Prospective, randomized, clinical trial on the effects of laparoscopic insufflation pressures on portal pressures in dogs

OBJECTIVE

The adverse effects of intra-abdominal pressure from capnoperitoneum on cardiovascular and pulmonary systems have been well documented, but the effects on portal pressures in dogs with various insufflation pressures is poorly defined. The aim of the present study was to measure the effect of a range of insufflation pressures on the portal pressure, using direct pressure measurements in patients undergoing laparoscopy.

STUDY DESIGN

Clinical randomized prospective study.

ANIMALS

Nine client-owned dogs undergoing routine laparoscopy.

METHODS

Two rounds of direct portal pressure assessments were performed, at insufflation pressures of 0, 6, 10, and 14 mmHg in a predetermined randomized sequence. The data were analyzed for effects of insufflation pressure, hemodynamic alterations, and round. A best-fit exponential model of the relationship between portal pressure and insufflation pressure was created.

RESULTS

Portal pressure increased by 38% at 6 mmHg, 95% at 10 mmHg, and 175% at 14 mmHg compared to baseline. Portal pressure increased at an average rate of 7.45% per mmHg of insufflation pressure. Effects of weight, weight/insufflation pressure interaction, and round of insufflation were not statistically significant. No systemic hemodynamic adverse events were observed.

CONCLUSION

Portal pressure increased as insufflation pressure increased. There was no clinically significant difference in baseline portal pressure between rounds of insufflation.

CLINICAL SIGNIFICANCE

This exponential model of portal pressure supports the use of the minimum insufflation pressure to allow visualization during laparoscopy. The return of portal pressure to baseline following desufflation supports the comparison of portal pressure measurements before and after laparoscopic shunt attenuation.

Laparoscopic vs. open adrenalectomy: perioperative data and survival analysis in 70 dogs with an adrenal tumor

Adrenalectomy is the treatment of choice in case of functional adrenal tumors and malignant adrenal incidentalomas. Laparoscopic adrenalectomy (LA) in dogs has gained popularity in recent years, however, clinical studies on large patient populations are scarce. This retrospective study describes perioperative and recurrence data, survival, and prognostic factors in 70 dogs that underwent LA or open adrenalectomy (OA) in our hospital between 2008 and 2022. Diagnosis was based on history, clinical signs, endocrine function tests and advanced diagnostic imaging. Laparoscopic adrenalectomy was performed in 42 dogs (n = 27 naturally occurring hypercortisolism, n = 4 pheochromocytoma, n = 1 pheochromocytoma with concurrent hypercortisolism, n = 10 incidentaloma) and OA in 28 dogs (n = 22 hypercortisolism, n = 3 pheochromocytoma, n = 3 incidentaloma). Bilateral adrenalectomy was performed in 8/70 dogs. Surgical duration of LA and OA did not differ significantly in unilateral and bilateral procedures (P = 0.108 and P = 0.101, respectively). Systemic hypertension occurred in 7/41 and 1/28 dogs during LA and OA, respectively (P = 0.130). Hypotension occurred in 2/41 and 4/28 dogs during LA and OA, respectively (P = 0.214). A total of 40/42 dogs in the LA group and 27/28 in the OA group survived to discharge (P = 0.810). Mean hospital stay was significantly shorter (P = 0.006) after LA (1.5 days, range 1-3) than after OA (2.2 days, range 1-4). No significant differences were demonstrated between LA and OA groups in recurrence of adrenal-dependent endocrine disease (P = 0.332), disease-free period (P = 0.733) and survival time (P = 0.353). The disease-specific 1-, 2- and 3-year survival rates were 95, 89, and 89% after LA and 92, 88, and 81% after OA. Tumor size was significantly associated with the occurrence of a recurrence. In addition, tumor size had a negative effect on the disease-free period and survival time. This study shows a favorable outcome of both LA and OA in dogs. Based on low perioperative complication rate, short hospitalization time and long-term outcomes comparable to OA in selected cases, the less invasive laparoscopic approach is considered the preferred technique.

