RESUMO
OBJECTIVE: To document the utilization and training of laparoscopic and thoracoscopic minimally invasive surgery (MIS) techniques within the American, European, Australian and New Zealand Colleges of Small Animal Veterinary Surgeons (ACVS, ECVS, and ANZCVS) in 2020. STUDY DESIGN: Observational study. SAMPLE POPULATION: Diplomates and residents of the ACVS, ECVS, and FANZCVS. METHODS: An electronic survey was sent using veterinary list servers. Questions were organized into categories evaluating (1) the demographics of the study population and the caseload, (2) comfort level with specific procedures, (3) motivating factors and limitations, and (4) surgical training and the role of the governing bodies. RESULTS: Respondents included 111 practicing surgeons and 28 residents. Respondents' soft-tissue MIS caseloads had increased since they first started performing MIS; however, most respondents were only comfortable performing basic laparoscopy. Over half of the respondents agreed on the patient benefits and high standard of care provided by MIS. Perceived adequate soft-tissue training in MIS during residency was strongly associated with perceived proficiency at the time of survey response. Most respondents agreed that the specialty colleges should take a more active role in developing standards for soft-tissue MIS, with residents agreeing that a required standardized course would be beneficial. CONCLUSION: Soft-tissue MIS is widely performed by diplomates and residents. Perceived adequate soft-tissue MIS training was strongly associated with perceived proficiency. CLINICAL SIGNIFICANCE: There is substantial underutilization of advanced MIS techniques in veterinary specialty surgical practice, which might be improved by a stronger focus on MIS training during residency.
Assuntos
Internato e Residência , Laparoscopia , Toracoscopia , Toracoscopia/veterinária , Toracoscopia/educação , Toracoscopia/métodos , Animais , Laparoscopia/veterinária , Laparoscopia/educação , Laparoscopia/estatística & dados numéricos , Inquéritos e Questionários , Austrália , Cirurgia Veterinária/educação , Nova Zelândia , Educação em Veterinária , Médicos Veterinários/estatística & dados numéricos , Humanos , Competência ClínicaRESUMO
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.
Assuntos
Toracoscopia , Animais , Toracoscopia/veterinária , Toracoscopia/métodos , Ovinos , Anel Vascular/veterinária , Anel Vascular/cirurgia , Doenças dos Ovinos/cirurgia , Masculino , Feminino , Aorta Torácica/cirurgia , Aorta Torácica/anormalidadesRESUMO
Intraoperative near-infrared fluorescence imaging allows for real time, noninvasive visualization of anatomic structures (blood vessels, lymphatic vessels) or diseased states (cancer, inflammation). This technique is easily adapted to thoracoscopy and has allowed for improved detection of lung tumors and other various cancers, thoracic lymphatics, and cardiothoracic vasculature.
Assuntos
Toracoscopia , Animais , Toracoscopia/veterinária , Toracoscopia/métodos , Cães , Gatos , Doenças do Cão/cirurgia , Doenças do Cão/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/veterinária , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Doenças do Gato/cirurgia , Cirurgia Assistida por Computador/veterinária , Cirurgia Assistida por Computador/métodosRESUMO
Thoracoscopy pericardiotomy consists of endoscopic access to the thoracic cavity to perform the opening of the pericardial sac, described in the equine species only through the intercostal access, and there are no studies addressing the singleport transdiaphragmatic access, so the objective was to develop the pericardiotomy technique by transdiaphragmatic thoracoscopy using a single port. The technique was performed using six cadavers of adult horses, positioned in dorsal decubitus, making it possible to initiate access with an incision in the region proximal to the xiphoid process, for the introduction of an 11 mm endotip trocar, which through the diaphragm reached the thoracic cavity. After accessing the thorax, a rigid endoscope with a working portal was entered, proceeding with the introduction of endoscopic scissors, used to open the pericardium. Pericardiotomy was initiated through the phrenic-pericardial ligament. After the procedure, the corpses were sent for necropsy for evaluation of inadvertent injuries and examination of the diaphragm and pericardium. The access allowed the visualization of the structures of the caudal portion of the thorax, in addition to the visualization and manipulation of the pericardium. The mean surgical time was 24.16 ± 7.03, allowing extensive pericardiotomy. It was concluded that transdiaphragmatic thoracoscopy is an adequate procedure for the visualization and access of the pericardium, as well as the structures present in the caudal region of both hemithoraxes. Therefore, the proposed technique, pericardiotomy by thoracoscopy using a singleport transdiaphragmatic approach, was promising, proving to be a viable alternative for pericardial procedures in the equine species.
