Variables associated with the prevalence of self-reported work-related musculoskeletal disorders in veterinary laparoscopic surgeons.

OBJECTIVE: To investigate the relationship between physical attributes and difficulty performing laparoscopic maneuvers with the prevalence of self-reported musculoskeletal injury. STUDY DESIGN: Online survey. SAMPLE POPULATION: Surgeons (n = 140) with 3 or more years of laparoscopic experience. METHODS: Electronic survey distributed via LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, presence of musculoskeletal injuries, and surgical practice data. Statistical analysis was performed using the Shapiro-Wilk test, linear regression, logistic regression, and Wilcoxon rank sum tests. RESULTS: A total of 52 of the 140 respondents reported a musculoskeletal injury with 38 specifying at least one injury (72%). Neck strain was the most prevalent reported musculoskeletal injury (18/52, 34.6%), followed by shoulder tendinopathies (16/52, 30.8%), arm/hand tendonitis (8/52, 15.4%), carpal tunnel (7/52, 13.5%), back pain (4/52, 7.7%) and arm/hand arthritis (1/52, 1.9%). Women were significantly more likely to report a musculoskeletal problem than men (p = .011) with the odds of women reporting a musculoskeletal injury 2.59 times greater than men. Women and surgeons with smaller glove sizes were significantly more likely to report shoulder tendonitis (p = .034, p = .1) and neck strain (p = .009, p = .001). Respondents with a musculoskeletal problem experienced significantly more difficulty using rotating cup biopsy forceps (p < .001) and perceived this as difficult a greater amount of time (p = .006). CONCLUSION: Female surgeons report more musculoskeletal injuries than their male counterparts. Surgeons with musculoskeletal injuries experience more difficulty performing particular laparoscopic maneuvers. CLINICAL SIGNIFICANCE: Improving ergonomics for women and surgeons with smaller glove sizes must be prioritized to improve surgeon health and laparoscopic instrument use.

Resolution of chronic regurgitation in an 8 month old Babydoll sheep by thoracoscopic treatment of a vascular ring anomaly.

OBJECTIVE: The objective was to describe the successful thoracoscopic treatment of esophageal entrapment resulting from a vascular ring anomaly (VRA) comprising a persistent right aortic arch (PRAA) and left ligamentum arteriosum (LA) in a Babydoll sheep wether. STUDY DESIGN: Case report. ANIMAL: Eight month old Babydoll sheep wether, 13 kg. METHODS: The patient presented with a weight half that of its sibling, persistent regurgitation following eating, and delayed growth noted from the age of approximately 2 months, coinciding with the introduction of solid feed into the diet. Plain thoracic radiographs were within normal limits but computed tomography angiography (CTA) confirmed multiple congenital vascular anomalies. The primary finding was esophageal and tracheal entrapment by a PRAA and left LA. Thoracoscopic transection of the LA was performed with a bipolar vessel sealing device with the aid of transesophageal endoscopy. RESULTS: Immediate improvement in attitude and absence of regurgitation were observed. The patient was discharged and subsequently reintroduced to grazing and long-stem hay, which were previously not tolerated. By 6 months post discharge, the patient's weight was 36 kg, comparable to an age-matched sibling and considered appropriate for the stage of growth. CONCLUSION: Thoracoscopic transection of the LA in sheep is a feasible treatment for esophageal compression resulting from a VRA. Surgical intervention resolved the clinical signs and allowed normal digestive rumination, restoring bidirectional esophageal function in a ruminant.

Looking to the Future; Veterinary Robotic Surgery.

This article details the rise of surgical robots in the human surgical sphere as well as their use in veterinary medicine. Sections will describe in detail the equipment required for these procedures and the advantages and disadvantages of their use. Specific attention is given to the articulated instrumentation, which affords psychomotor benefits not only for surgical precision but also for surgeon ergonomics. A discussion of the possible indications and current use of robotics in veterinary medicine and the challenges to integrating robotics is also provided.

Minimally invasive splenectomy is associated with a low perioperative complication rate and short operative time in cats.

