Claude A. Ragle

C-reactive protein in the differentiation of pyometra from cystic endometrial hyperplasia/mucometra in dogs.

Hematological parameters, plasma C-reactive protein (CRP), and tumor necrosis factor alpha were analyzed in 64 dogs with a presumptive diagnosis of pyometra. Final diagnosis (i.e., pyometra or cystic endometrial hyperplasia [CEH]) was determined by histopathology. As a single test, the percentage of band neutrophils had the highest sensitivity in the prediction of pyometra (sensitivity, 94%). The combination of percentage of bands and CRP had the highest sensitivity (97.7%; specificity, 75%) in predicting the presence of pyometra. The most common clinical signs noted in the study were vaginal discharge, polyuria, polydipsia, lethargy, and gastrointestinal signs. A combination of three or more of these clinical signs was significantly associated with pyometra.

Assessment of laparoscopic skills before and after simulation training with a canine abdominal model

OBJECTIVE-To determine whether scores for basic laparoscopic skills were significantly associated with extent of laparoscopic experience and compare basic laparoscopic skill scores obtained before and after 2 laparoscopic training sessions incorporating a canine abdominal model. DESIGN-Evaluation study. SAMPLE POPULATION-8 experienced and 25 novice individuals. PROCEDURES-Novice participants were randomly assigned to control (n = 10) and training (15) groups. Individuals in the experienced and novice training groups were required to undergo 2 training sessions with a canine abdominal model. Basic laparoscopic skills were assessed twice on the basis of 3 tasks included in the McGill Inanimate Simulator for Training and Evaluation of Laparoscopic Skills (MISTELS). RESULTS-For the novice training group, laparoscopic skills scores were significantly higher after training than before, but for individuals in the novice control group, scores did not differ significantly between the first and second assessments. The increase in score for the novice training group was significantly higher than increases for the experienced group and for the novice control group, but the increase in score for the experienced group was not significantly different from the increase in score for the novice control group. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggested that basic laparoscopic skills scores obtained with the MISTELS were associated with extent of laparoscopic experience and that training with a canine abdominal model could increase skills scores for individuals without previous laparoscopic experience.

Effects of two training curricula on basic laparoscopic skills and surgical performance among veterinarians

OBJECTIVE To compare laparoscopic skills among veterinarians before and after undertaking 1 of 2 programs of simulation training. DESIGN Evaluation study. SAMPLE POPULATION 17 veterinarians at 1 institution. PROCEDURES Basic skills were tested by use of the McGill inanimate system for training and evaluation of laparoscopic skills (MISTELS). Surgical performance was assessed through an objective structured assessment of technical skills (OSATS). Both tests were performed prior to and after a 12-session training program, consisting of MISTELS exercises (curriculum A) or a variety of exercises (curriculum B). RESULTS Curriculum B led to improvement of scores obtained with both the MISTELS and the OSATS. Curriculum A did not result in higher scores obtained with the MISTELS, compared with curriculum B. Curriculum A did not lead to an improvement of scores obtained with the OSATS. Participant-perceived value of the training program was correlated positively with the improvement of scores for MISTELS suturing tasks and scores obtained with the OSATS. Time spent in clinical laparoscopic surgery and curriculum B training were both positively correlated with the post-training OSATS scores but not with post-training MISTELS scores. Conversely, simulation training time correlated with an increase in MISTELS scores but not OSATS scores. CONCLUSIONS AND CLINICAL RELEVANCE MISTELS training resulted in significant improvement of basic laparoscopic skills but not in the assessment used for surgical performance. This may have been due to the small number of study participants, the assessment tool, or the method of training. A varied curriculum may be advantageous when training veterinarians for clinical laparoscopic practice.

Use of a barbed suture for laparoscopic closure of the internal inguinal rings in a horse

CASE DESCRIPTION A 4-year-old castrated Arabian horse was evaluated for a history of a right-sided nonstrangulating inguinal hernia that was manually reducable. CLINICAL FINDINGS Physical examination revealed a right-sided hydrocele and bilateral enlargement of the inguinal rings detectable by both external digital and rectal palpation. TREATMENT AND OUTCOME Biportal laparoscopic internal inguinal ring closure was performed with a continuous suture line of unidirectional barbed suture applied with a mechanical suturing instrument. The barbed suture contributed to a secure closure with the added benefit of not requiring knots to be tied at either the beginning or end of the suture line. Follow-up physical examination and laparoscopy confirmed healing of the surgical sites and a reduction in size of the inguinal rings. The horse exercised for 20 months following surgery without recurrence of the inguinal hernia. CLINICAL RELEVANCE In horses, laparoscopic application of unidirectional barbed sutures should be considered among the treatment options for recurrent inguinal herniation. This technique was accomplished with only 2 portals/side, in contrast to the additional 3 to 4 portals that are most commonly required. The use of a barbed suture with a mechanical suturing instrument offered added security to the closure. The difficulties of dual instrument suturing and intracorporeal knot tying were eliminated, dramatically reducing the challenges of performing suture reduction of the internal inguinal ring.

Dorsally recumbent urinary endoscopic surgery.

Laparoscopic cystotomy is the method of choice for treatment of a cystic calculus in the horse. The main advantage of this procedure over others is the excellent ability to view and gain operative access to the urinary bladder. This article describes the procedure, including techniques, instrumentation, preoperative and postoperative care, and complications.