Laparoscopic cholecystectomy using the subserosal layer dissection technique in dogs: 34 cases (2015‐2021)

OBJECTIVES

To describe a standardised subserosal layer dissection technique and evaluate its outcomes in canine laparoscopic cholecystectomy.

MATERIALS AND METHODS

Medical records of dogs undergoing laparoscopic cholecystectomy using the standardised subserosal layer dissection technique for the treatment of cholecystolithiasis, cholecystitis, and gall bladder mucocele at a single veterinary hospital from January 2015 to September 2021 were extracted. Operative time, subserosal layer dissection achievement rate, open conversion rate, and complication rate were evaluated.

RESULTS

Thirty-four dogs were included. The most common preoperative diagnosis was cholecystolithiasis (n=29). Operative time was 190 minutes (range: 110 to 330 minutes). Subserosal layer dissection of more than 90% of the gall bladder bed was achieved in 27 (79%) dogs. Conversion to open surgery was required in three (8.8%) dogs. There were no cases of intraoperative bleeding, bile duct injury, or reoperation.

CLINICAL SIGNIFICANCE

This study showed that laparoscopic cholecystectomy using the standardised subserosal layer dissection technique could be performed successfully in dogs. Future prospective clinical studies are needed to determine safety and effectiveness of this technique compared to standard techniques.

Retrospective comparison of open vs minimally invasive cystotomy in 28 cats using a composite outcome score

OBJECTIVES

The aim of this study was to compare the outcomes of cats undergoing open cystotomy with those undergoing minimally invasive surgery (MIS) for removal of cystic calculi by use of a composite outcome score.

METHODS

Twenty-eight cats were retrospectively enrolled and divided into two groups: open cystotomy (n = 14) and MIS (n = 14). The primary outcome measure was a composite outcome score, including three variables: pain scores ⩾2 at either 6 or 12 h postoperatively; failure to remove all stones as determined by postoperative radiographs; and postoperative complications requiring a visit to the hospital separate from the planned suture removal appointment. Other data collected included signalment, history, other procedures performed during anesthesia, willingness to eat the day after surgery and the financial cost of the procedures.

RESULTS

There was no significant difference in age, weight, sex or breed between the two groups. The risk of experiencing the composite outcome was 3/14 (21.4%) in the MIS group and 10/14 (71%) in the open procedure group (P = 0.02). The cats in the open surgery group had 8.3 times greater odds of developing the composite outcome than cats in the MIS group (odds ratio 8.3, 95% confidence interval 1.3-74.4; P = 0.02). In the MIS group, 10/14 cats were eating the day after surgery vs 3/14 in the open procedure group (P = 0.02). The procedural cost was higher in the MIS group, with a median cost of US$945 (interquartile range [IQR] US$872-1021) vs US$623 (IQR US$595-679) in the open group (P <0.01).

CONCLUSIONS AND RELEVANCE

In this study the composite outcome score provided evidence to support the use of MIS techniques in cats with cystic calculi. The composite outcome score should be considered in future veterinary studies as a promising method of assessing clinically relevant outcomes.

Focused ultrasound tumour ablation in small animal oncology

The cancer incidence rates for humans and animals remain high, and efforts to improve cancer treatment are crucial. Cancer treatment for solid tumours includes both treatment of the primary tumour and of metastasis. Surgery is commonly employed to resect primary and metastatic tumours, but is invasive, and is not always the optimal treatment modality. Prevention and treatment of metastatic disease often utilizes a multimodal approach, but metastasis remains a major cause of death for both human and veterinary cancer patients. Focused ultrasound (FUS) tumour ablation techniques represent a novel non-invasive approach to treating cancer. FUS ablation is precise, thus sparing adjacent critical structures while ablating the tumour. FUS ablation can occur in a thermal or non-thermal fashion. Thermal FUS ablation, also known as high intensity focused ultrasound (HIFU) ablation, destroys tumour cells via heat, whereas non-thermal FUS, known as histotripsy, ablates tumour cells via mechanical disintegration of tissue. Not only can HIFU and histotripsy ablate tumours, they also demonstrate potential to upregulate the host immune system towards an anti-tumour response. The aim of this report is provide a description of HIFU and histotripsy tumour ablation, with a focus on the basic principles of their ablation mechanisms and their clinical applicability in the field of veterinary oncology.

