Figure 2 Laparoscopy performed in 1974, before the introduction of video laparoscopy.
Source:Courtesy of Dr. David C. Twedt.
Fortunately, some surgeons saw these hard‐earned achievements for their true value and by early 1990s laparoscopic appendectomies were performed by these early adaptors in vast numbers. Shortly thereafter the “laparoscopic revolution” broke out and suddenly Semm's and Nezhat's expertise and publications were in great demand. Finally, in 2002 Semm received the Pioneer in endoscopy award from the Board of Governors of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) [5]. Nezhat also has won numerous awards and honors from prestigious societies like ACOG, ACS, ASRM, and the Excel Award from the Society of Laparoendoscopic Surgeons.
Small Animal MIS
With the human laparoscopic physicians leading the way, small animal MIS has not been nearly as controversial as its human counterpart. Like in the medical field, MIS was fairly slow to be incorporated in general veterinary clinical practice. Our development appears to parallel that of human surgery, but with an approximately 20‐year delay. A “laparoscopic revolution” like that in the human medical field cannot yet be claimed by veterinary surgeons, but MIS is steadily moving the stakes forward with more frequent use and improved surgical technique.
Early Work: 1970s
The first reports on laparoscopy in small animals were conducted on dogs in the early 1900s, but this was mainly experimental models prior to application in humans. Like gynecologists, theriogenologists were among the earliest clinical adapters of MIS in research and clinical veterinary medicine, during the 1950s and 1960s. However, in the early 1970s, work with diagnostic laparoscopy was emerging in the small animal field. Surgical application was sparse but David E. Wildt, a non‐DVM Ph D affiliated with the Division of Research Services at National Institute of Health, reported on male and female sterilization by occlusion of the vas deferens and uterine horn, respectively, in the early 1980s. Dr. Wildt, coedited the first textbook in 1980 on animal laparoscopy together with Richard Harrison, PhD, at Tulane University [7].
In 1977, the DVM Drs. Gerald F. Johnson and David C. Twedt (Figure 3), both at the time affiliated with the Animal Medical Center in New York, presented the first review of small animal laparoscopy for clinical use [8]. At that time, laparoscopy was exclusively a diagnostic tool (Figure 4), and nitrous oxide was the pneumoperitoneum gas of choice, especially if performed without general anesthesia. Air and carbon dioxide was also recommended, and the authors mention their preferred use of a Corkmaster (Figure 5), a carbon dioxide dispenser intended for opening wine bottles, adapted for generation of pneumoperitoneum [8].
Figure 3 From left to right, Drs. Todd Tams, Steve Hill, and David Twedt are enjoying video laparoscopy in 1995.
Source: Courtesy of Dr. David C. Twedt.
Figure 4 A proctoscope is used as a low‐cost laparoscope for visualization of a liver biopsy in the 1970s.
Source: Courtesy of Dr. David C. Twedt.
Figure 5 A Corkmaster, a carbon dioxide dispenser intended for opening wine bottles, adapted for generation of capnoperitoneum used by Drs. Twedt and Johnson in the 1970s. (Courtesy of Dr. David C. Twedt.)
MIS Takes Off in Small Animal Surgery: The 2000s and Beyond
Arthroscopy was the first globally embraced veterinary MIS technique, but this text is mainly focusing on the soft tissue MIS division. Here, it would take another two decades before MIS would be more commonly used in small animal surgery. In 2009, the American College of Surgeons added a requirement for MIS in the resident training programs.
In 1999 Dr. Lynetta J. Freeman published “Veterinary Endosurgery,” the first textbook dedicated to application of MIS in small animals. At that time, few clinical procedures had been described in dogs or cats, and the editor and her colleagues (Figure 6) shared their extensive clinical research and training experience from the R & D section of Ethicon Endosurgery.
Dr. Clarence A. Rawlings (Figure 7) and coworkers presented a series of publications in the early 2000s, describing the use of different laparoscopic‐assisted surgical techniques. These continue to serve an important function today, bridging between open and laparoscopic surgery. Dr. Rawlings has also dedicated himself to MIS training of veterinarians.
Small animal MIS has benefitted from an important advocate in Dr. Eric Monnet over the last 25 years. His contributions to the field have been imperative to clinical adaptation and development of laparoscopic and thoracoscopic technique. In addition, Dr. Monnet's contributions also include founding the Veterinary Endoscopy Society (Figure 8) in 2003, bringing American veterinarians together with a common mission of promoting and developing minimally invasive techniques. Over the last several years, the VES has developed into a strong international coalition of MIS veterinary surgeons from several continents. Furthermore, Dr. Monnet spearheaded the formation of the ACVS Fellowship in MIS in 2017. Since then a number of institutions have initiated training of Fellows in this discipline, with Dr. Ingrid Balsa, UC Davis, becoming the first‐approved ACVS Fellow MIS Small Animal Soft Tissue Surgery, in 2020.
Development of increasingly advanced clinical techniques are currently ongoing at a fast pace, and important contributions over the last two decades have been made by Drs Gilles Dupre, Phil Mayhew, Brad Case, and Ameet Singh. Dr. Mayhew remains one of the most prolific and important contributors of scientific clinical work in the area of small