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Gilman O, Moreira L, Dobromylskyj M, Doran I. A comparison of harmonic and traditional sharp staphylectomy techniques in 15 brachycephalic dogs. J Small Anim Pract 2023; 64:31-34. [PMID: 36178269 DOI: 10.1111/jsap.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/21/2022] [Accepted: 07/07/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The objective was to compare sharp staphylectomy and staphylectomy using harmonic focus shears, assess surgical time, intraoperative haemorrhage and outcome. Our hypothesis was that harmonic staphylectomy would result in reduced surgical time, decreased intraoperative haemorrhage and greater relative improvement. MATERIALS AND METHODS Dogs that were presented to Highcroft Veterinary Referrals between July 2020 and September 2021 with brachycephalic obstructive airway syndrome and underwent surgical correction were prospectively enrolled. Surgical technique was randomised, and surgical time, staphylectomy time, intraoperative haemorrhage, hospitalisation and change in patients' Cambridge BOAS Grade at a 14-day recheck were recorded. RESULTS Fifteen dogs were enrolled: seven dogs underwent sharp and eight underwent harmonic staphylectomy. Nine patients returned for follow-up, four of seven and five of eight, respectively. Harmonic staphylectomy was associated with less haemorrhage (0 versus 9 cotton buds) and a shorter average staphylectomy time (3 minutes 36 seconds versus 14 minutes 50 seconds). No statistically significant differences were observed in total surgery time, number of nights hospitalised, or change in Cambridge BOAS Grade. An average of 0.68 mm of thermal necrosis was seen at the cut edges of soft palates removed by harmonic staphylectomy. CLINICAL SIGNIFICANCE Harmonic staphylectomy can result in a reduction in staphylectomy time and degree of intraoperative haemorrhage compared to sharp staphylectomy, with no deleterious impact on postoperative recovery or the long-term outcome of patients.
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Affiliation(s)
- O Gilman
- Highcroft Veterinary Referrals, Bristol, BS14 9BE, UK
| | - L Moreira
- Willows Veterinary Centre and Referral Service, West Midlands, B90 4NH, UK
| | | | - I Doran
- Highcroft Veterinary Referrals, Bristol, BS14 9BE, UK
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Turkki OM, Bergman CE, Lee MH, Höglund OV. Complications of canine tonsillectomy by clamping technique combined with monopolar electrosurgery - a retrospective study of 39 cases. BMC Vet Res 2022; 18:242. [PMID: 35751056 PMCID: PMC9229076 DOI: 10.1186/s12917-022-03342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Canine tonsillectomy is performed due to acute or chronic tonsillitis, neoplasia, trauma or occasionally brachycephalic obstructive airway syndrome. Several tonsillectomy techniques are used but information about surgical complications is scarce. This retrospective study of patient records at the University Animal Hospital aimed to investigate complications related to canine tonsillectomy performed by 20-min clamping combined with monopolar electrosurgery. Inclusion criteria were bilateral tonsillectomy performed with “20-min clamping technique combined with monopolar electrosurgery without suture or ligation”. Exclusion criteria were unilateral tonsillectomy, tonsillar neoplasia, additional surgical procedures other than tonsillectomy, cases where sutures were used initially, and cases where unspecified or other methods of tonsillectomy were used. The search of the patient records of the University Animal Hospital included a 10-year period. Complications that required additional anaesthesia were defined as major complications. Minor complications were handled during surgery or after surgery without surgical intervention. Results Of 39 dogs that fulfilled the inclusion criteria, 11 dogs had complications and out of those 1 dog had two complications. Altogether, of the 12 complications, 2 were classified as major complications and 10 as minor. The most frequent complication was bleeding from the surgical site, in total 11 incidences; 10 dogs had an incidence of bleeding and out of those, 1 dog bled twice, both during and after surgery. Of these 10 dogs that bled, seven incidences of bleeding occurred during surgery and four incidences occurred after surgery. The two dogs with major complications were re-anaesthetized due to bleeding after surgery. No lethal complications occurred and all dogs survived to discharge. Conclusions Bleeding during and after surgery was a common complication in dogs after bilateral tonsillectomy using “20-min clamping technique combined with monopolar electrocautery”. Revision intervention was often needed, sometimes urgently. Although no comparison was made with another technique, the studied technique should be used with caution.