Comparison of intra- and postoperative variables between laparoscopic and open ovariectomy in rabbits (Oryctolagus cuniculus)

OBJECTIVE

To compare intraoperative and short-term postoperative variables pertaining to laparoscopic ovariectomy (LapOVE) and open ovariectomy (OVE) in rabbits (Oryctolagus cuniculus).

ANIMALS

Twelve 4- to 5-month-old female New Zealand White rabbits.

PROCEDURES

Rabbits were randomly assigned to undergo LapOVE (n = 6) or OVE (6), with a vessel-sealing device used to seal and transect the ovarian pedicles. Laparoscopic ovariectomy was performed with a 3-port approach. Variables were measured during surgery (surgery and anesthesia times and incision lengths) and for up to 7 days after surgery (food consumption, feces production, body weight, vital parameters, blood glucose and cortisol concentrations, abdominal palpation findings, facial grimace scale scores, and ethograms).

RESULTS

Mean surgery (43.2 vs 21.7 minutes) and anesthesia (76.2 vs 48.8 minutes) times were longer and mean incision length was shorter (24.0 vs 41.5 mm) for LapOVE versus OVE. No significant differences in postoperative variables were identified between groups. During LapOVE, small intestinal perforation occurred in 1 rabbit, which was then euthanized. Postoperative complications for the remaining rabbits included superficial incisional dehiscence (LapOVE, 1/5; OVE, 2/6), subcutaneous emphysema (LapOVE, 1/5; OVE, 0/6), and seroma formation (LapOVE, 1/5; OVE, 0/6).

CONCLUSIONS AND CLINICAL RELEVANCE

Surgery time for LapOVE was twice that of OVE, and LapOVE resulted in unique complications in rabbits. No evidence of a reduction in pain or faster return to baseline physiologic status was found for LapOVE. Further evaluation of LapOVE in rabbits is warranted, with modification to techniques used in this study or a larger sample size.

A comparison of outcomes between laparoscopic and open adrenalectomies in dogs

OBJECTIVE

To compare short- and long-term outcomes of dogs with adrenal tumors treated by adrenalectomy with laparoscopy or laparotomy.

STUDY DESIGN

Retrospective study of dogs that underwent adrenalectomy with laparoscopy or laparotomy.

SAMPLE POPULATION

Fourteen dogs treated with laparoscopic adrenalectomy (LA) and twenty-six dogs treated with open midline adrenalectomy (OA).

METHODS

Dogs treated with LA were matched with 1 or 2 dogs treated with OA on the basis of histological nature, size, and side of the tumor. Intraoperative complications, postoperative complications, and long-term survival were compared between LA and OA.

RESULTS

Intraoperative hypotension occurred in 2 of 14 (14.3%) dogs in the LA group and in 16 of 26 (61.5%) dogs in the OA group (P = .007). The surgical time was 69.8 ± 21.8 minutes for the LA group and 108.6 ± 42 minutes for the OA group (P = .0003). The hospitalization time was 39.3 ± 14.9 hours for the LA group and 46.3 ± 25.1 hours for the OA group (P = .1453). The 1- and 2-year survival rates were 77% and 77%, respectively, for the LA group and 77% and 66%, respectively, for the OA group (P = .6144).

CONCLUSION

Laparoscopic adrenalectomy was associated with a shorter surgical time and a reduced incidence of hypotension compared with open adrenalectomy in this case-matched study. Short- and long-term outcomes were not affected by the surgical technique used to complete the adrenalectomy.

CLINICAL SIGNIFICANCE

Laparoscopy can be recommended for adrenalectomy in dogs; however, appropriate case selection is required.