OBJECTIVE: To report the perioperative outcome and complications in cats undergoing minimally invasive splenectomy. ANIMALS: 17 client-owned cats. METHODS: Perioperative data were collected from cats undergoing minimally invasive splenectomy from September 2010 to June 2023. Data included history, signalment, preoperative examination and diagnostic testing results, operative technique and time, perioperative outcomes, complications, hospitalization duration, histopathological diagnosis, and outcome. RESULTS: 13 spayed females and 4 neutered males were included, with a median age of 144 months (48 to 196 months). Seven cats underwent total laparoscopic splenectomy (TLS), with 1 cat requiring conversion from TLS to laparoscopic-assisted splenectomy (LAS) due to splenomegaly and an additional cat requiring conversion from TLS to open splenectomy due to uncontrollable splenic capsular hemorrhage. Ten cats underwent LAS, with 1 cat requiring conversion to open splenectomy due to splenomegaly. Additional procedures were performed in 13 cats, with the most common being liver biopsy in 10 cats. Median operative times were 50 minutes (45 to 90 minutes) for TLS and 35 minutes (25 to 80 minutes) for LAS. An intraoperative complication occurred in 1 cat. All but 1 cat survived to discharge. Median follow-up time was 234 days (18 to 1,761 days), with 15 of 16 cats confirmed alive at 30 days and 9 of 16 cats alive at 180 days postoperatively. CLINICAL RELEVANCE: Minimally invasive splenectomy in this cohort of cats was associated with short operative times and a low perioperative complication rate. Veterinary surgeons may consider minimally invasive splenectomy as an efficient and feasible technique in the treatment of splenomegaly or modestly sized splenic masses for diagnostic and therapeutic purposes in cats.

Clinical presentation and short-term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts.

OBJECTIVE: To describe demographics, clinical presentation, shunt anatomy, clinical progression, and complications in large dogs ≥15 kg with single extrahepatic portosystemic shunts (EHPSS) treated with or without surgery. STUDY DESIGN: Multicenter retrospective (10 university hospitals, one private referral institution). ANIMALS: Dogs ≥15 kg (n = 63). METHODS: Medical records of dogs ≥15 kg diagnosed with EHPSS between January 01, 2005 and December 31, 2020 were reviewed. Dogs had a minimum follow-up of 90 days. Signalment, clinical signs, diagnostics, shunt anatomy, treatment interventions, and perioperative complications were assessed. RESULTS: Median age was 21.9 months (IQR: 9-36.8). The breed most represented was the Golden retriever (17/63 dogs). Portocaval (17/63) and splenocaval (15/63) shunt configurations were most common. Portal vein hypoplasia was noted in 18 imaging reports. Of the surgically treated dogs, 14/45 (35.6%) had short-term complications, and 3/45 (6.7%) had shunt-related deaths. Medical management was discontinued in 15/40 and reduced in 9/40 of surviving dogs who had surgical attenuation. All medically managed, nonattenuated dogs (18/18) were maintained on their original shunt-related medication regimens. CONCLUSIONS: Clinical presentation of dogs ≥15 kg with extrahepatic portosystemic shunts was similar to the more commonly reported small breed dogs. Surgical management of single EHPSS in large dogs ≥15 kg had similar clinical short-term outcomes as small breed dogs. CLINICAL SIGNIFICANCE: Clinicians should be aware that large breed dogs with EHPSS share similar characteristics and clinical outcomes to small breed dogs. The significance of the presence of a hypoplastic portal vein warrants further research. Surgical treatment is a viable option for large breed dogs with EHPSS.

Variables affecting surgeons' use of, and preferences for, instrumentation in veterinary laparoscopy.

