Jeffrey J. Runge

Evaluation of single port access gastropexy and ovariectomy using articulating instruments and angled telescopes in dogs

OBJECTIVE To describe in dogs, a technique for single port access gastropexy and ovariectomy (SPAGO) using a commercially available multitrocar port and to evaluate short-term outcome. DESIGN Retrospective case series. ANIMALS Dogs (n = 18). PROCEDURES A commercially available multitrocar port was inserted into the abdomen lateral to the rectus abdominis muscle and 2-5 cm caudal to the right rib. Dogs were tilted 45° in both left and right recumbency and bilateral ovariectomy performed using articulating graspers, a bipolar vessel sealing device and a 30° telescope. The laparoscopic assisted incisional gastropexy was performed after ovariectomy at the multitrocar port insertion site by grasping the antral portion of the stomach with a 10 mm DuVall forceps and suturing the seromuscular layer of the antral region of the stomach to the transversus abdominis muscle. RESULTS Eighteen dogs (median weight, 34.5 kg; range, 14.7-59.2 kg) met the inclusion criteria. Median surgical time for SPAGO was 65 minutes (range, 50-225 minutes). Intra-operative complications included, incorrect multitrocar port placement location (n = 3) and mild hemorrhage from a splenic laceration (1) All dogs recovered from surgery and were discharged from the hospital. CONCLUSIONS Single port access gastropexy and ovariectomy is a feasible procedure to provide prophylaxis against gastric dilation-volvulus and a simultaneous means of sterilization in female dogs. Careful and accurate initial multitrocar port insertion is necessary to have optimal operative viewing as well as to reduce the chances of inadvertent splenic laceration.

Transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi in dogs and cats: 27 cases (2006–2008)

OBJECTIVE To describe the use of transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi and to report the outcome in dogs and cats. DESIGN Retrospective case series. ANIMALS 23 dogs and 4 cats. PROCEDURES Medical records were reviewed for signalment, procedure time, stone number, stone location, pre- and postoperative radiographs, procedure-associated complications, and short-term outcome. A ventral midline approach was made into the abdomen over the urinary bladder apex. A screw cannula was inserted at the bladder apex for normograde rigid and flexible cystourethroscopy. All uroliths were removed via a stone basket device and retrograde flushing and suction. Long-term follow-up (1 year after surgery) information was obtained by telephone or e-mail contact with owners. RESULTS 27 animals with cystic and urethral calculi were included. Median patient weight was 8.3 kg (18.3 lb; range, 1.8 to 42.6 kg [4.0 to 93.7 lb]). Urolith number ranged from 1 to > 35 (median, 7). Urolith size ranged from < 1 to 30 mm (median, 4.5 mm). Fifteen of the 27 animals had a previous cystotomy (range, 1 to 5 procedures). Median procedure time was 66 minutes (range, 50 to 80 minutes). All patients were discharged within 24 hours. No postoperative complications were reported at the time of suture removal. At the time of long-term follow-up, the 22 clients that could be contacted were satisfied with the procedure. CONCLUSIONS AND CLINICAL RELEVANCE Transvesicular percutaneous cystolithotomy may decrease the need for urethrotomy, serial transurethral endoscopic procedures, and abdominal insufflation associated with other minimally invasive interventions currently available. This procedure also provided excellent visualization for bladder and urethral luminal inspection.

Occlusive thrombi arise in mammals but not birds in response to arterial injury: evolutionary insight into human cardiovascular disease

Mammalian platelets are small, anuclear circulating cells that form tightly adherent, shear-resistant thrombi to prevent blood loss after vessel injury. Platelet thrombi that form in coronary and carotid arteries also underlie common vascular diseases such as myocardial infarction and stroke and are the target of drugs used to treat these diseases. Birds have high-pressure cardiovascular systems like mammals but generate nucleated thrombocytes rather than platelets. Here, we show that avian thrombocytes respond to many of the same activating stimuli as mammalian platelets but are unable to form shear-resistant aggregates ex vivo. Avian thrombocytes are larger than mammalian platelets, spread less efficiently on collagen, and express much lower levels of the α(₂b)β₃ integrin required for aggregate formation, features predicted to make thrombocyte aggregates less resistant than platelets are to the high fluid shear forces of the arterial vasculature. In vivo carotid vessel injury stimulates the formation of occlusive platelet thrombi in mice but not in the size- and flow-matched carotid artery of the Australian budgerigar. These studies indicate that unique physical and molecular features of mammalian platelets enable them to form shear-resistant arterial thrombi, an essential element in the pathogenesis of human cardiovascular diseases.

