Influence of a single locking throw on the in vitro holding security of five friction throws

OBJECTIVE

To compare the in vitro security of four different friction throws (square, surgeon's, Miller's, and strangle), with and without a locking throw, and a slip knot, on a vascular ligation model.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Nine groups with nine samples per group.

METHODS

Four throws (square, surgeon's, Miller's, and strangle), with and without a locking throw, and a square throw locked in slip knot fashion, were tested to measure leakage pressure.

RESULTS

The square and surgeon's throws leaked at a lower pressure than the Miller's and strangle throws (p < .0001). The leakage pressure was below physiologic arterial pressure for the square and the surgeon's throws. After the addition of a locking throw, the five knots leaked at a similar pressure (p = .5233) above physiologic arterial pressure.

CONCLUSION

Following the addition of a locking throw, all the constructs tested in this study leaked at a similar pressure. The leakage pressure for all knots exceeded physiologic arterial pressures.

CLINICAL SIGNIFICANCE

Any throw tested may be appropriate for secure vascular ligation if the initial throw is applied correctly.

Comparison of Hemorrhagic Complications with Double-ligated versus Auto-ligated Feline Ovarian Pedicles by Fourth-Year Veterinary Students

The objective of this article is to compare the occurrence of hemorrhagic complications in student-performed feline ovarian pedicle ligations using the traditional suture pedicle double-ligation (PDL) to the suture-less auto-ligation (AL) techniques, and to describe the stepwise method of teaching the AL technique to students. A total of 287 cats underwent an ovariohysterectomy (OHE) performed by a fourth-year veterinary student trained by veterinary faculty to perform the AL technique beginning with a low-fidelity model and progressing to live patient surgeries. Students performed the AL and PDL techniques on 146 and 141 cats respectively. Hemorrhagic complications occurred in 4 of 146 cats (2.7%) in the AL group and 8 of 141 (5.7%) in the PDL group and were not found to be significantly different (p = 0.2496). This article demonstrates that novice surgeons can safely perform the AL technique on feline ovarian pedicles without significantly increasing complications compared to the traditionally taught method when a stepwise training program is implemented. Additionally, this technique has been shown to be safe, effective, and more efficient when performed by experienced veterinary surgeons.¹ Veterinary institutions should consider including the AL technique in their core curricula as a standard method for feline ovarian pedicle ligation. Doing so will facilitate the development of more proficient entry-level practitioners who are better able to serve their patients, clients, employers, humane societies, and their communities by using a more efficient and safe feline ovariohysterectomy technique.

Colored ligature: Trivial but innovative modification

Background

Vascular ligation and its detachment remain a necessary skill for a surgeon. We often use two threads of the same color to ligate a vessel. However, some problems (grasping the mixed-up threads and/or difficulty in releasing the entanglement) may occur while using same colored ligatures. To solve these problems, we devised to use ligatures of different colors, and here, we present this ingenious idea.

Methods

When a vessel is encountered that needs to be cut, we pass two different colored threads behind it.

Results

We can grasp the two threads without mixing them up. In addition, in case of entanglement, unwinding of the entangled threads is quicker. We then finally tie a knot with these threads and cut the vessel visible between them.

Conclusion

Using different colored ligatures enhance surgical convenience in the operating room.

Retention of basic suturing skills with brief or extended practice in veterinary students

OBJECTIVE

To evaluate the effect of practice duration on accuracy, retention, and confidence when learning how to tie basic surgical knots.

STUDY DESIGN

Prospective study.

SAMPLE POPULATION

Fifteen first-year veterinary students.

METHODS

Students were randomly assigned to a 2-week practice (TWP) or an 8-week practice (EWP) to learn how to tie surgeon's, strangle, and miller's knots. Students' knot-tying accuracy and confidence were evaluated immediately after training, at an intermediate time point (2-6 weeks postpractice), and at 12 weeks postpractice.

RESULTS

Students who had been trained during an extended period tied the strangle knot correctly more often at all assessments (P = .025). The ability of students trained for 2 weeks to tie the strangle knot correctly decreased over time (P = .028). These students lost some confidence (P = .03) and repositioned suture more frequently (P = .03) while constructing the strangle knot at the final time point compared with students trained for 8 weeks. Students who completed TWP felt more confident at placing surgeon's knots than friction knots at the final assessment period (P = .0164 miller's knot, P = .0056 strangle knot), whereas confidence did not differ between knot types for students who completed EWP. All students felt less confident with their knot-tying skills at 12 weeks postpractice.

CONCLUSION

Training for 8 weeks rather than for 2 weeks resulted in superior knot tying skills. Students' confidence decreased 12 weeks after training.

CLINICAL SIGNIFICANCE

Prolonged distributed practice is recommended to train students for more complex tasks such as placement of a strangle knot.

High-quality, high-volume spay-neuter: Access to care and the challenge to private practitioners

IMPACT

Low-cost spay-neuter clinics were first established nearly 50 years ago in response to the numbers of dogs and cats euthanized in animal shelters. Since then, high-quality, high-volume spay-neuter (HQHVSN) clinics have been established throughout the USA and have contributed to a significant reduction in animal euthanasia in shelters. These clinics, specializing in efficient systems and surgical techniques, provide an avenue for clients who cannot afford surgery to sterilize their pets. These clinics have also helped animal shelters with limited financial resources implement spay-neuter prior to adoption policies.

RESPONSE

The veterinary profession's reaction to HQHVSN clinics has been mixed; some practitioners question the quality of care provided or fear the loss of clientele, while others recognize the need for such clinics and support their development.

CHALLENGES

As veterinary education has become more expensive and veterinary care more sophisticated, the cost of veterinary care, including spay-neuter surgery, has risen. With increasing costs, the numbers of pets that receive little or no veterinary care has increased. Indeed, a 2018 survey by the Access to Veterinary Care Coalition documented that more than 25% of pet-owning households in the USA experienced difficulties obtaining veterinary care for their pets and the most frequent barrier was financial.

AIM

This review looks at the reality of HQHVSN clinics and what this means for the private practitioner. By adopting similar systems and techniques that lower the cost of spay-neuter surgery, practitioners could potentially pass on cost savings to clients. Moreover, the same principles may be applied to other aspects of basic care to further address access to care issues.