Thoracoscopy pulmonary biopsy by two portals with a novel pre-tied loop ligature device in rabbits: an experimental study / Biópsia pulmonar por toracoscopia por dois portais com uma nova ligadura de alça pré-amarrada em coelhos: um estudo experimental

ABSTRACT: Thoracoscopy is replacing open lung biopsies because it is less invasive, usually the technique is done using three portals and intracorporeal suture technique. This study described the feasibility and efficacy of a novel pre tied loop ligature and to propose a thoracoscopic access strategy with two portals to perform lung biopsy in patients under 5 kg. Ten rabbits were positioned in dorsal recumbency. Total thoracoscopic lung biopsy was performed using a combined transdiaphragmatic approach and a right intercostal approach. A pre tied loop ligature was placed to perform a caudal lung lobe biopsy. Insufflation of the thoracic cavity was not performed. The total surgery time was 41.4 ± 14.5 min. The procedure was carried out free of complications that prevented slippage or tightening the knot or that made it come loose after the lung biopsy; there was no serious complication during the surgical procedure. The samples obtained averaged 1x0.64x0.45 cm (Length, Width, Depth) and were considered satisfactory according to the histopathologic evaluation. Thorax radiographs taken before and after the surgeries were compared and showed no pneumothorax or hemothorax. Necropsy confirmed no knot failure occurred at the biopsy site. The use of the novel pre tied loop ligature is a safe and effective technique, avoiding problems with the limited size of the thoracic cavity in small patients.

RESUMO: A toracoscopia está substituindo as biópsias pulmonares abertas por ser menos invasiva. Usualmente a técnica é feita utilizando três portais e ligaduras feitas intra corporalmente. O objetivo deste estudo foi descrever a viabilidade e eficácia de uma nova ligadura com alça pré-amarrada e propor uma estratégia de acesso toracoscópico com dois portais para realizar biópsia pulmonar em pacientes com menos de 5kg. Dez coelhos foram posicionados em decúbito dorsal. A biópsia pulmonar por toracoscopia total foi feita pela abordagem combinada transdiafragmática e abordagem intercostal direita. Uma nova ligadura pré-amarrada foi colocada para realizar uma biópsia do lobo pulmonar caudal. Não foi realizada insuflação da cavidade torácica. O tempo total de cirurgia foi de 41,4 ± 14,5 min. Os procedimentos foram realizados sem complicações que impedissem o escorregamento ou aperto do nó ou que o soltassem após a biópsia pulmonar; não houve nenhuma intercorrência grave durante o procedimento cirúrgico. As amostras coletadas tinham tamanho médio 1x0,64x0,45 cm e foram consideradas satisfatórias de acordo com a avaliação histopatológica. As radiografias de tórax feitas antes e depois das cirurgias foram comparadas e não mostraram pneumotórax ou hemotórax. A necropsia confirmou que não ocorreu falha do nó no local da biópsia. Conclui-se que uso da nova ligadura com alça pré-amarrada é uma técnica segura e eficaz, evitando problemas com o tamanho limitado da cavidade torácica em pacientes pequenos.

Thoracoscopy pulmonary biopsy by two portals with a novel pre-tied loop ligature device in rabbits: an experimental study / Biópsia pulmonar por toracoscopia por dois portais com uma nova ligadura de alça pré-amarrada em coelhos: um estudo experimental

Thoracoscopy is replacing open lung biopsies because it is less invasive, usually the technique is done using three portals and intracorporeal suture technique. This study described the feasibility and efficacy of a novel pre tied loop ligature and to propose a thoracoscopic access strategy with two portals to perform lung biopsy in patients under 5 kg. Ten rabbits were positioned in dorsal recumbency. Total thoracoscopic lung biopsy was performed using a combined transdiaphragmatic approach and a right intercostal approach. A pre tied loop ligature was placed to perform a caudal lung lobe biopsy. Insufflation of the thoracic cavity was not performed. The total surgery time was 41.4 ± 14.5 min. The procedure was carried out free of complications that prevented slippage or tightening the knot or that made it come loose after the lung biopsy; there was no serious complication during the surgical procedure. The samples obtained averaged 1x0.64x0.45 cm (Length, Width, Depth) and were considered satisfactory according to the histopathologic evaluation. Thorax radiographs taken before and after the surgeries were compared and showed no pneumothorax or hemothorax. Necropsy confirmed no knot failure occurred at the biopsy site. The use of the novel pre tied loop ligature is a safe and effective technique, avoiding problems with the limited size of the thoracic cavity in small patients.