OBJECTIVE: To investigate the impact of variables on use and preference of common laparoscopic instruments. STUDY DESIGN: Online survey. SAMPLE POPULATION: Surgeons (n = 140) with 3 years or more laparoscopic experience. METHODS: Electronic survey distributed via specialty group LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, preferences, and surgical practice data. Statistical analysis was performed using Fishers exact, ANOVA, Tukey Kramer honestly significant difference (HSD) test, linear regression, and logistic regression. RESULTS: Ninety-eight of 140 respondents answered instrument-related questions and the completion rate of these questions was 76%: 48% of females and 49% of males responded to the survey. The median glove size of respondents was size 7 (range, 5.5 to 8.5). Closing laparoscopic Babcock forceps (p = .018), rotating cup biopsy forceps (p = .003), and manipulating endoscopic staplers (p < .001) were more difficult for surgeons with smaller glove sizes. The median difficulty score for the endoscopic stapler was 4/10 and the median percentage of time this was found difficult was 25%. Reusable instruments were preferred over disposable single-use instruments. The pistol grip was preferred for grasping and retracting (54/98, 55%) and fine dissection (46/96, 48%), while the axial grip was preferred for suturing and knot tying (61/98, 62%). CONCLUSION: Surgeons with smaller glove sizes (<6.5) experience more difficulty when using common laparoscopic instruments. The endoscopic stapler was the most difficult to use. CLINICAL SIGNIFICANCE: When purchasing laparoscopic instrumentation, surgeons should review all available options in handle size and design to improve ergonomics during minimally invasive procedures.

Evaluating gender discrepancies in the time to successful match into a small animal surgery residency program.

OBJECTIVE: To determine any association between gender and likelihood of first attempt match and overall time to match into an American College of Veterinary Surgery (ACVS)-registered small animal surgical residency program (SASRP). STUDY DESIGN: Online survey. SAMPLE POPULATION: A total of 100 (77 female, 23 male) ACVS small animal surgery residents or diplomates participating in a SASRP during the past 5 years. METHODS: An online survey was sent to eligible individuals. Respondents anonymously provided information related to demographics, postgraduate internships, and qualifications at the time of each surgical residency application. First attempt and overall match success were evaluated by gender through univariable analysis and then via a multivariable model. RESULTS: Men were 2.89 times more likely to match directly into a SASRP following a rotating internship than women (p = .041), and women completed more total internships than men prior to successful match into a SASRP (p = .030); however, men were found to have more publications at the time of first residency application (p < .001) or successful match (p = .018). Multivariable analysis revealed no association between gender on overall match success or first attempt match rate when considering all other qualifications. CONCLUSION: No evidence for gender bias was found during the Veterinary Internship and Residency Matching Program (VIRMP) SASRP applicant selection process; however, gender specific patterns in research qualifications were identified. IMPACT: Gender-blinded assessment is not considered necessary for the VIRMP small animal surgical resident selection process. Efforts should be made to educate applicants about the impact of research on the residency selection process and encourage research engagement of female students and graduates.

Multifactorial assessment of leukocyte reduced platelet rich plasma injection in dogs undergoing tibial plateau leveling osteotomy: A retrospective study.

This study assessed the effects of concurrent intra-articular injection and Tibial Plateau Leveling Osteotomy (TPLO) plate surface treatment with leukoreduced platelet rich plasma (lPRP) on outcomes of dogs undergoing TPLO. A retrospective study of medical records for cases presenting from January 2018 to December 2020 was performed. Client-owned dogs with naturally occurring cranial cruciate ligament rupture that underwent TPLO surgery were divided into two groups. The lPRP group included cases that underwent intra-articular injection and plate surface treatment at the time of their TPLO. The control group (C) underwent TPLO without PRP treatment. Data analyzed included: presence of surgical site infection, implant removal rate, degree of change in OA progression score, lameness score progression and radiographic bone healing. The short- and long-term complication rate, hospitalization and antibiotic therapy were also compared between the groups. Descriptive statistics, comparison analyses (Chi square test, t-test, Fisher's exact test) and multi-level logistic regression models were used for statistical analysis. A total of 110 cases met the study inclusion criteria: 54 = lPRP, 56 = C. There were no significant differences between groups with regard to gender, age, presence of meniscal tear, weight, or body condition score. Significant findings included: improved radiographic healing of the osteotomy in the lPRP group, improved global OA scores in the lPRP group, and improved lameness score at recheck examination in the lPRP group. There was no significant difference between the lPRP and C group with regard to surgical site infection and implant removal rate. Concurrent intra-articular injection and plate surface treatment with leukocyte reduced PRP at the time of TPLO, is beneficial in slowing the progression of OA, hastening the radiographic evidence of osteotomy healing, and improved lameness score on recheck examination. Leukocyte reduced PRP was not a significant factor in reducing SSI or implant removal rate.