Pressure-Volume Curve during Capnoperitoneum in Cats

Laparoscopy is a growing field in veterinary medicine, although guidelines are lacking. The objective of this study was to evaluate the pressure-volume curve during capnoperitoneum in cats. A total of 59 female cats were scheduled for routine laparoscopy. Pressure and volume data were recorded and processed, and the yield point of the curve was calculated using a method based on a capacitor discharging function. For the remaining 40 cats, a linear-like pressure-volume curve was observed until a yield point with a mean cutoff pressure (COP) of 6.44 ± 1.7 mmHg (SD) (range, 2.72-13.00 mmHg) and a mean cutoff volume (COV) of 387 ± 144.35 mL (SD) (range, 178.84-968.43 mL) was reached. The mean mL/kg CO₂ value in cats was 208 ± 34.69 mL/kg (range, 100.00-288.46 mL/kg). The COV correlated with COP and body weight but not with body condition score (BCS). COP correlated only with the COV. This study suggests that feline patients have a pressure-volume curve similar to that of canine patients, and the same pressure limit recommendations can be used for both species. After a yield point of 6.44 mmHg is reached, the increment in volume decreases exponentially as the intra-abdominal pressure (IAP) increases.

Gallbladder leiomyoma treated by laparoscopic cholecystectomy in a dog

CASE DESCRIPTION

A 12-year-old spayed female Chinese Crested was referred because of a mass detected in the gallbladder during ultrasonographic evaluation of the abdomen, which had been prompted by a history of high serum liver enzyme activities.

CLINICAL FINDINGS

Serum biochemical analysis revealed mild hypoglobulinemia and high alkaline phosphatase, γ-glutamyltransferase, and alanine aminotransferase activities. Abdominal ultrasonography revealed diffuse hepatopathy and multiple pedunculated mucosal structures within the gallbladder.

TREATMENT AND OUTCOME

Following initial treatment with ursodiol (11.4 mg/kg [5.18 mg/lb], PO, q 12 h) and S-adenosylmethionine (30 mg/kg [13.6 mg/lb], PO, q 24 h) for 1 month to address possible cholestasis, no change was noted in ultrasonographic or serum biochemical findings. Consequently, laparoscopic cholecystectomy was performed concurrently with laparoscopic liver biopsy. Histologic evaluation of resected gallbladder tissue and the liver biopsy specimen revealed evidence of multifocal to coalescing leiomyomas of the gallbladder and multifocal lipogranulomas of the liver. Eleven days after the dog was discharged from the hospital, it was taken to an emergency clinic because of anorexia, vomiting, and diarrhea. Mild pancreatitis or gastroenteritis was suspected, supportive treatment was provided, and ursodiol and S-adenosylmethionine administration was reinitiated. At the time of follow-up telephone contact with the owner 234 days after surgery, the dog continued to receive ursodiol and S-adenosylmethionine and had no clinical signs associated with hepatobiliary disease.

CLINICAL RELEVANCE

Leiomyomas, although rare, can develop in dogs and should be considered as a differential diagnosis for intramural gallbladder lesions. Laparoscopic cholecystectomy served as a minimally invasive surgical treatment for this benign neoplasia.

Pneumoperitoneum in Veterinary Laparoscopy: A Review

Objective: To review the effects of carbon dioxide pneumoperitoneum during laparoscopy, evaluate alternative techniques to establishing a working space and compare this to current recommendations in veterinary surgery. Study Design: Literature review. Sample Population: 92 peer-reviewed articles. Methods: An electronic database search identified human and veterinary literature on the effects of pneumoperitoneum (carbon dioxide insufflation for laparoscopy) and alternatives with a focus on adaptation to the veterinary field. Results: Laparoscopy is the preferred surgical approach for many human and several veterinary procedures due to the lower morbidity associated with minimally invasive surgery, compared to laparotomy. The establishment of a pneumoperitoneum with a gas most commonly facilitates a working space. Carbon dioxide is the preferred gas for insufflation as it is inert, inexpensive, noncombustible, colorless, excreted by the lungs and highly soluble in water. Detrimental side effects such as acidosis, hypercapnia, reduction in cardiac output, decreased pulmonary compliance, hypothermia and post-operative pain have been associated with a pneumoperitoneum established with CO₂ insufflation. As such alternatives have been suggested such as helium, nitrous oxide, warmed and humidified carbon dioxide and gasless laparoscopy. None of these alternatives have found a consistent benefit over standard carbon dioxide insufflation. Conclusions: The physiologic alterations seen with CO₂ insufflation at the current recommended intra-abdominal pressures are mild and of transient duration. Clinical Significance: The current recommendations in veterinary laparoscopy for a pneumoperitoneum using carbon dioxide appear to be safe and effective.