Assuntos
Pericardiectomia , Toracoscopia , Cavalos , Animais , Pericardiectomia/métodos , Pericardiectomia/veterinária , Toracoscopia/veterinária , Toracoscopia/métodosRESUMO
OBJECTIVE: To evaluate the effects of combining one-lung ventilation and carbon dioxide insufflation (OLV-CDI) on intrathoracic working space (determined by means of CT) during thoracoscopy in dogs and investigate conditions that could safely improve working space compared with OLV alone. ANIMALS: 6 healthy Beagles. PROCEDURES: Dogs were anesthetized, and right- or left-sided (n = 3/side) OLV was instituted. On the blocked side, a laparoscopic trocar sleeve was placed in the ninth intercostal space for CDI. CT was performed under 3 conditions: with OLV alone, with OLV-CDI at an intrapleural pressure (IPP) of 3 mm Hg, and with OLV-CDI at an IPP of 5 mm Hg. Working space volume (WSV), ventilation space volume (VSV), and thoracic cavity volume (TCV) were determined from CT images. RESULTS: With OLV-CDI at an IPP of 3 or 5 mm Hg, WSV and TCV were significantly increased, compared with values obtained during OLV alone. With OLV-CDI at an IPP of 5 mm Hg, VSV and Spo2 were significantly decreased, compared with values obtained during OLV alone. Additionally, contralateral pneumothorax was observed in 4 dogs at an IPP of 5 mm Hg. CLINICAL RELEVANCE: Combining OLV and CDI could provide a larger working space than OLV alone, even with an IPP of 3 mm Hg, in dogs of limited size. However, an evaluation of the effects on oxygenation and cardiovascular variables is needed before clinical use.
Assuntos
Insuflação , Ventilação Monopulmonar , Animais , Dióxido de Carbono , Cães , Insuflação/veterinária , Ventilação Monopulmonar/veterinária , Respiração , Respiração Artificial/veterinária , Toracoscopia/métodos , Toracoscopia/veterináriaRESUMO
Novel approaches and innovations in small animal thoracoscopy are being rapidly developed; this article aims to describe recent updates in commonly performed thoracoscopic procedures, including lung lobectomy, pericardiectomy and pericardial and cardiac neoplasia evaluation, chylothorax treatment, cranial mediastinal mass resection, persistent right aortic arch treatment, and management of pyothorax and primary spontaneous pneumothorax.
Assuntos
Pneumopatias , Toracoscopia , Animais , Pneumopatias/veterinária , Pericardiectomia/métodos , Pericardiectomia/veterinária , Toracoscopia/métodos , Toracoscopia/veterináriaRESUMO
OBJECTIVE: To evaluate thoracoscopic treatment of persistent right aortic arch (PRAA) in dogs with and without the use of one lung ventilation (OLV). STUDY DESIGN: Retrospective cohort study. ANIMALS: Twenty-two (client-owned and shelter) dogs diagnosed with PRAA. METHODS: Medical records were reviewed retrospectively and intraoperative and immediate postoperative data were compared between dogs that underwent thoracoscopic treatment of PRAA with (OLV+) and without (OLV-) OLV. RESULTS: Ten of the 12 dogs in the OLV+ group and 7/10 dogs in the OLV- group had their left ligamentum arteriosum successfully ligated during thoracoscopy. Median surgical time, surgery complications, anesthesia complications, and rate of conversion to an open thoracotomy due to limited visualization or surgical complications were similar between the two groups. CONCLUSION: Thoracoscopic treatment of PRAA can be performed with or without OLV. Surgical time, intraoperative complications, and conversion rates were similar between dogs that underwent thoracoscopic treatment of PRAA with and without OLV. OLV may not have contributed to improved visualization in this group of dogs. CLINICAL SIGNIFICANCE (OR IMPACT): The use of OLV is safe during thoracoscopic treatment of PRAA. OLV did not appear to provide significant benefits in this case series and thoracoscopic treatment of PRAA in dogs may be performed successfully with or without the use of OLV.
