J. Brad Case

Surgical time and severity of postoperative pain in dogs undergoing laparoscopic ovariectomy with one, two, or three instrument cannulas

OBJECTIVE To determine whether number of instrument cannulas is associated with surgical time or severity of postoperative pain in dogs undergoing laparoscopic ovariectomy. DESIGN Randomized clinical trial. ANIMALS 18 healthy dogs. PROCEDURES Dogs were randomly assigned to undergo laparoscopic ovariectomy with 1, 2, or 3 instrument cannulas. Surgical time and intraoperative and postoperative complications were recorded. Severity of pain was monitored 2, 4, 8, 12, and 24 hours after surgery by means of pain scoring with a modified Melbourne Pain Scale and palpation of surgical sites with variably sized von Frey filaments. Owner-assessed postoperative comfort was also evaluated. RESULTS Surgical time was significantly longer with 1 cannula (mean ± SD, 29.7 ± 5.6 minutes) than with 2 cannulas (18.2 ± 4.4 minutes) or 3 cannulas (19.3 ± 3.4 minutes). Intraoperative complications included splenic puncture (2 dogs), pedicle hemorrhage (1 dog), and SC emphysema (1 dog); complication rates were not significantly different among groups. Total pain score was significantly lower for dogs with 2 cannulas than for dogs with 3 cannulas; total pain score for dogs with 1 cannula did not differ significantly from scores for dogs with 2 cannulas or 3 cannulas. Owner assessments of postoperative comfort and number of days pain medications were administered did not differ among groups. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that laparoscopic ovariectomy with 2 instrument cannulas, rather than with 1, resulted in shorter surgical times without increasing severity of postoperative pain.

Single Incision Laparoscopic‐Assisted Intestinal Surgery (SILAIS) in 7 Dogs and 1 Cat

Objectives To describe the clinical findings and short-term outcome in 7 dogs and 1 cat undergoing single-incision laparoscopic-assisted intestinal surgery (SILAIS) using an SILS™ or EndoCone™ port. Study Design Prospective case series. Animals Dogs (n = 7) and cat (n = 1). Methods An SILS™ port using three 5-mm instrument cannulas or EndoCone™ port was used to perform an initial limited laparoscopic abdominal exploration. The stomach and descending duodenum were explored intracorporeally and the jejunum through orad descending colon was explored extracorporeally. All intestinal procedures (enterotomy, biopsy, resection, and anastomosis) were performed extracorporeally. Omentalization of affected bowel was accomplished either intracorporeally or extracorporeally. Short-term outcome was determined. Results SILAIS was completed successfully in all but 1 dog and all animals had a good short-term outcome. Most (n = 5) animals were discharged the day after surgery. SILAIS was performed in a median of 120 minutes (interquartile range; 82–148 minutes) and was associated with a moderate level of difficulty. No major complications occurred but conversion to celiotomy (n = 1) and enlargement of the incision (n = 3) was required because of inability to exteriorize the affected bowel. Conclusions SILAIS using an SILS™ or EndoCone™ port in dogs and cats is feasible and appears effective in selected cases. Single portal laparoscopic-assisted intestinal surgery might be an effective method of minimizing morbidity in dogs and cats with uncomplicated intestinal disease.OBJECTIVES To describe the clinical findings and short-term outcome in 7 dogs and 1 cat undergoing single-incision laparoscopic-assisted intestinal surgery (SILAIS) using an SILS™ or EndoCone™ port. STUDY DESIGN Prospective case series. ANIMALS Dogs (n = 7) and cat (n = 1). METHODS An SILS™ port using three 5-mm instrument cannulas or EndoCone™ port was used to perform an initial limited laparoscopic abdominal exploration. The stomach and descending duodenum were explored intracorporeally and the jejunum through orad descending colon was explored extracorporeally. All intestinal procedures (enterotomy, biopsy, resection, and anastomosis) were performed extracorporeally. Omentalization of affected bowel was accomplished either intracorporeally or extracorporeally. Short-term outcome was determined. RESULTS SILAIS was completed successfully in all but 1 dog and all animals had a good short-term outcome. Most (n = 5) animals were discharged the day after surgery. SILAIS was performed in a median of 120 minutes (interquartile range; 82-148 minutes) and was associated with a moderate level of difficulty. No major complications occurred but conversion to celiotomy (n = 1) and enlargement of the incision (n = 3) was required because of inability to exteriorize the affected bowel. CONCLUSIONS SILAIS using an SILS™ or EndoCone™ port in dogs and cats is feasible and appears effective in selected cases. Single portal laparoscopic-assisted intestinal surgery might be an effective method of minimizing morbidity in dogs and cats with uncomplicated intestinal disease.