A toracoscopia está substituindo as biópsias pulmonares abertas por ser menos invasiva. Usualmente a técnica é feita utilizando três portais e ligaduras feitas intra corporalmente. O objetivo deste estudo foi descrever a viabilidade e eficácia de uma nova ligadura com alça pré-amarrada e propor uma estratégia de acesso toracoscópico com dois portais para realizar biópsia pulmonar em pacientes com menos de 5kg. Dez coelhos foram posicionados em decúbito dorsal. A biópsia pulmonar por toracoscopia total foi feita pela abordagem combinada transdiafragmática e abordagem intercostal direita. Uma nova ligadura pré-amarrada foi colocada para realizar uma biópsia do lobo pulmonar caudal. Não foi realizada insuflação da cavidade torácica. O tempo total de cirurgia foi de 41,4 ± 14,5 min. Os procedimentos foram realizados sem complicações que impedissem o escorregamento ou aperto do nó ou que o soltassem após a biópsia pulmonar; não houve nenhuma intercorrência grave durante o procedimento cirúrgico. As amostras coletadas tinham tamanho médio 1x0,64x0,45 cm e foram consideradas satisfatórias de acordo com a avaliação histopatológica. As radiografias de tórax feitas antes e depois das cirurgias foram comparadas e não mostraram pneumotórax ou hemotórax. A necropsia confirmou que não ocorreu falha do nó no local da biópsia. Conclui-se que uso da nova ligadura com alça pré-amarrada é uma técnica segura e eficaz, evitando problemas com o tamanho limitado da cavidade torácica em pacientes pequenos.

Bilateral double-pigtail ureteral stent placement for management of ureteral obstruction secondary to transitional cell carcinoma in a dog

Background: Transitional cell carcinoma (TCC) usually affects the trigone region of the bladder and proximal portionof the urethra. TCC in dogs is often complicated by local tumor invasion and obstruction of the urethra, ureters, or both.Urinary obstruction is the cause of death in approximately 60% of dogs with TCC. Radical surgeries are associated withmorbidity and mortality rates. Stents have recently been evaluated for use in dogs with ureteral obstruction resulting froma variety of urinary tract tumors. This report aims to describe bilateral ureteral stent placement for treatment of malignantureteral obstruction and long-term follow-up in a dog.Case: An 11-year-old female spayed Maltese dog with ureteral obstruction secondary to transitional cell carcinoma (TCC)in the bladder trigone. After palliative debulking procedure and diagnostic of TCC in bladder and NSAIDs treatment,recurrence has occurred causing ureteral obstruction and TCC had invaded the abdominal wall. Abdominal wall localtumor resection, trigone mass debulking and bilateral ureteral stent placement was made. A double-pigtail ureteral stentof appropriate length was advanced to bypass the ureteral obstruction. Stent sizes were 3.5 Fr in diameter and from 8 to32 cm in length. The patient underwent surgical resection of the transitional cell carcinoma in the abdominal wall. Thecorrect location of the bilateral ureteral pigtail stent was certified by abdominal radiography. Recovery was uneventfuland the dog was discharged 2 days after surgery. Eleven months after stent placement, the dog developed lumbar vertebrae metastasis, without evidence of recurrent ureteral obstruction. The owners elected euthanasia 517 days after originalpresentation and 337 days after ureteral stent placement. Euthanasia was unrelated to the local tumor obstruction but was...

