Laparoscopic ultrasound-guided microwave ablation of hepatocellular carcinoma in a dog.

OBJECTIVE: The aim of the study was to describe laparoscopic ultrasound (LUS) to guide microwave ablation (MWA) of hepatocellular carcinoma (HCC) in a dog. ANIMALS: A 13-year-old female spayed Husky. STUDY DESIGN: Case report. METHODS: The dog was referred for laparoscopic MWA of a caudate lobe HCC measuring 2.7 cm × 1.9 cm× 2.3 cm. Laparoscopic ultrasound was used to guide percutaneous placement of a MWA probe within the caudate lobe mass. LUS was used to determine the tumor margins for placement of the probe within the medial and lateral aspects as well as the center of the mass. Additionally, LUS allowed visualization of vessels within the tumor so they could be avoided during probe placement. RESULTS: Safe ablation was accomplished, and the dog recovered uneventfully with no complications. Follow-up computed tomography (CT) 3- and 12-months postoperatively revealed complete ablation of the caudate lobe mass. However, progressive increase in size of the right medial lobe mass occurred. Right medial liver lobectomy was performed 13 months after MWA, with a histopathologic diagnosis of HCC. The dog was euthanized 777 days post MWA and 1445 days post initial left lateral lobectomy for HCC. CONCLUSION: Laparoscopic ultrasound was useful in guiding complete and safe MWA of an HCC in this dog. Laparoscopic ultrasound should be considered when performing laparoscopic MWA of liver lesions in dogs.

Use of near-infrared fluorescence angiography with indocyanine green to evaluate direct cutaneous arteries used for canine axial pattern flaps.

OBJECTIVE: To describe the use of near-infrared angiography (NIRFA) to identify the vascularization of three canine axial pattern flaps (APFs) omocervical (OMO), thoracodorsal (THO), and caudal superficial epigastric (CSE); to establish a vascular fluorescence pattern (VFP) grading system; and to evaluate the effect of NIRFA on surgeon flap dimension planning compared to traditional landmark palpation (LP) and visualization assessments. STUDY DESIGN: Experimental study. ANIMALS: A total of 15 healthy, client-owned dogs. METHODS: Dogs were sedated and flap sites were clipped. LP-based margins were drawn and preinjection images were recorded. Indocyanine green (ICG) was administered and VFP images were recorded. VFP scores were determined by five surgeons. Margin alterations were performed based on NIRFA-ICG images. Altered measurements were compared between LP and NIRFA-ICG images. RESULTS: Vascularization of the CSE flap was most visible with NIRFA with VFP scores 4/4 for 13/15 dogs. Intersurgeon agreement for VFP grades was poorest for THO (ICC = 0.35) and intermediate for OMO (ICC = 0.49) flaps. Surgeons were more likely to adjust dimensions for CSE flaps relative to OMO (OR 17.3, 95% CI: 6.2, 47.8) or THO (25.5; 8.6, 75.7). CONCLUSION: Using a grading system, we demonstrated that the CSE flap was most visible. Surgeons were more likely to adjust the LP-CSE flap margins based on fluorescence patterns and were more likely to rely on LP when visualization scores were low. CLINICAL SIGNIFICANCE: NIRFA has possible applications identifying some direct cutaneous arteries of APFs and their associated angiosomes in real-time. Further investigation is indicated to study NIRFA's potential to improve patient specific APF planning.

Outcome of video-assisted thoracoscopic treatment of idiopathic chylothorax in 15 cats.

