Dr. Justin Ganjei

Dr. Justin Ganjei Board-certified veterinary surgeon in VA/MD/DC specializing in minimally invasive surgery & IR
(12)

09/20/2024

Cystoscopic urethral bulking agent injection to treat urinary incontinence in a female dog. This non-invasive procedure involves injecting a bulking agent into the submucosal region of the proximal urethra to help increase urethral resistance and decrease urinary incontinence. It is very effective but temporary lasting around 12-18 months. This pup did great and was fully continent following the procedure!

Here is a side-by-side of a bulldog with brachycephalic obstructive airway syndrome (BOAS) with one of the worst everted...
08/31/2024

Here is a side-by-side of a bulldog with brachycephalic obstructive airway syndrome (BOAS) with one of the worst everted laryngeal saccules I’ve ever seen compared to a normal dog’s upper airway. You don’t have to be a veterinarian to see the difference and understand why we recommend these dogs have surgery to help them breathe better!

Laparoscopic medial iliac lymph node resection using sentinel lymph node mapping with indocyanine green served two ways!...
08/30/2024

Laparoscopic medial iliac lymph node resection using sentinel lymph node mapping with indocyanine green served two ways! Sentinel lymph node mapping is a method of identifying the exact lymph nodes draining a specific region or tumor. The affected region can be injected with indocyanine green (or other agents) and then the draining lymph nodes will light up with the agent using near infrared imaging. In this specific case these were medial iliac lymph nodes draining an a**l sac tumor. This lymph node appeared normal on ultrasound but came back metastatic! This dog had a very easy recovery given the minimally invasive method of treatment here and this case also highlights (literally) the advantages of enhanced visualization of laparoscopy!

08/25/2024
02/10/2024

Here’s a little clip of a laparoscopic adrenalectomy for a pheochromocytoma with phrenicoabdominal invasion in a dog. Been slacking on posting MIS stuff despite a ton of content and not much time to edit but trying to be better!

Hard to believe that 13+ years ago I was a student in this lab😳. And yes, I am not gowned up because this is a teaching ...
01/26/2024

Hard to believe that 13+ years ago I was a student in this lab😳. And yes, I am not gowned up because this is a teaching lab and these are not live animals, not a surgical suite, for those good at looking at pictures but not so much at reading😂🤦‍♂️ Happy to be giving back to Virginia-Maryland College of Veterinary Medicine after all they did for me.

Virginia-Maryland College of Veterinary Medicine alumnus Justin Ganjei, an accomplished veterinary surgeon in Maryland, offers his expertise to help today’s veterinary students learn proper surgery techniques.

Here is a post with the story behind the kitty with the pelvic fracture I posted recently.
01/12/2024

Here is a post with the story behind the kitty with the pelvic fracture I posted recently.

Starting off the new year with a nice polytrauma case. This 1yr. Kitten got loose and came back limping on the right bac...
01/06/2024

Starting off the new year with a nice polytrauma case. This 1yr. Kitten got loose and came back limping on the right back leg. On examination it had an open wound over the right distal tibia with clear evidence of an open fracture (bone sticking out). Radiographs also revealed several pelvic fractures and a sacroiliac luxation. After an initial surgery to attempt to fix the tibial fracture didn’t pan out, she was referred for surgical repair. We staged the procedures to fix the pelvic fracture first (it was already 5+ days old) and then the tibial fracture. We used an SOP plate here to stabilize the fracture. This system allows for contouring in multiple planes and has the benefits of being locking. Look at that sexy contour!🤤 let me know if you want to see the tibial fracture repair🤠

Fun with Veterinary Referral Associates using state of the art technology from Arthrex!
01/05/2024

Fun with Veterinary Referral Associates using state of the art technology from Arthrex!

Laparoscopic view of the cysterna chyli (a lymphatic center) highlighted using near infrared imaging with indocyanin green (ICG) during thoracic duct ligation in vascular mode. This structure is nearly invisible to the naked eye and this state of the art technology from makes it very easy to locate.

