If you’re a clinic owner and a technophile, you probably have all the latest and the greatest equipment available. But when it comes to endoscopy, the first thing you need to know is that you will use it, said Eric Lindquist, DrMedVet. Lindquist, a highly experienced endoscopy practitioner and incoming president of the International Veterinary Ultrasound Society for 2013/2014, advises veterinarians that before laying out the cash for endoscopy equipment, the first part of your plan should be to make sure it’s going to be economically viable for your clinic. "The main thing is to make sure they are actually going to use it and work it into their workflow in a useful and economically viable manner that merits the purchase and the training and the time involved to become proficient at endoscopy,” Lindquist said. "I have known people who could be in and out of the gastrointestinal tract in 15 minutes with optimal samples with endoscopy, and others that take an hour-and-a-half with inadequate samples. "It depends on the person and the ability to become efficient at this instrumentation.” Unlike ultrasound, which can be applied to just about any internal medicine case, endoscopy is used mainly for gastrointestinal, respiratory and lower urinary tracts, plus laparoscopy if the endoscopist is so inclined, noted Lindquist. "It can be used in tandem like we do with the ultrasound-guided laser ablation, but endoscopy is still much more limited regarding applicable cases that come through the door with higher maintenance and cleaning involved,” he said. "Therefore the economic viability of endoscopy is much less than that of ultrasound unless the clinic lives by laparoscopy, where applications are more vast.” Questions and More Questions Practitioners may have a lot of questions when considering endoscopy and the equipment choices on the market today. Return on investment (ROI) should be a clinic’s top consideration when making such an equipment purchase, said John Small, president of Biovision Veterinary Endoscopy LLC in Denver. Small said a practitioner should expect to pay $30,000 to $40,000 for a new system. Once a buyer gets past price, Small recommends asking the vendor several questions. "What procedures can I perform with your equipment package? What kind of ROI should I expect based on other customer performances with your equipment? Do you provide surgical training? What warranty do you offer? Who has your equipment?” Chelsea Corwin, a marketing associate with Karl Storz Endoscopy of Tuttllingen, Germany, believes that practitioners should think about asking and answering a few questions themselves. Corwin said a clinic should have several price points and options in mind based on what type of procedures it would like to perform. "Far too many times we see customers purchase equipment that can’t grow with the practice and that has a limited on functionality over the long run,” she said. "Cost of ownership is critical over a seven- to 10-year period, as this is the time most veterinarians keep an asset before they upgrade. Spending on the right equipment up front is important. It can help prevent obsolescence, and avoid having to buy additional equipment within two years due to technology changing.” New Technology The newest endoscopic technologies are broadening veterinarians’ ability to perform a greater array of procedures, according to manufacturers. BioVision has its NeedleView Arthroscope Suite, which Small said enables a variety of treatments in differing situations, such as performing quick diagnostic arthroscopic procedures on standing horses in the field or therapeutic procedures in the operating room. The company markets the technology as a complement to MRIs, ultrasounds and X-rays. The 18-gauge arthroscopes enable vets to get into the stifle, carpus and coffin joints plus smaller joints such as the navicular bursa, according to the maker. The company also uses an 18-gauge needle for companion animals that enable diagnostics on areas like elbows, shoulders, hips and knees. Karl Storz reports having a greater number of doctors approach them to increase diagnostic capabilities. "We see a lot of doctors who are interested in expanding their practice in the minimally invasive areas, whether it be in orthopedic, surgical or dermatology,” Corwin said. As minimally invasive surgery continues to become the first option in veterinary medicine, companies doing research and development are working to produce technology that is not only smaller, but that can provide better diagnostic and procedural capabilities—all with the main goal of improving outcomes, Corwin added. Like Lindquist and Small, Corwin emphasized that it takes time and a bit of effort to learn how to make the best use of the new equipment, which itself should also be able to grow with a practice. It is important to choose equipment that offers a universal platform a practice can build upon as the practitioner’s comfort level with what can be done in the field of endoscopy increases, she said. "There’s no sense in buying equipment if you don’t feel comfortable using it and if the system can’t grow as skill sets increase,” Corwin said. She noted that it’s also important to select a seller that offers continuing education courses and training.