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Affiliation(s)
- Outi Marita Turkki
- AniCura Small Animal Hospital Bagarmossen, Ljusnevägen 17, SE 128 48 , Bagarmossen, Sweden.
| | - Caroline Elisabeth Bergman
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Box 7054, 750 07, Uppsala, Sweden
| | - Marcel H Lee
- Evidensia Södra Djursjukhuset Kungens Kurva, Månskärsvägen 13, Kungens Kurva, 141 75, Huddinge, Sweden
| | - Odd Viking Höglund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Box 7054, 750 07, Uppsala, Sweden
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Brachycephalic Obstructive Airway Syndrome. Vet Clin North Am Small Anim Pract 2022; 52:749-780. [DOI: 10.1016/j.cvsm.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Phillips H. Updates in Upper Respiratory Surgery. Vet Clin North Am Small Anim Pract 2022; 52:339-368. [DOI: 10.1016/j.cvsm.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gabriel L, Aryazand Y, Buote N. Respiratory obstruction due to tonsillar lymphoglandular polyp in a brachycephalic dog: a case report. BMC Vet Res 2021; 17:372. [PMID: 34863171 PMCID: PMC8642999 DOI: 10.1186/s12917-021-03082-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory distress is one of the most common afflictions of brachycephalic dogs. Dogs in respiratory distress usually present to the emergency service with a constellation of clinical signs including but not limited to: stertorous breathing, dyspnea, gagging, cyanotic mucus membranes, hyperthermia, and commonly a history of gastrointestinal signs. While Brachycephalic Obstructive Airway Syndrome is the most common cause of respiratory distress in dogs with brachycephalic conformation, any condition eliciting an inflammatory response in the oropharynx, can result in obstruction. There is no previous report of respiratory obstruction leading to emergency tonsillectomy caused by tonsillar polyps. CASE PRESENTATION A 9-month-old male intact English bulldog presented to the emergency service in severe respiratory distress. Due to continued severe dyspnea and cyanosis the patient was induced with propofol (Propofol, Hospira) 4 mg/kg intravenously titrated to effect and tracheal intubation performed. Intubation was noted to be difficult due the presence of two, large, inflamed masses in the oropharynx region. The remainder of his physical exam was unremarkable. Minimum database blood work and chest radiographs revealed only minor abnormalities. The patient was placed under anesthesia and the masses were transected sharply using a carbon dioxide (CO2) laser (Aesculight, Bothell, WA, USA). Anesthesia and recovery were uneventful, and the patient was discharged the following day. Histopathology results of the masses revealed them to be benign lymphoglandular polyps. CONCLUSIONS This is the first report of bilateral tonsillar polyps causing life-threatening respiratory obstruction in a dog. Both masses were excised safely and completely with the CO2 laser. Difficulties inherent to oropharyngeal surgery include the hemorrhage, small working space, tissue swelling and difficult visualization. Surgical excision of these polyps alleviated all emergent and chronic clinical signs, and the patient's remains healthy 12-months post-treatment.
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Affiliation(s)
- Leah Gabriel
- VCA West Los Angeles Animal Hospital, Surgery Department, Los Angeles, California, USA
| | - Yazdan Aryazand
- VCA West Los Angeles Animal Hospital, Surgery Department, Los Angeles, California, USA
| | - Nicole Buote
- Cornell University College of Veterinary Medicine, Small Animal Surgery Department, 930 Campus Road, Ithaca, NY, 14853, USA.
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Köhler C, Fromme V, Kohl S, Winter K, Weidauer J, Kiefer I. 3T MRI characteristics of the palatine tonsil in brachycephalic dogs. Vet Rec 2021; 190:e1077. [PMID: 34750822 DOI: 10.1002/vetr.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 09/21/2021] [Accepted: 10/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Investigation of the MRI characteristics of the palatine tonsil in brachycephalic dogs in 3T high-field system. MATERIAL AND METHODS Eighty-five brachycephalic dogs and 37 normocephalic dogs were divided into five groups: group 1 French bulldogs (FBs) with neurological clinical signs (n = 37), group 2 FBs with brachycephalic obstructive airway syndrome (BOAS) (n = 22), group 3 pugs with neurological clinical signs (n = 17), group 4 pugs with BOAS (n = 9) and group 5 normocephalic dogs (n = 37). Cross-sectional area and volume measurements were performed, and tonsillar margination and contour, shape, signal intensity and homogeneity/heterogeneity of the palatine tonsils were evaluated and compared. RESULTS Cross-sectional area and volume measurements of the tonsils showed no significant differences between brachycephalic and normocephalic dogs with the exception of the dogs of group 2 (FB BOAS), which showed relatively high volume and large cross-sectional area in comparison to other groups. In 87% of the brachycephalic animals, the tonsils were well defined. A smooth contour was detectable in 91.8% and a rounded shape in 94.7% of brachycephalic dogs. Signal intensity was assessed as hyperintense in relation to the musculature and iso- to hyperintense to the soft palate. Heterogeneous appearance was described in 86.9% of the brachycephalic animals. CONCLUSIONS The MRI characteristics of the tonsils of brachycephalic dogs do not differ considerably from those of normocephalic dogs. In FBs with distinct clinical signs of obstructive airway syndrome, increase in cross-sectional area and volume of the tonsils was detected.