Assuntos
Doenças do Cão , Pneumopatias , Ventilação Monopulmonar , Animais , Aorta Torácica/cirurgia , Doenças do Cão/cirurgia , Cães , Humanos , Pneumopatias/cirurgia , Pneumopatias/veterinária , Ventilação Monopulmonar/veterinária , Estudos Retrospectivos , Toracoscopia/veterinária , Toracotomia/veterináriaRESUMO
Background: Spontaneous pneumothorax in dogs is characterized by an accumulation of air in the interpleural space without underlying trauma and consecutive acute onset of respiratory distress. Underlying causes for spontaneous pneumothorax vary with ruptured bullae being one of the main causes. Treatment after initial stabilization often requires partial or complete surgical resection of affected lung lobes. Partial lung lobectomy can be performed with stapling devices or sealing devices for example, by different surgical approaches including video-assisted thoracoscopic surgery. However, inter-thoracic surgery in small-sized dogs using either of the techniques is challenging. Case Description: A 12-year-old Shih Tzu was presented with spontaneous pneumothorax. Further diagnostics with computed tomography and intercostal thoracoscopy revealed a bulla in the right middle lung lobe. Partial lung lobectomy (2.5 × 2.5 × 2 cm) of the respective lung lobe was performed by an intercostal approach using the Caiman® 5 Seal & Cut sealing device. The Caiman® 5 Seal & Cut device allowed quick and safe partial lung lobectomy in the treatment of spontaneous pneumothorax without intra- or post-operative complications. The dog was discharged 2 days after surgery in good clinical condition. This report demonstrates the in-vivo efficacy and safety of the Caiman® 5 Seal & Cut sealing device for partial lung lobectomy in a small breed dog. Conclusion: Using the Caiman® 5 Seal & Cut device lung tissue could be resected without intra- or post-operative complications in a small breed dog. This case may emphasize the use of the device in fully video-assisted thoracoscopic surgery also in small-sized patients.
Assuntos
Jacarés e Crocodilos , Doenças do Cão , Pneumopatias , Pneumotórax , Cães , Animais , Pneumotórax/cirurgia , Pneumotórax/veterinária , Pneumotórax/complicações , Pulmão/cirurgia , Pneumopatias/complicações , Pneumopatias/cirurgia , Pneumopatias/veterinária , Toracoscopia/métodos , Toracoscopia/veterinária , Complicações Pós-Operatórias/veterinária , Doenças do Cão/cirurgiaRESUMO
OBJECTIVE: To evaluate the feasibility of thoracoscopic placement of three vascular attenuation devices by using the azygos vein as a model for portoazygos (PA) shunts and to describe the approach for thoracoscopic placement of these attenuation devices in small breed dogs. STUDY DESIGN: Randomized, prospective, cadaveric study. ANIMALS: Cadavers of 10 adult small breed dogs. METHODS: Cadavers were placed in sternal recumbency with left dorsolateral obliquity, and three thoracoscopic ports were established in the right hemithorax at the mid-10th intercostal space and dorsal third of the ninth and 11th intercostal spaces. The caudal azygos vein was thoracoscopically isolated along three adjacent segments bordered by four intercostal arteries, beginning just cranial to the first intercostal artery visualized cranial to the diaphragm. Three attenuation devices including coated cellophane, uncoated cellophane, and a 5-mm ameroid constrictor were thoracoscopically placed around one segment in each dog. Minor port access modifications were required to improve working space and triangulation in three dogs. Ability to successfully place the device, time required for placement, endoscopic clip configuration, and complications associated with placement were recorded. RESULTS: Median dog weight was 7.7 kg (range, 1.8-11). All attenuation devices were successfully placed thoracoscopically in all cadavers. No difference was detected in time required for placement between the ameroid constrictor and coated and uncoated cellophane (range, 2.3-33.8 minutes, P = .8). CONCLUSION: Ameroid constrictors and thin film bands were consistently placed via thoracoscopy around the caudal azygos vein of small breed dogs. CLINICAL SIGNIFICANCE: These results justify further investigation of thoracoscopic PA shunt attenuation in affected dogs.
Assuntos
Veia Ázigos/cirurgia , Cães/cirurgia , Derivação Portossistêmica Cirúrgica/veterinária , Toracoscopia/veterinária , Animais , Cadáver , Estudos de Viabilidade , Feminino , Masculino , Estudos ProspectivosRESUMO
OBJECTIVE: To compare the efficacy of a variable-angle endoscope (VAE) for canine thoracoscopic exploration to a traditional fixed-angle endoscope (FAE). STUDY DESIGN: Randomized, prospective, comparative study. SAMPLE POPULATION: Five fresh canine cadavers. METHODS: Twelve predetermined anatomical locations were labeled after median sternotomy in each cadaveric thorax. Two board-certified veterinary surgeons performed thoracoscopic evaluation of each thorax using a fixed-angle (30°) and a variable-angle (0°-120°) endoscope with and without lungs mechanically ventilated. The order of surgeon, lung ventilation, and endoscope were determined using a randomized block design. Time to visualize each anatomical location was compared for surgeon, endoscope, and lung ventilation status. Primary outcome measures were time to individual anatomical location, total simulated thoracoscopic exploration time, and ability to identify anatomical location within the designated time period. RESULTS: Lung ventilation (difference = 184 seconds, P = .015, 95% CI = 45-342 seconds) and endoscope type (difference = 112 seconds, P = .029; 95% CI = 10-213 seconds) had an effect on the cumulative time for complete thoracoscopic exploration. The VAE shortened the time to identify three of the 12 anatomical locations when controlling for the effects of lung ventilation. Use of the VAE did not improve time to identification for any locations compared to the FAE when lungs were not ventilated. The VAE facilitated significantly shorter cumulative thoracoscopic exploration time compared with the FAE. Failure to identify predetermined locations was more common with the FAE than with the VAE. CONCLUSION: Use of a rigid VAE decreased cumulative thoracoscopic exploration time and provided an alternative to one-lung ventilation for circumventing the visual impediments of lung ventilation. CLINICAL SIGNIFICANCE: This cadaveric study provides evidence that one-lung ventilation and use of a VAE may improve surgeon efficiency during exploratory thoracoscopy.