Ureteral stent placement using a double J-catheter in the treatment of ectopic ureter in a dog

Background: Ectopic ureter is a congenital anomaly in which the final segment of one or both ureteral orifices is locateddistal to the bladder trigone. It may be classified as intra- or extramural. Surgical treatment of ectopic ureters in dogs isrecommended and the approach varies with the classification. In the postoperative period, complications are common.When stenosis of the new ureteral ostium occurs, immediate repeated surgery is recommended. This study aimed at usingthe double J catheter placement following neoureterostomy to treat urethral obstruction secondary to the surgical treatmentof an intramural ectopic ureter in a dog.Case: An 8-month-old female French bulldog with dysuria and urinary incontinence was seen at a private veterinaryhospital in Jaboticabal, São Paulo. The patient had previously been diagnosed with an intramural ectopic ureter on theright side following imaging tests (ultrasound, computed tomography, and abdominal radiography, excretory urography)and had undergone neoureterostomy and closure of the intramural pathway approximately a year ago. Ultrasonographicexamination showed dilation of the caudal portion of the ureter and hydroureter, which was suggestive of right ureteralstenosis. Computed tomography was also performed to evaluate the kidneys, ureters, and bladder; an increase in the diameter of the right ureter in its middle portion and close to the bladder triangle was observed. A new surgical interventionwas indicated and performed. The ureteral route was identified in a region of the bladder trigone, incised, and probed witha urethral probe No. 04. The intramural course in the proximal urethra was identified and probed with a 16G epiduralcatheter. It was necessary to perform a neoureterostomy. A longitudinal incision (spatulation) of approximately 5 mm wasmade in the distal portion of the right ureter to increase the circumference of the...

Ureteral stent placement using a double J-catheter in the treatment of ectopic ureter in a dog

Background: Ectopic ureter is a congenital anomaly in which the final segment of one or both ureteral orifices is locateddistal to the bladder trigone. It may be classified as intra- or extramural. Surgical treatment of ectopic ureters in dogs isrecommended and the approach varies with the classification. In the postoperative period, complications are common.When stenosis of the new ureteral ostium occurs, immediate repeated surgery is recommended. This study aimed at usingthe double J catheter placement following neoureterostomy to treat urethral obstruction secondary to the surgical treatmentof an intramural ectopic ureter in a dog.Case: An 8-month-old female French bulldog with dysuria and urinary incontinence was seen at a private veterinaryhospital in Jaboticabal, São Paulo. The patient had previously been diagnosed with an intramural ectopic ureter on theright side following imaging tests (ultrasound, computed tomography, and abdominal radiography, excretory urography)and had undergone neoureterostomy and closure of the intramural pathway approximately a year ago. Ultrasonographicexamination showed dilation of the caudal portion of the ureter and hydroureter, which was suggestive of right ureteralstenosis. Computed tomography was also performed to evaluate the kidneys, ureters, and bladder; an increase in the diameter of the right ureter in its middle portion and close to the bladder triangle was observed. A new surgical interventionwas indicated and performed. The ureteral route was identified in a region of the bladder trigone, incised, and probed witha urethral probe No. 04. The intramural course in the proximal urethra was identified and probed with a 16G epiduralcatheter. It was necessary to perform a neoureterostomy. A longitudinal incision (spatulation) of approximately 5 mm wasmade in the distal portion of the right ureter to increase the circumference of the...(AU)

Bilateral double-pigtail ureteral stent placement for management of ureteral obstruction secondary to transitional cell carcinoma in a dog

