Influence of a single locking throw on the in vitro holding security of five friction throws.

OBJECTIVE: To compare the in vitro security of four different friction throws (square, surgeon's, Miller's, and strangle), with and without a locking throw, and a slip knot, on a vascular ligation model. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Nine groups with nine samples per group. METHODS: Four throws (square, surgeon's, Miller's, and strangle), with and without a locking throw, and a square throw locked in slip knot fashion, were tested to measure leakage pressure. RESULTS: The square and surgeon's throws leaked at a lower pressure than the Miller's and strangle throws (p < .0001). The leakage pressure was below physiologic arterial pressure for the square and the surgeon's throws. After the addition of a locking throw, the five knots leaked at a similar pressure (p = .5233) above physiologic arterial pressure. CONCLUSION: Following the addition of a locking throw, all the constructs tested in this study leaked at a similar pressure. The leakage pressure for all knots exceeded physiologic arterial pressures. CLINICAL SIGNIFICANCE: Any throw tested may be appropriate for secure vascular ligation if the initial throw is applied correctly.

Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study.

OBJECTIVE: To compare leakage pressures of vesicourethral anastomosis (VUA) performed with conventional and unidirectional barbed sutures in canine cadaveric tissue. STUDY DESIGN: Experimental, ex-vivo, randomized study. ANIMALS: A total of 24 male canine bladders with the urethra. METHODS: Specimens after prostatectomy were randomly divided into a unidirectional barbed suture (UBS) or a conventional suture (C) group. For the UBS group, the VUA was performed with 4-0 unidirectional barbed sutures. For the C group, the VUA was performed with 4-0 monofilament absorbable suture. The VUA was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and the number of suture bites were recorded. RESULTS: The median suturing time was 12.70 minutes (range: 7.50-16.10 min) for the UBS group and 17.30 minutes (range: 14.00-21.30 min) for the C group (p < .0002). The median leakage pressure was 8.60 mmHg (range: 5.00-17.20 mmHg) for the UBS group and 11.70 mmHg (range: 6.00-18.50 mmHg) for the C group (p = .236). The median number of suture bites was 14 (range:11-27) for the UBS group and 19 (range:17-28) for the C group (p = .012). CONCLUSION: Unidirectional barbed suture does not statistically affect the acute leakage pressure of VUA in normal cadaveric specimen. It resulted in a shorter surgical time and fewer suture bite placements. CLINICAL SIGNIFICANCE: A urinary catheter will still be required when a unidirectional barbed suture is used to complete a VUA in dogs to prevent extravasation of urine in the postoperative period.

Three-dimensional versus two-dimensional laparoscopy for cholecystectomy in a canine cadaveric study.

OBJECTIVE: To compare the effect of three-dimensional (3D) and two-dimensional (2D) laparoscopy on surgical time and intraoperative complications during cholecystectomies in canine cadavers. STUDY DESIGN: Experimental prospective study. ANIMALS: Twelve canine cadavers. METHODS: The laparoscopic cholecystectomies were performed in canine cadavers with four cannulas and with either 2D or 3D cameras by a single surgeon. The following surgical times were recorded: time from insertion of laparoscopic instruments to first endoclip placement, time from first endoclip placement to second endoclip placement, time from second endoclip placement to complete gall bladder dissection, and total surgical time. The cystic duct length distal to the first endoclip, intraoperative complications, and the amount of liver attached to the gall bladder were also recorded. RESULTS: Time from the insertion of the instruments to the application of the first endoclip was shorter for the 3D group than for the 2D group (p = .016). Other surgical times were not different between groups. There was no difference in the cystic duct length distal to the first endoclip, intraoperative complications, or the amount of liver attachment. CONCLUSION: Three-dimensional laparoscopy shortened the time from insertion of the laparoscopic instruments to placement of the first endoclip. However, total surgical time was not affected by the type of camera in laparoscopic cholecystectomy. CLINICAL SIGNIFICANCE: Three-dimensional laparoscopy may be beneficial when performing procedures requiring enhanced spatial orientation. However, this technique did not shorten the total surgical time in this cadaveric study. Further studies in a clinical setting are necessary for the optimization of the future use of 3D laparoscopy.

Clinical outcomes of the use of unidirectional barbed sutures in gastrointestinal surgery for dogs and cats: A retrospective study.