Evaluation of Laparoscopic‐Assisted Ovariohysterectomy for Treatment of Canine Pyometra

OBJECTIVE To describe a technique for treating pyometra in dogs using a 3-portal laparoscopic-assisted ovariohysterectomy (LAOVH) and evaluate outcome. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n = 12). METHODS Dogs with open or closed-cervix pyometra with moderately sized (1-4 cm) uterine horn diameters based on preoperative ultrasonography and no evidence of perforation were included in the study. A 3-portal technique for LAOVH was used. A wound retraction device was inserted into the caudal portal after enlargement of the incision to 3-4 cm to simplify removal of the uterus with minimal tension. RESULTS Twelve dogs (median weight, 23.3 kg; range, 2.1-46.0 kg) met the inclusion criteria. Median uterine diameter was 3.0 cm (range, 1.2-4.0 cm). Median surgical time for LAOVH was 107 minutes (range, 82-120 minutes). Complications included mild hemorrhage from the uterine vessels in 1 dog during uterine removal through the wound retraction device and intra-abdominal uterine rupture in 1 dog which necessitated conversion to an open approach. All dogs recovered from surgery and were discharged. CONCLUSIONS LAOVH can be used for treatment of select cases of canine pyometra. Careful case selection is mandatory to improve success and minimize conversion to an open approach. Gentle handling of the reproductive organs is imperative to avoid iatrogenic uterine rupture.

Evaluation of the learning curve for a board-certified veterinary surgeon performing laparoendoscopic single-site ovariectomy in dogs

OBJECTIVE To define the learning curve and evaluate the outcome for a board-certified veterinary surgeon performing laparoendoscopic single-site (LESS) ovariectomy in dogs. DESIGN Retrospective case review and learning curve evaluation with a skill acquisition model. Animals-27 client-owned dogs. Procedures-Between April 2011 and December 2012, 27 dogs underwent elective LESS ovariectomy performed by a single experienced board-certified laparoscopic surgeon by means of the same technique. Medical records for these patients were reviewed to determine whether a learning curve could be detected. A commercially available multitrocar port was inserted through a 15- to 20-mm incision at the umbilicus, and LESS ovariectomy was performed with articulating graspers, a bipolar vessel-sealing device, and a 30° telescope. Surgical performance of the surgeon was quantified with an exponential skill acquisition model, and how skill was gained with repetition of the same novel surgical procedure was examined. RESULTS Median patient body weight was 20 kg (44 lb; range, 3.5 to 41 kg [7.7 to 90.2 lb]). Median surgical time was 35 minutes (range, 20 to 80 minutes). Median patient age was 314 days (range, 176 to 2,913 days). The skill acquisition model revealed that a comparable surgeon could reach 90% of optimal surgery performance after approximately 8 procedures (8.6, 95% confidence interval, 0.5 to 16.6 procedures). According to the model, with each surgery, surgical time would be expected to decrease by 27% (95% confidence interval, 2% to 52%). Complications were limited to minor hemorrhage due to a splenic laceration and a postoperative incisional infection. Follow-up information was available for all 27 cases. All owners were satisfied and indicated that they would pursue LESS ovariectomy again. CONCLUSIONS AND CLINICAL RELEVANCE The learning curve for LESS ovariectomy was short and definable. Short-term outcome was excellent. Results of this study suggested that an experienced laparoscopic surgeon may anticipate achieving proficiency with this technique after performing approximately 8 procedures.

Evaluation of coagulation in dogs with partial or complete extrahepatic biliary tract obstruction by means of thromboelastography