Assuntos
Doenças do Cão , Ventilação Monopulmonar , Toracoscopia , Animais , Cadáver , Cães , Endoscópios , Ventilação Monopulmonar/instrumentação , Ventilação Monopulmonar/veterinária , Estudos Prospectivos , Toracoscopia/instrumentação , Toracoscopia/veterináriaRESUMO
This study aimed to evaluate the impact of minimally invasive partial pericardiotomy on echocardiographic variables of morphometry and function in healthy horses. Minimally invasive pericardiotomy was performed in six healthy horses. Echocardiographic evaluation was executed in different moments: prior to the surgical procedure (M0); 24 hours post procedure (M1); 72 hours post procedure (M2) and 28 days post procedure (M3). The following variables were measured: Right ventricular internal diameter in diastole and systole (RVd and RVs), interventricular septum thickness in diastole and systole (IVSd and IVSs), left ventricular internal diameter in diastole and systole (LVd and LVs), left ventricular free wall thickness in diastole and systole (LVFWd and LVFWs), aortic root diameter (Ao) and left atrial diameter (LA). From this data, the following variables were calculated: fractional shortening (FS%), fractional thickening of the interventricular septum (IVS%), fractional thickening of the left ventricular free wall (LVFW%) and the relationship between left atrial and aortic diameters (LA/Ao). After 28 days, a new thoracoscopy was performed for inspection of the thoracic cavity. In M1 and M2 ECO evaluations, a statistically significant change in LVFW and a decrease in RVd, LVd, LVFWs, LA, LVs, FS% and IVS was documented. Pericardiotomy is a promising technique in horses, with minor postoperative complication. The variations in the echocardiographic parameters were transient and did not cause hemodynamic damage to the animals.(AU)
O objetivo do presente estudo foi avaliar o impacto da pericardiotomia parcial minimamente invasiva sobre as variáveis ecocardiográficas morfométricas e funcionais em cavalos, visto que não há nenhum trabalho que tenha avaliado o impacto da pericardiotomia na espécie equina. Foram utilizados seis cavalos hígidos, nos quais se realizou pericardiotomia minimamente invasiva. Em todos eles, foi efetuado exame ecocardiográfico em diferentes momentos: previamente ao procedimento cirúrgico (M0); 24 horas após (M1); 72 horas após (M2) e 28 dias após (M3). Foram mensurados: diâmetro interno do ventrículo direito (VDd e VDs), espessura do septo interventricular (SIVd e SIVs), diâmetro interno do ventrículo esquerdo (VEd e VEs), espessura da parede livre do ventrículo esquerdo (PLVEd e PLVEs), diâmetro interno da aorta (Ao) e diâmetro atrial esquerdo (AE). Foram calculadas as variáveis fração de encurtamento (FEC%), espessamento fracional do septo interventricular (SIV%), espessamento fracional da parede livre do ventrículo esquerdo (PLVE%) e relação entre diâmetro do átrio esquerdo e diâmetro aórtico (AE/Ao). Após 28 dias, realizou-se nova toracoscopia para inspeção da cavidade torácica. Nas avaliações do ECO no M1 e no M2, houve alteração estatisticamente significativa no PLVE em diástole (28±5,5 e 31,7±2, respectivamente) e diminuição dos parâmetros VDd,(30,1±11,6 e 31,7± 10,7) VEd (113,3±21 e 121,7±13,7), PLVEs (42±8,2 e 43,9±2,8), AE (78,5±6,1 e 82,7±4,7), VEs (74,1±16 e 71,5±9,3), FEC (34,4±10,2 e 41,2±5,7) e SIV (27,1±8,7 e 42,3±27,9). A técnica de pericardiotomia empregada mostrou-se promissora em equinos. As variações dos parâmetros ecocardiográficos foram transitórias, não causando prejuízos hemodinâmicos aos animais.(AU)
Assuntos
Animais , Pericardiectomia/veterinária , Testes de Função Cardíaca/veterinária , Cavalos/cirurgia , Toracoscopia/veterinária , Ecocardiografia/veterináriaRESUMO
