Laparoscopic adrenalectomy: comparison between pneumoperitoneum and the use of a laparoscopic lift device in dog cadavers / Adrenalectomia laparoscópica: comparação entre o pneumoperitônio e o uso de dispositivo paraliftlaparoscopy em cadáveres de cães

This study evaluated the feasibility of abdominal liftfor laparoscopic adrenalectomy and compared it with the conventional laparoscopic technique using pneumoperitoneum with medicinal CO2 in dog cadavers. The total surgical time (TST), adrenalectomy time (AT), and gland integrity after removal were evaluated. Thirty-eight adrenalectomies were performed in 19 cadavers. Regardless of the antimere, the TST was significantly lower in the CO2 procedures than in the lift laparoscopy procedures (P=0.001). When comparing the techniques between antimeres, the TST was significantly higher on the left side with lift laparoscopy than with CO2 (P=0.015) and similar between the techniques on the right side of the animals (P=0.086). In the comparison of AT, regardless of the execution side, no differences were observed between the techniques (P=0.05). The same was observed when AT was evaluated separately using antimeres (P=0.902). Of the 38 adrenals evaluated, 92.1% were removed in a single block, and 32.29% had a superficial lesion in the capsule. There was no difference between the groups in the removal capacity in a single block (P=0.340) and capsule integrity (P=0.287). Abdominal lift for laparoscopic adrenalectomy is a feasible technique in dog cadavers; however, it requires a longer surgical time than the conventional technique. The traction force used to elevate the abdominal wall must be evaluated.

O presente trabalho teve como objetivo avaliar a exequibilidade da adrenalectomia laparoscópica utilizando dispositivo de elevação da parede abdominal via liftlaparoscopy e comparar com a técnica laparoscópica convencional utilizando pneumoperitônio com CO2 medicinal em cadáveres de cães. Para isso, avaliou-se tempo cirúrgico total (TCT), tempo de adrenalectomia (TA) e integridade das glândulas após remoção. Foram realizadas 38 adrenalectomias em 19 cadáveres. Independentemente do antímero, o TCT foi significativamente menor nos procedimentos com CO2 do que com liftlaparoscopy (P=0,001). Na comparação das técnicas entre antímeros, o TCT foi significativamente maior no lado esquerdo com liftlaparoscopy do que com CO2 (P = 0,015) e semelhante entre as técnicas no lado direito dos animais (P=0,086). Já na comparação do TA, independente do lado de execução, não foram observadas diferenças entre os métodos (P=0,05). O mesmo foi observado quando o TA foi avaliado separadamente por antímero (P=0,902). Das 38 adrenais avaliadas, 92,1% foram removidas em um único bloco e destas, 32,29% apresentaram lesão superficial na cápsula. Não houve diferença entre grupos para capacidade de remoção em um único bloco (P=0,340) e da integridade da cápsula (P=0,287). A adrenalectomia laparoscópica por elevação da parede abdominal é factível de ser realizada em cadáveres de cães, entretanto, demanda maior tempo cirúrgico quando comparada à técnica convencional. Além disso, a força de tração empregada para elevar a parede abdominal necessita ser avaliada.

Efeitos da PEEP na ventilação controlada a volume sobre parâmetros hemodinâmicos em suínos submetidos ao pneumoperitônio associado ao cefalodeclive / Effects of PEEP on hemodynamic variables in pigs submitted to volume-controlled ventilation under pneumoperitoneum associated to cephalodeclive

Videolaparoscopic procedures have gained prominence due to their low invasiveness, causing less surgical trauma and better post-surgical recovery. However, the increase in intra-abdominal pressure due to the institution of pneumoperitoneum can alter the patient's homeostasis. Therefore, volume-controlled ventilation, associated with positive end-expiratory pressure (PEEP), improves arterial oxygenation and prevents pulmonary collapse, but it can lead to important hemodynamic changes. The aim of this study was to evaluate, comparatively, the effects of positive end expiratorypressure (PEEP) on hemodynamic variables of pigs submitted to volume-controlled ventilation, during pneumoperitoneum and maintained in head-down tilt and determine which PEEP value promotes greater stability on hemodynamic variables. Twenty-four pigs were used, between 55 and 65-day-old, weighing between 15 and 25 kg, randomly divided into 3 distinct groups differentiated by positive end-expiratory pressure: PEEP 0 (volume-controlled ventilation and PEEP of 0 cmH2O), PEEP 5 (volume-controlled ventilation and PEEP of 5 cmH2O) and PEEP 10 (volume-controlled ventilation and PEEP of 10 cmH2O). Volume-controlled ventilation was adjusted to 8 mL/kg of tidal volume and a respiratory rate of 25 movements per min. Anesthesia was maintained with continuous infusion of propofol (0.2 mg/kg/min) and midazolam (1 mg/kg/h). Pneumoperitoneum was performed with carbon dioxide (CO2), keeping the intraabdominal pressure at 15 mmHg and the animals were positioned on a 30° head-down tilt. The evaluations of hemodynamic variables started 30 min after induction of anesthesia (M0), followed by measurements at 15-min intervals (from M15 to M90), completing a total of 7 evaluations. The variables of interest were collected over 90 min and submitted to analysis of variance followed by Tukey's post-hoc test, with P < 0.05. The PEEP 10 group had higher values of CVP and mCPP, while the PEEP 5 group, mPAP and PVR were higher. The PEEP 0 group, on the other hand, had higher means of CI. Regarding the moments, there were differences in HR, SAP, DAP, MAP, CO, IC and TPR. According to the literature, important hemodynamic effects due to pneumoperitoneum are reported, which can be caused by the pressure used in abdominal insufflation, CO2 accumulation, duration of the surgical procedure, hydration status and patient positioning. Mechanical ventilation associated with PEEP can also cause an increase in intrathoracic pressure and, therefore, reduce cardiac output. Cardiovascular changes are proportional to the PEEP used. Central venous pressure (PVC) measure the patient's preload, and intrathoracic pressure can interfere with this parameter. The peak pressure values in the PEEP 10 group were higher than the other groups, demonstrating that the increase in intrathoracic pressure results in higher PVC values. Regarding PAPm and PCPm, these variables can be influenced according to the PEEP values and the patient's position. In relation to CI, the increase in PEEP may reflect on intrathoracic pressure, resulting in greater compression of the heart, with a consequent reduction in cardiac output and cardiac index. Therefore, it is concluded that the PEEP effects of 0 cmH2O and 5 cmH2O on hemodynamics are discrete, under the proposed conditions.(AU)

