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Romain Pizzi, the vet who pioneered keyhole surgery for animals, has operated on sharks, chimps even a moon bear

In 2012, the conservation charity Free the Bears approached Romain Pizzi, one of the most innovative wildlife surgeons in Europe, with an unusual patient. A specialist in laparoscopic (keyhole) surgery – until recently rare in veterinary medicine – Pizzi has operated on giraffes and tarantulas, penguins and baboons, giant tortoises and at least one shark, and maintains a reputation for taking on cases others won’t. If you’re in possession of a tiger with gallstones, or a suspiciously sickly beaver, you call Pizzi. As Matt Hunt, CEO of Free the Bears says, “We have other vets who are incredibly talented. But Romain is one of a kind.”

The patient in question was a three-year-old female Asiatic black bear, also known as a moon bear, called Champa. Moon bears, poached for their bile and bodyparts, are classified as vulnerable by the International Union for Conservation of Nature. Rescued as a cub and brought to a Free the Bears sanctuary in Laos, Champa had a deformed skull and impaired vision. While other bears would socialise, she would mope around her enclosure, head down, seemingly in agony. Pizzi suspected she had hydrocephalus, a rare condition in which excess cerebrospinal fluid builds up in the skull, causing brain damage.

Catching
Catching a red-eye: Romain Pizzi is based in Edinburgh where he treats rockhopper penguins, but flies around the world for operations. Photograph: Tim Flach

“Anywhere else in the world, the recommendation would have been to euthanise her,” Hunt says. But in Laos, which has a Buddhist tradition and strict conservation laws shaped in part as a response to the bear-bile trade, euthanasia is forbidden. So Hunt asked Pizzi for an alternative solution. “We started talking about the possibility of surgery,” Hunt says.

Veterinary surgeons operate under unique constraints. There’s scale: it’s hard to fit an elephant in an MRI machine. There’s temperament: you don’t want a tiger to wake up on the operating table. And there are financial pressures. A cutting-edge surgery on a domestic pet can cost tens of thousands of pounds. By contrast, wildlife charities can be forced to function on small budgets. And surgeries are often performed in the field, at sanctuaries and wildlife reserves with few of the average zoo luxuries, such as sterile theatres and reliable electricity.

In Champa’s case, even confirming the diagnosis proved impossible. “There’s no money in Laos,” Pizzi says. “There’s no MRI scanner in the whole country. They don’t even do the operation on humans.” The nearest human hospital refused to admit an animal for an x-ray. What’s more, no vet had ever attempted to perform brain surgery on a bear before. Pizzi went on undeterred. Without an MRI, visualising Champa’s brain in advance was challenging. So he contacted the National Museum of Scotland, which keeps an archive of mammal skeletons for scientific study, and borrowed the skull of a young female moon bear, which he x-rayed to help create a digital replica – a kind of map. “You find a different way,” he says.

Bearing
Bearing up: Champa the moon bear’s brain surgery. Photograph: Matt Hunt/Free The Bears

Before long, Pizzi turned to Jonathan Cracknell, a veterinary anaesthetist and regular collaborator, to assist – “I’m his gas man,” Cracknell says. Pizzi and Donna Brown, head veterinary nurse at Edinburgh Zoo, set about sourcing supplies for a six-hour operation. Then, in February 2013, having prepared as much as possible, they packed up their equipment and boarded a plane to Laos.

Pizzi has always had an affinity for small and fragile things. Growing up in Port Elizabeth, South Africa, he wanted to be a paediatrician. Later, when he was a teenage student at Pretoria Boys High School (alumni include Elon Musk), he came across a dove that had fallen from its nest. “I nursed it back to health and then released it,” he says. “It would visit for weeks afterwards.”