OBJECTIVE: To report the clinical outcomes of gastrointestinal surgery using unidirectional barbed sutures in single-layer appositional closure in dogs and cats. STUDY DESIGN: Retrospective and descriptive study. SAMPLE POPULATION: Twenty-six client-owned dogs; three client-owned cats. METHODS: Medical records of dogs and cats that received gastrointestinal surgery closed with unidirectional barbed sutures were reviewed to collect information on signalment, physical examinations, diagnostics, surgical procedures, and complications. Short- and long-term follow-up information was collected from the medical records, the owners, or the referring veterinarians. RESULTS: Six gastrotomies, 21 enterotomies, and nine enterectomies were closed with a simple continuous pattern with unidirectional barbed glycomer 631 sutures. Nine dogs had multiple surgical sites closed with unidirectional barbed sutures. None of the cases in the study developed leakage, dehiscence, or septic peritonitis during the 14-day short-term follow up. Long-term follow up information was collected for 19 patients. The median long-term follow-up time was 1076 days (range: 20-2179 days). Two dogs had intestinal obstruction due to strictures at the surgical site 20 and 27 days after surgery. Both were resolved with an enterectomy of the original surgical site. CONCLUSION: Unidirectional barbed suture was not associated with a risk of leakage or dehiscence after gastrointestinal surgery in dogs and cats. However, strictures may develop in the long term. CLINICAL SIGNIFICANCE: Unidirectional barbed sutures can be used during gastrointestinal surgery in client-owned dogs and cats. Further investigation of the role of unidirectional barbed sutures leading to abscess, fibrosis, or stricture is necessary.

Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue.

OBJECTIVE: To compare conventional and intracorporeal vesicourethral anastomosis (VUA) in canine cadaveric tissue. STUDY DESIGN: Cadaveric ex vivo study. STUDY POPULATION: Twenty-eight canine bladders with urethra. METHODS: Specimens after prostatectomy were randomly divided into intracorporeal (I) group or conventional (C) group. For the I group, VUA was performed in a simulator with laparoscopic needle holders and telescope. For the C group, the anastomosis was performed in vitro with standard instruments. The VUA was performed with 4-0 monofilament absorbable suture and was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and number of suture bites were recorded. RESULTS: Fourteen samples were entered in each group. The dorsal side of the anastomosis was initially performed, followed by the ventral side. The median suturing time was 30.8 minutes (range, 19.3-39.2) for the I group and 17.3 minutes (range, 9.2-21.3) for the C group (P < .0001). The median leakage pressure was 10.9 mm Hg (range, 4.1-29.7) for the I group and 10.8 mm Hg (range, 6.2-18.5) for the C group (P = .94). The median number of stitches was 20 (range, 14-26) for the I group and 19 (range, 11-28) for the C group (P = .96). The distribution of the site of leakage was similar between groups (P = .381). CONCLUSION: Vesicourethral anastomosis can be performed with leakage pressures similar to intracorporeal and conventional suturing. CLINICAL SIGNIFICANCE: This study represents the first step toward laparoscopic radical prostatectomy in dogs.

Thoracoscopic treatment of persistent right aortic arch in dogs with and without one lung ventilation.

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.

Laparoscopic correction of sliding hiatal hernia in eight dogs: Description of technique, complications, and short-term outcome.

OBJECTIVE: To describe a novel laparoscopic technique to treat sliding hiatal hernia in dogs. STUDY DESIGN: Retrospective case series. ANIMALS: Eight dogs with sliding hiatal hernia treated with laparoscopy. METHODS: Surgery reports were reviewed for technique description and animal outcomes. RESULTS: Six dogs were brachycephalic. Dogs were placed in right lateral oblique recumbency. Four dogs were placed in a reverse Trendelenburg position to visualize the esophageal hiatus. A single port was placed 2 cm caudal to the last rib on the left side. An extra cannula was added in four dogs. A large-bore orogastric tube was introduced in five dogs and used in four dogs to reduce the hernia. A unidirectional nonabsorbable barbed suture was used for the closure of the esophageal hiatus and the esophagopexy. A left-sided gastropexy was performed for all the cases. The gastropexy was performed with a gastrostomy tube to bypass the esophagus in four dogs. Intraoperative complications included pneumothorax in three dogs. Conversion was elective in three cases and emergent in one case. Clinical signs were recorded as improved in each dog. The median follow-up time was 16.5 days (range, 9-264). CONCLUSION: Hiatal hernia repair was performed laparoscopically in this population. Repair included a combination of esophageal plication, esophagopexy, and left-sided gastropexy. Reverse Trendelenburg animal positioning and orogastric tube placement facilitated the reduction of the hernia. CLINICAL SIGNIFICANCE: Laparoscopy is an option for the treatment of sliding hiatal hernia in dogs.