Comparison of Attempts Needed for Veterinary Students to Reach Proficiency in a Basic and Advanced Robotic Simulator Task.

Surgical training of students is one of the most difficult aspects of veterinary medical education. Competing interests of house officers, owner's wishes, and ethical concerns have led to increasing use of inanimate models for basic surgical skills training. Robotic simulators have benefits for psychomotor training but have not been previously investigated in veterinary medicine. Understanding the necessary practice time for new training devices is important when determining their potential value. The aim of this study was to compare the number of attempts needed for veterinary students to reach proficiency in both a basic and advanced robotic simulator task, and to assess the predictive nature of performance variables. Each student performed a basic and advanced tasks on the Mimic dV-Trainer™ until proficiency was reached. Students required a median of eight attempts (95% CI = 7-8, range: 6-11) to reach proficiency for the basic task versus 22 attempts (95% CI = 20-26, range: 11-62) for the advanced task. The median time required to complete training for the basic and advanced task was 13.5 minutes (range: 8-24 minutes) and 26.5 minutes (range: 11-82 minutes) respectively. The difference in task attempts supports the training protocol and confirms proficiency can be attained in a short period of time. The number of attempts to reach proficiency correlated with specific performance variables which can be used by educators to aid in training students on a robotic simulator. Continued investigations on robotic simulators should be performed to investigate their use in improving psychomotor skills in veterinary students.

A narrative review of the impact of work hours and insufficient rest on job performance.

OBJECTIVE: This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management. STUDY DESIGN: Narrative review. METHODS: Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar. RESULTS: Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine. CONCLUSION: Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur. CLINICAL SIGNIFICANCE (OR IMPACT): A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.

Laparoscopic partial pancreatectomy in a cat with exocrine pancreatic carcinoma.

Case summary: Minimally invasive surgery is an increasingly popular alternative to open surgery in veterinary medicine. Compared with traditional surgical approaches, laparoscopic pancreatectomy provides a less invasive approach and has several potential benefits, including improved visualization, reduced infection rate and decreased postoperative pain. Laparoscopic partial pancreatectomy has been described in humans, dogs and pigs but not cats. Pancreatectomy with or without chemotherapy is a treatment option for exocrine pancreatic carcinoma, a rare but malignant cancer in cats. We report the case of a 16-year-old male neutered domestic longhair cat diagnosed with exocrine pancreatic carcinoma that was treated with laparoscopic partial pancreatectomy, carboplatin and toceranib phosphate. A three-port technique using a 5 mm 0º telescope and bipolar vessel sealing device was performed to remove the entire left limb of the pancreas. No intra- or postoperative complications occurred, and the patient was discharged the following day. Forty days postoperatively, the patient received its first of five doses of carboplatin, which were given every 4-5 weeks over a period of 4 months. A maintenance protocol of toceranib phosphate was started after completion of carboplatin treatment. At the time of this article being submitted, the patient had survived for more than 221 days. Relevance and novel information: This is the first report of a laparoscopic partial pancreatectomy performed on a feline patient for pancreatic carcinoma.

Laparoscopic vertical sleeve gastrectomy in felines: A cadaveric feasibility study and experimental case series in two cats.