He studied veterinary science at the University of Pretoria and, after graduating, came to the UK in 1999 to undertake a masters at London Zoo. He was stunned by how far veterinary surgery techniques lagged behind human medicine, and quickly developed an interest in laparoscopy, in which surgical tools are passed into the body through a small tube. “I think there were two of us who started doing it in the UK around the same time,” says Pizzi. Today, he lectures veterinary students on the technique. “He has an incredible thirst for knowledge and an eye for detail, and is always looking to apply or pioneer new techniques in our field,” says Nic Masters, head of veterinary services at London Zoo.

In June last year I visited Pizzi at work at the National Wildlife Rescue Centre in Fishcross, about an hour’s drive northwest of Edinburgh. Pizzi splits his time between running the veterinary service here, working at Edinburgh Zoo and travelling for surgeries. Since he joined in 2010, the centre has grown into one of the largest wildlife rehabilitation hubs in the UK. Every day, members of the public telephone to report injured wildlife. Drivers are dispatched to collect the animals and, late in the afternoon, their vans roll up to the centre and unload their casualties. The Rescue Centre treated 9,300 animals in 2016. This year, Pizzi expects that number to pass 10,000.

Through
Through the keyhole: Pizzi performs laparoscopic surgery on a female jaguar. Photograph: Romain Pizzi

A series of low brick buildings and enclosures, the centre is divided into four sections: small mammals; large mammals; seals and waterfowl; and birds. The corridors are thick with rasping shrieks and caws. The air is acrid. Whiteboards list the species currently requiring Pizzi’s attention. Today, “birds” alone lists woodpeckers, crossbills, jackdaws, crows, robins, thrushes, blue tits and great tits, goldfinches, bullfinches, ospreys, lapwings, oystercatchers, kestrels, a pheasant and several varieties of owl.

Pizzi’s case load has helped him develop new approaches. When he started working at the centre, he would stay late at night, practising on cadavers, familiarising himself with anatomies, developing new techniques. Now his desk is littered with GoPro cameras – used for teaching – and a Philips electric razor to remove fur. Nearby is a portable x-ray and an ultrasound. He’s seen every affliction: bacteria, broken bones, even a rare case of balloon syndrome, in which a damaged glottis caused a hedgehog to inflate to the size of a beach ball.

When I visit, Pizzi has plenty to do. A hedgehog has an infection, so Pizzi prescribes Betamox, an antibiotic, and an antifungal for ringworm. A rabbit with a suspected spinal fracture needs an x-ray. And there’s an exploratory laparoscopy to perform on a beaver called Justin. (“It took me a week to figure out why,” Pizzi says. “Justin. Justin Beaver.”) His patient roster is broad: from chimpanzees to tarantulas, but it saddens him that the endangered species – lions, rhinos, bears – get all the attention when there are animals threatened here in the UK. “I never want to just be doing these big operations the media likes,” he says. “I probably make more of a difference here.”

In
In depth knowledge: Pizzi examines an angel shark. Photograph: Romain Pizzi

Champa’s surgery started poorly. Keyhole surgery requires the use of an insufflator, which uses carbon dioxide to inflate the body cavity wide enough to accommodate surgical implements. The problem: when Pizzi and Cracknell arrived at the rescue centre in Laos, they couldn’t find a carbon dioxide cylinder compatible with the machine.

The centre itself is in a national park near the city of Luang Prabang, with few amenities. The answer finally came from an unlikely source. “There was one bar that does draft beer. Once a week they had a keg come up from Luang Prabang,” Pizzi says. “They said, OK, we’ll have no draft beer for the next five days.” They donated their CO2, which Pizzi connected with some gas piping and hose clamps.

Anaesthesia proved tricky. “She went down on the sedative and stopped breathing,” says Hunt. The room was cramped and humid, made warmer by the presence of a BBC documentary crew who had come to film the procedure. Sweat dripped on to the floor tiles. As Pizzi prepared to drill into the skull – using a Dremel woodworking tool – everyone held their breath. It was indeed hydrocephalus. Pizzi was able to fit a ventriculoperitoneal shunt, a tube that sits in the brain cavity and funnels excess fluid down into the abdomen, where it is absorbed by the body. However, when Pizzi started to fit the tube, a minor disaster struck: the sanctuary’s electricity supply – already stretched by the film crew’s lights – blew. “The electrics arced and fused,” says Cracknell. The insufflator was fried.