Celioscopy and partial salpingectomy in a pregnant bitch / Celioscopia e salpingectomia parcial em fêmea canina gestante

This case report presents a celioscopy procedure followed by partial salpingectomy (PS) in a pregnant bitch referred to elective video assisted ovariohysterectomy. Through celioscopy it was visualized the embryonic vesicles and PS was performed after conversion to minioceliotomy. The puppies were born by eutocic delivery without clinical alterations. The case suggested that short and regular pneumoperitoneum is not deleterious to dog fetus and video surgery could be used in pregnant bitches. PS allows the fetus development and promotes bitch neutering.

Este trabalho relata um caso de celioscopia seguido de salpingectomia parcial (SP) em fêmea canina gestante encaminhada à ovariohisterectomia eletiva videoassistida. Por celioscopia foram identificadas vesículas gestacionais e a SP foi aplicada após conversão para miniceliotomia. Não foram observadas alterações clínicas nos filhotes, os quais nasceram por parto eutócico. Sugere-se que o pneumoperitônio regular por tempo reduzido não seja deletério para fetos caninos e a videocirurgia pode ser aplicada em caninos gestantes. A SP permite a continuidade do desenvolvimento fetal e a esterilização de fêmeas caninas.

Celioscopy and partial salpingectomy in a pregnant bitch / Celioscopia e salpingectomia parcial em fêmea canina gestante

This case report presents a celioscopy procedure followed by partial salpingectomy (PS) in a pregnant bitch referred to elective video assisted ovariohysterectomy. Through celioscopy it was visualized the embryonic vesicles and PS was performed after conversion to minioceliotomy. The puppies were born by eutocic delivery without clinical alterations. The case suggested that short and regular pneumoperitoneum is not deleterious to dog fetus and video surgery could be used in pregnant bitches. PS allows the fetus development and promotes bitch neutering.(AU)

Este trabalho relata um caso de celioscopia seguido de salpingectomia parcial (SP) em fêmea canina gestante encaminhada à ovariohisterectomia eletiva videoassistida. Por celioscopia foram identificadas vesículas gestacionais e a SP foi aplicada após conversão para miniceliotomia. Não foram observadas alterações clínicas nos filhotes, os quais nasceram por parto eutócico. Sugere-se que o pneumoperitônio regular por tempo reduzido não seja deletério para fetos caninos e a videocirurgia pode ser aplicada em caninos gestantes. A SP permite a continuidade do desenvolvimento fetal e a esterilização de fêmeas caninas.(AU)

Does CO2 pneumoperitoneum in laparoscopy interfere with collagen deposition in abdominal surgical wounds?

Purpose. To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats.. Methods. This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis.. Results. There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003).. Conclusion. At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.(AU)

Does CO2 pneumoperitoneum in laparoscopy interfere with collagen deposition in abdominal surgical wounds?

Purpose To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats. Methods This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis. Results There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003). Conclusion At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.(AU)

Single incision laparoscopic surgery (SILS TM) using an umbilical hernial approach for cryptorchidectomy of a degenerated testis in a dog / Aplicação do portal único (SILS TM) por acesso herniário umbilical para criptorquidectomia de testículo degenerado em cão

SILS TM via an umbilical hernia opening was used in the correction of an abdominal cryptorchidism in a dog. The SILS TM port was inserted through a 2.5 cm skin incision on the umbilical hernia and pneumoperitoneum was established with CO2. A 10mm telescope, 5mm laparoscopic Babcock clamp, and a clamp with combined cutting and coagulation features were used for the dissection and removal of the testicle through the SILS TM port. The treatment proved to be effective, easy, and quick to perform. However, the lack of triangulation between clamps and telescope limited the movement of the instruments, making it more laborious than a multiple-trocar approach. It can be concluded that the use of a SILS TM port through a pre-existing opening of the abdominal wall enables a reduction of the risks associated with multiple incisions; such as injury and manipulation of internal organs, pain, bleeding, and development of new hernias.(AU)

Objetivou-se proceder um tratamento para um caso de criptorquidismo canino, utilizando-se abordagem laparoscópica com portal único SILS TM, por meio de acesso abdominal via abertura de hérnia umbilical. Realizou-se uma incisão de 2,5 cm da pele em cima da hérnia umbilical, por onde introduziu-se trocater SILS TM, seguido do estabelecimento do pneumoperitônio com CO2. Utilizou-se ótica de 10mm, pinça laparoscópica de apreensão tipo Babcock de 5mm e pinça com corte e coagulação simultâneos para liberação e retirada do testículo e do trocater SILS TM, pelo acesso herniário. O tratamento proposto mostrou-se efetivo, de execução relativamente fácil e rápida. Entretanto, a ausência de triangulação entre as pinças e a óptica resultou em maior limitação na movimentação dos instrumentais, em comparação ao procedimento realizado com utilização de múltiplos portais. Pode-se concluir que a utilização do trocater SILS TM em uma falha pré-existente da parede abdominal possibilita significativa redução dos riscos potenciais de múltiplas incisões, como lesão de órgãos internos, manipulação, dor, sangramento e formação de novas hérnias.(AU)

Changes in arterial partial pressure and end-expired pressure of carbon dioxide in prepubescent and adult bitches undergoing ovariohysterectomy by videolaparoscopy or conventional laparotomy / Variações nas pressões parciais arteriais e expiradas de dióxido de carbono em cadelas pré-púberes e adultas submetidasà ovário histerectomiavídeo laparoscópica ou convencional