Background: Transitional cell carcinoma (TCC) usually affects the trigone region of the bladder and proximal portionof the urethra. TCC in dogs is often complicated by local tumor invasion and obstruction of the urethra, ureters, or both.Urinary obstruction is the cause of death in approximately 60% of dogs with TCC. Radical surgeries are associated withmorbidity and mortality rates. Stents have recently been evaluated for use in dogs with ureteral obstruction resulting froma variety of urinary tract tumors. This report aims to describe bilateral ureteral stent placement for treatment of malignantureteral obstruction and long-term follow-up in a dog.Case: An 11-year-old female spayed Maltese dog with ureteral obstruction secondary to transitional cell carcinoma (TCC)in the bladder trigone. After palliative debulking procedure and diagnostic of TCC in bladder and NSAIDs treatment,recurrence has occurred causing ureteral obstruction and TCC had invaded the abdominal wall. Abdominal wall localtumor resection, trigone mass debulking and bilateral ureteral stent placement was made. A double-pigtail ureteral stentof appropriate length was advanced to bypass the ureteral obstruction. Stent sizes were 3.5 Fr in diameter and from 8 to32 cm in length. The patient underwent surgical resection of the transitional cell carcinoma in the abdominal wall. Thecorrect location of the bilateral ureteral pigtail stent was certified by abdominal radiography. Recovery was uneventfuland the dog was discharged 2 days after surgery. Eleven months after stent placement, the dog developed lumbar vertebrae metastasis, without evidence of recurrent ureteral obstruction. The owners elected euthanasia 517 days after originalpresentation and 337 days after ureteral stent placement. Euthanasia was unrelated to the local tumor obstruction but was...(AU)

The feasibility and effectiveness of thoracoscopic transdiaphragmatic approach for lung biopsy in rabbits: a randomized study

Purpose To assess the feasibility of thoracoscopic transdiaphragmatic approach for biopsy of all lung lobes and to determine the optimal intercostal space (ICS) for biopsy of each lung lobe. Methods Ten rabbits were positioned in dorsal recumbency. Total thoracoscopy lung biopsy was made combined transdiaphragmatic approach and right ICS approaches. A camera port was made in the transdiaphragmatic approach and the instrument port was made of ICS 7 and ICS 9. A pre tied loop ligature was placed to performed a caudal lung lobe biopsy and to simulate biopsies of the others lung lobes. Results Biopsy of the cranial aspect of the right caudal lung lobe was performed at ICS 9. Simulated biopsy of the accessory lung lobe was performed at ICS 9. Simulated lung biopsy of the right cranial and middle lung lobes was performed at ICS 7. The caudal and dorsal aspect of the right caudal lung lobe was not visualized by telescope at transdiaphragmatic approach, and biopsy was not performed. Conclusions Thoracoscopic transdiaphragmatic approach for lung lobes biopsies was a feasible technique, except for the caudal aspect of the right caudal lung lobe. An ideal intercostal port for biopsy of each right lung lobe was determined.(AU)

Interlocking nail combined with locking plate fixation for a distal diaphysis femur comminuted fracture in a dog

Background: Interlocking Nail (ILN) is similar a solid intramedullary pins with screws or bolts passing through one and nail holes (locking effect). This implant mostly have been putted normograde, passing by trochanteric fossa of femur, although it is reported to be inserted through the knee, passing by fracture focus and ending close to proximal femur. It is carried out especially when there is a comminuted fracture in distal third shaft of femur. Locking plate systems work as internal fixators with some advantages compared to conventional plates. It can be used combined with intramedullary pin, and is an effective technique for increase stifeness stabilization of comminuted long-bone fractures, especially for bending. Some studies reported the use of plate-nail to increase even more the stiffness of implants, because of locking screw in plate and nail. Based on the same propose, we aim to report a case of an ILNs normograde (from distal to proximal) connected to a locking plate in highly comminuted distal diaphyseal fracture since it is rarely report in veterinary medicine orthopaedics.Case: A 5-year-old male mixed breed dog was assessed and diagnosed a fracture of the femur in the right pelvic limb. On physical examination, the dog had nonweight bearing lameness in the affected limb and, mobility of the fragments was noted following digital pressure. A comminuted fracture of the distal diaphysis of the femur was identified. A lateral approach to the shaft of the femur, the incision was extended to the stifle joint through a lateral incision because the fracture seemed to extend throughout the physis. Open but do not touch approach was performed and reduction was gotten without modified environment of fracture hematoma. A surgical drill was inserted through the access in distal extremity of the bone to open the medullary cavity of the femur.[...]

