Maurício Veloso Brun

Training for laparoendoscopic single-site surgery (LESS).

BACKGROUNDnLaparoendoscopic single-site surgery (LESS) is a laparoscopic surgery in which a single small incision is made, associated with the use of a special device (single-port), or several small incisions grouped in one location (single-incision) are made, through which the laparoscopic trocars are inserted. The incision is made in the abdomen, preferably in the umbilicus. Certain peculiarities are noted in this approach, such as the difficulty, and sometimes the impossibility, of centering the image, the need to move both the camera and instruments together, requiring even more delicate and precise movements than in laparoscopy. Since information on training for LESS is scarce in the current literature, the authors report their experience with five different cases of this nature, performed in two porcine models, and then discuss a training plan for LESS.nnnMETHODSnFive LESS procedures were performed in two pigs using different training techniques: two (one single-port and one single-incision) transumbilical laparoscopic cholecystectomies; one right-sided single-incision laparoscopic radical nephrectomy; one single-incision transumbilical laparoscopic radical nephrectomy; and one single-port transumbilical laparoscopic nephrectomy.nnnDISCUSSIONnDifferent from what was observed in the transition from open surgery to laparoscopy, the Halstedian model should not be used in the teaching of LESS since this procedure requires that professionals partner together, thus requiring not only the training of surgeons, but of the whole team.nnnCONCLUSIONnLESS procedures are feasible and considered as further refinements in laparoscopic techniques. However, the peculiarities and difficulties inherent in these procedures require a specific training program combining theory and practice. The authors believe that this training is essential to achieve proficiency levels before the technique can be tried on human subjects.

Laparoscopia nas hérnias diafragmáticas: estudo experimental em cães

The most common type of diaphragmatic hernia in dogs and cats is the traumatic one. As an anatomic alteration, surgery is the elected treatment. The purpose of this study was to evaluate videolaparoscopic surgery in the diagnostic and treatment of diaphragmatic hernia in dogs. In the first phase of the study diaphragmatic hernias were performed in dogs. One week later the dogs were summited to a laparoscopic surgery to make diagnostic and surgical correction. Laparoscopic access showed to be efficient for identification of the defect and visceral displacement and for the surgical treatment.The most common type of diaphragmatic hernia in dogs and cats is the traumatic one.As an anatomic alteration surgery is the elected treatment. The purpose of this study was to evaluate videothoracoscopic surgery in the diagnostic and treatment of diaphragmatic hernia in eight dogs. In the first phase of the study diaphragmatic hernias were performed in the dogs through laparoscopic access. One week later the dogs were summited to a thoracoscopic surgery to make diagnostic and surgical correction. Thoracoscopic access showed to be efficient for identification of the defects and visceral displacements and for the surgical treatment.

Ovariosalpingohisterectomia vídeo-assistida ou convencional em cadelas com o uso de Ligasure atlas

ABSTRACT In this study the authors compared two differentprocedures of ovariosalpingohysterectomy (OSH) in dogs. Forthat, 18 dogs were randomly assigned into 2 different groups:group I (GI) in which the OSH was performed by celiotomyand group II (GII) in which it was a video-assisted procedureusing two portals positioned in the umbilical and pre pubicregions, under dorsal recumbence position. In both groups themethod of hemostasis was the Ligasure Atlas ® . The authors didnot observe significant differences between both methods forthe surgical time or complications during and after the surgicalprocedure and blood loss. It was concluded that OSH usingvideo-assisted surgery with two portals and the conventionaltechnique, both using Ligasure Atlas ® are safe, fast and effectiveto be used in dogs. Key words : bipolar energy, laparoscopic assisted surgery,canine. INTRODUCAO A ovariosalpingohisterectomia (OSH) e umprocedimento cirurgico de elevada frequencia empequenos animais, sendo empregada no controlepopulacional ou para a prevencao e terapeutica dedoencas do sistema reprodutor (HEDLUND, 2005;MALM et al., 2004; GARGALLO et al., 2009). Entre asprincipais complicacoes decorrentes da OSH,indiferentemente do acesso cirurgico, destacam-se:hemorragia, estro recorrente, piometra de coto uterino,ligadura acidental de ureter, entre outras (SCHIOCHETet al

Laparoscopic cystotomy for urolith removal in dogs: three case reports

The use of laparoscopic surgery for the removal of cystic calculi in three dogs was reported. Three trocars were used, one in the ventral midline (10mm) and the others in the right (10mm) and left (5mm) flanks. The calculi were removed and the bladder was sutured with intracorporeal technique in two layers, a simple continuous pattern and interrupted or continuous Lembert pattern. No postoperative complications were observed. One patient had a recurrence of urolithiasis, attributed to inadequate conservative treatment and to the lack of an appropriate diet. It was submitted to another similar videolaparoscopic cystotomy without complication. The proposed technique is appropriate and an alternative to conventional cystotomy for treatment of canine vesical urolithiasis.

Colopexia incisional por celiotomia ou transparietal auxiliada por laparoscopia em cães

Two groups of dogs, GA (n=8) and GL (n=16) were used to compare the conventional and the transparietal laparsocopic assisted technique for colopexy and to compare with the conventional surgery. In the GA group, the colopexy was proceded by incisional technique trough celiotomy. In the GL group, the colopexy was performed using the transparietal laparoscopic assisted technique. The GL dogs were separated in four subgroups (S1, S2, S3 and S4) with four dogs each. In each subgroup a different stent was used, capton of infusion tube (S1); plastic disks made with NaCl solutions bottles (S2); disks made with rubber (S3) and silicone disks (S4). The time for complete surgery was statically higher in the GL group than GA. Seven GA dogs maintained the colopexy and all of these presented adherences of the omentum in the suture zone. In three GL animals, all of the S4 subgroup the colopexies were not maintained. In all dogs of this subgroup dermatitis and/or cellulites were observed. Best results were obtained in the S3 subgroup dogs. The main histological observations in the 14d-after surgery biopsies in GL animals were related to a higher connective tissue deposition at the colon adherence, and infiltration of this type of tissue into the associated musculature. In the 28d biopsies, no difference was found between groups. In both groups, the collagen fibers presented mature aspect. Concluding, the transparietal laparoscopic assisted technique is viable, however itx92s associated with tissue lesions in the regions in contact with the material used to support the suture. The rubber disk presented better results.