This paper aimed to determine arterial partial pressure of carbon dioxide (PaCO2), end-expired CO2 pressure (ETCO2), and the difference between arterial and end-expired CO2 pressure (Pa - ETCO2) in prepubescent and adult bitches undergoing videolaparoscopic or conventional ovariohyterectomy (OH). Forty bitches were randomly assigned to four groups: Conventional Adult (CA), Conventional Pediatric (CP), Videolaparoscopic Adult (VA) and Videolaparoscopic Pediatric (VP). Pulse rate (PR), respiratory rate (RR), systolic, mean, and diastolic arterial pressures (SAP, MAP, DAP), ETCO2, peak inspiratory pressure (PIP), pH, arterial partial pressure of oxygen (PaO2), PaCO2, base excess (BE) and HCO3 - were measured. Based on the PaCO2 and ETCO2 values, Pa-ETCO2 was determined. There was no significant difference in PaCO2 between the VA (42.5±5.2 to 53.7±5.2) and VP (48.4±5.4 to55.4±5.7) groups. During the postoperative period, all groups presented with hypertension. However, mild hypertension (SAP 150 to 159mmHg) was observed in the VP group as compared to severe hypertension (SAP>180mmHg) in the CA group, suggesting that both the age range and videolaparoscopic OH are associated with lower levels of hypertension during the postoperative period in dogs.(AU)

O objetivo deste estudo foi determinar a pressão parcial de dióxido de carbono (PaCO2), pressão ao final da expiração de CO2 (ETCO2) e diferença artério-alveolar de CO2 (Pa-ETCO2) em cadelas pré-púberes e adultas submetidas à ovário-histerectomia (OH) videolaparoscópica ou convencional. Foram distribuídas 40 cadelas em quatro grupos: Convencional Adulto (CA), Convencional Pediátrico (CP), Videolaparoscópico Adulto (VA) e Videolaparoscópico Pediátrico (VP). Foram mensurados frequência de pulso (FP), frequência respiratória (FR), pressões arteriais sistólica (PAS), média (PAM) e diastólica (PAD), ETCO2, pressão de pico inspiratória (PIP), pH, pressão parcial arterial de oxigênio (PaO2), PaCO2, excesso de bases (EB) e HCO3 -. Com base nos valores de PaCO2 e ETCO2 encontrados, foi determinada a Pa-ETCO2. Não foram encontradas diferenças significativas nos valores de PaCO2 entre os grupos VA (42.5±5.2-53,7±5,2) e VP (48.4±5.4 - 55,4±5,7). Todos os grupos apresentaram hipertensão arterial no período pós-operatório. Entretanto, o grupo VP apresentou hipertensão moderada (PAS 150-159mmHg) em comparação ao grupo CA, que apresentou hipertensão severa (PAS>180 mmHg), sugerindo que tanto a faixa etária, quanto a execução de OH por videolaparoscopia, estão associadas a menores taxas de hipertensão pós-operatória em cadelas.(AU)

Avaliação do fluxo de saída do ventrículo esquerdo em gatos anestesiados submetidos ao pneumoperitônio e à posição deTrendelenburg / Evaluation left ventricle Outflow in cats anesthetized submitted to pneumoperitoneum and Trendelenburg position

Objetivou-se avaliar os efeitos do pneumoperitônio e da posição de Trendelenburg sobre o fluxo de saída do ventrículo esquerdo em gatos anestesiados. Quatorze gatos foram alocados aleatoriamente em dois grupos, ambos submetidos ao pneumoperitônio com 10mmHg de dióxido de carbono (CO2). No grupo controle (GC n=7), os animais foram submetidos apenas ao pneumoperitônio e, no grupo Trendelenburg (GTREN n=7), os animais foram colocados em cefalodeclive 20° após o pneumoperitônio. A indução anestésica foi realizada com isoflurano, utilizando-se caixa de indução. Posteriormente, os animais foram mantidos sob anestesia inalatória com o mesmo fármaco. Foram avaliados a velocidade do fluxo de saída do ventrículo esquerdo (VFSVE), os gradientes máximo (GmáxSVE) e médio (GmédSVE) de pressão e a integral velocidade-tempo (IVT). Os parâmetros foram mensurados nos momentos T0 (basal), antes da insuflação; T5 (cinco), T15 (quinze) e T30 (trinta) minutos após a insuflação. Os resultados mostraram um aumento da VFSVE no GC, em T15 e T30 (P=0,024), e um aumento do GmáxSVE no GC, em T30 (P=0,045). As variáveis não se alteraram significativamente em nenhum momento no GTREN. Dessa forma, conclui-se que a posição de Trendelenburg favoreceu o sistema cardiovascular, preservando os índices de fluxo sanguíneo na saída do ventrículo esquerdo.(AU)

The aim of this study was to evaluate the effects of pneumoperitoneum and Trendelenburg position on the left ventricular outflow in anesthetized cats. Fourteen cats were randomly divided into two groups, both submitted to pneumoperitoneum of 10 mmHg with carbon dioxide (CO2), and in the control group (GC n = 7) the animals were subjected only to pneumoperitoneum and the Trendelenburg group (n = 7 GTREN) the animals were placed in cefalodeclive 20° after pneumoperitoneum. Anesthesia of the animals was performed with isoflurane using induction box, keeping the animals under inhalation anesthesia with the same drug. We evaluated the speed of the left ventricular outflow (VFSVE), the maximum pressure gradient (GmáxSVE), mean pressure gradient (GmédSVE) and velocity-time integrals (IVT). The parameters were measured in time, T0 (baseline), before the insufflation; T5 (five); T15 (fifteen) and T30 (thirty) minutes after inflation. The results showed an increase in VFSVE in GC, T15 and T30 (p = 0,024) and an increase in GmáxSVE in GC in T30 (p = 0,045). The variables did not change significantly at any time in GTREN. Thus, it is concluded that the Trendelenburg position favored the cardiovascular system, preserving blood flow rates in the left ventricular outflow.(AU)

