not long thereafter, one of his students received approval for a research proposal using the NeedleView®. We have recently completed the first phase of that 6-month study (undertaken with Olivier Lepage, DMV, MSc, PhD, HDR, DipECVS of the University of Lyon and his student Isé B. François, DMV, in Marcy L’Etoile, France).

Cervical stenotic myelopathy (wobbler syndrome) is a common cause of spinal ataxia in young horses. This developmental disorder is characterized by postnatal deformation of the cervical vertebrae, resulting in stenosis of the vertebral canal and spinal cord compression. Dysfunction of the equine cervical cord can result in a wide spectrum of clinical signs ranging from total paresis to poor performance as a result of the neuropraxia and discomfort in proprioception. The diagnosis is based on history, clinical signs, radiographic changes, myelography, and cerebrospinal fluid analysis. Presently, the treatment of wobbler horses is based on the principle of eliminating cervical cord compression by the surgical stabilization of the intervertebral space with a threaded titanium implant (Seattle Slew implant).

It seemed possible that the open approach used for the stabilization surgery would permit successful insertion of a 25-gauge catheter into the subarachnoid space. Then the NeedleView® scope was inserted through this catheter and the spinal cord visualized for signs of myelographic compression. The objectives of the study are to describe the ventral intercervical approach for endoscopy assessment of the cervical canal and to evaluate the safety and innocuousness of the implantation of mesenchymal stem cells underneath the pia mater. Stem cell transplantation has shown benefit in canines with spinal cord injury and in humans with amyotrophic lateral sclerosis (ALS); we believe direct transplantation of mesenchymal stem cells into the cervical canal may improve the postoperative success of the surgery and reduce the convalescence time of horses with cervical stenotic myelopathy. Our clinical experimentation took place in late February and early March 2015. Our schedule calls for two months for statistical analysis and another three months for writing up the results and the article.

Key benefit(s) of the NeedleView® modality: The scope’s small size will make it possible to put it directly into the spinal cord, allowing the direct placement of stem cells.

Needleview Researcher: Dr. Sherman Canapp

From Biovision’s Views Newsletter, Issue 2, May 2015

Sherman Canapp

Vet: Sherman Canapp, DVM, DACVS, DACVSRM
Affiliation: VOSM — Veterinary Orthopedic & Sports Medicine Group
Position: Owner and Chief of Staff
Focus: Canine
Location: Annapolis Junction, MD
Contact: 
URL: http://vetsportsmedicine.com/

Use: Currently performing clinical research into the efficacy of regenerative medicine therapies in canine unilateral supraspinatus tendinopathy

I most recently became involved with Biovision at the start of Veterinary Orthopedic & Sports Medicine Group’s Canine Health Foundation clinical trial on the efficacy of regenerative medicine therapies. This is a pioneer study with Virginia Tech that we hope will shape the future of veterinary medicine, and therefore a great opportunity for Biovision’s involvement. This trial requires a confirmed diagnosis of unilateral supraspinatus tendinopathy, which can be confirmed through diagnostic ultrasound. This trial also has extensive exclusion criteria, including concurrent pathologies, which can only be confirmed through arthroscopy.

The NeedleView® technology then came into play for this clinical trial since we require a definitive diagnosis before treatment–something that only arthroscopy can provide. The NeedleView® is less invasive than traditional arthroscopy and allows us to perform advanced diagnostics without the need for a full setup in an operating room. We believe that the NeedleView® will be an advantage to this study moving forward.

Our use of the NeedleView® technology will expand upon the feasibility of using this technology in a clinical setting, as well as its ease of use in advanced diagnostics. Through our study on regenerative medicine therapies, we will be able to gain a better understanding of the uses of the technology as a diagnostic tool for canine shoulder injuries and develop efficient protocols for use in a clinical setting.

Key benefits of the NeedleView® modality: Traditional arthroscopy is a tool that we use on a daily basis, but there are times that traditional arthroscopy is not needed. One of the biggest benefits of the NeedleView® technology is that it allows for advanced diagnostics by a less invasive means. Veterinary medicine focuses on advances in medicine and patient care. Minimally invasive procedures that also allow a patient to be under anesthesia for less time are a huge benefit to the community overall. The NeedleView® can be used for intra-articular and soft tissue imaging, such as arthroscopy of the meniscus, cranial cruciate ligament, medial shoulder instability, biceps tears, fragmented medical coronoid processes, and osteochondritis dissecans. The NeedleView® is versatile in that it can be used in all joints, including the shoulder, carpus, hip, stifle, and hock.