OBJECTIVE: To evaluate the outcomes and complications of video-assisted thoracoscopic (VATS) treatment of chylothorax in cats. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Fifteen client-owned cats. METHODS: The medical records of cats undergoing thoracoscopic thoracic duct ligation (TDL) for treatment of idiopathic chylothorax were reviewed. Cats undergoing additional procedures including thoracoscopic pericardectomy and/or laparoscopic cisterna chyli ablation (CCA)_were included. Follow up was obtained through communication with the referring veterinarian or owner. RESULTS: All cats underwent thoracoscopic TDL. Thirteen cats underwent simultaneous pericardectomy and two cats underwent laparoscopic CCA without pericardectomy. Conversion from a thoracoscopic to open approach was necessary in 2/15 (13%) of thoracic duct ligations and 1/11 (9%) of pericardectomies. The most common postoperative complication was persistent pleural effusion in five cats (33%). Four of 15 cats (27%) died or were euthanized prior to hospital discharge following surgery. Recurrence of effusion occurred in 1/7 (14%) of cats that sustained resolution of the effusion at the time of surgery with a median follow up of 8 months. The overall mortality attributed to chylothorax was 47%. CONCLUSION: Thoracoscopic treatment of idiopathic chylothorax resulted in a low incidence of intraoperative complications or conversion in the study population; however, mortality related to feline idiopathic chylothorax remained high. CLINICAL SIGNIFICANCE: While VATS treatment of idiopathic chylothorax is technically feasible, further consideration of the underlying pathology and current treatment algorithm is needed to improve outcomes as this remains a frustrating disease to treat in the feline population.

Laparoscopic partial pancreatectomy of the left limb using a harmonic scalpel in nine cats.

OBJECTIVE: To describe a laparoscopic technique and outcome for partial pancreatectomy in cats. STUDY DESIGN: Prospective cohort study. ANIMALS: Nine cats. METHODS: Laparoscopic pancreatectomy was performed using a single incision laparoscopic surgery port and an additional 5.5 mm port. The left pancreatic limb was dissected, sealed and divided at the level of the splenic vein insertion to the portal vein using a harmonic device. Surgical time and complications were recorded. The weight and length of the resected pancreatic limb was recorded. Pre- and postoperative trypsin-like immunoreactivity (TLI), pancreatic lipase immunoreactivity (PLI), and hemoglobin A1C were documented. RESULTS: Laparoscopic partial pancreatectomy was performed successfully in all cats. One grade 1 intraoperative complication occurred (1/9; 11%) resulting in minor hemorrhage from a caudal splenic vein branch. A grade 2 postoperative complication occurred within 3 days after surgery in one cat (1/9; 11%), involving localized, sterile peritonitis in the region of the pancreatic angle. Signs resolved with conservative management. No cats exhibited signs of pancreatitis postoperatively. Long-term, mean TLI decreased by 37% ± 38% (p = .03) following partial pancreatectomy, while PLI and A1C were unchanged. All cats were alive and clinically well at last follow-up 250 to 446 days following surgery. CONCLUSIONS: Laparoscopic partial pancreatectomy using a harmonic device is effective in cats, and offers a minimally-invasive alternative to open surgical pancreatectomy techniques. Laparoscopic pancreatectomy of the left limb results in adequate exocrine and endocrine function in the long-term.

Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model.

OBJECTIVE: We tested the feasibility and effectiveness of a percutaneous atrial transseptal extracorporeal membrane oxygenation (ECMO) cannulation strategy in a right ventricular failure (RVF) model. METHODS: We performed 4 nonsurvival porcine experiments. Percutaneous transseptal access was achieved using a steerable introducer. For guidance, we used fluoroscopy, transesophageal echocardiogram (TEE), and intracardiac echocardiography (ICE). A ProtekDuo rapid deployment cannula (LivaNova, London, UK) was advanced across the septum into the left atrium by 2 to 3 cm. Pulmonary hypertension (PH) was induced by partially clamping the pulmonary artery. ECMO flow was cycled from high (2 to 3 L/min) to low (0.2 to 0.3 L/min) over 2 to 3 hours. RESULTS: Transseptal access using TEE and fluoroscopy was successful in 1 animal and unsuccessful in 1 animal. ICE provided optimal visualization for the remaining 2 animals. Mean arterial pressure (MAP) was associated immediately and consistently with high versus low ECMO flow rate (mean difference: 29 ± 3.1 mm Hg, P = 0.004) but was not restored to baseline values. RV pressure values were dynamic. Given time to equilibrate, mean RV pressure was restored to a baseline level. CONCLUSIONS: Percutaneous right atrium to left atrium transseptal cannulation relieved PH-RVF. MAP was restored to a viable level, and mean RV pressure was restored to a baseline level. Transseptal ECMO shows promise as a cannulation strategy to bridge patients with PH-RVF to lung transplant.