A systematic review of complications related to laparoscopic and laparoscopic-assisted procedures in dogs

OBJECTIVE

To evaluate and report the quality of the scientific literature reporting complications associated with laparoscopic and laparoscopic-assisted procedures in client-owned or healthy research dogs and to report and illustrate laparoscopic complications related to individual organ systems.

STUDY DESIGN

Systematic review.

ANIMALS

Client-owned or healthy research dogs.

METHODS

A literature review was performed by using PubMed and CAB abstracts for English-language studies providing descriptions of complications related to laparoscopic and laparoscopic-assisted procedures in dogs. Study selection used PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment was performed by using a MINORS (Methodological Items for Non-Randomized Studies) scoring system and a grading scale of level of evidence. Descriptive statistics were used.

RESULTS

In total, 741 manuscripts were identified, with 64 manuscripts eligible for data extraction and quality assessment. The most represented organ system was the female genital tract, represented by 22 (34.4%) studies. The most commonly reported intraoperative and postoperative complications were related to abdominal entry and portal incisions, respectively. In 53 of 54 non-randomized studies, high risk of bias was found. Forty-eight (75%) studies provided level III or IV evidence.

CONCLUSION

This report provides an updated review of complications related to laparoscopic and laparoscopic-assisted procedures in dogs, classified by organ system. The overall quality of evidence was low, limiting direct comparison of complication rates between studies.

CLINICAL SIGNIFICANCE

There is a need for implementation of standardized criteria for defining complications, study time frames and greater numbers of high quality prospective randomized trials in veterinary laparoscopy to permit comparison of complication and conversion rates between published studies and across organ systems.

Outcome in dogs undergoing adrenalectomy for small adrenal gland tumours without vascular invasion

Veterinary studies have reported the outcome of adrenalectomies in dogs; however, these studies typically include a wide variety of adrenal tumour sizes, including cases with or without vascular invasion. The purpose of this study was to report outcome in a cohort of dogs with histologically confirmed small adrenal tumours without vascular invasion treated with adrenalectomy. This retrospective study was conducted using data from the University of Florida and University of California-Davis databases between 2010 and 2017. Dogs were included if they underwent excision of an adrenal gland tumour with a maximal diameter ≤ 3 cm, without evidence of vascular invasion to any location as assessed via computed tomography. Fifty-one dogs met the inclusion criteria. The short-term survival rate of dogs undergoing adrenalectomy was 92.2%, and one-year disease-specific survival was 83.3%. Twenty-eight of 51 (54.9%) dogs were diagnosed with a malignancy. Minor complications were observed commonly intra-operatively and post-operatively. Major complications were observed in six dogs, and included sudden death, respiratory arrest, acute kidney injury, haemorrhage, hypotension and aspiration pneumonia. Short-term mortality occurred in four dogs. Sudden death and haemorrhage were the most common major complications leading to death. While adrenalectomy is sometimes controversial because of the high perioperative mortality rates previously reported, the results of this study support that adrenalectomy for small tumours with no vascular invasion can be performed with low risk.

Complications related to entry techniques for laparoscopy in 159 dogs and cats

OBJECTIVE

To report the frequency and risk factors of complications related to 3 entry techniques for laparoscopy in small animals.

STUDY DESIGN

Single-institution retrospective case series.

ANIMALS

159 client-owned dogs and cats.

METHODS

Medical records were reviewed for dogs and cats undergoing laparoscopic surgery with carbon dioxide (CO₂ ) insufflation between 2006 and 2018. Data including entry site, entry technique, signalment, body conformation, complications, and operating surgeon/resident were analyzed by univariate regression analysis. Factors with P < .25 were included in multivariate regression analysis.