OBJECTIVE To characterize in vitro coagulation status in a cohort of dogs with extrahepatic biliary tract obstruction (EHBO) and to evaluate these patients for hypercoagulability by means of thromboelastography. DESIGN Prospective cohort study. Animals-10 dogs with EHBO and 19 healthy control dogs. PROCEDURES Partial or complete EHBO was confirmed via exploratory celiotomy. Venous blood samples were collected for evaluation of prothrombin time (PT) and activated partial thromboplastin time (APTT); fibrinogen and D-dimer concentrations; protein C and antithrombin activities; and factor VII, VIII, and XI coagulant activities in plasma as well as thromboelastography in whole blood. Thromboelastography variables were measured from the thromboelastography tracing, and a coagulation index was calculated. Thromboelastography results were compared with those of healthy control dogs previously evaluated by the same laboratory. RESULTS Hypercoagulability was diagnosed in all dogs with EHBO on the basis of a high coagulation index. Thromboelastography variables, including maximal amplitude, α-angle, and coagulation index, were significantly higher, and K (clot formation time) and R (reaction time) were significantly lower in these dogs than in control dogs. All dogs with EHBO had PT and APTT within respective reference ranges. Plasma D-dimer and fibrinogen concentrations were above reference ranges in 8 and 7 dogs, respectively, and protein C and antithrombin activities were below reference ranges in 3 and 1 dogs, respectively. CONCLUSIONS AND CLINICAL RELEVANCE In vitro hypercoagulability was commonly detected in dogs with naturally occurring EHBO. The traditional view of EHBO as a disease that causes hypocoagulability may need to be reconsidered.

Evaluation of risk factors for morbidity and mortality after pylorectomy and gastroduodenostomy in dogs.

OBJECTIVES To (1) identify and describe the type and frequency of postoperative complications after pylorectomy and gastroduodenostomy in dogs and (2) identify preoperative and intraoperative risk factors, including the presence of neoplasia, prognostic for patient mortality after surgery. STUDY DESIGN Case series. ANIMALS Dogs (n=24) treated by pylorectomy and gastroduodenostomy. METHODS Medical records (2000-2007) for 2 teaching hospitals of dogs treated that had pylorectomy and gastroduodenostomy were reviewed. Pre-, intra-, and postoperative data were obtained from the medical record. RESULTS Of the 24 dogs, 75% survived 14 days, but 10 (41%) died by 3 months. Overall median survival time (MST) was 578 days. On log-rank univariate analysis, preoperative weight loss (P=.001) and malignant neoplasia (P=.01) were associated with decreased survival time. Dogs with malignant neoplasia had a MST of 33 days. Common postoperative morbidity included hypoalbuminemia (62.5%) and anemia (58.3%). CONCLUSIONS Pylorectomy with gastroduodenostomy has a good short-term outcome but long-term survival time is poor in dogs with malignant neoplasia. CLINICAL RELEVANCE Overall, most dogs treated with pylorectomy and gastroduodenostomy survived the postoperative period; however, preoperative weight loss and malignant neoplasia were associated with decreased survival time. Because dogs with malignant neoplasia have markedly shortened survival times, pertinent preoperative, diagnostics steps should be exhausted to identify underlying neoplasia.

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.

Intraoperative near-infrared fluorescence imaging targeting folate receptors identifies lung cancer in a large-animal model

Complete tumor resection is the most important predictor of patient survival with non–small cell lung cancer. Methods for intraoperative margin assessment after lung cancer excision are lacking. This study evaluated near‐infrared (NIR) intraoperative imaging with a folate‐targeted molecular contrast agent (OTL0038) for the localization of primary lung adenocarcinomas, lymph node sampling, and margin assessment.

Laparoscopic treatment of ovarian remnant syndrome in dogs and cats: 7 cases (2010–2013)

OBJECTIVE To describe the technique and evaluate the outcome of laparoscopic treatment of ovarian remnant syndrome (ORS) in dogs and cats. DESIGN Retrospective case series. ANIMALS 7 client-owned dogs and cats. PROCEDURES Medical records of dogs and cats with ORS that were treated laparoscopically at 3 large veterinary teaching hospitals were reviewed. Laparoscopic ovarian remnant resection was performed by means of either a 3-port or single-port technique with the patient in dorsal recumbency. The area caudal to both kidneys was thoroughly inspected for evidence of ovarian tissue by tilting the patient laterally. Any ovarian remnant tissue in these areas was resected with a bipolar vessel sealer. RESULTS 5 female dogs and 2 female cats that had previously undergone ovariectomy or ovariohysterectomy were included in the study. Six procedures were performed with a standard 3-port technique, and 1 was performed with a single-port technique. Median surgery time was 90 minutes (range, 50 to 150 minutes). No patient required conversion to laparotomy. Six of the 7 patients had complete resolution of clinical signs after surgery. One patient underwent laparotomy 7 weeks after surgery for management of stump pyometra, but no further ovarian tissue was detected. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopic management of ORS in this cohort of dogs and cats was associated with minimal morbidity. Laparoscopic treatment of ORS in dogs and cats may be recommended for appropriately selected patients.