A comparison of outcomes between laparoscopic and open adrenalectomies in dogs.

OBJECTIVE: To compare short- and long-term outcomes of dogs with adrenal tumors treated by adrenalectomy with laparoscopy or laparotomy. STUDY DESIGN: Retrospective study of dogs that underwent adrenalectomy with laparoscopy or laparotomy. SAMPLE POPULATION: Fourteen dogs treated with laparoscopic adrenalectomy (LA) and twenty-six dogs treated with open midline adrenalectomy (OA). METHODS: Dogs treated with LA were matched with 1 or 2 dogs treated with OA on the basis of histological nature, size, and side of the tumor. Intraoperative complications, postoperative complications, and long-term survival were compared between LA and OA. RESULTS: Intraoperative hypotension occurred in 2 of 14 (14.3%) dogs in the LA group and in 16 of 26 (61.5%) dogs in the OA group (P = .007). The surgical time was 69.8 ± 21.8 minutes for the LA group and 108.6 ± 42 minutes for the OA group (P = .0003). The hospitalization time was 39.3 ± 14.9 hours for the LA group and 46.3 ± 25.1 hours for the OA group (P = .1453). The 1- and 2-year survival rates were 77% and 77%, respectively, for the LA group and 77% and 66%, respectively, for the OA group (P = .6144). CONCLUSION: Laparoscopic adrenalectomy was associated with a shorter surgical time and a reduced incidence of hypotension compared with open adrenalectomy in this case-matched study. Short- and long-term outcomes were not affected by the surgical technique used to complete the adrenalectomy. CLINICAL SIGNIFICANCE: Laparoscopy can be recommended for adrenalectomy in dogs; however, appropriate case selection is required.

Ex vivo comparison of hand-sutured versus circular stapled anastomosis in canine large intestine.

OBJECTIVE: To compare leakage pressures of colonic anastomoses performed with circular staplers to conventional hand-sewn techniques in dogs. STUDY DESIGN: Ex-vivo study. ANIMALS: Colon from 11 canine cadavers. METHODS: Thirty-two colonic anastomoses were performed. Four segments from each colon were randomly assigned to one of four techniques: hand-sewn colonic anastomoses performed with 4-0 glycomer 631 (G) and 4-0 barbed glycomer 631 (BG), and circular stapled colonic anastomoses using 4.8 mm End-to-End Anastomosis (EEA C4.8mm) and 3.5 mm End-to-End Anastomosis (EEA C3.5mm), 21 mm diameter circular staples in cadaveric canine colon. Leakage pressure was defined as the pressure at which dye-containing solution was first observed to leak from the anastomosis site. RESULTS: Leakage pressures were 49.5 mmHg (range:16-72) in group G, 45.5 mmHg (range:19-80) in group BG, 5.3 mmHg (range:0-31) in group C3.5mm, and 29.5 mmHg (range:23-50.3) in group C4.8mm. Anastomoses leaked at lower pressures when stapled rather than hand-sewn (C4.8mm-G p = .0313, C4.8mm-BG p = .0131, C3.5mm-G p = .0469, C3.5mm-BG p = .0313). Two of the C3.5mm constructs leaked immediately after saline infusion with 4/6 leaking at <5.3 mmHg. CONCLUSION: End-to-end colonic anastomoses closed with circular stapler leaked at lower pressures than hand-sutured anastomoses. Use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses. CLINICAL SIGNIFICANCE: These results provide evidence to support hand-suturing colonic anatomoses with G and BG in dogs. The 4.8 mm staples may be considered in anatomical locations difficult to reach.

Surgical treatment of persistent right aortic arch with combined ligamentum arteriosum transection and esophageal diverticulum resection in three dogs.