OBJECTIVE: To evaluate the feasibility of laparoscopic vertical sleeve gastrectomy (LVSG) in feline cadavers using endoscopic stapling equipment and report clinical outcomes in two live feline subjects. STUDY DESIGN: Cadaveric study and experimental case series. ANIMALS: Ten feline cadavers; two feline subjects. METHODS: LVSG technique was refined on feline cadavers and included retraction of the liver, dissection of the stomach, assessment of proper location for gastrectomy via stapling, and leak testing. Appropriateness of gastrectomy, gastrectomy %, surgical times and complications were recorded. The procedure was performed on two live feline subjects, and they were followed for 4 months to report surgical complications. RESULTS: LVSG was completed in 9/10 cadavers and both live patients. Stenosis at the incisura was recorded in 2/9 cadavers. No obvious leaks were seen in the 8 cadavers that were tested or either live patient. The mean surgical time for all cadaver procedures and live patients was 110.4 and 115 minutes, respectively. Mean weight of resected cadaver stomach was 10 g and the mean % of the total stomach weight resected was 27.6%. No intra- or postoperative surgical complications occurred in the live subjects. CONCLUSION: LVSG technique appears feasible and safe for use in live patients. CLINICAL RELEVANCE: This LVSG technique may be safely used for partial gastric resection in cats. Further studies are necessary to determine if it is effective at reversing the effects of obesity and diabetes in this population.

3D printed cannulas for use in laparoscopic surgery in feline patients: A cadaveric study and case series.

OBJECTIVE: To evaluate custom 3D printed laparoscopic cannulas (3DPC) in a feline cadaveric abdominal surgery model and report their use in two live feline subjects. STUDY DESIGN: Experimental cadaver study, live subject case series. ANIMALS: Ten feline cadavers; two feline subjects. METHODS: Custom 3DPCs were initially modeled in a PLA filament material and then created in an autoclavable dental resin for use in live patients. The surgery time, number of surgical collisions and cannula complications were recorded during cadaver procedures before and after use of 3DPCs. Cannula complications were recorded during live procedures and patients were followed to suture removal to record any incisional complications. RESULTS: There was a significant reduction in mean surgical time (125.6 vs. 95.2 min, p = 0.03), mean number of instrument collisions (6.8 vs. 2.6, p = 0.03), and mean number of cannula complications (10 vs. 2.2, p = 0.03) with the use of only 3DPCs during the procedure. During the live procedures the use of the 3DPCs was successful and no postoperative complications occurred at the incision sites. CONCLUSION: The use of customized 3DPCs may improve surgical dexterity and decrease complications in advanced procedures and was not associated with any clinical complications in two cats. The use of 3DPCs in veterinary medicine may allow for wider practice of laparoscopic techniques in small animals.

Laparoscopic twist technique has the best overall artifact profile when comparing three laparoscopic hepatic cup biopsy techniques for dogs.

OBJECTIVE: To determine the difference in histologic artifacts and morphologic diagnosis among 3 laparoscopic cup biopsy forceps techniques and wedge hepatic samples. ANIMALS: Cadavers of 20 client-owned dogs following euthanasia for unrelated reasons between January 3 and July 29, 2021. PROCEDURES: Four biopsy techniques were performed from the margin of 3 liver lobes/dog. Laparoscopic techniques used 5-mm cup biopsy forceps to obtain biopsy samples by pulling the forceps forcefully caudally to free a sample (the PULL technique), rotating the forceps 360° in 1 direction until freed (the TWST technique), or pulling the forceps through a 5-mm cannula to remove the sample (the CAN technique); wedge biopsy samples served as the control (CON). Data collected included sample weight, histologic features, diagnosis, and artifact characterization. Gwet AC1 or intraclass correlation coefficients (ICCs) were calculated to detect agreement among techniques. RESULTS: Sample weights for CON and TWST were significantly larger (P < .001 and P = .035, respectively) than for PULL and CAN. There was excellent agreement among all techniques for most diagnostic features (Gwet AC1, 0.93 to 1). The TWST technique resulted in the best overall artifact profile for laparoscopic techniques, with 90% of samples (54/60) having crisp edges and 65% of samples (39/60) having no or mild tearing. The agreement was moderate to good (ICC, 0.73 for edges and 0.76 for tearing) among all cup biopsy forceps techniques. CLINICAL RELEVANCE: The TWST technique resulted in the largest sample and had the fewest artifacts, supporting its continued use during laparoscopic procedures.

Laparoscopic adipose-derived stem cell harvest technique with bipolar sealing device: Outcome in 12 dogs.