RESULTS

Complications occurred in 33 of 159 (21%) surgeries and were considered minor (CO₂ leaks, omental insufflation, repeated entry) in 30 of 33 (91%) cases. The Ternamian visual entry, modified Hasson, and Veress needle entry techniques were associated with complications in 7 (9%), 17 (26%), and 9 (60%) surgeries, respectively. Major complications occurred in 3 of 159 (2%) surgeries, in which entry-related hemorrhage prompted conversion to an open technique (2 [13%] entries with Veress needle) and 1 [1%] with the Ternamian visual). Entry location and entry technique remained significant in the final multivariate model. Complications were 11.7 times more likely after a paramedian entry than after a midline entry; the odds ratio of complications were 5 and 28 times higher after modified Hasson and Veress needle entries, respectively, than after Ternamian visual entry.

CONCLUSION

In this study, a Ternamian visual entry technique and midline entry site appeared associated with fewer complications than 2 other techniques.

CLINICAL SIGNIFICANCE

The findings in this study are preliminary, and superiority of any entry technique must be reevaluated in a prospective randomized controlled study.

Use of Minimally Invasive Surgery in the Diagnosis and Treatment of Cancer in Dogs and Cats

Surgical management of neoplastic disease is common in veterinary medicine. Minimally invasive surgery (MIS) has gained widespread acceptance by veterinary surgeons and is experiencing rapid growth and frequency of use. Many neoplastic diseases in the abdomen and thorax of dogs and cats can be treated as effectively with MIS as with traditional open surgery. Additionally, MIS allows for less invasive options for organ biopsy in cancer patients either for initial diagnosis or for staging to inform prognosis and treatment. Despite the recent increase in MIS, additional research is required to further characterize the benefits to oncology patients and to ensure that surgical oncologic principles and patient outcomes are not compromised by the use of MIS.

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 1-Defining populations at risk

OBJECTIVES

Thrombosis is a well-recognized phenomenon in dogs and cats with a significant impact on morbidity and mortality. Despite growing awareness of thrombosis and increased use of antithrombotic therapy, there is little information in the veterinary literature to guide the use of anticoagulant and antiplatelet medications. The goal of Domain 1 was to explore the association between disease and thrombosis in a number of conditions identified as potential risk factors in the current veterinary literature, to provide the basis for prescribing recommendations.

DESIGN

A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. Revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated included immune-mediated hemolytic anemia, protein-losing nephropathy, pancreatitis, glucocorticoid therapy, hyperadrenocorticism, neoplasia, sepsis, cerebrovascular disease, and cardiac disease.

SETTINGS

Academic and referral veterinary medical centers.

RESULTS

Of the diseases evaluated, a high risk for thrombosis was defined as dogs with immune-mediated hemolytic anemia or protein-losing nephropathy, cats with cardiomyopathy and associated risk factors, or dogs/cats with >1 disease or risk factor for thrombosis. Low or moderate risk for thrombosis was defined as dogs or cats with a single risk factor or disease, or dogs or cats with known risk factor conditions that are likely to resolve in days to weeks following treatment.

CONCLUSIONS

Documented disease associations with thrombosis provide the basis for recommendations on prescribing provided in subsequent domains. Numerous knowledge gaps were identified that represent opportunities for future study.

Treating canine Cushing's syndrome: Current options and future prospects

Naturally occurring hypercortisolism, also known as Cushing's syndrome, is a common endocrine disorder in dogs that can be caused by an adenocorticotrophic hormone (ACTH)-producing pituitary adenoma (pituitary-dependent hypercortisolism, PDH; 80-85% of cases), or by an adrenocortical tumor (ACT; 15-20% of cases). To determine the optimal treatment strategy, differentiating between these two main causes is essential. Good treatment options are surgical removal of the causal tumor, i.e. hypophysectomy for PDH and adrenalectomy for an ACT, or radiotherapy in cases with PDH. Because these options are not without risks, not widely available and not suitable for every patient, pharmacotherapy is often used. In cases with PDH, the steroidogenesis inhibitor trilostane is most often used. In cases with an ACT, either trilostane or the adrenocorticolytic drug mitotane can be used. Although mostly effective, both treatments have disadvantages. This review discusses the current treatment options for canine hypercortisolism, and considers their mechanism of action, efficacy, adverse effects, and effect on survival. In addition, developments in both adrenal-targeting and pituitary-targeting drugs that have the potential to become future treatment options are discussed, as a more selective and preferably also tumor-targeted approach could have many advantages for both PDH and ACTs.