Comparison of surgical variables in cats undergoing single‐incision laparoscopic ovariectomy using a LigaSure or extracorporeal suture versus open ovariectomy

OBJECTIVE To evaluate the applicability of single-incision laparoscopic ovariectomy (SILOVE) in cats using a single-incision laparoscopic port (SILP); to compare surgical time, complications, and postoperative pain after SILOVE using a LigaSure (SILOVE-LS) or extracorporeal suture (SILOVE-ECS), and open ovariectomy (open-OVE). STUDY DESIGN Randomized, blinded, prospective study. ANIMALS Healthy, domestic female cats (n = 24). METHODS Cats underwent physical examination, packed cell volume, total solids and blood urea nitrogen analysis. Cats were randomly assigned to 1 of 3 groups: SILOVE-LS (n = 8), SILOVE-ECS (8) or open-OVE (8). Surgical time, complications, and postoperative pain scores were recorded. RESULTS Single-incision laparoscopic ovariectomy was successful in (n = 8) SILOVE-LS cats and (n = 5) SILOVE-ECS cats. Surgical time was significantly longer for the SILOVE-ECS group compared with the SILOVE-LS (P < .0001) and open-OVE (P < .0001) groups, which were not different (P = .55). Complications were more frequent in the SILOVE-ECS group and removal of the SILP was required to complete ovariectomy in 3 cats. Cumulative 4-hour pain scores were not different between groups. CONCLUSIONS Single-incision laparoscopic ovariectomy using a SILP is a feasible method for OVE in cats. Single-incision laparoscopic ovariectomy using an extracorporeal suture is more time consuming and associated with more complications than either the SILOVE-LS or open-OVE methods.Objective To evaluate the applicability of single-incision laparoscopic ovariectomy (SILOVE) in cats using a single-incision laparoscopic port (SILP); to compare surgical time, complications, and postoperative pain after SILOVE using a LigaSure (SILOVE-LS) or extracorporeal suture (SILOVE-ECS), and open ovariectomy (open-OVE). Study Design Randomized, blinded, prospective study. Animals Healthy, domestic female cats (n = 24). Methods Cats underwent physical examination, packed cell volume, total solids and blood urea nitrogen analysis. Cats were randomly assigned to 1 of 3 groups: SILOVE-LS (n = 8), SILOVE-ECS (8) or open-OVE (8). Surgical time, complications, and postoperative pain scores were recorded. Results Single-incision laparoscopic ovariectomy was successful in (n = 8) SILOVE-LS cats and (n = 5) SILOVE-ECS cats. Surgical time was significantly longer for the SILOVE-ECS group compared with the SILOVE-LS (P < .0001) and open-OVE (P < .0001) groups, which were not different (P = .55). Complications were more frequent in the SILOVE-ECS group and removal of the SILP was required to complete ovariectomy in 3 cats. Cumulative 4-hour pain scores were not different between groups. Conclusions Single-incision laparoscopic ovariectomy using a SILP is a feasible method for OVE in cats. Single-incision laparoscopic ovariectomy using an extracorporeal suture is more time consuming and associated with more complications than either the SILOVE-LS or open-OVE methods.

Evaluation of costs and time required for laparoscopic-assisted versus open cystotomy for urinary cystolith removal in dogs: 43 cases (2009-2012)

OBJECTIVE To compare required time and costs of surgery and hospitalization as well as prevalence of incomplete urinary cystolith removal associated with laparoscopic-assisted cystotomy versus open cystotomy in dogs. DESIGN Retrospective case series. ANIMALS 20 dogs with urolithiasis treated by laparoscopic-assisted cystotomy and 23 dogs treated by open cystotomy. PROCEDURES Medical records were reviewed. Surgery cost, hospitalization cost, total cost, surgery time, days in hospital, incomplete cystolith removal, and number of doses of analgesic administered IV after surgery were compared between the laparoscopic-assisted cystotomy and open cystotomy groups. Results-Surgery cost and total cost were significantly higher in the laparoscopic-assisted cystotomy group. Hospitalization cost, days in hospital, and prevalence of incomplete cystolith removal did not differ significantly between groups. Number of doses of analgesic was significantly lower in the laparoscopic-assisted cystotomy group. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopic-assisted cystotomy was more time-consuming and expensive but associated with fewer postoperative doses of injectable analgesics, compared with open cystotomy. Laparoscopic-assisted cystotomy is an acceptable, more expensive, and minimally invasive alternative to open cystotomy for the removal of urinary cystoliths in dogs.

Biomechanical comparison of glycomer 631 and glycomer 631 knotless for use in canine incisional gastropexy.

