Soft palate and tonsil resection using PlasmaKnife dissector in dogs with brachycephalic obstructive airway syndrome – A novel technique


Dr Emil Ofner

Authors : Emil Ofner, DVM
Marina Barižon, DVM
Mario Grubišić, DVM
Silvijo Tarasić, Eng; OLYMPUS d.o.o. Zagreb

Small Animal Veterinary Clinic More, Šibenik, Croatia

Key words : Brachycephalic syndrome, PlasmaKnife


Brachycephalic obstructive airway syndrome is chronic, repetitive and life threatening disorder and because of that it often requires immediate surgical intervention. In literature, there are many described surgical techniques to treat different aspects of brachycephalic syndrome. The soft palate and tonsil resection using Gyrus PlasmaKnife dissector is a novel technique which is in our opinion ideal for every veterinary practice.


Brachycephalic Obstructive Airway Syndrome (BOAS) is a complex chronic condition characterized by narrowing or collapse of the different airway passages. This disorder is hereditary and because of that associated with different breeds of dogs. Depending on general skull morphology dogs can have brachycephalic, mesaticephalic and dolichocephalic heads. Phenotypic selection in search for round heads and foreshortened nose in brachycephalic breeds of dogs resulted in loss of sagittal crest and a braincase longer than the facial bones. Rostral shortening of the skull in brachycephalic breeds, without paralell reduction in the associated soft tissues, results in disproportion causing abnormal airway resistance. These primary anatomic defects lead to secondary changes over time (Table 1). At the time of presentation, clinical sings can be mild, moderate or severe. All moderate and severe cases are accompanied with sleep difficulties, coughing, dyspnoea, gagging, retching and syncope. While moderate and severe cases need prompt surgical intervention only mild cases can be managed conservatively.

Patients and methods

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Last decade, there is a huge increase of pure breed dogs and breed related disorders in Dalmatia. Brachycephalic breeds which have round heads resembled those of human infants are becoming very popular. Among breeds presented with BOAS in our clinic overrepresented breeds are Pugs, French Bulldogs and Cavalier King Charles Spaniels.
Most patients in time of presentation have serious and life threatening symptoms. Because of that diagnostic procedure needs to be done quickly with skilled team. In Veterinary Clinic More all patients with BOAS are put under general anesthesia, intubated and after radiographic examination, laryngo-tracheo-bronchoscopy procedure with or without rhinoscopy is done. After a complete examination of upper and lower respiratory pathways we prepare surgical planning. In almost all situations we do a soft palate resection. If needed, vertical or horizontal external nares resection, tonsillectomy or everted laryngeal saccules excision is done also.
To clearly and precisely visualize the surgical site is critical in all surgical procedures involved in BOAS. Because of that, all patients should be positioned in sternal recumbency with maxilla resting on the perch and the mandible should be suspended by rolled gauze ventrally (Picture 1 ). If soft palate resection is going to be done all tissues extending mid to the caudal aspect of tonsillar crypt should be excised. The soft palate is grasped with Allis clamps, pulled rostrally and dissected with PlasmaKnife dissector (Picture 2). If tonsils are enlarged in order to clear out as much space as possible we also do unilateral or bilateral tonsillectomy.


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Though in available literature, there are lots of papers about soft palate dissection we didn’t find anything about using PlasmaKnife dissector for soft palate and tonsil resection. Traditionally resection is done with sharp dissection using Metzenbaum scissors or monopolar electrocautery. Other reported techniques include bipolar sealing devices (LigaSure), laser or harmonic scalpel. Surgery time for soft palate resection was about 12 minutes for sharp dissection, and about 5 minutes for laser surgery.
PlasmaKnife dissector is triode-tipped bipolar instrument (Picture 3) which attaches to the Gyrus G3 WorkStation generator (Picture 4). It uses PlasmaCision technology that enables both simultaneous and sequential hemostatic sealing and cutting. PlasmaCision leverages the electricaly conductive properties of tissue fluid to form a tightly defined low temperature plasma field over the active pole of the triode tip. The instrument has two main modes of operation, PlasmaCision cut phase and pure coagulation phase. In cut phase a low-temperature plasma field precisely divides tissue and coagulates blood vessels. In pure coagulation phase tip delivers controlled radio frequency energy for sealing larger blood vessels ( Pictures 5 and 6). Tip design has both convex and flat surfaces. The convex part for pin point accurate dissection and flat surface provides maximum tissue contact for effective hemostasis along with a suction channel for blood and vapor (Picture 7). Switching between modes is done by foot pedal.
Surgical time for soft palate resection with PlasmaKnife dissector was average 63 seconds and 44 seconds for unilateral tonsillectomy. Realized time was about 10 times faster in comparison to traditional sharp dissection and 5 times faster comparing to laser surgery. Production of smoke and vapors was minimal and suction channel was not needed. Postoperatively, all dogs received local dexamethasone to reduce swelling (Picture 8). We didn’t have any postoperative complications.


PlasmaKnife dissector in combination with Gyrus G3 WorkStation generator is multi – functional instrument and provides versatility, efficiency, clean incisions, and hemostatic performance with minimal tissue damage.