Solução hipersaturada de sal ou de glicerina a 98% como conservantes de centros frênicos caninos utilizados na reparação de defeitos musculares em ratos wistar

Aiming to evaluate the over saturated salt solution (1.5g commercially available salt in 1.5ml of tridestilled water) as tissue conservator of the canine frenic center and to compare its conservator potential with the well-established glycerin 98% conservator solution, peaces of this tissue were implanted to repair produced muscle lesions in 28 Wistar rats. Previously both solutions had been tested for bacterial and fungal contaminations, both exams with negative results. In each experimental animal, lesions were made in both Rectus abdominis muscles and repaired with the tissue preserved in both solutions. The animals were divided in seven groups and sacrificed in three, five, seven, 10, 15, 30 and 60 days after reparation for histological evaluation of the implanted region. In macroscopic exam the complete substitution of the implants by live tissue was observed, without rejection of the implanted tissue. In the microscopic evaluation we observed that the substitutions were made by fibrous conjunctive tissue deposition. At the end of the evaluation period, the implanted membranes were not present in repaired regions. In both conserved tissues there were not differences in tissue reactions. The over saturated salt, and 98% glycerin solutions presented similar results in the canine frenic center preservation indicating that both solutions may be utilized to preserve this membrane.

Lavado traqueobrônquico auxiliado por endoscópio rígido ou por tubo endotraqueal em cães

The present study aimed to evaluate the results of rigid endoscopy and endotracheal tube techniques for collecting tracheobronchic fluid from dogs. Twenty eight erratic or housed dogs, were allocated into to two groups. In group 1, tracheobronchic washing was applied to seven healthy dogs and seven dogs with clinical signs of respiratory disease. In group 2, seven healthy and seven dogs with respiratory disease were submitted to endo-bronchial washing by rigid endoscopy. Using rigid endoscopy, a lower volume was introduced but a higher percentage of washing fluid was recovered. There was no difference regarding the time necessary to perform both techniques. Bacterial counts were higher in samples collected by rigid endoscopy, but there was no difference in total nucleated cell counts from these samples. Thus, the use of rigid endoscopy to collect tracheobronchic fluid was found to be advantageous when compared to the conventional technique using endotracheal tube.

Colopexia laparoscópica com retalho de tela de polipropileno em cães

A new laparoscopic colopexy technique was tested in dogs without intracorporeal sutures. The use of polypropylene mesh in eleven mongrel dogs was evaluated. The serosal surface of the descendent colon and transverse abdominal muscle were put in contact with the mesh application, taking into consideration that the polypropylene implant was positioned through the mesocolon and under the muscle flap. Finally, the extremities of the mesh were clipped. The procedures lasted 36:00±13:15min, without any kind of complications. In the post-operative period, adequate colopexy in seven dogs was observed. In three dogs the colopexy was partial and in one the bowel did not adhere to the muscles or mesh. The proposed procedure is viable for dogs, however, it is necessary to make some adjustments.

Resistência à tração de colopexias incisionais realizadas por cirurgia laparoscópica ou celiotomia em cães

In the present study the traction resistance and histological features of incisional colopexys made by open or laparoscopic surgery were evaluated. For this purpose, 15 mongrel dogs were located in two groups. In the GL group (n= 8) the colopexy adhesion was made by a laparoscopic surgery, and in GA group (n= 7) by a celiotomy. For the laparoscopic procedures the dogs were positioned in dorsal decubitus and four trocars were introduced in the left and right position of umbilical region. The incisions produced in descendent colon and in the abdominal wall were sutured in two layers of intracorporeal suturing. In the GA group the colon suture was similar to the realized in GL group. Fourteen days after the surgeries the dogs were killed to collect samples of abdominal wall and colon descendent, which were used in resistance tests and in histological evaluations. The total surgery time and colon fixation time were higher in the GL group (p 0.05), and the rupture force in GL segments was 43.68±16.45N and in GA was 39.70±15.15N. No differences were found in histological examination between GL and GA groups, and in all dogs the fibers of collagen were mature. The results verified for the laparoscopic technique of colopexy, that presented surgical adhesions with similar quality of the provoked by a conventional technique, allow concluding that the laparoscopic procedure may be utilized as an alternative for rectal prolapse treatment in dogs.

Videolaparoscopia no diagnóstico e tratamento da síndrome do ovário remanescente em uma gata

Ovarian remnant syndrome (ORS) refers to the presence of functional ovarian tissue in a previously ovariohysterectomized animal. This report describes a case of remaining ovary syndrome in a cat that was submitted to ovariohysterectomy six months later. Three laparoscopic portals of 5mm were created in the abdominal walls (in the right and left lateral abdominal flank, and one in the ventral abdominal midline). It was observed the presence of one mass in the site of ovarians region. Both tissues were removed using Metzenbaum scissors and monopolar cauterization. The histological examination demonstrated ovarian tissue in the left carried by side. The post-operative time was uneventful. The treatment of ovarian remnant syndrome in a cat can be successfully performed by laparoscopic surgery.