OBJECTIVE To compare the load to failure of incisional gastropexy performed with standard glycomer 631 (G) and with knotless glycomer 631 (GV) in ex vivo model of gastropexy. STUDY DESIGN Cadaveric study. SAMPLE POPULATION Cadaveric canine stomach and body wall (n = 24). METHODS Specimens were divided into 4 groups based on suture type (G, GV) and size (3 metric, 2 metric). An incisional gastropexy was performed on all samples, and load to failure evaluated. RESULTS Gastropexy with GV had significantly higher load to failure than gastropexy performed with G (P = .0006). Suture size had no significant effect on maximum load to failure (P = .36). The interaction between size of the suture and suture materials had a significant effect on the load to failure of the gastropexy (P = .0474). Knotless glycomer 631, 3 metric had significantly greater load to failure than G 3 metric (P = .0016) and G 2 metric (P = .0107). CONCLUSION A knotless suture appears to have comparable, if not greater load to failure than a standard suture of similar composition when used in canine incisional gastropexy in an acute ex vivo model.Objective To compare the load to failure of incisional gastropexy performed with standard glycomer 631 (G) and with knotless glycomer 631 (GV) in ex vivo model of gastropexy. Study Design Cadaveric study. Sample Population Cadaveric canine stomach and body wall (n = 24). Methods Specimens were divided into 4 groups based on suture type (G, GV) and size (3 metric, 2 metric). An incisional gastropexy was performed on all samples, and load to failure evaluated. Results Gastropexy with GV had significantly higher load to failure than gastropexy performed with G (P = .0006). Suture size had no significant effect on maximum load to failure (P = .36). The interaction between size of the suture and suture materials had a significant effect on the load to failure of the gastropexy (P = .0474). Knotless glycomer 631, 3 metric had significantly greater load to failure than G 3 metric (P = .0016) and G 2 metric (P = .0107). Conclusion A knotless suture appears to have comparable, if not greater load to failure than a standard suture of similar composition when used in canine incisional gastropexy in an acute ex vivo model.

Outcome evaluation of a thoracoscopic pericardial window procedure or subtotal pericardectomy via thoracotomy for the treatment of pericardial effusion in dogs

OBJECTIVE To evaluate the disease-free interval (DFI) and median survival time (MST) in dogs with idiopathic and neoplastic pericardial effusion surgically treated by a thoracoscopic pericardial window procedure or subtotal pericardectomy via thoracotomy and to compare DFI and MST in dogs with and without a mass on preoperative echocardiography that underwent either surgical technique. DESIGN Retrospective cohort study. ANIMALS 58 dogs with pericardial effusion. PROCEDURES Medical records between 1985 and 2010 were evaluated. Dogs were included in the study if they had confirmed pericardial effusion and underwent a thoracoscopic pericardial window procedure or subtotal pericardectomy via thoracotomy. RESULTS Clinical signs of dogs at initial evaluation were similar, with the exception of lethargy, between dogs treated by subtotal pericardectomy via thoracotomy or the pericardial window procedure. Dogs with idiopathic pericardial effusion that underwent the thoracoscopic pericardial window procedure had significantly shorter DFI and MST than did those treated by subtotal pericardectomy via thoracotomy. For neoplastic pericardial effusion, DFI and MST were not significantly different between dogs treated with either surgical technique. CONCLUSIONS AND CLINICAL RELEVANCE Dogs with idiopathic pericardial effusion treated with a subtotal pericardectomy via thoracotomy had a significantly longer DFI and MST, compared with dogs treated by the thoracoscopic pericardial window procedure. This difference in outcome may be related to inaccuracy of the initial diagnosis or ineffectiveness of the pericardial window to palliate the signs of idiopathic pericardial effusion long term.

Thoracoscopic subtotal pericardiectomy and right atrial mass resection in a dog

CASE DESCRIPTION A 10-year-old spayed female Corgi mix was examined for a 3-week history of lethargy and weight gain. CLINICAL FINDINGS Physical examination findings included muffled heart sounds and a distended abdomen with a fluid wave on ballottement. Thoracic radiography revealed a globoid cardiac silhouette, and thoracic ultrasonography indicated pericardial effusion and a pedunculated mass originating from the right auricle. TREATMENT AND OUTCOME Initial treatment consisted of pericardiocentesis. One week later, thoracoscopic right atrial mass resection was performed. No surgical complications were noted, and the dog was discharged approximately 28 hours after surgery. Results of histologic examination of the mass indicated a grade 2 hemangiosarcoma with incomplete margins. Treatment with doxorubicin was initiated 35 days after surgery. The dog survived for 177 days after mass resection, when it was euthanized because of complications related to metastatic disease. CLINICAL RELEVANCE Findings suggested that thoracoscopic right atrial mass removal combined with adjunct doxorubicin treatment may be a viable alternative to thoracotomy in dogs with right atrial masses.

Efficacy of decontamination and sterilization of a single-use single-incision laparoscopic surgery port.