OBJECTIVE: To determine the optimal intercostal space (ICS) for thoracoscopic-assisted pulmonary surgery for lung lobectomy in cats. SAMPLE: 8 cat cadavers. PROCEDURES: Cadavers were placed in lateral recumbency. A 5-cm minithoracotomy incision was made in the middle third of ICS 4 through 7 on the left side and 4 through 8 on the right side, and a wound retractor device was placed. A camera port was made in the middle third of ICS 9. Each lung lobe was sequentially exteriorized at each respective ICS. A thoracoabdominal stapler was placed to simulate a lung lobectomy, and distance from the stapler anvil to the hilus was measured. RESULTS: For the left cranial lung lobe, there was no significant difference in median distance from the stapler anvil to the pulmonary hilus for ICS 4 through 6. Simulated lobectomy of the left caudal lung lobe performed at ICS 5 and 6 resulted in a significantly shorter distance, compared with lobectomy performed at ICS 4 and 7. Simulated lobectomy of the right cranial and right middle lung lobes performed at ICS 4 and 5 resulted in a significantly shorter distance, compared with lobectomy performed at ICS 7. Simulated lobectomy of the accessory and right caudal lung lobes at ICS 5 and 6 resulted in a significantly shorter distance than for lobectomy performed at ICS 8. CONCLUSIONS AND CLINICAL RELEVANCE: An optimal ICS for a minithoracotomy incision was determined for thoracoscopic-assisted lung lobectomy in cats.
Assuntos
Gatos/cirurgia , Pulmão/cirurgia , Toracoscopia/veterinária , Animais , Cadáver , Humanos , Suturas/veterinária , Toracoscopia/métodos , Toracotomia/veterináriaRESUMO
Mesothelioma is a very aggressive malignant tumor with low survival rates that is often diagnosed belatedly. Pericardial effusion is a common consequence in cases of mesothelioma, with pericardiocentesis and pericardiectomy indicated; therefor thoracocentesis is necessary to drain the contents no longer retained in the pericardium. The present report describes a mesothelioma-carrying dog with a history of cardiac tamponade that underwent thoracoscopic pericardiectomy and, later, thoracoscopic implantation of a fully implantable catheter to function as a thoracic drain. In the consulted literature, there is no use of a fully implantable catheter for this purpose. The authors consider that there was an improvement in the quality of life.
Assuntos
Doenças do Cão/cirurgia , Neoplasias Pulmonares/cirurgia , Mesotelioma/cirurgia , Pericardiectomia/veterinária , Toracoscopia/veterinária , Animais , Cateteres de Demora/veterinária , Cães , Feminino , Mesotelioma Maligno , Derrame Pericárdico/cirurgia , Derrame Pericárdico/veterinária , Pericardiectomia/métodos , Toracoscopia/métodosRESUMO
OBJECTIVE: To describe a hybrid, single-port, minimally invasive cisterna chyli ablation (CCA) technique in clinical cases of canine idiopathic chylothorax and evaluate this technique as a method for mesenteric lymphangiography (ML) in canine cadavers and clinical cases of idiopathic chylothorax. STUDY DESIGN: Cadaveric and retrospective study. ANIMALS: Six canine cadavers and 14 client-owned dogs with naturally occurring idiopathic chylothorax. METHODS: Both cadaveric and clinically affected dogs were placed in sternal recumbency. A wound retractor device (WRD) and a single-port device were placed in the abdominal flank 2-3 cm caudal to the 13th rib. Mesenteric lymphangiography was evaluated by using indocyanine green (ICG) in 6 canine cadavers. Single-port laparoscopic CCA was performed in all clinical cases with idiopathic chylothorax. RESULTS: Successful ML was completed by using ICG in all 6 canine cadavers. A right- or left-sided single-port laparoscopic CCA was successfully performed in 14 dogs with naturally occurring idiopathic chylothorax. Mesenteric lymphangiography was successfully performed through the WRD in 11 of these cases. No intraoperative complications were reported. Three dogs developed severe chyloabdomen postoperatively, with 1 dog requiring multiple abdominocenteses. CONCLUSION: Direct ML and single-port laparoscopic CCA was performed through a WRD in dogs positioned in sternal recumbency. Although minimal operative complications were noted, postoperative chyloabdomen was reported. CLINICAL SIGNIFICANCE: This hybrid single-port laparoscopic technique performed in sternal recumbency allows both a CCA and an intraoperative ML through the same incision. This procedure may be combined with thoracoscopic thoracic duct ligation and pericardectomy for the treatment of idiopathic chylothorax in dogs.