Avaliação do fluxo de saída do ventrículo esquerdo em gatos anestesiados submetidos ao pneumoperitônio e à posição deTrendelenburg / Evaluation left ventricle Outflow in cats anesthetized submitted to pneumoperitoneum and Trendelenburg position

Objetivou-se avaliar os efeitos do pneumoperitônio e da posição de Trendelenburg sobre o fluxo de saída do ventrículo esquerdo em gatos anestesiados. Quatorze gatos foram alocados aleatoriamente em dois grupos, ambos submetidos ao pneumoperitônio com 10mmHg de dióxido de carbono (CO2). No grupo controle (GC n=7), os animais foram submetidos apenas ao pneumoperitônio e, no grupo Trendelenburg (GTREN n=7), os animais foram colocados em cefalodeclive 20° após o pneumoperitônio. A indução anestésica foi realizada com isoflurano, utilizando-se caixa de indução. Posteriormente, os animais foram mantidos sob anestesia inalatória com o mesmo fármaco. Foram avaliados a velocidade do fluxo de saída do ventrículo esquerdo (VFSVE), os gradientes máximo (GmáxSVE) e médio (GmédSVE) de pressão e a integral velocidade-tempo (IVT). Os parâmetros foram mensurados nos momentos T0 (basal), antes da insuflação; T5 (cinco), T15 (quinze) e T30 (trinta) minutos após a insuflação. Os resultados mostraram um aumento da VFSVE no GC, em T15 e T30 (P=0,024), e um aumento do GmáxSVE no GC, em T30 (P=0,045). As variáveis não se alteraram significativamente em nenhum momento no GTREN. Dessa forma, conclui-se que a posição de Trendelenburg favoreceu o sistema cardiovascular, preservando os índices de fluxo sanguíneo na saída do ventrículo esquerdo.(AU)

The aim of this study was to evaluate the effects of pneumoperitoneum and Trendelenburg position on the left ventricular outflow in anesthetized cats. Fourteen cats were randomly divided into two groups, both submitted to pneumoperitoneum of 10 mmHg with carbon dioxide (CO2), and in the control group (GC n = 7) the animals were subjected only to pneumoperitoneum and the Trendelenburg group (n = 7 GTREN) the animals were placed in cefalodeclive 20° after pneumoperitoneum. Anesthesia of the animals was performed with isoflurane using induction box, keeping the animals under inhalation anesthesia with the same drug. We evaluated the speed of the left ventricular outflow (VFSVE), the maximum pressure gradient (GmáxSVE), mean pressure gradient (GmédSVE) and velocity-time integrals (IVT). The parameters were measured in time, T0 (baseline), before the insufflation; T5 (five); T15 (fifteen) and T30 (thirty) minutes after inflation. The results showed an increase in VFSVE in GC, T15 and T30 (p = 0,024) and an increase in GmáxSVE in GC in T30 (p = 0,045). The variables did not change significantly at any time in GTREN. Thus, it is concluded that the Trendelenburg position favored the cardiovascular system, preserving blood flow rates in the left ventricular outflow.(AU)

A prototype single-port device for pressurized intraperitoneal aerosol chemotherapy. Technical feasibility and local drug distribution

Purpose: To evaluate the technical feasibility and homogeneity of drug distribution of pressurized intraperitoneal aerosol chemotherapy (PIPAC) based on a novel process of intraperitoneal drug application (multidirectional aerosolization). Methods: This was an in vivo experimental study in pigs. A single-port device was manufactured at the smallest diameter possible for multidirectional aerosolization of the chemotherapeutic drug under positive intraperitoneal pressure. Four domestic pigs were used in the study, one control animal that received multidirectional microjets of 9 mL/sec for 30 min and three animals that received multidirectional aerosolization (pig 02: 9 mL/sec for 30 min; pigs 03 and 04: 3 mL/sec for 15 min). Aerosolized silver nitrate solution was applied for anatomopathological evaluation of intraperitoneal drug distribution. Results: Injection time was able to maintain the pneumoperitoneum pressure below 20 mmHg. The rate of moderate silver nitrate staining was 45.4% for pig 01, 36.3% for pig 02, 36.3% for pig 03, and 72.7% for pig 04. Conclusions: Intra-abdominal drug distribution had a broad pattern, especially in animals exposed to the drug for 30 min. Our sample of only four animals was not large enough to demonstrate an association between aerosolization and a higher silver nitrate concentration in the stained abdominal regions.(AU)

The effects of enoxaparin on the liver in experimental pneumoperitoneum model

PURPOSE:To investigate the potential protective effects of enoxaparin against the adverse events of carbon dioxide (CO2) pneumoperitoneum.METHODS:Thirty four rats were divided into three groups: Group 1 (sham) underwent insertion of Veress needle into the abdomen and 90 min of anesthesia with no gas insufflation. The animals in control and enoxaparin groups were subjected to 90 min of 14 mmHg CO2 pneumoperitoneum. Enoxaparin (100 u/kg) was administered subcutaneously to the rats in enoxaparin group one hour before the operation. After 90 min of pneumoperitoneum, the rats were allowed for reperfusion through 60 min. Blood and liver samples were obtained for biochemical and histopathological examination.RESULTS:Treatment with enoxaparin decreased the histopathological abnormalities when compared with the control group. The highest levels of oxidative stress parameters were found in control group. The use of enoxaparin decreased the levels of all oxidative stress parameters, but the difference between the control and enoxaparin groups was not statistically significant.CONCLUSION:Enoxaparin ameliorated the harmful effects of high pressure CO2 pneumoperitoneum on the liver.(AU)

Uso de dispositivo de elevação abdominal na coleta de biópsia hepática laparoscópica por less: estudo de viabilidade em cadáveres caninos