Short-term outcome of laparoscopic cholecystectomy for benign gall bladder diseases in 76 dogs

Laparoscopic cholecystectomy (LC) is widely accepted as the standard treatment for benign gall bladder diseases in humans because it has proven to be less invasive and safer than are traditional methods. However, the efficacy of LC in dogs remains unclear. The present study aimed to examine the short-term outcome of LC for benign gall bladder diseases in dogs. We enrolled 76 consecutive dogs that underwent LC for benign gall bladder diseases at our hospital between April 2008 and October 2016. Dogs with jaundice, gall bladder ruptures, abdominal effusion, or extrahepatic biliary obstruction were not excluded from the indication. Factors including age, body weight, sex, clinical sign, disease, operative time, conversion to open surgery, perioperative complications, and postoperative hospital stay were investigated. The median age of the dogs was 11 years, and the median body weight was 5.4 kg. Fifty percent of the dogs exhibited no symptoms at the initial visit. Preoperative elevation of total bilirubin levels was observed in 16 dogs (21%). LC was successfully completed in 71 dogs (93%); the median operative time was 124 min. Although gall bladder ruptures were observed in 2 (2.6%) dogs, the operations were completed successfully. Three dogs (4.1%) had to be converted to open cholecystectomy and 2 (2.6%) underwent reoperation. Two dogs (2.6%) died intraoperatively and 2 (2.6%) died postoperatively. LC was a feasible, safe, and appropriate procedure considering the current operative indications for benign gall bladder diseases in dogs.

Feasibility of single-port retroperitoneoscopic adrenalectomy in dogs

OBJECTIVE

To evaluate the feasibility of single-port retroperitoneoscopic adrenalectomy (SPRA) in dogs.

STUDY DESIGN

A pilot experimental study.

ANIMALS

Eight healthy beagle dogs.

METHODS

SPRA was performed on the left and right sides (4 dogs each). Resection of the adrenal gland was performed through a SILS port using a retroperitoneal approach. Operative time was defined from skin incision to the completion of skin suture. Postoperative pain was evaluated by using 3 pain scores. Integrity of the adrenal gland capsule was evaluated by histologic assessment.

RESULTS

Mean time taken to complete the SPRA was 44.1 minutes (range, 37-51) and was significantly longer on the right side than on the left side (P < .05). There were no complications intraoperatively or during 14 days of postoperative monitoring. The adrenal gland capsule was found to be injured in 3 of the 8 dogs by histologic assessment.

CONCLUSION

This is the first report of SPRA in the veterinary literature. With this technique it is possible to perform adrenalectomy with some risk of capsule penetration and with excellent visibility.

CLINICAL SIGNIFICANCE

This study suggests that SPRA is feasible and can be used to resect small adrenal tumors with minimal complications.

Investigating the impact of innate dexterity skills and visuospatial aptitude on the performance of baseline laparoscopic skills in veterinary students

OBJECTIVE

To determine if manual dexterity and visuospatial skills can be used to predict baseline laparoscopic surgery skills in veterinary students.

STUDY DESIGN

Pilot study.

METHODS

Veterinary students (n = 45) from years 1-4 volunteered for this study. An hour-long electronic questionnaire was completed by participants. The first section was used to collect demographics and information about prior nonsurgical experiences. The second section included 3 tests of visuospatial skills, including the Purdue Visualization of Rotations Test, Mental Rotations Test, and Raven's Advanced Progressive Matrices Test. Multiple tests were administered to assess innate dexterity, including the grooved pegboard test, indirect and direct zigzag tracking tests, and the 3Dconnexion proficiency test. Each dexterity test was performed once with the left hand and once with the right hand. The order of task performance was randomized. Basic laparoscopic skills were assessed using the validated fundamentals of laparoscopic surgery (FLS) peg transfer task.