Lift laparoscopy in dogs and cats: 12 cases (2008-2009)

OBJECTIVE To describe clinical and physiologic changes during lift laparoscopy in dogs and cats and determine immediate surgical outcome. DESIGN Retrospective case series. ANIMALS Client-owned dogs (n = 7) and cats (5). PROCEDURES A custom-made lift device was used to retract the abdominal wall for laparoscopic instrumentation. The lift device was used first in 3 dog cadavers to assess the risk of complications. Thereafter, the device was used for routine laparoscopic procedures in client-owned animals. Data collected from medical records included signalment, body weight, clinical signs, diagnosis, surgery type and duration, conversion from laparoscopic to open surgery, preoperative American Society of Anesthesiologists score, mean intraoperative respiratory rate, mean and peak end-tidal partial pressure of CO(2) during the laparoscopic surgery, ventilation method, mean saturation of hemoglobin with O(2), mean and systolic arterial pressures during the laparoscopic surgery, total anesthesia time, signs of pain immediately after recovery, duration of hospitalization, and postoperative complications. RESULTS Lift laparoscopy was successfully performed in 10 of the 12 patients. No adverse effects were noted with the use of this technique. However, in 1 dog and 1 cat, conversion to laparotomy was necessary because of poor visualization. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that lift laparoscopy is feasible in dogs and cats and is an option that can be used in clinical practice, especially if creation of positive-pressure pneumoperitoneum is not desirable.

Laparoscopic removal of a bladder urolith in a standing horse.

CASE DESCRIPTION An 11-year-old Arabian gelding was evaluated for hematuria, stranguria, and pollakiuria that had been observed for 1 week. CLINICAL FINDINGS Transrectal palpation revealed a 5-cm firm round mass in the urinary bladder. Cystoscopy and transrectal ultrasonography confirmed the diagnosis of urinary bladder urolithiasis. TREATMENT AND OUTCOME A multiportal transparalumbar fossa laparoscopic approach was selected for cystotomy and urolith removal. Cystotomy and urolith removal was performed with sedation and local anesthesia with the horse standing. No perioperative complications were observed. Urination returned to normal 5 days after surgery. The horse returned to its previous level of activity at 3 weeks after surgery. CLINICAL RELEVANCE Findings suggested that minimally invasive transparalumbar fossa laparoscopic approach can be successfully used for cystotomy and urolith extraction in standing horses; this avoids the disadvantages of conventional laparocystotomy for removal of large uroliths in male equids and the potential complications of general anesthesia and recovery. The technique provided excellent viewing and access to the bladder, permitting extraction of the urolith and secure closure of the cystotomy with minimal tension and tissue trauma to the bladder.

Hemodynamic Changes During Laparoscopic Radiofrequency Ablation of Normal Adrenal Tissue in Dogs

OBJECTIVE To determine the hemodynamic response to radiofrequency ablation (RFA) of normal adrenal tissue in dogs. STUDY DESIGN Experimental study. ANIMALS Healthy adult mixed-breed dogs (n=6). METHODS During general anesthesia a Swan-Ganz thermodilution catheter was flow directed into the pulmonary artery and used to quantify cardiac output. An arterial catheter was used for direct blood pressure measurements. An RFA device was introduced into the left adrenal gland under observation through laparoscopic instrumentation. Blood samples were collected and hemodynamic variables studied after a stable surgical anesthetic depth was achieved (time 1), during CO(2) insufflation of the abdomen (time 2), during adrenal RFA (time 3), and after completed RFA (time 4). Catecholamine determinations were performed with a human enzyme immunoassay. Histopathology was performed to verify medullary necrosis. RESULTS Arterial, pulmonary arterial and central venous pressure, and plasma norepinephrine increased more during RFA than during abdominal insufflation. Heart rate and cardiac index did not differ between time points. High baseline epinephrine was present and significant differences between time points were not detected. Systemic vascular resistance had very high individual variation and differences were not detected. CONCLUSIONS RFA of normal adrenal tissues is associated with severe hemodynamic alterations. Further studies of the optimal blockage of catecholamine-induced hypertension in dogs are warranted. CLINICAL RELEVANCE Clinicians should prepare for potential hypertensive crisis during RFA of adrenal masses, especially if treating a margin of normal tissue.

Pneumocephalus secondary to removal of an osteoma from the paranasal sinuses of a horse.

CASE DESCRIPTION A 2-year-old Quarter Horse was evaluated because of a progressive left-sided facial deformity and unilateral nasal and ocular discharge. CLINICAL FINDINGS Physical examination revealed convexity of the left frontonasal region, left-sided nasal and ocular discharge, and decreased air flow through the left nares. Radiography and computed tomography revealed an extensively mineralized mass occupying most of the left paranasal sinuses. TREATMENT AND OUTCOME The mass was surgically debulked, but complete removal was precluded because the mass was tightly adhered to the frontal and maxillary bones. Results of histologic examination of the mass were consistent with a diagnosis of osteoma. The horse developed transient pyrexia and colic following surgery, and postoperative radiography revealed gas opacities in the lateral ventricles of the brain, consistent with iatrogenic pneumocephalus. However, the horse did not develop any neurologic signs and was performing normally 2 years after surgery. CLINICAL RELEVANCE Findings reinforce concerns that paranasal sinus surgery in horses can be associated with intracranial complications such as pneumocephalus. In horses with a mass involving the paranasal sinuses, computed tomography may be helpful in determining the boundaries of the mass and formulating a surgical treatment plan.

Dorsally Recumbent Female Equine Urogenital Endoscopic Surgery

The ventral abdominal approach for laparoscopy is versatile. Reported techniques using a ventral approach in the mare include bilateral ovariectomy and granulosa cell tumor removal. Laparoscopic ovariectomy is performed by way of four instrument portals in the caudoventral aspect of the insufflated abdomen. The procedure has several advantages over the traditional approaches of colpotomy and celiotomy, including tension-free closure of all incisions and minimal invasiveness.