O objetivo do presente estudo foi avaliar a viabilidade da técnica laparoscópica por LESS (com único portal), utilizando um dispositivo de elevação mecânica da parede abdominal, a plataforma de tração multidirecional (ES201800465 U) e compará-la com pneumoperitônio de baixa pressão na obtenção de biópsia hepática em cadáveres caninos no que se refere a determinadas variáveis operacionais. Para tanto, foram utilizados 18 cadáveres, distribuídos em três grupos, onde foi realizada a biópsia hepática com único portal e pneumoperitônio de 2mmHg (grupo G1), 4mmHg (grupo G2) e gasless, através da plataforma de tração multidirecional (grupo G3). Todos os procedimentos foram realizados com portal de 11mm, posicionado na cicatriz umbilical, e uma óptica rígida de 10mm e 0º. O peso dos cadáveres, o tempo operatório total e os tempos de cada etapa dos procedimentos foram registrados. O grau de dificuldade do acesso cirúrgico e da coleta das biópsias hepáticas, bem como, a avaliação do espaço de trabalho intra-abdominal foram mensurados pelo cirurgião. Além disso, dois avaliadores proficientes em videocirurgia e cegos ao tipo de procedimento realizaram a avaliação dos vídeos gravados durante o intra-operatório e pontuaram conforme escala pré-estabelecida sobre o espaço de trabalho e dificuldades para a coleta das biópsias hepáticas. Os fragmentos de tecido hepático coletados através da pinça laparoscópica tipo punch foram pesados em balança de alta precisão. O peso médio dos cadáveres selecionados para o estudo foi de 8,7± 3,8 kg. O tempo médio cirúrgico total foi maior no grupo G1 (30,3± 13,5) min, seguido do grupo G3 (27,3± 7,3) min e com menor tempo o grupo G2 (24,8± 5,3) min (p= 0,6). Não houve diferença estatística entre os grupos quanto a qualidade do espaço de trabalho, entretanto escores mais baixos foram registrados para o grupo G1, demonstrando que foi necessária maior manipulação de vísceras para atingir o órgão alvo. Em contrapartida, o grupo G3 recebeu escores mais altos, sugerindo um espaço de trabalho excelente, com visualização clara do órgão alvo e mínima ou nenhuma manipulação de vísceras. Houve diferença estatística na comparação da coleta de biópsia entre os lobos hepáticos, tanto no grupo G1 (p= 0,0093), quanto no G2 (p= 0,00006) e G3 (p= 0,0053). O lobo hepático lateral direito foi considerado o de mais difícil acesso para realizar a biópsia em nosso estudo. O peso médio das amostras coletadas foram G1 (96,2±11,58) mg, G2 (90,77±10,57) mg, G3 (87,63±16,42) mg. A técnica de biópsia hepática por LESS usando o dispositivo de elevação abdominal foi exequível em cadáveres caninos e similar à técnica com pneumoperitônio, representando uma alternativa para evitar as alterações orgânicas associadas ao uso de pneumoperitônio.

The aim of the present study was to evaluate the viability of the LESS laparoscopic technique (with a single portal), using a mechanical device for lifting the abdominal wall, the multidirectional traction platform (ES201800465 U) and comparing it with low pressure pneumoperitoneum in obtaining of liver biopsy in canine cadavers with respect to certain operational variables. For this purpose, 18 cadavers were used, distributed in three groups, where liver biopsy with a single portal and pneumoperitoneum of 2 mmHg (group G1), 4 mmHg (group G2) and gasless was performed, through the multidirectional traction platform (group G3). The surgical team remained fixed on their function. The dogs were placed in the supine position. All procedures were performed with an 11mm portal, positioned on the 10mm and 0º nephroscope umbilical scar. The weight of the corpses, the total operative time and the times of each stage of the procedures were recorded. The degree of difficulty of surgical access and collection of liver biopsies, as well as the assessment of the intra-abdominal workspace were measured by the surgeon. In addition, two evaluators, proficient in video surgery, and blinded to the type of procedure performed the evaluation of the intra-abdominal videos recorded during the operation and scored according to a pre-established scale on the working space and difficulties in collecting liver biopsies. The fragments of hepatic tissue collected using laparoscopic punch biopsy forceps were weighed on a high precision scale. The average weight of the cadavers selected for the study was 8.7 ± 3.8 kg. The mean total surgical time was longer in the G1 group (30.3 ± 13.5) min, followed by the G3 group (27.3 ± 7.3) min and with a shorter time in the G2 group (24.8 ± 5.3) min (p= 0,6). There was no statistical difference between the groups regarding the quality of the working space, however lower scores were registered for the G1 group, demonstrating that greater viscera manipulation was necessary to reach the target organ. In contrast, the G3 group received higher scores, suggesting an excellent working space, with clear visualization of the target organ and minimal or no manipulation of the viscera. There was a statistical difference in the comparison of biopsy collection between the hepatic lobes, both in the G1 (p = 0.0093), and in the G2 (p = 0.00006) and G3 (p = 0.0053) groups. The right lateral hepatic lobe was considered the most difficult to access to perform the biopsy in our study. The average weight of the samples collected were G1 (96.2 ± 11.58) mg, G2 (90.77 ± 10.57) mg, G3 (87.63 ± 16.42) mg. The liver biopsy technique by LESS using the abdominal elevation device was feasible in canine cadavers and similar to the technique with pneumoperitoneum, representing an alternative to avoid the organic changes associated with the use of pneumoperitoneum.

Colecistectomia laparoscópica com três portais em cães via gasless ou pneumoperitônio com CO2.