Interlocking nail combined with locking plate fixation for a distal diaphysis femur comminuted fracture in a dog

Background: Interlocking Nail (ILN) is similar a solid intramedullary pins with screws or bolts passing through one and nail holes (locking effect). This implant mostly have been putted normograde, passing by trochanteric fossa of femur, although it is reported to be inserted through the knee, passing by fracture focus and ending close to proximal femur. It is carried out especially when there is a comminuted fracture in distal third shaft of femur. Locking plate systems work as internal fixators with some advantages compared to conventional plates. It can be used combined with intramedullary pin, and is an effective technique for increase stifeness stabilization of comminuted long-bone fractures, especially for bending. Some studies reported the use of plate-nail to increase even more the stiffness of implants, because of locking screw in plate and nail. Based on the same propose, we aim to report a case of an ILNs normograde (from distal to proximal) connected to a locking plate in highly comminuted distal diaphyseal fracture since it is rarely report in veterinary medicine orthopaedics.Case: A 5-year-old male mixed breed dog was assessed and diagnosed a fracture of the femur in the right pelvic limb. On physical examination, the dog had nonweight bearing lameness in the affected limb and, mobility of the fragments was noted following digital pressure. A comminuted fracture of the distal diaphysis of the femur was identified. A lateral approach to the shaft of the femur, the incision was extended to the stifle joint through a lateral incision because the fracture seemed to extend throughout the physis. Open but do not touch approach was performed and reduction was gotten without modified environment of fracture hematoma. A surgical drill was inserted through the access in distal extremity of the bone to open the medullary cavity of the femur.[...](AU)

Pantarsal arthrodesis with a locking plate as treatment for reabsorptive calcaneal injury in an obese dog: case report

The purpose of this study was to describe a pantarsal arthrodesis using a medial locking plate in an overweight dog. A 5-year-old, 28 kg, female dachshund presented with a left plantigraded hindlimb with calcaneous osteolytic injury and bone exposure. First, the patient was treated for the skin wound and started on a weight-loss program. A customized locking plate was used in the pantarsal arthrodesis. A normal hindlimb position and gait were observed after 27 days, and bone fusion was achieved at 60 days postoperatively. Implant removal was performed at 120 days, and the patient was discharged. The dog was kept on weight-loss therapy until it achieved a body weight of 11 kg. The customized bone implant used for pantarsal arthrodesis proved feasible and effective in treating an obese dog with low bone density.

Pantarsal arthrodesis with a locking plate as treatment for reabsorptive calcaneal injury in an obese dog: case report

The purpose of this study was to describe a pantarsal arthrodesis using a medial locking plate in an overweight dog. A 5-year-old, 28 kg, female dachshund presented with a left plantigraded hindlimb with calcaneous osteolytic injury and bone exposure. First, the patient was treated for the skin wound and started on a weight-loss program. A customized locking plate was used in the pantarsal arthrodesis. A normal hindlimb position and gait were observed after 27 days, and bone fusion was achieved at 60 days postoperatively. Implant removal was performed at 120 days, and the patient was discharged. The dog was kept on weight-loss therapy until it achieved a body weight of 11 kg. The customized bone implant used for pantarsal arthrodesis proved feasible and effective in treating an obese dog with low bone density.(AU)

Cervical laminectomy for the treatment of chronic caudal cervical spondylomyelopathy in a dog

Background: Cervical spondylomyelopathy (CSM) is a common disease of the cervical spine, and causes neurogenic disorders commonly diagnosed in large and giant breeds dogs. There are many surgical procedures proposed for the treatment of CSM. Although many authors report a high success rate (between 70% and 90%) after surgical procedures, the high number of techniques described reflects the difficulty in treating this disorder. The objective of this paper is to report a case of CSM with chronic ventral compression (intervertebral disc extrusion) that was treated with dorsal decompression, and to demonstrate the effectiveness of the decompressive technique through pre- and post-operative myelograms. Case: A 9-year-old Doberman Pinscher dog weighing 41.8 kg presented due to a history of tetraparesis. Neurological examination did not reveal any alteration in mental status. There was absence of conscious proprioception on the four limbs; the pelvic limbs were more severely affected. Bilateral patellar hyperreflexia and normal flexor withdrawal reflex were observed on the hind limbs. There was decreased flexor withdrawal reflex and increased extensor tone on the forelimbs. The patient exhibited pain during caudal cervical palpation, and no alterations were seen on the cutaneous trunci reflex. Superficial pain was absent in the hind limbs; forelimbs exhibited presence of motor [...](AU)