Again, we are thankful to Mr. Silvijo Tarasić and Olympus d.o.o. Zagreb who recognized our enthusiasm and provided technical expertise that greatly assisted us in implementing new technology improvements in our practice.

Dr Nikola Bunevski- macedonain vet in Zagreb, Croatia. Real Balkan story


Dr Nikola Bunevski

1.How long  you work in Croatia? (tell us more about your internship in the university)?

I’m working in croatia for 2,5 years and 2,5 years on postgraduate studies on the University of Veterinary Medicine in Zagreb Croatia. Postgraduate studies on the University of Veterinary Medicine where on the Department of Surgery Orthopedic Ophthalmology and Anesthesiology -they were excellent ,on the Department of Surgery here in Zagreb  are working excellent veterinarians who are excellent in their surgical skills from which you can learn a lot!!! I’m really grateful that i have a chance to be there and learn so much.

2.Why and how you decided to go in Croatia,not in country of West Europe?


Veterinary Clinic Kreszinger

I was thinking a lot where to sign up  for Postgraduate studies. I was looking for postgraduate studies in Athens, Sofia, Belgrade, Zagreb and Ljubljana, because they are offering programs that i can afford, and i see the Department of Surgery here in Croatia, and realize that they have new modern clinic and a lot of cases where I can learn a lot.

3.Tell us more about the level of veterinary medicine in Croatia?



The level of veterinary medicine in Croatia? I can tell you that the veterinarians are working very hard to push up the level of veterinary medicine to be similar like western european countries. Croatian Small Animal Veterinary Section (CSAVS) are organizing a lot of events workshops educations and a lot of professors and educators are coming from around the world and giving lectures and teaching us how to perform better veterinary medicine. The level is high and is growing rapidly. I’m really feel blessed that i have a chance to meet so good friends/veterinarians here in Croatia.

4.And in Macedonia?

The faculties of veterinary medicine in Macedonia are young. Veterinary medicine is changing especially from the young new veterinarians side. I know a lot of young veterinarians in Macedonia who are working a lot and they are giving best from them self to change the future of in Macedonia.I really hope that soon a lot of young veterinarians will come in the clinic where im working so we can exchange knowledge and not just here but around Europe to experience some good veterinary practice . I really believe that those young veterinarians will make changes, I’m in very good contact with a lot of them helping in everyway that I can, and I’m expecting some of them here in Zagreb  to work together for some time, some of them already came. It’s really great when you share knowledge.

5.Future plans?



I don’t have plans for future. But i have a dreams-to be a better veterinarian and have a chance to collect some new knowledge, maybe to return and work again in my home country Macedonia, or in some place where I can practice good veterinary practice, places like here in Croatia or somewhere around the world.

6 .What do you think about Vets on The Balkans?

Sharing is caring. Every information is priceless. We are working near each other we have similar problems and questions, it will be better for each of us if we share those questions and problems to one another, we will come to answers faster and painless. Vets on the Balkans can serve that purpose.Thank you for having me.

The team of Vets on The Balkans :” Thank you very much Dr Nikola Bunevski  for sharing with us ! We are proud of having vet like you on the Balkans!!! “



Dr Nikola Bunevski

Dr Nikola Bunevski

He graduated:

Trakya University

Faculty of Veterinary Medicine – Stara Zagora , R. Bulgaria

major: Veterinary Medicine (September 2001 – February 2008)

Professional title: Doctor of Veterinary Medicine

He got his Master calss :

University of Zagreb

Faculty of Veterinary Medicine-Zagreb Croatia

Department of Surgery,Ortopedics Ophtalmology and Anesteziology.

Profesional title:University Master of Surgery (2010-2012)



Member of the Veterinary Chamber of Macedonia


Member of  Croatian Small Animal Veterinary Section

Member of the Veterinary Chamber of Croatia.

Member of the Society of Radiology genetically influenced skeletal disorders in small animals eV (GRSK)-Germany.

Participation in WSAVA Continuing Education Course in topic: Oncology and Reconstructive Surgery, Stara Zagora, R. Bulgaria (October 2006)

Certificate of attendance-Small Animal Veterinary Symposium Belgrade Serbia 2010

Certificate of attendance-17th  FECAVA Eurocongress Istambul-Turkey 2011

Certificate of attendance-Small animal Orthopedics seminar-Belgrade Serbia 2011

Certificate of attendance-Small Animal Veterinary Symposium Belgrade Serbia 2011

Certificate of attendance-Small animal  Neurology seminar-Belgrade Serbia 2012

Certificate of attendance-Small Animal Veterinary Symposium Belgrade Serbia 2012

Certificate Course Participant- All About the Stifle Joint Course Opatija Croatia 2013

Certificate of attendance-1 Congres of Croatian Small Animal Veterinary Section  Zagreb Croatia2014

Certificate Course Participant-AOVET Course-Principles in Smal Animal Fracture Management  Zagreb Croatia 2014

Certificate of attendance-Belgrade Veterinary Neurology Conference Belgrade Serbia 2014.

Vertificate of attendance-20th FECAVA Eurocongress Munich Germany 2014

Certificate attended as a Faculty-A Practical Approach to External Skeletal Fixation Opatija Croatia 2014

Certificate of attendance-2 Congres of Croatian Small Animal Veterinary Section  Zagreb Croatia2015