For what practitioner/practice is NeedleView® best suited? Arthroscopy in general requires dedicated training and expertise. If a veterinarian has the skills necessary to perform arthroscopies for his or her patients, it should be recommended to utilize these skills as arthroscopy is less invasive for the patient as compared to traditional exploratory surgery. Diagnostic musculoskeletal ultrasound, MRI, and CT scan are also viable advanced diagnostic options, but may not always be the most effective depending on the injury or suspected injury. All advanced diagnostics require training and considerable monetary commitment, but few are as versatile as arthroscopy and minimally-invasive procedures. Veterinarians who have less experience with arthroscopy should also be encouraged that the NeedleView® technology, at 1.2 millimeters O.D., is less challenging to insert into a joint as compared to a 2.4- or 1.9-millimeter scope. As a cost benefit, we have found that arthroscopy with the NeedleView® can be performed in our treatment or procedure area and does not require full draping in an operating room. By using our treatment area, we have also found that our patients require less time spent under anesthesia, as we do not have the added time of setting up arthroscopy equipment and patient preparation in an operating room.

Trying Single-Port Lap Spay and Gastropexy for the First Time

From Biovision’s “Views” newsletter (Q1 2015)

What Vets Have to Say About:
Trying Single-Port Laparoscopic Spay and Gastropexy for the First Time

By Marjorie Wallwey, Biovision Veterinary Endoscopy

Eight of your veterinarian colleagues took part in a Biovision-sponsored hands-on lab at the North American Veterinary Community (NAVC) conference in Orlando, FL. They came from across the country (Minnesota; Florida; New Jersey; and Kentucky) and around the world (United Kingdom; Bermuda; and Trinidad and Tobago). Their practice settings range from a single-doc hospital to a university, and from a 3-doc clinic in a village of 11,000 to an internationally-accredited nonprofit organization that trains and places guide dogs with visually-impaired individuals. What they all had in common was a desire to explore the single-port laparoscopic modality and see whether it lives up to its promise. Spoiler alert: it does, indeed.

First, Some Background

The lab was promoted in NAVC’s conference program. Pre-registration was required, at a cost of $1,150 per participant. Participants were required to read educational material and view procedure videos in advance. In addition, they were required to attend a presentation the night before the wetlab (the presentation recapped the lead instructor’s experience performing 3,000+ lap-assisted OHEs). The lab combined didactic and hands-on settings; after an introductory discussion, participants scrubbed in to perform a laparoscopic-assisted ovariohysterectomy/ovariectomy/prophylactic gastropexy combination and laparoscopic exploratory on live, recoverable dogs. All procedures were performed on patients as part of their preparation for adoption.

Purposely keeping the class size small — with a student-to-instructor ratio of 2:1 — allowed for lots of interaction and individualized instruction. By the end of the session, participants were able to:

  • Place a trocar
  • Manipulate instruments inside the abdomen
  • Use bipolar cautery
  • Use the video/visualization tower equipment
  • Use CO2 insufflation
  • Use a surgical positioning table (Tippy Table) for patient positioning to utilize gravity as a retractor
  • Use transabdominal procedures for fixation

Instructors were Ray Cox, DVM and Markee Kuschel, DVM of Deer Creek Animal Hospital and the Center for the Advancement of Rigid Endoscopy (C.A.R.E.) in Littleton, CO, as well as Jim Houchens, DVM of Arvada Veterinary Hospital in Arvada, CO. Drs. Cox and Kuschel pioneered single-port laparoscopic procedures and have made the modality a profitable centerpiece of their practice for nearly 20 years. Dr. Houchens has nearly a decade of experience using the modality. The wetlab included discussion of the science of rigid endoscopy, the economics, and the profitability of incorporating rigid endoscopy into private practice.

What the Participants Had to Say

As part of its standard procedures for hands-on labs, NAVC asked participants to complete evaluations rating aspects of the lab. Five of the 8 participants returned evaluations. Here’s what they had to say about trying single-port laparoscopic spay and gastropexy for the first time.

Please rate the lab instructors:

  • Jim Houchens — “Very Good” = 80%; “Excellent” = 20%
  • Ray Cox — “Very Good” = 60%; “Excellent” = 40%
  • Markee Kuschel — “Very Good’ = 60%; “Excellent” = 40%

Were you able to complete the objectives laid out in the beginning of the lab:

  • Yes = 100%

How would you rate the overall experience of the lab:

  • “Good” = 60%
  • “Excellent” = 40%

Will these new procedures apply to your practice:

  • “Agree” = 100%

Considering the price, did you get your money’s worth:

  • “Strongly Agree” = 20%
  • “Agree” = 80%

Will the procedures/skills learned in this lab:

  • Improve your ability to practice? “Yes” = 100%
  • Make your practice more professionally rewarding? “Yes” = 100%

And, perhaps most telling of all…

Having experienced this lab, would you attend another NAVC hands-on lab:

  • “Yes” = 100%

As the participants discussed, lap-assisted spay and gastropexy are merely the foundational procedures. Once learned, they open up the possibility of a myriad of procedures.