Assuntos
Quilotórax/veterinária , Doenças do Cão/cirurgia , Pericardiectomia/veterinária , Toracoscopia/veterinária , Técnicas de Ablação , Angiografia , Animais , Cadáver , Quilotórax/cirurgia , Cães , Feminino , Laparoscopia , Ligadura/veterinária , Masculino , Pericardiectomia/métodos , Estudos Retrospectivos , Ducto Torácico/cirurgia , Toracoscopia/métodosRESUMO
Interstitial lung diseases are a group of diffuse parenchymal lung diseases that include interstitial lung fibrosis. The aim of this study is to characterize the clinical and pathological findings of idiopathic pulmonary fibrosis in three cats and to investigate possible etiological agents through bacteriological and mycological exams and immunohistochemistry. All three cats were female and aged from 10 to 14 years old, they presented with a clinical history of weight loss and dyspnea. The radiographic changes were similar in all cats and included increased pulmonary radiopacity with a mixed bronchointerstitial pattern progressing to an alveolar pattern. Two cats died during lung biopsy procedures. At necropsy, the lesions were limited to the pulmonary parenchyma and were firm, hypocrepitant with a multinodular appearance on the pleural surface; they failed to completely collapse when the thorax was opened. In the pleural region, there were multifocal star-shaped scarring lesions, with parenchymal retraction. Microscopically, all three cats had multifocal-to-coalescing fibrosis, type II pneumocyte hyperplasia, hypertrophy or hyperplasia of the smooth muscle tissue of terminal bronchioles and an accumulation of macrophages within the alveolar spaces. There was no growth on bacteriological or mycological cultures, and the immunohistochemical evaluations for the presence of viral etiological agents (FIV, FeLV, FCoV, FCV and FHV-1) were also negative.(AU)
As enfermidades pulmonares intersticiais são um grupo de doenças difusas do parênquima pulmonar, nas quais a fibrose pulmonar está incluída. O objetivo deste trabalho é caracterizar os achados clínicos e patológicos da fibrose pulmonar idiopática em três gatas, e avaliar possíveis agentes etiológicos através dos exames bacteriológicos, micológicos e imuno-histoquímicos. As três gatas tinham entre 10 e 14 anos de idade e histórico clínico de emagrecimento e dispneia. As alterações radiográficas observadas foram similares, com aumento de radiopacidade difuso dos campos pulmonares de padrão misto broncointersticial e eventualmente alveolar. Dois felinos morreram durante procedimento de biópsia pulmonar. No exame de necropsia as lesões eram exclusivas no parênquima pulmonar os quais estavam firmes, hipocreptantes, com aspecto levemente multinodular em superfície pleural e não colapsaram após a abertura da cavidade torácica. Em região pleural havia lesões cicatriciais de aspecto estrelar multifocais, com retração do parênquima. Microscopicamente, todos os gatos apresentaram fibrose multifocal a coalescente, hiperplasia dos pneumócitos do tipo II e hiperplasia e hipertrofia do músculo liso de bronquíolos terminais e acúmulo de macrófagos no interior de espaços alveolares. Não houve crescimento nas culturas bacteriana e micológica, e os exames de imuno-histoquímica para avaliação de possíveis agentes virais (FIV, FeLV, FCoV, FCV e FHV-1) foram negativos em todos os felinos.(AU)
Assuntos
Animais , Gatos , Gatos , Fibrose Pulmonar Idiopática/diagnóstico , Fibrose Pulmonar Idiopática/patologia , Fibrose Pulmonar Idiopática/veterinária , Toracoscopia/veterinária , Fibrose Pulmonar Idiopática/sangueRESUMO
OBJECTIVE: To evaluate the long-term outcome of video-assisted thoracoscopic (VATS) thoracic duct ligation (TDL) and pericardectomy for treatment of chylothorax in dogs. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Thirty-nine client-owned dogs. METHODS: Dogs were included if they had undergone a VATS TDL and pericardectomy and had at least 1-year follow-up or had died within 1 postoperative year. Medical records were evaluated, and recorded data included clinicopathological and diagnostic imaging results, surgical findings, complications, conversion rates, and long-term resolution and recurrence rates. RESULTS: Thirty-nine dogs met the inclusion criteria. Two dogs died intraoperatively; 1 was euthanized after severe restrictive pleuritis was diagnosed intraoperatively, and 1 underwent ventricular fibrillation and cardiac arrest during pericardectomy and could not be resuscitated. Conversion to an open approach was required in 1 of 39 (3%) dogs for TDL and 4 of 36 (11%) dogs for pericardectomy. Overall follow-up time was median 38 months (range, 3-115). Resolution of pleural effusion occurred in 35 of 37 (95%) dogs that survived the perioperative period. Late recurrence of pleural effusion was seen at 12, 12, and 19 months postoperatively in 3 of 35 (9%) dogs that survived the perioperative period and in which chylothorax had initially resolved. CONCLUSION: Successful long-term resolution of chylothorax was seen in a high proportion of dogs that underwent VATS TDL and pericardectomy, although late recurrence was sometimes seen. CLINICAL SIGNIFICANCE: Video-assisted thoracoscopic thoracic duct ligation and pericardectomy are highly successful in dogs with chylothorax. Future studies should evaluate whether pericardectomy is required in dogs without evidence of pericardial disease.
