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

Dr. Christoph Koch

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: christoph.koch@vetsuisse.unibe.ch
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.