It’s time to try the laparoscopic modality for yourself.

Openings are available for C.A.R.E.’s full-day, hands-on, 2:1 student-to-instructor ratio CE session —
“Practical Single-Port Laparoscopy for the General Practitioner” — on May 14, 2015 in Littleton, CO. Registration is $895.

CLICK HERE to learn more and register.

 

CE Course: “Practical Single-Port Laparoscopy for the General Practitioner” on May 14, 2015

CE Course: “Practical Single-Port Laparoscopy for the General Practitioner” on May 14, 2015

Openings Still Available — May 14, 2015 — Littleton, CO

CE Course: “Practical Single-Port Laparoscopy for the General Practitioner”

When your peers who take a CE course answer:

  • Will the procedures/skills learned in this lab improve your ability to practice? — 100% Yes
  • Will the procedures/skills learned in this lab make your practice more professionally rewarding? — 100% Yes
  • Considering the price [to register for the lab], did you get your money’s worth? — 100% Yes

…it might just be time to check it out for yourself! The laparoscopic modality offers:

  • Smaller incisions
  • Less Pain
  • Increased Safety
  • Superior Visualization
  • Faster Recovery
  • Higher Profits

And then when you learn that more than 70% of clients on average will choose laparoscopy if it is available and if they are given a choice — even if the cost is higher — it’s time to secure your space in “Practical Single-Port Laparoscopy for the General Practitioner.”

Co-sponsored by Biovision and presented by the Center for the Advancement of Rigid Endoscopy (C.A.R.E.), this full-day, hands-on wetlab is offered on May 14, 2015 from 8 a.m. to 6 p.m. in Littleton, Colorado.

At C.A.R.E., the focus is on keeping the student-to-instructor ratio purposely low. Drs. Cox and Kuschel feel strongly that by doing so, they give their students the greatest opportunities for hands-on experience and one-on-one instruction.

SEE FOR YOURSELF!

Click any image for a short video

vid-01

Ray Cox, DVM, Center for the Advancement of Rigid Endoscopy (CARE)

Dr. Ray Cox, founder of the Center for the Advancement of Rigid Endoscopy (C.A.R.E.), and Dr. Markee Kuschel discuss the benefits and learning curve of laparoscopy and how C.A.R.E.’s “hands-on” continuing education (CE) differs from others.

vid-02

Dr. Bill Moyle of Lone Tree Veterinary Medical Center

Dr. Bill Moyle — who first learned laparoscopic-assisted procedures at age 70 — and Dr. Lamar Burstein of Lone Tree Veterinary Medical Center (Lone Tree, CO) discuss the benefits of laparoscopy, the learning curve of this modality, and their experience being trained by Dr. Ray Cox and Dr. Markee Kuschel at C.A.R.E.

vid-03

Dr. Mark Motichka of Parker Center Animal Clinic

Dr. Mark Motichka of Parker Center Animal Clinic (Parker, CO) discusses how learning and incorporating laparoscopic-assisted procedures helps his practice deliver on its commitment to provide the best medicine and care to their patients.

Click to register and explore what you’ll have the opportunity to learn from the vets who pioneered single-port laparoscopic techniques and have been using the modality for 20+ years.

Big Changes to Section 179 Deduction for U.S. Practices

From Biovision’s “Views” newsletter, Issue 4 (April/May 2014)

Industry News

First-Year Write-Off of Tangible Property Decreased; Bonus Depreciation Eliminated

Deduction Remains an Important Component of Assessing Affordability and ROI

By Marjorie A. Wallwey, Biovision Veterinary Endoscopy

Benjamin Franklin once said, “…in this world nothing can be said to be certain, except death and taxes.” While the existence of taxes remains certain, the amount of those taxes can change seemingly at random. The Section 179 deduction available to business owners under the United States Internal Revenue Service Code provides a prime example.

General business tax practices call for any fixed asset placed in service to be capitalized and depreciated over a set period of time (typically five to seven years) until its book value is zero. Qualified Section 179 deductions, however, allow the entire cost—with certain stipulations—to be taken immediately in the year the asset is placed in service. Such immediate deductions can be valuable as they free up cash for expansion, growth and self-investment.