OBJECTIVE: To describe the treatment of persistent right aortic arch (PRAA) in dogs with combined ligamentum arteriosum (LA) transection and esophageal diverticulum resection. ANIMALS: Three client owned dogs. STUDY DESIGN: Short case series. METHODS: Medical records were reviewed for clinical signs, diagnostic procedures, surgical treatment, post-operative therapies including medications and feeding regime, outcomes, and follow-up imaging. RESULTS: Esophageal resection was performed using a thoracoabdominal (TA) stapler with suture overlay. All dogs recovered well from surgery and did not experience any peri- or post-operative complications. The last follow-up was performed between 64 and 1004 days post-operatively. In all cases, regurgitation resolved and did not recur in any dogs. No dogs required medical therapy or dietary modifications. In two cases, follow-up imaging was performed that revealed marked improvement of esophageal dilation. CONCLUSION: Resection of esophageal diverticulum secondary to PRAA utilizing a TA stapler with suture overlay was technically feasible and did not seem associated with early or late complications.

Epicardial Posterior Papillary Muscle Repositioning with Mitral Annular Reduction for FIMR Treatment: Initial Ex Vivo Heart Model Study.

BACKGROUND: High recurrent functional ischemic mitral regurgitation (FIMR) has been observed after annuloplasty. Since annuloplasty alone could not prevent late recurrent FIMR or improve the survival rate after CABG, adjunctive subvalvular opt for better treatment tailored for each individual patient. METHODS: Ex vivo ovine heart models with annular dilatation and PPM displacement were used for analysis of mitral regurgitation (MR) flow, left ventricular and annular geometry after treatment by mitral annular reduction alone (MA, nMA = 12) or combined with epicardial PPM repositioning (MA+PPM, nMA+PPM=13). RESULTS: MR significantly was reduced from baseline in both the MA (P = .03) and MA+PPM (P = .02) groups, but was not significantly different between the groups. The septo-lateral mitral annular distance decreased after applying both methods (MA group P = .005; MA+PPM group P = .05). The tethering α angle of the APM in the frontal plane significantly increased from baseline in the MA+PPM group (P = .027). Furthermore, the MA+PPM group had a larger APM and PPM α angle in the frontal plane compared with the MA group after reducing the MR (P = .04). There were no statistically significant changes in tethering angles found in the MA group compared with baseline. MR reduction correlated with percentage decrease of septo-lateral mitral annular distance (rs = 0.51, P = .01), the percentage decrease of fibrosa-PPM distance (rs = 0.43, P = .03), and the percentage increase of the PPM anterior displacement (rs = -0.41, P = .04). CONCLUSION: The decreased tethered angle of the PPM referred to the annulus, and the decreased interpapillary muscles distance suggested the PPM was repositioned inward and toward the septal annulus by the epicardial pushing pad. Epicardial repositioning of the PPM adjunct with mitral annular reduction facilitated leaflet coaptation without the risk of overlying restriction of the mitral annular orifice.

Postoperative outcomes of 12 cats with ureteral obstruction treated with ureteroneocystostomy.

OBJECTIVE: To report complications and long-term outcomes of cats with benign ureteral obstruction treated with ureteroneocystostomy and to determine the effects of double pigtail catheter (DPT) placement on postoperative outcomes. STUDY DESIGN: Retrospective study. ANIMALS: Twelve client-owned cats with ureteral urolithiasis treated with ureteroneocystostomy. METHODS: Records were reviewed for signalment, location of the obstruction, diagnostic tests, surgical technique, perioperative complications, long-term measurements of kidney function, and survival. Cats were divided into two groups; in one group, a DPT was placed at the time of ureteroneocystostomy, and, in the other group, a DPT was not placed at the time of ureteroneocystostomy (NDPT). RESULTS: A DPT was placed in six of 12 cats. The NDPT group included four cats with temporary catheters and two cats with no catheter. Median creatinine concentration decreased from 10.4 mg/dL (range, 1.6-20.3) to 2.2 mg/dL (range, 1.1-3.6) at the time of discharge (P = .015) in all cats. Two cats in the NDPT group required revision surgery for uroabdomen. Eleven cats were discharged from the hospital. Long-term complications (hematuria, pollakiuria, urinary tract infections) were more common in the DPT group (P = .047). Seven cats were alive a median of 329 days (range, 8-1772) after surgery. Median creatinine concentration was 2.0 mg/dL (range, 0.6-6.4) at a median of 157 days (range, 43-1772) after surgery. CONCLUSION: Ureteroneocystostomy resulted in acceptable long-term outcomes in 11 of 12 cats. The placement of a DPT did not influence the long-term outcome in this small population. CLINICAL SIGNIFICANCE: Ureteroneocystostomy with or without intraoperative placement of a DPT should be considered to relieve benign ureteral obstructions in cats.

