Resumo
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.
Resumo
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.
Assuntos
Animais , Coelhos , Cirurgia Torácica , Toracoscopia/veterinária , Biópsia/veterináriaResumo
Background: Ovariectomy(OVE) and ovariohysterectomy (OVH) are the most performed surgical procedures in Veterinary Medicine. In videosurgery, both in stray animals at sterilization campaigns and in the increasing demand of tutors to perform the technique. Laparoscopy results in reduced tissue damage, due to minimal organ manipulation and surgical access hemostasis can be performed by several methods, such as electro-coagulation, clips, and intra and extracorporeal ligatures. A pre-tied ligature system, or endoloop, is a haemostatic technique comprised of a slipknot and knot pusher, which is inserted into the abdominal cavity through one of the laparoscopic ports. The aim of this study was to describe a novel OVE technique in cats, in which haemostasis was performed using miniloop, aimed at reducing the number of ports needed for knot tying.Material, Methods & Results: Ten healthy not spayed female cats, aged 6 months to 5 years, were selected for this study. They were submitted to an OVE using miniloop as haemostasis method. Access to the peritoneal cavity was through two 5 mm ports on the midline of the ventral abdomen, 5 cm apart, with one immediately caudal to the umbilical scar and the other in between the last pair of teats. The first trocar was inserted at the caudal incision using the Hasson technique and a 5 mm zero-degree optics attached to a camera was introduced through it. The placement of the second access port was video assisted. For ovary exposure, the patients were positioned in lateral recumbency on the contralateral side to the ovary being removed. The miniloop was composed of a 2 mm diameter minitrocar, a 1.8 mm knot pusher, and a pre-tied slipknot. It was introduced percutaneously at the lateral abdominal wall. It was inserted attached to a pre-tied loop ligature.[...]
Assuntos
Feminino , Animais , Gatos , Hemostasia Cirúrgica/métodos , Laparoscopia/veterinária , Ovariectomia/métodos , Ovariectomia/veterinária , Cirurgia Vídeoassistida/veterinária , Hemostasia Cirúrgica/veterinária , Técnicas de Sutura/veterináriaResumo
Background: Ovariectomy(OVE) and ovariohysterectomy (OVH) are the most performed surgical procedures in Veterinary Medicine. In videosurgery, both in stray animals at sterilization campaigns and in the increasing demand of tutors to perform the technique. Laparoscopy results in reduced tissue damage, due to minimal organ manipulation and surgical access hemostasis can be performed by several methods, such as electro-coagulation, clips, and intra and extracorporeal ligatures. A pre-tied ligature system, or endoloop, is a haemostatic technique comprised of a slipknot and knot pusher, which is inserted into the abdominal cavity through one of the laparoscopic ports. The aim of this study was to describe a novel OVE technique in cats, in which haemostasis was performed using miniloop, aimed at reducing the number of ports needed for knot tying.Material, Methods & Results: Ten healthy not spayed female cats, aged 6 months to 5 years, were selected for this study. They were submitted to an OVE using miniloop as haemostasis method. Access to the peritoneal cavity was through two 5 mm ports on the midline of the ventral abdomen, 5 cm apart, with one immediately caudal to the umbilical scar and the other in between the last pair of teats. The first trocar was inserted at the caudal incision using the Hasson technique and a 5 mm zero-degree optics attached to a camera was introduced through it. The placement of the second access port was video assisted. For ovary exposure, the patients were positioned in lateral recumbency on the contralateral side to the ovary being removed. The miniloop was composed of a 2 mm diameter minitrocar, a 1.8 mm knot pusher, and a pre-tied slipknot. It was introduced percutaneously at the lateral abdominal wall. It was inserted attached to a pre-tied loop ligature.[...](AU)