OBJECTIVE To determine the efficacy of decontamination and sterilization of a disposable port intended for use during single-incision laparoscopy. SAMPLE 5 material samples obtained from each of 3 laparoscopic surgery ports. PROCEDURES Ports were assigned to undergo decontamination and ethylene oxide sterilization without bacterial inoculation (negative control port), with bacterial inoculation (Staphylococcus aureus, Escherichia coli, and Mycobacterium fortuitum) and without decontamination and sterilization (positive control port), or with bacterial inoculation followed by decontamination and ethylene oxide sterilization (treated port). Each port underwent testing 5 times; during each time, a sample of the foam portion of each port was obtained and bacteriologic culture testing was performed. Bacteriologic culture scores were determined for each port sample. RESULTS None of the treated port samples had positive bacteriologic culture results. All 5 positive control port samples had positive bacteriologic culture results. One negative control port sample had positive bacteriologic culture results; a spore-forming Bacillus sp organism was cultured from that port sample, which was thought to be an environmental contaminant. Bacteriologic culture scores for the treated port samples were significantly lower than those for the positive control port samples. Bacteriologic culture scores for the treated port samples were not significantly different from those for negative control port samples. CONCLUSIONS AND CLINICAL RELEVANCE Results of this study indicated standard procedures for decontamination and sterilization of a single-use port intended for use during singleincision laparoscopic surgery were effective for elimination of inoculated bacteria. Reuse of this port may be safe for laparoscopic surgery of animals.

Evaluation of Video-Assisted Thoracic Surgery for Treatment of Spontaneous Pneumothorax and Pulmonary Bullae in Dogs

OBJECTIVE To describe the operative findings and clinical outcome in dogs undergoing video-assisted thoracic surgery (VATS) for treatment of spontaneous pneumothorax and pulmonary bullae. STUDY DESIGN Multi-institutional retrospective case series. ANIMALS Dogs (n = 12) with spontaneous pneumothorax and/or pulmonary bullae. METHODS Medical records (2008-2013) were reviewed for signalment, clinical signs, diagnostic imaging, surgical and histopathologic findings, and outcome in 12 dogs that had VATS for treatment of spontaneous pneumothorax and pulmonary bullae. In particular, conversion to median sternotomy and surgical success were evaluated. RESULTS Twelve dogs had initial VATS for spontaneous pneumothorax and/or pulmonary bullae. Conversion to median sternotomy because of inability to identify a parenchymal lesion/leak was necessary in 7 (58%) dogs. VATS without conversion to median sternotomy was performed in 6 (50%) dogs. Successful surgical outcomes occurred in 5 (83%) dogs that had conversion to median sternotomy, and in 3 (50%) dogs that had VATS without conversion to median sternotomy. CONCLUSIONS Exploratory thoracoscopy was associated with a high rate of conversion to median sternotomy because of inability to identify leaking pulmonary lesions in dogs with spontaneous pneumothorax and pulmonary bullae. Failure to convert to a median sternotomy may be associated with recurrent or persistent pneumothorax.

Single-port laparoscopic cryptorchidectomy in dogs and cats: 25 cases (2009-2014)

OBJECTIVE To describe the operative technique for single-port laparoscopic cryptorchidectomy (SPLC) in dogs and cats and evaluate clinical outcome for patients that underwent the procedure. DESIGN Retrospective case series. ANIMALS 25 client-owned dogs (n = 22) and cats (3). PROCEDURES Dogs and cats that underwent SPLC with 3 commercially available single-port devices between 2009 and 2014 were retrospectively identified through a multi-institutional medical records review. Surgery was performed via a single-port device placed through a 1.5- to 3.0-cm abdominal incision either at the region of the umbilicus or caudal to the right 13th rib. The cryptorchidectomy was performed with graspers, a bipolar vessel sealing device, and a 30° telescope. RESULTS SPLC was performed with a single-incision laparoscopic surgery port (n = 15), a multitrocar wound-retractor access system (8), or a metal resterilizable single-port access device (2). Median age was 365 days (range, 166 to 3,285 days). Median body weight was 18.9 kg (41.6 lb; range, 1.3 to 70 kg [2.9 to 154 lb]). Median surgical time was 38 minutes (range, 15 to 70 minutes). Thirty-two testes were removed (12 left, 6 right, and 7 bilateral). Four patients had 1 additional abdominal surgical procedure performed concurrently during SPLC. No intraoperative or postoperative complications were encountered. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that SPLC can be performed in a wide range of dogs and cats with cryptorchidism and can be combined with other elective laparoscopic surgical procedures. The SPLC technique was associated with a low morbidity rate and provided a potentially less invasive alternative to traditional open and multiport laparoscopic techniques.