Animal
Animal magic: chimpanzee Ruma and her baby. Photograph: Tim Flach

But Pizzi was prepared. “There’s so many things that can go wrong,” he says. “I try to build in a redundancy for all the main equipment.” He produced his favourite piece of frugal innovation: an inflatable mattress pump. “You run that into the abdomen in short bursts and it will puff up with air,” says Pizzi. “Not ideal, but it’s OK.”

“He comes up with amazing things,” says Cracknell. “There are some surgeries where, halfway through, you might think, ‘I’ve bitten off more than I can chew.’ With Romain, I’ve never had one go wrong.” The surgery took six hours. The next day, he and Hunt went to Champa’s den, where she was starting to wake up. “For many years she’d been in pain, she’d been blind, she never looked up,” says Hunt. “And we called her, and she looked up and fixed us with her eyes. It was quite amazing.”

Whenever Pizzi treats endangered species, there’s always a great awareness of what its death means. Pizzi has operated on the Socorro dove, a beautiful brown bird native to the Revillagigedo Islands off the west coast of Mexico, now extinct in the wild. And he keeps a photo of himself with the last-known Partula Faba, or Captain Cook’s bean snail, named because it was first discovered on Cook’s expedition in 1769. It died at Edinburgh Zoo in 2016, its species with it.

Loving
Loving touch: Romain Pizzi preparing for surgery. Photograph: Tim Flach/Wired © The Condé Nast Publications Ltd

Later this year, Pizzi will fly back to Laos to operate on Champa again. It’s been four years, but her health has deteriorated. Shunts can become blocked, pressure builds in the brain. Pizzi will operate, check the shunts and replace them if needed. But maybe that’s not the answer. Maybe it would be better if Champa died. She remains brain-damaged. That’s the question veterinarians have to deal with. How much suffering is enough? And who are we keeping the animal alive for? If we wanted to save our wildlife we’d be preserving their habitats, not burning down forests, polluting their environments, hunting them into extinction.

“Conservation – it’s such a meaningless word,” Pizzi says later, over dinner. “Keeping animals and breeding them in captivity, in some people’s minds that’s conservation, because you’re not taking them from the wild. I don’t think that’s genuine. When people come into the zoo, they’re not going to save the orangutans. They just want a good day out.”

“In veterinary medicine, people say ‘unnecessary suffering’,” Pizzi continues. “Which means that there is some suffering we’re OK with.” We hate to see zoo animals suffer, but care little about the cattle slaughtered for agriculture. (Pizzi is vegetarian.) We fret about mass extinction, but not enough to change our habits. Therein lies the tragedy of Pizzi’s work: he can develop new ways to save wildlife, but even if he saves 10,000 animals this year, it’s just a drop in the rapidly acidifying ocean.

Fangs
Fangs a lot: removing a diseased gall bladder from a moon bear. Photograph: Romain Pizzi

He thinks about that a lot. But, then, he also thinks about the case of a white-tailed sea eagle he once treated. It had a broken wing and one leg. “It’s easier to kill the bird, and maybe it’s the right thing,” Pizzi says. The bone was protruding through the skin. But the bird had spirit; even then, it tried to fly. “Do I go in and chop a bunch of the dead bone out? How much is too much intervention?” He ended up setting the bones and released it after three months with a tracking implant. Its flight always looked a bit off; to this day he wonders if he should have done more. But the eagle lived, and it flew – until it died, four years later, of natural causes.

This is an edited version of a piece that originally ran in Wired magazine. Oliver Franklin-Wallis/Wired © The Condé Nast Publications Ltd

Read more: www.theguardian.com

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