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Affiliation(s)
- Claudia Köhler
- Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
| | - Vivian Fromme
- Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
| | - Stefan Kohl
- Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Jenny Weidauer
- Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
| | - Ingmar Kiefer
- Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
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Chu KL, Duffy DJ, Vieson MD, Moore GE. Ex vivo comparison of leakage pressures and leakage location with a novel technique for creation of functional side-to-side canine small intestinal anastomoses. Vet Surg 2020; 49:1024-1034. [PMID: 32255208 DOI: 10.1111/vsu.13408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/08/2019] [Accepted: 05/19/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the ability of functional side-to-side small intestinal anastomoses (FSS-SIA) created with an electrothermal bipolar vessel sealing (EBVS) device to resist leakage. STUDY DESIGN Experimental, ex vivo. SAMPLE POPULATION Jejunal segments (n = 130) from 10 healthy canine cadavers. METHODS Four types of anastomoses were created (two segments/construct and 15 constructs/group): EBVS (group A), EBVS + transverse stapling (group B), stapled (group C), and EBVS + suture augmentation (group D). Initial leakage pressure (ILP), initial leakage location (ILL), and maximal intraluminal pressure were compared between groups, and five group A constructs were analyzed histologically. RESULTS Initial leakage pressure was greater in group D than in groups A, B, and C (P < .011). There was a difference in ILL among groups (P = .003). Leakage occurred at the side-to-side intestinal anastomosis fusion line in 13 of 15 (87%) constructs for groups A and B and in nine of 15 (60%) constructs for group D. Maximal intraluminal pressure was greater in group C than in groups A, B, and D (P < .004). Histological examination was consistent with collagenous fusion without cavitation defects. CONCLUSION Functional side-to-side small intestinal anastomosis was consistently achieved with an EBVS device. Augmentation of EBVS anastomoses with simple interrupted sutures along the anastomotic fusion line increased ILP compared with stapled anastomoses. CLINICAL SIGNIFICANCE Despite the success and feasibility of creating an FSS-SIA with an EBVS device, additional in vivo studies are required to determine the effectiveness of intestinal fusion prior to clinical implementation.
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Affiliation(s)
- Kyle L Chu
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Miranda D Vieson
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
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Chassang L, Bismuth C. Technological Advances in Surgical Equipment in Exotic Pet Medicine. Vet Clin North Am Exot Anim Pract 2019; 22:471-487. [PMID: 31395326 DOI: 10.1016/j.cvex.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgery can be challenging in exotic pets owing to their small size and blood volume, and their increased anesthetic risk compared with small animals. Various devices are available to facilitate suturing, cutting, and hemostasis in the human and veterinary fields. These surgical equipment improve the simplicity, rapidity, and effectiveness of surgery. Vessel-sealing devices, radiosurgery, lasers, and ultrasound devices are commonly used because of their ease of use and increase in surgical efficiency. Other surgical devices are available (eg, stapling devices) but are not discussed in this article.
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Affiliation(s)
- Lucile Chassang
- Service NAC, CHV Fregis, 43 Avenue Aristide Briand, 94110 Arcueil, France.
| | - Camille Bismuth
- Service de Chirurgie, CHV Fregis, 43 Avenue Aristide Briand, 94110 Arcueil, France
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Valenzano D, Hayes G, Gludish D, Weese S. Performance and microbiological safety testing after multiple use cycles and hydrogen peroxide sterilization of a 5-mm vessel-sealing device. Vet Surg 2019; 48:885-889. [PMID: 30882923 DOI: 10.1111/vsu.13191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/10/2019] [Accepted: 02/26/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the functional and microbiological safety of a single-use laparoscopic vessel-sealing device in a multiuse setting. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Twelve 5-mm LigaSure Maryland jaw devices. METHODS Handsets underwent repeated test cycles until failure. The handset packaging was opened, and handsets were agitated in phosphate-buffered saline (PBS). The PBS was removed, centrifuged, and submitted for culture. Canine ovariectomy was simulated on cadaveric tissue, after which vascular seal quality was evaluated by pressure testing of sealed porcine carotid arteries. The handsets were cleaned and sterilized with hydrogen peroxide gas and repackaged. RESULTS Mean ± SD cycles to failure was 7.7 ± 2.8, with a minimum of 4 and a maximum of 12 use cycles achieved. Eleven of the 12 handsets failed by failure of handset activation after depression of the activation trigger. Only 1 handset failed to hold an adequate vascular seal under 300 mm Hg of pressure. No handset exhibited positive bacterial culture at any cycle. CONCLUSION The sterilization method used in this study resulted in an excellent microbiological safety profile. Most of the handsets failed by activation button failure. CLINICAL SIGNIFICANCE Under the conditions of this study, hydrogen peroxide sterilization achieved microbiological safety. Handsets can successfully be reused until activation button failure without negative effects on the vascular seal or increased risk of infection to the patient.
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Affiliation(s)
- D Valenzano
- Department of Clinical Studies, Cornell University, Ithaca, New York
| | - G Hayes
- Department of Clinical Studies, Cornell University, Ithaca, New York
| | - D Gludish
- Department of Clinical Studies, Cornell University, Ithaca, New York
| | - S Weese
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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