OBJECTIVE: This study aimed to describe the technique and clinical outcomes in dogs undergoing Laparoscopic Adipose-Derived Stem Cell Harvest via bipolar sealing device (LADSCHB) for degenerative orthopaedic and neurologic disease. STUDY DESIGN: Descriptive retrospective case series. ANIMALS: Eleven dogs with orthopaedic disease and one dog with degenerative spinal disease were enrolled in the study. METHODS: Medical records of dogs undergoing LADSCHB were reviewed for signalment, weight, reason for the procedure, anaesthesia time, surgery time, other procedures performed, post-operative pain protocols, incision size, amount of adipose tissue collected, number of viable cells collected, days to discharge, short-term complications, and owner satisfaction. RESULTS: The median weight of the population was 34.2 kg (range 9.2-62 kg), the median surgery time was 39 min (range 15-45 min), mean incision length was 2.5 cm, the median amount of adipose collected was 60 g, and the median number of viable stem cells was 21 million cells. Conversion to open laparotomy was not needed. The most common reason for the harvest was osteoarthritis of the elbow (8/12 cases). Nine cases had other procedures performed at the same time as the harvest. No complications were noted during the procedure or within the post-operative period. All owners surveyed were satisfied with the laparoscopic harvest procedure. CONCLUSIONS: LADSCHB was technically feasible, productive, and not associated with any complications. This procedure was performed rapidly and was paired with other surgical procedures. CLINICAL SIGNIFICANCE: LADSCHB allows for stem cell harvest with commonly utilized laparoscopic equipment. This surgical technique could lead to the increased ability to treat patients with diseases that benefit from stem cell therapy.

Complications and outcomes associated with laparoscopic-assisted splenectomy in dogs.

OBJECTIVE: To report the perioperative characteristics and outcomes of dogs undergoing laparoscopic-assisted splenectomy (LAS). ANIMALS: 136 client-owned dogs. PROCEDURES: Multicentric retrospective study. Medical records of dogs undergoing LAS for treatment of naturally occurring splenic disease from January 1, 2014, to July 31, 2020, were reviewed. History, signalment, physical examination and preoperative diagnostic test results, procedural information, complications, duration of hospitalization, histopathologic diagnosis, and perioperative outcomes were recorded. Perioperative complications were defined using the Veterinary Cooperative Oncology Group - Common Terminology Criteria for Adverse Events (VCOG-CTCAE v2) guidelines. RESULTS: LAS was performed for treatment of a splenic mass (124/136 [91%]), immune-mediated disease (7/136 [5%]), splenomegaly (4/136 [3%]), or immune-mediated disease in conjunction with a splenic mass (1/136 [1%]). Median splenic mass size was 1.3 cm3/kg body weight. Conversion to open laparotomy occurred in 5.9% (8/136) of dogs. Complications occurred in 78 dogs, with all being grade 2 or lower. Median surgical time was 47 minutes, and median postoperative hospital stay was 28 hours. All but 1 dog survived to discharge, the exception being postoperative death due to a suspected portal vein thrombus. CLINICAL RELEVANCE: In the dogs of this report, LAS was associated with low rates of major complications, morbidity, and mortality when performed for a variety of splenic pathologies. Minimally invasive surgeons can consider the LAS technique to perform total splenectomy in dogs without hemoabdomen and with spleens with modest-sized splenic masses up to 55.2 cm3/kg, with minimal rates of complications, morbidity, and mortality.

Analysis of patient outcome and owner satisfaction with double limb amputations: 14 dogs and four cats.