Os objetivos desta tese foram, em uma primeira etapa, avaliar os resultados da colecistectomia laparoscópica (CL) via três portais de acesso em cães com doenças benignas da vesícula biliar em um estudo retrospectivo. A segunda etapa consistiu na proposição e avaliação da exeqüibilidade de uma técnica correspondente na modalidade gaslessem cadáveres caninos, utilizando um dispositivo personalizado de elevação mecânica da parede abdominal, e compará-la à técnica com pneumoperitônio em determinadas variáveis cirúrgicas. No artigo 1, foram revisados os registros médicos de 14 casos de CL operados por dois cirurgiões com diferentes proeficiências. O tempo cirúrgico médio foi de 69,21 ± 21.7 min (variação 45-104), não houve conversão em nenhum dos pacientes e 85,7% dos cães receberam alta hospitalar no dia do procedimento. As complicações transoperatórias em sua maioria foram classificadas como menores. Dois pacientes apresentaram complicações pós-operatórias que exigiram reintervenção, sendo um dos casos não relacionado à CL, e vieram a óbito após o segundo procedimento cirúrgico. No estudo prospectivo do artigo 2, 16 cadáveres foram distribuídos em dois grupos, os do GCG (n=8) foram submetidos à CL com o uso da plataforma de tração multidirecional e os do GCP (n=8) submetidos à CL com pneumoperitônio (10 mmHg). O tempo operatório total, os tempos de cada etapa do procedimento e as complicações transoperatórias foram registrados. O grau de dificuldade das abordagens cirúrgicas foi avaliado pelo cirurgião e auxiliar a partir de duas escalas adaptadas, uma escala visual analógica e uma escala Likert. A técnica proposta de CL gasless foi exeqüível em todos os animais. O tempo cirúrgico total foi maior para o grupo GCG (p=0,02), assim como o tempo para a etapa de dissecção da vesícula biliar do leito hepático (p=0,03). Para ambas as escalas, o grau de dificuldade para execução do procedimento foi maior para o GCG nas etapas de exposição e dissecção do ducto cístico, hemostasia e transecção do ducto cístico, visualização de estruturas anatômicas e para o somatório de todas as etapas (p<0,05). Não houve diferença na incidência de complicações transoperatórias entre as duas técnicas. Diante dos resultados apresentados, concluímos que a CL com três portais de acesso é uma abordagem viável e segura para o tratamento de doenças benignas da vesícula biliar em cães, possibilitando a redução da lesão de acesso cirúrgico por dispensar um trocarte adicional, sem ampliar a complexidade do procedimento considerando o acesso de quatro portais. A CL utilizando a plataforma de tração multidirecional foi viável em cadáveres caninos e similar à técnica correspondente utilizando pneumoperitônio quanto à incidência de complicações transoperatórias. Ainda que o tempo cirúrgico e o grau de dificuldade para a execução da técnica proposta sejam superiores, viabilizar uma técnica de CL que dispense o uso de pneumoperitônio representa uma valiosa alternativa para pacientes incapazes de compensar as alterações promovidas pela insuflação abdominal.

The aims of this thesis were, in a first step, to evaluate the results of laparoscopic cholecystectomy (CL) via three-port access in dogs with benign gallbladder diseases in a retrospective study. The second step consisted of proposing and evaluating the feasibility of a gasless three-port access CL in canine cadavers, using a personalized device for mechanical elevation of the abdominal wall, and comparing it to the corresponding technique with pneumoperitoneum in certain surgical variables. In article 1, the medical records of 14 cases of CL performed by two surgeons with different proficiencies were reviewed. The average surgical time was 69.21± 21.7 min (range 45-104), there was no conversion in any of the patients and 85.7% of the dogs were discharged on the day of the procedure. Most intraoperative complications were classified as minor. Two patients had postoperative complications that required reintervention, one of which was unrelated to CL, anddied after the second surgical procedure. In the prospective study of article 2, 16 cadavers were divided into two groups, those from the GCG (n = 8) were submitted to CL using the multidirectional traction platform and those from the GCP (n = 8) underwent CL with pneumoperitoneum (10 mmHg). The total surgical time, the times of each stage of the procedure, and the intraoperative complications were recorded. The degree of difficulty of surgical approaches was assessed by the surgeon and auxiliary fromtwo types of adapted scales, a visual analog scale and a Likert scale. The proposed gasless CL technique was feasible in all animals. The total surgical time was longer for the GCG group (p=0.02), as well as the time for the stage of gallbladder dissection of the liver bed (p=0.03).For both scales, the degree of difficulty in performing the procedure was greater for the GCG in the stages of exposure and dissection of the cystic duct, hemostasis, and transection of the cystic duct, visualization of anatomical structures, and for the sum ofall steps (p<0.05). There was no difference in the incidence of intraoperative complications between the two techniques. Given the results presented, we conclude that CL with three-port access is a viable and safe approach for the treatment of benign gallbladder diseases in dogs, making it possible to reduce the surgical access injury by avoiding the use of an additional trocar, without increasing the complexity of the procedure considering the access of four-port. CL using the multidirectional traction platform was viable in canine cadavers and similar to the corresponding technique using pneumoperitoneum for the incidence of intraoperative complications. Even though the surgical time and the degree of difficulty for the execution of the proposed technique are higher, to enable a CL technique that does not require the use ofpneumoperitoneum represents a valuable alternative for patients unable to compensate for changes caused by abdominal insufflation.

Video-assisted ovariohysterectomy in domestic cats (Felis catus, Linnaeus, 1758) using two access portals

PURPOSE: To describe video-assisted ovariohysterectomy (OHE) with two portals access in adult intact queens.METHODSFifty-two females cats were used. A 4 mm cannula was positioned in the abdomen through an incision close to the umbilicus (first portal), and a pneumoperitoneum was established. A second portal was positioned in the midline of the pre-pubic region. Females were positioned in right lateral recumbency to locate the left ovarian pedicle, and the uterine horn was held by a transcutaneous suture. The pedicle was cauterized and incised. The procedure was then performed on the contralateral ovary. The ovaries were exteriorized from the abdomen, along with the uterus, through the second access point. The uterine body was exposed, fixed and sectioned, and the abdominal incisions were sutured.RESULTSSurgeries were performed in an average of 41.4±14.2 minutes. The main complications included hypotension (7.7%) and subcutaneous emphysema (7.7%), and 13.5% of the surgeries were converted to laparotomy.CONCLUSIONOvariohysterectomy using a video-assisted technique and two access portals is safe, has minimal risks and is effective for the spaying of queens.(AU)