RESULTS

There was an association between left-handed grooved pegboard scores (95% CI -10046.36 to -1636.53, P-value = .008) and left-handed indirect zigzag tracking task (95% CI -35.78 to -8.20, P-value = .003) with FLS peg transfer scores. Individuals who reported playing videogames achieved higher scores on the FLS peg transfer task than those without videogame experience (95% CI 583.59 to 3509.97, P-value = .007).

CONCLUSION

The results of this study suggest that dexterity was a better predictor of baseline laparoscopic skills than visuospatial skills in veterinary students.

Comparison of postoperative pain and inflammation reaction in dogs undergoing preventive laparoscopic-assisted and incisional gastropexy

This study compared the effects of postoperative pain and inflammation reaction after preventive laparoscopic-assisted gastropexy (LAG) and incisional gastropexy (IG) in 10 clinically normal Beagles. Surgical time, incision length, visual analog scale (VAS) score, University of Melbourne Pain Scale (UMPS) score, and plasma C-reactive protein (CRP), plasma cortisol (COR), and serum interleukin-6 (IL-6) levels were evaluated. The VAS and UMPS scores and COR and IL-6 levels were recorded at 0.5, 1, 2, 4, 8, 12, 18 and 24 hr after surgery. CRP level was recorded at 12, 24 and 48 hr after surgery. The VAS and UMPS scores showed no significant intergroup differences. Compared to IG, LAG had significantly lower surgical time (45 ± 9.91 min vs 64 ± 5.30 min; P<0.05), incision length (46 ± 8.21 mm vs 129 ± 19.49 mm; P<0.05), CRP level (12 hr after surgery; 4.58 ± 1.58 mg/dl vs 12.4 ± 1.34 mg/dl; P<0.01), and COR level (1 hr after surgery; 10.79 ± 3.07 µg/dl vs 15.9 ± 3.77 µg/dl; P<0.05). IL-6 levels showed no significant intergroup differences at any time point. However, LAG resulted in lower IL-6 levels than did IG at all postoperative time points. Neither procedure resulted in significant surgical complications. LAG produced lower surgical stress than did IG, suggesting that LAG is a safe, minimally invasive, and highly useful technique for preventing canine gastric dilatation-volvulus. Nevertheless, since this study used experimental models, its usefulness should be evaluated in future cases.

Muscular workload of veterinary students during simulated open and laparoscopic surgery: A pilot study

OBJECTIVE

To compare upper extremity muscle activity and workload between simulated open surgery, multiple port laparoscopic surgery (MLS), and single incision laparoscopic surgery (SLS) techniques in veterinary students.

STUDY DESIGN

Pilot study.

POPULATION

Veterinary students (n = 10) from years 1 to 4.

METHODS

Bipolar skin surface electrodes were fixed bilaterally to the forearm flexor, forearm extensor, biceps brachii, triceps brachii, and upper trapezius muscles. Electromyography data were recorded during one repetition of 2 simulated surgical exercises via open surgery, MLS, and SLS. Participants completed a validated workload survey after each simulated surgical technique. Muscle activity and perceived workload were compared between surgical techniques with 1-way ANOVAs and Fisher's LSD post hoc tests.

RESULTS

Muscle activity during peg transfer was higher with MLS and SLS compared to simulated open surgery in the right and left forearm extensors (both P < .0001), right (P < .0001) and left biceps (P = .0005), right triceps (P = .0004), and right upper trapezius muscles (P = .0211). Similar results were found for the right and left forearm extensors (both P < .0001), right (P = .0381) and left (P = .0147) forearm flexors, right biceps (P < .0001), and right triceps (P = .0004) during a simulated suture task. Participants found laparoscopic techniques more mentally demanding, physically demanding, complex, and stressful compared to a simulated open surgical technique.

CONCLUSION

In veterinary students, average muscle activity and perceived workload were highest using MLS and SLS compared to an open surgical technique when performing simulated surgical exercises in a laparoscopic box trainer.