Laparoscopic Cholecystectomy with Single Port Access System in 15 Dogs.

OBJECTIVE: To evaluate the outcome of laparoscopic cholecystectomy performed with a single port access system (SPAS) in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Fifteen client-owned dogs with nonobstructive gallbladder disease. METHODS: Medical records were reviewed for signalment, clinical signs, diagnostic imaging, surgical findings, and outcome until suture removal. RESULTS: The SPAS was placed 1 cm caudal to the umbilicus. The procedure was completed with the SPAS alone in two cases. An additional cannula was added in 12 cases. In the last 10 cases, the additional cannula was placed at the beginning of the procedure. Dissection began at the cystic duct in 11 dogs (73%). In three cases (20%), the SPAS procedure was converted to a laparotomy; two of these conversions were elective, and one was emergent. The risk of conversion was affected by the experience of the surgeon (odds ratio = 0.53; P = .0105), and the rate of conversion was reduced when a cannula was added at the beginning of the procedure (P = .022). Fourteen dogs were discharged from the hospital. One dog died after being discharged due to severe cholangiohepatitis, and another dog died due to leakage of a gastrostomy tube. CONCLUSIONS: The use of SPAS for cholecystectomy in dogs has an acceptable outcome. The experience gained by the surgeon and the addition of a cannula reduced the risk of conversion. CLINICAL RELEVANCE/IMPACT: Laparoscopic cholecystectomy can be performed with a SPAS. The placement of an additional cannula at the beginning of the procedure is highly recommended.

Paramedian incisional complications after prophylactic laparoscopy-assisted gastropexy in 411 dogs.

OBJECTIVE: To determine the frequency and types of paramedian incisional complications after prophylactic laparoscopy-assisted gastropexy (LAG) in dogs and to evaluate potential risk factors for complications. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Client-owned dogs (N = 411). METHODS: Records for dogs that underwent single-incision-port laparoscopy-assisted gastropexy (SIPLAG) or multiple-port laparoscopy-assisted gastropexy (MPLAG) at five veterinary referral hospitals were reviewed. Information regarding signalment, surgical procedures, perioperative care, and incisional complications was collected. Follow-up information was obtained by review of medical records and/or communication with owners. Potential risk factors for complications were examined statistically. RESULTS: Paramedian incisional complications were observed in 78 of 411 (19%) dogs. The most common complication was seroma formation, which occurred in 51 (12.4%) dogs. Surgical site infections were observed in 16 (3.9%) dogs, and dehiscence or development of excessive scar tissue at the incision site were each observed in nine (2.2%) dogs. Complications resolved with conservative treatment in 75 of 78 (96.2%) dogs and with surgical treatment in three of 78 (3.8%) dogs. The odds of complications were approximately twice as high in dogs undergoing SIPLAG than in dogs undergoing MPLAG (odds ratio, 2.03; P = .006). CONCLUSION: Minor paramedian incisional complications, particularly seroma formation, were frequently observed after LAG. Most complications were successfully managed conservatively. Single-incision-port laparoscopy-assisted gastropexy was associated with a higher complication rate compared with MPLAG. CLINICAL SIGNIFICANCE: Owners should be informed that there is a relatively high rate of minor paramedian incisional complications after LAG. The risk of complications appears to be higher for SIPLAG than for MPLAG.

Outcome after surgical and conservative treatments of canine peritoneopericardial diaphragmatic hernia: A multi-institutional study of 128 dogs.

OBJECTIVE: To compare demographics and disease characteristics in dogs in which peritoneopericardial diaphragmatic hernia (PPDH) had been diagnosed and report outcomes after surgical treatment (ST) or conservative treatment (CT). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: One hundred twenty-eight dogs (91 ST, 37 CT) in which PPDH had been diagnosed. METHODS: Medical records were reviewed for demographics, perioperative findings, and outcomes. Follow-up was obtained via telephone interview and email correspondence with owners and referring veterinarians. Baseline variables were compared between treatment groups. RESULTS: Dogs treated surgically were younger (P < .001), more likely to be sexually intact (P = .002), more likely to have clinical signs from PPDH vs an incidental diagnosis (P < .001), and more likely to have other congenital abnormalities (P = .003) compared with dogs treated conservatively. Ninety-seven percent of ST dogs were discharged from hospitals. Intraoperative and postoperative complications were reported in 22% and 41% of dogs, respectively, although most complications were classified as low grade (75% and 83%, respectively). Follow-up was available in 87 dogs, at a median of 1062 days. Hernia recurrence was not reported in any surgically treated dog. The deaths of nine dogs (five ST, four CT) could be attributed to PPDH, and long median survival times were observed in both the ST and CT groups (8.2 and 5 years, respectively). CONCLUSION: Preoperative characteristics differed between dogs treated conservatively vs surgically. Surgical treatment was associated with low operative mortality, and both ST and CT dogs had good long-term survival. CLINICAL SIGNIFICANCE: A diagnosis of PPDH can confer a good long-term prognosis for both ST and CT dogs.