DIFERENTES VALORES DE PRESSÃO POSITIVA AO FINAL DA EXPIRAÇÃO, EM SUÍNOS SUBMETIDOS À VENTILAÇÃO CONTROLADA A VOLUME DURANTE O PNEUMOPERITÔNIO E CEFALODECLIVE

Com o delineamento proposto, objetivou-se avaliar a ventilação controlada a volume com diferentes pressões positivas ao final da expiração (PEEP), em suínos submetidos ao pneumoperitônio e posicionados em cefalodeclive. Foram utilizados 24 suínos da raça Large White, com cerca de 55 a 65 dias de idade, pesando entre 15 e 25 kg, distribuídos em 3 grupos (n = 8), o qual diferenciaram-se pela pressão positiva ao final da expiração: PEEP 0 (ventilação controlada a volume e PEEP 0 cmH2O), PEEP 5 (ventilação controlada a volume e PEEP 5 cmH2O) e PEEP 10 (ventilação controlada a volume e PEEP 10 cmH2O). A manutenção da anestesia foi realizada com infusão contínua de propofol (0,2 mg/kg/min) e midazolan (1 mg/kg/h). A ventilação controlada a volume foi ajustada em 8 mL/kg de volume corrente e frequência respiratória de 25 movimentos por minutos. A PEEP foi estabelecida de acordo com cada grupo experimental. Em seguida, os animais foram posicionados em cefalodeclive de 30° e submetidos ao pneumoperitônio com pressão de 15 mmHg. Submeteram-se os dados à análise de variância e o teste de separação de médias (Tukey) foi realizado ao nível de 5% de significância utilizando o programa SAS. O grupo PEEP 10 apresentou maiores valores de Ppico, Cdyn, SO2, IO, PVC e PCPm, enquanto no grupo PEEP 5, [P(a-ET)CO2], IR, PAPm e RVP foram maiores. Já o grupo PEEP 0, apresentou médias mais altas da Rdyn, PvCO2 e IC. Com relação aos momentos, houve diferenças na PaO2, PaCO2, pH, PCO2, ETCO2, Ppico, Pmédia, PAO2, Qs/Qt, IO, VO2, FC, PAS, PAD, PAM, DC, IC, RPT e IRPT. Conclui-se que a PEEP de 10 cmH2O promove melhor estabilidade ventilatória e o pneumoperitônio de 15 mmHg associado ao cefalodeclive aumentam os shunts pulmonares e os níveis da PaCO2.

The aim of the present studuy was to evaluate volume-controlled ventilation with different positive end-expiratory pressures (PEEP), in pigs submitted to pneumoperitoneum and maintained in head-down tilt. Twenty-four Large White pigs were used, between 55 and 65 days old, weighing between 15 and 25 kg, divided into three distinct groups differentiated by positive end-expiratory pressure: PEEP 0 (volume-controlled ventilation and PEEP 0 cmH2O), PEEP 5 (volume-controlled ventilation and PEEP 5 cmH2O) and PEEP 10 (volume-controlled ventilation and PEEP 10 cmH2O) were included in the study. Anesthesia was maintained with continuous infusion of propofol (0.2 mg/kg/min) and midazolam (1 mg/kg/h). Volume-controlled ventilation was adjusted to 8 mL/kg of tidal volume and a respiratory rate of 25 movements per minute. The animals were positioned on a 30 ° head-down tilt and submitted to pneumoperitoneum of 15 mmHg. Numeric data were submitted to analysis of variance followed by Tukey´s post-hoc test, with p < 0.05. The PEEP 10 group showed higher values of Ppico, Cdyn, SO2, IO, PVC and PCPm, while in the PEEP 5 group, [P (a-ET) CO2], IR, PAPm and RVP were higher. The PEEP 0 group had higher means of Rdyn, PvCO2 and IC. Differences between groups were found in PaO2, PaCO2, pH, PCO2, ETCO2, Ppico, Pmédia, PAO2, Qs/Qt, IO,VO2, FC, PAS, PAD, PAM, DC, IC, RPT e IRPT. It is concluded that the 10 cmH2O PEEP provides better ventilatory stability and the 15 mmHg pneumoperitoneum associated with the cephalodeclive increases pulmonary shunts and PaCO2 levels.

Videolaparoscopic splenectomy with bipolar electrosurgery in dog with splenic mass / Esplenectomia videolaparoscópica com eletrocirurgia bipolar em cão com massa esplênica

Background: The main indications to splenectomy in dogs are splenic neoplasms and torsions as well as serious injuries and hemolytic diseases refractory to medical therapy. Animal laparoscopic splenectomy is basically described in experimental studies, while in humans the technique has been established as a standard surgical treatment of splenic disorders. Due to the shortage of reports showing the applicability of this technique in veterinary routine, this study aimed to report a case of laparoscopic splenectomy using bipolar hemostasis and transparietal sutures in a dog that presented splenic mass.Case: A 12-years-old dachshund male was referred for splenectomy due to suspected of splenic neoplasm, after observation of splenic nodules during an ultrasound examination. The splenectomy was performed by videosurgery, with three portal accesses after clinical and laboratory evaluation. The first portal was positioned laterally to the fourth right mammary gland, and the second one in the umbilicus scar; the third one was introduced by paramedian access, laterally to the penis (on the left position). After establishment of CO2 pneumoperitoneum was visualized the splenic mass and performed the first temporary transparietal suture using nylon 0; the spleen was elevated in order to exposure the branches of the splenic vessels. It was realized bipolar cauterization and splenic ablation...(AU)