This handsome boy (Monty and Miller) was presented to our emergency service for acute onset collapse after a routine neu...
12/22/2023

This handsome boy (Monty and Miller) was presented to our emergency service for acute onset collapse after a routine neuter. His work-up revealed that he was bleeding internally likely due to a slipped ligature from his recent neuter. Although routine castrations are performed in the prescrotal region (not in the abdomen), the testicular artery originates from the abdomen. Occasionally a ligature used to tie off this vessel when doing a neuter will fail and the artery will retract back into the abdomen and can be a source of major hemorrhage, as was the case for Monty. These are usually performed through a routine ventral abdominal incision which is a major surgery. I elected to attempt a minimally invasive approach here (shocker I know 😂) not only for the obvious advantages of being less invasive, but also for the enhanced visualization to find the bleeding vessel. I used a vessel sealing device to cauterize the testicular artery making a nice seal. The procedure went very smoothly and Monty had a rapid recovery! We also used his own blood to perform an autotranfusion to help with his anemia from the blood loss which greatly reduces the risk of a reaction since it’s his own blood. Here Monty is looking handsome as ever at his two week recheck!

Veterinary Referral Associates

Need some CE credits?  Catch a webinar on some wound management tonight at 8!
12/05/2023

Need some CE credits? Catch a webinar on some wound management tonight at 8!

The day has come! Today, we explore the wonders of hypochlorous in wound management. Dr. Justin Ganjei will guide you through its potential and clinical uses. Earn 0.5 CE credit recognized by RACE.

Secure your spot now! https://ow.ly/YoE650Q4BP8

12/01/2023

Tracheal collapse is a common airway disorder we see in toy breed dogs. In this condition the trachea, which is made of incomplete cartilaginous rings, degenerates over time leading to progressive collapse. This in turn leads to a vicious cycle of coughing, inflammation, and various degrees of respiratory distress. Fortunately most dogs can be managed medically but when medical management fails we look to interventional options. Tracheal stents can be placed in a non-invasive, interventional manner using a combination of fluoroscopy and endoscopy to deploy a permanent stent inside the trachea and hold it open thus preventing collapse. Here is a video of a dog with severe respiratory distress from tracheal collapse showing the appearance of the trachea before and after stent placement. This dog, which came into the hospital in a respiratory crisis and required intubation to breathe was able to go home hours after the procedure breathing great! Veterinary Referral Associates

New clinical trial at our hospital for dogs with elbow osteoarthritis. Reach out if interested!
11/09/2023

New clinical trial at our hospital for dogs with elbow osteoarthritis. Reach out if interested!

🐾 Join our groundbreaking arthritis treatment study! 🙌 Veterinary Referral Associates is seeking dogs aged 2-12, weighing between 22 lbs to 110 lbs, suffering from elbow arthritis. 🐶✨

✔️ As a participant, your furry friend will receive fully-funded veterinary exams, CT scans, blood work, and treatment. Plus, there's a compliance incentive awaiting those who complete the 12-month study! 🩺💉

📋 To be considered, your dog must have confirmed elbow arthritis (via CT scan) and lameness in one or both forelimbs. They should be in overall good health and not pregnant or lactating. Sedation will be required. 📝🔬

✅ Don't miss this opportunity to make a difference in canine health! Contact our team at [email protected] to inquire about participation and help advance arthritis treatment for our four-legged friends! 📞👩‍⚕️

Snuck a quick lap chole in before heading down to blacksburg for the week to teach
11/07/2023

Snuck a quick lap chole in before heading down to blacksburg for the week to teach

Happy fracture Friday!  What’s better than a regular fracture repair?  Minimally invasive fracture repair!  This is a 1y...
11/04/2023

Happy fracture Friday! What’s better than a regular fracture repair? Minimally invasive fracture repair! This is a 1yr. cat that sustained unknown trauma resulting in a Salter Harris fracture (growth plate fracture) of the distal femur. Instead of doing a traditional open approach to fix this we performed a minimally invasive approach using pins through two very small (2mm incisions). We were able to do this using fluoroscopy in our minimally invasive suite, which allows for real time x-ray during surgery to ensure the fracture reduction and fixation was perfect. The surgery was very brief and the patient went home a few hours later feeling much more comfortable than if we were to open him up!

Healed skin graft of the metatarsal region looking beautiful!  This for was resection of a subcutaneous mast cell tumor ...
10/07/2023

Healed skin graft of the metatarsal region looking beautiful! This for was resection of a subcutaneous mast cell tumor of the distal limb treated with marginal resection and skin graft used to close the wound.