Laparoscopic entry techniques: What is the controversy?

OBJECTIVE: To review reported complications related to the different laparoscopic entry techniques in the human and veterinary literature and describe the benefits and limitations of each technique. STUDY DESIGN: Literature review of 57 peer-reviewed articles. METHODS: An electronic database search identified human and veterinary literature describing complications related to entry technique during laparoscopy. RESULTS: Open- and closed-entry techniques may result in trauma of abdominal organs or vasculature. During laparoscopy in man, injury to bowel and major vasculature is reported in 0.02% and 0.04% of procedures with open- or closed-entry techniques, respectively. Designs of Veress needles and trocar cannula assemblies have been developed to improve ease and safety. Early complications, defined as those observed at the time of port entry into the abdominal cavity, result from the puncture of a blood vessel leading to substantial visible hemorrhage. Late complications are detected 24 or 48 hours after surgery and result from the puncture of a loop of intestine that was not detected at the time of initial surgery. The major reasons for iatrogenic trauma in man are related to anatomical factors and the presence of adhesions. No explanation for cause of complications was identified for animals. CONCLUSION: There is no consensus in the human or veterinary literature about the best entry technique for laparoscopy. The rate of complications related to entry technique in small animals is not known because the data are underreported. CLINICAL SIGNIFICANCE: Complications related to entry techniques are expected in both man and animals. Improvements in techniques and equipment design are being developed to minimize risk.

Influence of length of incision and number of suture lines on the biomechanical properties of incisional gastropexy.

OBJECTIVE: To determine the effect of the length of incision and of the number of suture lines on the load to failure of incisional gastropexy in an ex vivo model. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Thirty-six hound-mix fresh canine cadavers. METHODS: Specimens were randomly divided into four groups of incisional gastropexies varying in length of incision (2 or 4 cm) and number of suture lines (one or two). Load to failure was measured. Number of suture bites on each side of the gastropexy and number of inadvertent full thickness gastric suture bites were recorded. RESULTS: Incisional gastropexies performed with one or two suture lines sustained loads to failure of 53.80 ± 12.10 N and 53.30 ± 10.60 N (P = .887), respectively. Loads to failure equal to 49.70 ± 10.80 N and 57.30 ± 10.60 N (P = .048) were measured on incisional gastropexies performed with 2- or 4-cm-suture lines, respectively. There was no interaction between the length of the incision and the number of suture lines (P = .634). CONCLUSION: Length of incision but not number of suture lines influenced the biomechanical properties of gastropexies in this acute cadaveric model. CLINICAL SIGNIFICANCE: According to this acute in vitro experiment, gastropexy can be performed with either one or two suture lines.

Determination of surgical exposure obtained with integrated endoscopic thoracolumbar hemilaminectomy in large-breed cadaveric dogs.

OBJECTIVE: To define boundaries of minimally invasive integrated endoscopic hemilaminectomy at 4 sites in the canine thoracolumbar spine. STUDY DESIGN: Experimental, randomized cadaveric study. ANIMALS: Six cadaver dogs that had been humanely euthanized for reasons unrelated to this study. METHODS: Hemilaminectomy was performed with an integrated endoscopic system at T11-12, T12-13, L1-2, and L2-3, 1 at each site, on the left or right side of each dog. Each site was randomly assigned either a 19-mm or a 23-mm cannula. The entire procedure, including soft tissue dissection, was performed through the cannula. Afterward, spines were imaged by computed tomography (CT) to measure the cranial and caudal extent of the hemilaminectomy from the center of the disc space. RESULTS: The mean ± SD cranial extent of the hemilaminectomy was 4.5 ± 1.4 mm for the 19-mm cannula and 5.6 ± 1.4 mm for the 23-mm cannulas (P = .0757). The caudal extent of the hemilaminectomy was 9.5 ± 2.2 mm for the 19-mm cannula and 10.3 ± 1.6 mm for the 23-mm cannula (P = .206). The mean length of the hemilaminectomy was 13.0 ± 1.5 mm for the 19-mm cannula and 15.0 ± 2.1 mm for the 23-mm cannula (P = .022). CONCLUSION: Integrated endoscopic systems were reliably used to access the spinal canal within the range of the above measurements relative to the disc space as identified by CT or magnetic resonance imaging. CLINICAL SIGNIFICANCE: Integrated endoscopy can be considered as an option in dogs with thoracolumbar disc extrusions or other pathology measuring within the parameters defined by this study. Access may be possible beyond the dimensions defined in this study with probing and repositioning.