In 2013, Section 179 permitted business owners to deduct the entire cost of a range of business property in the first year the property was put into use, up to a limit of $500,000 (although several states imposed their own limits). However, this provision expired at the end of 2013 and reverted to the limits stated in the 1986 tax law when the deduction was first introduced. This means that if Congress doesn’t take action, for 2014 and later years, the total amount that a business can expense via Section 179 will be $25,000. The tax provision for bonus depreciation also expired on Dec. 31, 2013.

It is unlikely that Congress will take action to reinstate the ATRA ’12 limit, increase it beyond $25,000, or reinstate bonus depreciation. So where does that leave U.S. veterinary practices and their capital equipment purchases?

  • First and foremost, seek advice from your tax professional: You know the specifics of your practice better than anyone; your tax professional knows the specifics of your tax situation better than anyone. He or she will be able to provide you with unbiased advice based on your goals and best interests–whether that means purchasing equipment in 2014 or holding off, claiming a full deduction this year or just a partial deduction to preserve deductions against income in future years, etc.
  • Plan capital expenditures wisely, factoring in current and future practice needs, price, return on investment, useful life/depreciation and tax deductibility: If old equipment needs to be replaced to sustain a currently-offered service, the determination is relatively simple. Don’t limit your vision, though. Take time to consider how new equipment or technology could help expand your service lines, add to your skills (even re-igniting your passion for your work), and set your practice apart from the competition for being innovative or offering the highest standard of care. While looming changes in tax law should never be a primary factor driving your capital expenditure decisions, return on investment (ROI) definitely should be. Here’s a basic fill-in chart for making sure your ROI calculation accounts for the Section 179 deduction. For purposes of illustration, we’ve inserted the respective figures for the purchase of a Biovision EndoDiagnostic + Surgical Suite (EDSS) and a Biovision NeedleView Arthro equipment suite.

(click on the images below to view full-size spreadsheets; EDSS is on the top; NeedleView Arthro is on the bottom — NOTE: THESE CALCULATIONS HAVE BEEN UPDATED FOR 2016; SEE HERE FOR EDSS AND HERE FOR NEEDLEVIEW®)

Biovision Veterinary Endoscopy EndoDiagnostic + Surgical Suite EDSS ROI CalculationBiovision Veterinary Endoscopy NeedleView<sup srcset=® Arthro Suite ROI Calculation” width=”300″ height=”142″ />

  • Finally, if you do buy, time it to take advantage of the current tax law: As long as you start using your newly purchased business equipment before the end of the tax year, you get the entire expensing deduction for that year, whether you started using the equipment in January or December. You’ll want to be sure that potentially-qualifying equipment is both fully paid and put into service before December 31, 2014.

Customer and Prospect Surveys Show High Regard for Biovision

From Biovision’s “Views” newsletter, Issue 4 (April/May 2014)

Biovision Comment

By Marjorie Wallwey, Biovision Veterinary Endoscopy

Earlier this year, Biovision completed its annual survey. We did things a little differently this time, though. We asked customers to indicate their satisfaction with Biovision equipment, sales, and service, just as we normally do. But we also asked them to tell us what factors influence their decision to purchase from Biovision. And for the first time ever, we asked the same things of prospective customers—those we’ve met at industry conferences over the years who’ve expressed an interest in our products but have not yet purchased from us. The results from both groups provided insight, and we’d like to share some of it with you.

Survey Results

Survey Results 2

By far, the majority of respondents said the key factors that convinced them of the value of Biovision equipment were:

  • Seeing the equipment in person at a veterinary conference (92.8%)
  • The ability to perform many procedures without needing a second vet (97.6%)
  • Taking part hands-on in a Biovision-sponsored wetlab or continuing education event (86.3%) – Don’t miss your chance to “take a test drive” at these upcoming events:
    • Ultrasound and Standing Arthroscopy of the Equine Stifle Joint – Advanced Hands-on Diagnostic Course (8 CE Credits) — 8:00 a.m. to 5:00 p.m. — August 23, 2014 – Fort Collins, CO (Colorado State University) — $750
    • Practical Single-Port Laparoscopy for the General Practitioner — 8:00 a.m. to 6 p.m. — November 13, 2014 – Littleton, CO (Center for the Advancement of Rigid Endoscopy) — $895

We are gratified by the results of the survey and are committed to always being worthy of your confidence and your business. We would be happy to address any questions or concerns you may have. Please contact us at 303-225-0960 or .