Assuntos
Quilotórax/veterinária , Doenças do Cão/cirurgia , Pericardiectomia/veterinária , Ducto Torácico/cirurgia , Cirurgia Torácica Vídeoassistida/veterinária , Animais , Quilotórax/cirurgia , Cães , Feminino , Ligadura/veterinária , Masculino , Pericardiectomia/métodos , Período Perioperatório , Derrame Pleural/veterinária , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/veterinária , Resultado do TratamentoRESUMO
Lung diseases are common in small animal clinical routine. Diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides a precise diagnosis. Thus thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared with thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy with a the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of Universidade Federal do Rio Grande do Sul (UFRGS), were assessed. Inclusion criteria were presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of FAVET/UFRGS. Surgical time was recorded from first incision to wound closure and surgical complications were reported. The dogs were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedure in any patient. Thoracoscopic assisted biopsy using guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications. Both devices provided good quality samples for histopathological analysis of lung abnormalities. However the cutting guillotine needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic access provided optimal approach for both hemithoraces.(AU)
As afecções pulmonares são comuns na rotina clínica de pequenos animais, todavia, por apresentarem sintomas inespecíficos, muitas vezes o diagnóstico dessas doenças torna-se limitado. Recursos de imagem como a radiografia e a ultrassonografia torácica são válidos como exames de triagem, mas somente a biopsia pulmonar pode possibilitar um diagnóstico específico da doença. A toracoscopia fornece um meio minimamente invasivo de diagnóstico para as doenças torácicas e oferece os benefícios de melhor iluminação e ampliação da imagem, quando comparado com a toracotomia. O presente estudo teve como objetivo avaliar as técnicas de biópsia pulmonar por meio da agulha cortante guilhotinada e da pinça de biopsia, guiadas por toracoscopia, pelo acesso transdiafragmático em cães que apresentavam imagem sugestiva de nódulo pulmonar em exame radiográfico prévio. Foram utilizados 14 cães, independente de raça, sexo, idade e peso corporal. Somente caninos com nódulos visíveis na radiografia torácica e que apresentaram condições clínicas e laboratoriais de serem anestesiados foram incluídos no estudo. Os cães foram posicionados em decúbito dorsal e foram realizados dois acessos à cavidade torácica: um primeiro portal intercostal, para introdução dos dispositivos de biopsia; e outro portal paraxifoide transdiafragmático para introdução do endoscópio. Com cada instrumento de biopsia foram coletadas três amostras do mesmo nódulo ou de nódulos macroscopicamente semelhantes e próximos quando o tamanho destes era inferior a um centímetro. Posteriormente as amostras foram encaminhadas para exame histopatológico. O tempo cirúrgico foi cronometrado da incisão ao fechamento da ferida, etodas as informações foram registradas. No pós-operatório os cães foram avaliados quanto à presença de enfisema subcutâneo, hematoma, seroma, infecção local e deiscência de pontos. Não foi necessário converter os procedimentos toracoscópicos para cirurgia convencional em nenhum dos caninos. Concluiu-se tratar de uma técnica segura, rápida sem complicações trans e pós-operatórias. Ambos dispositivos permitiram aquisição de material suficiente para análise histopatológica das alterações pulmonares, no entanto a agulha cortante guilhotinada apresentou maior eficácia, principalmente, em nódulos pulmonares de maior diâmetro. O acesso transdiafragmático mostrou-se eficiente para exploração de ambos os hemitórax.(AU)
Assuntos
Animais , Cães , Pneumonia/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico , Cães , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Toracoscopia/veterinária , Biópsia por Agulha/veterinária , Cirurgia Torácica Vídeoassistida/veterinária , Biópsia Guiada por Imagem/veterináriaRESUMO
OBJECTIVE To evaluate thoracoscopy as a treatment for dogs with persistent right aortic arch (PRAA) and to compare intra- and postoperative complications and short-term outcomes of dogs that underwent thoracoscopy versus thoracotomy for treatment of PRAA. DESIGN Retrospective cohort study. ANIMALS 30 dogs (24 client-owned and 6 shelter-owned) that had undergone thoracoscopy or thoracotomy for treatment of PPRA between 1998 and 2015. PROCEDURES Medical records were reviewed retrospectively, and data were compared between dogs that underwent thoracoscopy versus thoracotomy. For dogs that underwent thoracoscopy, linear regression was performed to compare duration of surgery with sequential order of thoracoscopies. RESULTS Dogs underwent a thoracotomy alone (n = 15), thoracoscopy alone (10), or thoracoscopy converted to thoracotomy (5) for treatment of PRAA. Median duration of surgery was not markedly different among groups, nor was the incidence of postoperative complications or median amount of time a thoracostomy tube was maintained in place. Median duration of hospitalization was 1 day (range, 0.5 to 2 days) for dogs that underwent thoracoscopy and 2 days (range, 0.5 to 22 days) for dogs that underwent thoracotomy or in which thoracoscopy was converted to a thoracotomy. CONCLUSIONS AND CLINICAL RELEVANCE Thoracoscopy was found to be an acceptable method for treating dogs with PRAA and was not associated with higher morbidity or mortality rates, compared with thoracotomy.