This was a fun case to collaborate with neuro on!
10/06/2023

This was a fun case to collaborate with neuro on!

Thanks to a four-hour double operation, including complex brain surgery, Jada, a 3-year-old Siamese cat, is beginning to return to her old self.

Laparoscopic view of the cysterna chyli (a lymphatic center) highlighted using near infrared imaging with indocyanin gre...
10/05/2023

Laparoscopic view of the cysterna chyli (a lymphatic center) highlighted using near infrared imaging with indocyanin green (ICG) during thoracic duct ligation in vascular mode. This structure is nearly invisible to the naked eye and this state of the art technology from makes it very easy to locate.

Teamwork got this sweet pup back to 💯:)
09/29/2023

Teamwork got this sweet pup back to 💯:)

Complications are unfortunately something that every surgeon will experience at some point in their life. Fortunately wi...
09/22/2023

Complications are unfortunately something that every surgeon will experience at some point in their life. Fortunately with most of the procedures we do the complication rates are pretty low. As the complexity of the procedure increases and with certain known patient risk factors, those complication rates can go up. With fracture repairs, one of the most serious complications is failure of the repair and re-fracture. Sometimes it's a compliance issue and sometimes its a technique issue, and sometimes it just happens. Of all the bones out there to fracture, I (and I don't think I'm alone in this) find humeral fracture repairs to be one of the more humbling procedures. No matter how good things may look and how great you feel after a repair, they can definitely fail. Here is an example of a humbling humeral fracture repair.

Tria is a 13 yr. FS DSH who suffered a fracture of her right humerus after likely falling off the step to get up on her bed. She has a lot of co-morbidities including diabetes, CKD, osteoarthritis, hyperthyroidism, etc. The humerus is a big bone to break from a little fall so we were suspicious of a pathologic fracture and she did have poor bone density (osteopenia). We discussed amputation but she really was not a good candidate for this given her osteoarthritis. We repaired her fracture initially with a bone plate and screws. I was happy with the repair and the biopsy of her bone showed no cancer. She did well for a week but then started limping again and on exam you could feel that the repair had unfortunately failed. On radiographs it was clear the bone had fractured at the distal aspect of the plate. It also looked like she had evidence of osteomyelitis (bone infection). At this point the options were revision v/s amputation and we already knew she wouldn't do well with the latter and we certainly weren't going to give up on her so revision it was.

There were several options for revision (larger/longer plate, orthogonal plates, external fixator) but looking at the fracture I felt it would be a great candidate for an interlocking nail. This system involves a large intramedullary nail that allows for 4 bolts to pass through the bone and interlock with the nail creating a really solid repair. Unfortunately we didn't have this system available but thanks to our friends Movora they leant me the system so that I could use it here. We went on to place the interlocking nail in a minimally invasive manner after removing the old plate and it worked great! Tria went on to make a full recovery. At 8 weeks you can see the robust callus that has formed and Tria is using her operated limb very well! This was truly the perfect system for this fracture and we are so happy that Tria's owners let us revise this fracture and let her go on to make a full recovery.

Veterinary Referral Associates

Been waiting for this moment since I got upgraded to 4K NIR capabilities! Near infrared imaging with indocyanine green t...
09/09/2023

Been waiting for this moment since I got upgraded to 4K NIR capabilities! Near infrared imaging with indocyanine green to highlight the thoracic duct during thoracoscopic thoracic duct ligation. It’s so perfect! 🥹

Tell me you have a hernia without telling me you have a hernia.
08/26/2023

Tell me you have a hernia without telling me you have a hernia.

Laparoscopic splenectomy to remove a splenic nodule found on ultrasound. This one came back benign.                     ...
08/09/2023

Laparoscopic splenectomy to remove a splenic nodule found on ultrasound. This one came back benign.

08/08/2023

Total laparoscopic gastropexy in an at risk breed for gastric dilatation and volvulus (GDV). Such an easy disease to prevent! Too expensive you say? It’s MUCH cheaper than what it costs to take them to emergency surgery when they’re dying! Not to mention significantly less invasive and much faster recovery! Get those at risk breeds pexied! How much does a GDV surgery cost on an emergency basis? Post your numbers and you’ll see! Veterinary Referral Associates DVM360.com

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