Os neoplasmas e as torções esplênicas, assim como os traumatismos graves e doenças hemolíticas refratárias a tratamento clínico, estão entre as principais indicações para esplenectomia total em cães [10].As hiperplasias nodulares, principal alteração não neoplásica em caninos [3], tem grande importância diferencial para os neoplasmas, principalmente para os linfomas, já que estes podem se apresentar de forma nodular [9,12].A videocirurgia teve início na Medicina Veterinária como técnica diagnóstica e, cada vez mais, vem sendo utilizada com diferentes fins terapêuticos. A esplenectomia laparoscópica em pequenos animais é basicamente descrita em estudos experimentais [11,13], enquanto, em humanos essa técnica já foi consagrada como tratamento padrão das afecções cirúrgicas do baço [13].Em estudo no qual foi comparado o acesso laparoscópico com o convencional para esplenectomia em cães constatou-se a viabilidade da técnica que, apesar de estar associada à maior tempo cirúrgico, possibilitou redução na lesão de acesso, menor perda sanguínea e menor pontuação na escala de dor [11].Em virtude da escassez de relatos da aplicabilidade dessa técnica na rotina veterinária, esse trabalho objetiva relatar um caso de esplenectomia videolaparoscópica com auxílio de hemostasia bipolar e suturas transparietais em cão com massa esplênica...(AU)

Rectal prolapse as a complication of transrectal NOTES in an experimental porcine model

Background: Rectal prolapse is the protrusion of one or more layers of the rectum through the anal sphincter. Some of the possible causes are tenesmus, endoparasitism and large bowel inflammation. Natural orifice transluminal endoscopic surgery (NOTES) consists of advanced techniques to gain access to body cavities through natural openings without skin incision. Different access routes may be used. However, transrectal NOTES has not been often reported. This paper reports a case of rectal prolapse after transrectal NOTES in a porcine model. Case: A healthy, female domestic swine underwent experimental peritoneoscopy through transrectal route. The animal weighed 20 kg and was approximately 90 days old. Under general anesthesia, a pneumoperitoneum was created and, after this, the rectal lining was pulled out and incised so that the endoscope could be introduced into the abdominal cavity. Subsequently, the cavity was deflated and the rectal wall was sutured under direct viewing with single-layer extramucosal sutures closed with 3-0 polyglactin 910 and simple continuous pattern in the muscular region and submucosa. There was edema of the rectal lining with a slight protrusion and was reduced manually. There was prolapse recurrence and a pursestring suture was placed around the anus. The suture ruptured about 72 h after the endoscopic procedure and self-mutilation of the perineal...(AU)

Rectal prolapse as a complication of transrectal NOTES in an experimental porcine model

Background: Rectal prolapse is the protrusion of one or more layers of the rectum through the anal sphincter. Some of the possible causes are tenesmus, endoparasitism and large bowel inflammation. Natural orifice transluminal endoscopic surgery (NOTES) consists of advanced techniques to gain access to body cavities through natural openings without skin incision. Different access routes may be used. However, transrectal NOTES has not been often reported. This paper reports a case of rectal prolapse after transrectal NOTES in a porcine model. Case: A healthy, female domestic swine underwent experimental peritoneoscopy through transrectal route. The animal weighed 20 kg and was approximately 90 days old. Under general anesthesia, a pneumoperitoneum was created and, after this, the rectal lining was pulled out and incised so that the endoscope could be introduced into the abdominal cavity. Subsequently, the cavity was deflated and the rectal wall was sutured under direct viewing with single-layer extramucosal sutures closed with 3-0 polyglactin 910 and simple continuous pattern in the muscular region and submucosa. There was edema of the rectal lining with a slight protrusion and was reduced manually. There was prolapse recurrence and a pursestring suture was placed around the anus. The suture ruptured about 72 h after the endoscopic procedure and self-mutilation of the perineal...

Videolaparoscopic splenectomy with bipolar electrosurgery in dog with splenic mass / Esplenectomia videolaparoscópica com eletrocirurgia bipolar em cão com massa esplênica

Background: The main indications to splenectomy in dogs are splenic neoplasms and torsions as well as serious injuries and hemolytic diseases refractory to medical therapy. Animal laparoscopic splenectomy is basically described in experimental studies, while in humans the technique has been established as a standard surgical treatment of splenic disorders. Due to the shortage of reports showing the applicability of this technique in veterinary routine, this study aimed to report a case of laparoscopic splenectomy using bipolar hemostasis and transparietal sutures in a dog that presented splenic mass.Case: A 12-years-old dachshund male was referred for splenectomy due to suspected of splenic neoplasm, after observation of splenic nodules during an ultrasound examination. The splenectomy was performed by videosurgery, with three portal accesses after clinical and laboratory evaluation. The first portal was positioned laterally to the fourth right mammary gland, and the second one in the umbilicus scar; the third one was introduced by paramedian access, laterally to the penis (on the left position). After establishment of CO2 pneumoperitoneum was visualized the splenic mass and performed the first temporary transparietal suture using nylon 0; the spleen was elevated in order to exposure the branches of the splenic vessels. It was realized bipolar cauterization and splenic ablation...

Os neoplasmas e as torções esplênicas, assim como os traumatismos graves e doenças hemolíticas refratárias a tratamento clínico, estão entre as principais indicações para esplenectomia total em cães [10].As hiperplasias nodulares, principal alteração não neoplásica em caninos [3], tem grande importância diferencial para os neoplasmas, principalmente para os linfomas, já que estes podem se apresentar de forma nodular [9,12].A videocirurgia teve início na Medicina Veterinária como técnica diagnóstica e, cada vez mais, vem sendo utilizada com diferentes fins terapêuticos. A esplenectomia laparoscópica em pequenos animais é basicamente descrita em estudos experimentais [11,13], enquanto, em humanos essa técnica já foi consagrada como tratamento padrão das afecções cirúrgicas do baço [13].Em estudo no qual foi comparado o acesso laparoscópico com o convencional para esplenectomia em cães constatou-se a viabilidade da técnica que, apesar de estar associada à maior tempo cirúrgico, possibilitou redução na lesão de acesso, menor perda sanguínea e menor pontuação na escala de dor [11].Em virtude da escassez de relatos da aplicabilidade dessa técnica na rotina veterinária, esse trabalho objetiva relatar um caso de esplenectomia videolaparoscópica com auxílio de hemostasia bipolar e suturas transparietais em cão com massa esplênica...