Assuntos
Aorta Torácica/anormalidades , Doenças do Cão/cirurgia , Animais , Aorta Torácica/cirurgia , Estudos de Coortes , Colorado , Doenças do Cão/congênito , Cães , Feminino , Masculino , Prontuários Médicos , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos , Toracoscopia/veterinária , Toracotomia/veterinária , Resultado do TratamentoRESUMO
OBJECTIVE: To describe a technique for video-assisted thoracoscopic (VATS) thoracic duct ligation (TDL) in normal cats with a bipolar vessel-sealing device and to assess durability of the seal. STUDY DESIGN: Prospective case series. ANIMALS: Six healthy research cats. METHODS: Cats were placed under anesthesia for computed tomography lymphangiography (CTLA) to identify thoracic duct anatomy. On the basis of CTLA findings, cats were positioned in either right or left lateral recumbency for a 3-port VATS TDL. Thoracic duct branches were dissected from the aorta after subcutaneous indirect near-infrared fluorescence (NIRF) lymphography with indocyanine green was performed to optimize detection. A vessel-sealing device was used to seal each thoracic duct in 1 or more locations. Postattenuation, indirect NIRF lymphography was repeated to confirm complete occlusion of thoracic duct flow. CTLA was repeated in all cats 3 months postoperatively. RESULTS: The thoracic duct was surgically approached from the right in 3 cats and from the left in 3 cats. A median of 2.5 (range 1-6) TDL seal sites were applied. In 2 cats, leakage of chyle was detected during dissection. At 3 months postoperatively, CTLA confirmed reestablished chylous flow in 5 of 6 cats, appearing to occur through recanalization of previously sealed sites rather than through development of de novo lymphatic vessels. CONCLUSION: VATS TDL is feasible in cats, although the variable and delicate nature of feline thoracic duct anatomy should be considered preoperatively. CLINICAL SIGNIFICANCE: Bipolar vessel-sealing devices are not a durable modality for thoracic duct sealing in healthy cats in a seal only fashion.
Assuntos
Gatos/cirurgia , Ducto Torácico/cirurgia , Cirurgia Torácica Vídeoassistida/veterinária , Toracoscopia/veterinária , Animais , Feminino , Ligadura/veterinária , Linfografia , Estudos Prospectivos , Cirurgia Torácica Vídeoassistida/instrumentação , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/instrumentação , Toracoscopia/métodosRESUMO
This study compared effects of isoflurane inhalation (ISO) and propofol-remifentanil combined total intravenous anesthesia (TIVA) on oxygenation during thoracoscopic lung lobectomy with 30-min one-lung ventilation (1LV). Thoracoscopic right middle lung lobectomy was performed in ten dogs divided into ISO and TIVA groups, and cardiopulmonary parameters were measured with blood gas analysis. Throughout the study, isoflurane was inhaled up to 1.5%, and the infusion rates of propofol and remifentanil were 0.2 to 0.4 mg/kg/min and 6 to 11 µg/kg/h, respectively. Cardiac index was not affected in the ISO group, but it increased during 1LV in the TIVA group. There were significant alterations in arterial oxygen pressure, arterial oxygen saturation, oxygen content, and shunt fraction associated with 1LV in each group. However, oxygen delivery did not decrease significantly due to open chest condition, 1LV, or surgical maneuver in either group, rather it increased during 1LV in the TIVA group. All parameters showed no significant difference between groups. Pulmonary vascular resistant index was unaffected in both groups, and there was no difference between groups except in re-ventilation phase. Accordingly, the effect of both anesthetic regimens on oxygenation was not different between groups and can be used with short-term 1LV for thoracoscopic lung lobectomy in dogs.