Cervical laminectomy for the treatment of chronic caudal cervical spondylomyelopathy in a dog

Background: Cervical spondylomyelopathy (CSM) is a common disease of the cervical spine, and causes neurogenic disorders commonly diagnosed in large and giant breeds dogs. There are many surgical procedures proposed for the treatment of CSM. Although many authors report a high success rate (between 70% and 90%) after surgical procedures, the high number of techniques described reflects the difficulty in treating this disorder. The objective of this paper is to report a case of CSM with chronic ventral compression (intervertebral disc extrusion) that was treated with dorsal decompression, and to demonstrate the effectiveness of the decompressive technique through pre- and post-operative myelograms. Case: A 9-year-old Doberman Pinscher dog weighing 41.8 kg presented due to a history of tetraparesis. Neurological examination did not reveal any alteration in mental status. There was absence of conscious proprioception on the four limbs; the pelvic limbs were more severely affected. Bilateral patellar hyperreflexia and normal flexor withdrawal reflex were observed on the hind limbs. There was decreased flexor withdrawal reflex and increased extensor tone on the forelimbs. The patient exhibited pain during caudal cervical palpation, and no alterations were seen on the cutaneous trunci reflex. Superficial pain was absent in the hind limbs; forelimbs exhibited presence of motor [...]

Intermuscular Lipoma in Dogs

Background: Lipoma is a benign tumor composed of mature adipose tissue commonly found in subcutaneous tissues. However, eventually, lipomas may be located between the muscle fasciae being classified as intermuscular lipomas. Complete surgical resection of the tumor mass is indicated as a treatment of affected patients.This report describes five cases of intermuscular lipoma in dogs, due to the scarcity of data in the literature and lipoma relative importance in the clinical and surgical routine. Case: Five dogs were presented with a history of a large volume in the limbs with progressive growth, suggesting the presence of neoplasia. The first step was to conduct anamnesis, when the owner reported slow growth, absence of pain, limping and licking of site. No other change was observed upon physical examination. Complete blood count (CBC) as well as liver assessment (FA) and renal (creatinine) were performed in all patients, and the results showed no changes. Fine needle aspiration cytology (FNAC) was performed and showed cells from adipose tissue, followed by histopathological examination of the lesions. Histopathological examination after incisional biopsy of the tumors showed malignancy-free tissue, composed of adipocytes without atypia, interspersed with fibrovascular stroma, confirming the lipoma diagnosis. Intermuscular lipomas were diagnosed in five dogs with a history of a [...]

Intermuscular Lipoma in Dogs

Background: Lipoma is a benign tumor composed of mature adipose tissue commonly found in subcutaneous tissues. However, eventually, lipomas may be located between the muscle fasciae being classified as intermuscular lipomas. Complete surgical resection of the tumor mass is indicated as a treatment of affected patients.This report describes five cases of intermuscular lipoma in dogs, due to the scarcity of data in the literature and lipoma relative importance in the clinical and surgical routine. Case: Five dogs were presented with a history of a large volume in the limbs with progressive growth, suggesting the presence of neoplasia. The first step was to conduct anamnesis, when the owner reported slow growth, absence of pain, limping and licking of site. No other change was observed upon physical examination. Complete blood count (CBC) as well as liver assessment (FA) and renal (creatinine) were performed in all patients, and the results showed no changes. Fine needle aspiration cytology (FNAC) was performed and showed cells from adipose tissue, followed by histopathological examination of the lesions. Histopathological examination after incisional biopsy of the tumors showed malignancy-free tissue, composed of adipocytes without atypia, interspersed with fibrovascular stroma, confirming the lipoma diagnosis. Intermuscular lipomas were diagnosed in five dogs with a history of a [...](AU)