OBJECTIVE: To evaluate the indications for, complications of, and surgical outcomes of dogs and cats that were treated with double limb amputations. ANIMALS: 14 dogs and 4 cats that underwent double limb amputations. PROCEDURES: Data collected retrospectively included patient-specific (species, age, weight, breed, sex, existing comorbidities) and amputation-specific (indication for amputation, full or partial limb amputation, associated complications, need for revision surgeries) variables. Owner satisfaction scores were also collected. RESULTS: The most common indication for double amputations was trauma (12/18) patients. Eleven patients had both amputations performed simultaneously. Nine patients had double partial limb amputations versus full limb amputations. Twelve patients underwent bilateral pelvic limb amputations, 4 underwent bilateral thoracic limb amputations, and 2 had 1 pelvic and 1 contralateral thoracic limb amputated. Five patients had reported complications over the course of the follow-up period, and complications for 3 patients were considered major. Revision surgery was reported for 2 animals. Owner satisfaction scores were reported as very satisfied/excellent (14/18), mildly satisfied (3/18), and strongly dissatisfied (1/18). Median time to follow-up was 450 days (range, 85 to 4,380 days). CLINICAL RELEVANCE: Double limb amputation may be a viable alternative to advanced limb-sparing procedures or humane euthanasia based on the owner satisfaction data and the relatively low rate of major complications in this study. Future studies should clarify patient selection criteria and differences in function between surgical types.

The use of a caudal auricular axial pattern flap for repair of a degloving pinna wound in a dog.

A 3-year-old male neutered French bulldog was presented for an anatomical degloving injury of the left pinna following a conflict with a larger dog at a park. Approximately 2/3 of the dorsal skin was removed from the convex surface of the left pinna along with an irregular, full thickness injury on the lateral aspect of the pinna distal to the cutaneous marginal pouch. A caudal auricular axial pattern flap (CAAPF) was used to reconstruct the pinna. The flap healed with no noted necrosis over the long-term. Postoperative cellulitis was noted for approximately 3 mo. The dog was medically managed for bilateral otitis externa multiple times over the course of recovery. Long-term function and cosmesis at 1.5 y after surgery revealed adequate functional movement of the pinna and acceptable cosmesis. It is concluded that, rather than a pinnectomy, a CAAPF can be offered as a surgical option in dogs that have injuries localized to the pinna. Key clinical message: A CAAPF is an alternative to pinnectomy for reconstruction of the pinna after degloving injury and yields a functional and cosmetically acceptable outcome.

Utilisation d'un lambeau auriculaire caudal axial pour la réparation d'une plaie de dégantage du pavillon de l'oreille chez un chien. Un bouledogue français mâle castré âgé de 3 ans a été présenté pour une blessure anatomique par dégantage du pavillon gauche suite à un conflit avec un chien plus gros dans un parc. Environ les 2/3 de la peau dorsale ont été retirés de la surface convexe du pavillon gauche avec une lésion irrégulière de pleine épaisseur sur la face latérale du pavillon distal par rapport à la poche cutanée marginale. Un lambeau auriculaire caudal axial (CAAPF) a été utilisé pour reconstruire le pavillon. Le lambeau a cicatrisé sans nécrose notée à long terme. Une cellulite postopératoire a été notée pendant environ 3 mois. Le chien a été pris en charge médicalement pour une otite externe bilatérale à plusieurs reprises au cours de sa convalescence. La fonction à long terme et l'esthétique à 1,5 ans après la chirurgie ont révélé un mouvement fonctionnel adéquat du pavillon de l'oreille et une esthétique acceptable. Il est conclu que, plutôt qu'une pinnectomie, un CAAPF peut être proposé comme option chirurgicale chez les chiens qui ont des blessures localisées au pavillon.Message clinique clé :Un CAAPF est une alternative à la pinnectomie pour la reconstruction du pavillon après une blessure par dégantage et donne un résultat fonctionnel et esthétiquement acceptable.(Traduit par Dr Serge Messier).

Updates in Laparoscopy.

Minimally invasive surgery continues to be an active area of experimental and clinical research in veterinary medicine. The advances we make in this field correspond to multiple benefits for our patients. New MIS approaches (retroperitoneal, NOTES, robotics) continue to be investigated to provide better visualization and manipulation of important anatomic structures for specific procedures. Increasing the number of MIS techniques available to our patient population is of utmost concern for clinicians and owners and is encouraging exciting new clinical research. New technologies (near-infrared fluorescence, barbed suture, 3D printing) are at the forefront of these developments.