Outcome in dogs with presumptive idiopathic pericardial effusion after thoracoscopic pericardectomy and pericardioscopy.

OBJECTIVE: To report the outcome of dogs with presumptive echocardiographic idiopathic pericardial effusion treated with thoracoscopic pericardectomy and pericardioscopy. STUDY DESIGN: Multi-institutional retrospective study (2011-2017). ANIMALS: Eighteen dogs. METHODS: Records were searched for dogs with pericardial effusion and no identified cause by preoperative echocardiography and subsequent thoracoscopic pericardectomy and pericardioscopy. Collected data included presenting complaint, physical examination, laboratory results, imaging, and operative findings. Follow-up was obtained via telephone interview and/or recheck examination. RESULTS: No evidence of mass lesions or cause for the effusion was identified in any of the dogs by preoperative echocardiography. Nine dogs had unremarkable pericardioscopic examination results. Nine dogs had pericardioscopic abnormalities consistent with masses, nodules, or adhesions. Median survival time (MST) for the 9 dogs with abnormalities identified by pericardioscopy was 66 days, whereas MST for the 9 dogs with unremarkable pericardioscopic examination results was not reached (P = .0067). Median survival time for dogs based on histopathologic diagnosis alone was not different between dogs with a diagnosis of neoplasia and dogs with a diagnosis of pericarditis (P = .1056). Among dogs with lesions identified during pericardioscopy, MST did not differ between those with a diagnosis of malignancy and those with a diagnosis of pericarditis (P = .78). CONCLUSION: Dogs with presumptive idiopathic pericardial effusion without evidence of masses, nodules, and/or adhesions during thoracoscopic pericardectomy and pericardioscopy lived longer than dogs in which abnormalities were identified during pericardioscopy. CLINICAL SIGNIFICANCE: Thoracoscopic pericardectomy/pericardioscopy and targeted biopsy of the pericardium and pleura are recommended in dogs with echocardiographic idiopathic pericardial effusion.

Left Ventricular Dilatation and Posterior Papillary Muscle Displacement in an Ex Vivo Pulsatile Model of Functional Mitral Regurgitation.

BACKGROUND: Surgical method of choice for functional mitral regurgitation (FMR) is debatable, since recurrence of FMR post-annuloplasty has been reported in a significant number of cases. Developing a pulsatile FMR heart model by left ventricular dilatation can be a favorable option for usage in the primary stages of developing new surgical techniques that adjunctively targets the posterior papillary muscle (PPM) geometry. METHODS: PPM of ex vivo ovine hearts (N = 22) was displaced by three different sizes of patches to induce left ventricular dilatation and FMR. Mitral regurgitation (MR) flow, left ventricular and annular geometry were measured from the dynamic pulsatile flow system before and after patch placement. RESULTS: Outward displacement of PPM was significantly increased in all patch sizes compared to baseline (P = .016, P = .031, and P = .008 from small to large patch, respectively). Left ventricular volume (LVV) significantly increased from 18.53 (15.01-26.03) mL at baseline to 27.5 (19.45-42.46) mL after large patch placement (P = .031). However, the small and medium patch groups did not show significant changes in the LVV after patch placement. MR significantly increased 554 (185-1,919.3) mL/min after applying the large patch compared to baseline (P = .016). There were no significant changes from baseline in MR flow after applying the small and medium patch. Application of the large patch produced the highest proportion of FMR heart models (87.5%, P = .031). CONCLUSION: The large patch ex vivo pulsatile heart model demonstrated outward displacement of the PPM and significantly produced MR flow. This ex vivo pulsatile heart model can be used to facilitate surgical techniques that targets the PPM displacement in FMR patients.