Laparoscopic adrenalectomy for resection of unilateral noninvasive adrenal masses in dogs is associated with excellent outcomes in experienced centers.

OBJECTIVE: To report the short- and long-term outcomes of laparoscopic adrenalectomy (LA) for resection of unilateral adrenal masses and to document risk factors for conversion and peri- and postoperative morbidity. ANIMALS: 255 client-owned dogs. METHODS: Dogs were included if LA was attempted for resection of a unilateral adrenal mass. Medical records were evaluated and relevant data were reported, including complications, conversion, perioperative death, and long-term outcomes. Signalment, clinicopathological data, and surgical experience were factors statistically evaluated for possible associations with capsular penetration during surgery, conversion, surgical time, duration of hospital stay, death prior to discharge, mass recurrence, and survival time. RESULTS: 155 dogs had left-sided tumors, and 100 had right-sided tumors. Conversion to an open approach was performed in 9.4% of cases. Capsular penetration (19.2%) and major hemorrhage (5.4%) were the most prevalent intraoperative complications. Of the dogs operated on, 94.9% were discharged from the hospital. Lesion side, portion of the gland affected, and surgeon experience influenced surgical time. Conversion rate increased with increasing body condition score and lesion size. Risk of death prior to discharge increased with increasing lesion size. Risk of conversion and death prior to discharge were lower when performed by more experienced surgeons. Capsular penetration during LA increased the risk of tumor recurrence. CLINICAL RELEVANCE: LA for resection of unilateral adrenal masses is associated with excellent outcomes in experienced centers. Surgeons with greater experience with LA have lower surgical times, conversion rates, and risk of death prior to discharge.

Laparoscopic ultrasonography of the liver is feasible and safe in dogs.

OBJECTIVE: To describe the feasibility and technique for performing laparoscopic ultrasound (LUS) of the liver in dogs. ANIMALS: 12 client-owned dogs presenting for elective laparoscopic surgery from January 1, 2022, to October 31, 2022. METHODS: Laparoscopic exploration and LUS of the liver were performed in all dogs. Dogs were positioned in reverse Trendelenburg and laterally rotated to facilitate access to all liver lobes. Time to perform laparoscopic exploration and LUS, ability to visualize and access each liver lobe entirely, and any complications were recorded. Each dog underwent an elective laparoscopic procedure. The surgeon completed a National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire after surgery. RESULTS: Mean body weight was 25.9 kg (SD, ± 4.1 kg; range, 5.7 to 62 kg). All liver lobes were scanned to the level of the hilus in 10/12 dogs. In 2 dogs, the caudate lobe could not be completely imaged. Median time to perform LUS was 9 minutes (IQR, 5 to 16.5 minutes), and median NASA-TLX score was 9/100 (IQR, 6.3 to 20). There was a significantly strong negative correlation between time to perform LUS (r = -0.77; P = .0037) and NASA-TLX score (r = -0.84; P = .0006) with trial number. Minor complications occurred in 2 dogs during laparoscopic exploration. No complications occurred during LUS. CLINICAL RELEVANCE: LUS was feasible and safe in all dogs. The right lateral and caudate lobes were occasionally challenging to access. Technical demand and time to perform LUS improved with experience, suggesting a learning curve. Evaluation of LUS in dogs with clinical disease is warranted.

Computed tomographic features of double aortic arch in six dogs.

Double aortic arch (DAA) is a rare, congenital anomaly in small animals, resulting in a complete vascular ring encircling the esophagus and trachea, and subsequent compression of these organs. Few studies have reported utilizing CT angiography (CTA) for diagnosing DAA in dogs; thus, the imaging features are currently lacking in the literature. The objectives of this retrospective, multicenter, descriptive case series were to report the clinical and CTA characteristics of DAA in surgically treated cases. Medical records and CTA images were reviewed. Six juvenile dogs met the inclusion criteria (median age: 4.2 months; range: 2-5 months). The most common clinical signs included chronic regurgitation (100%), decreased body condition (67%), and coughing (50%). Common CTA features of DAA included a dominant left aortic arch (median diameter: 8.1 mm) and minor right aortic arch (median diameter: 4.3 mm; 83%), an aberrant right subclavian artery arising directly from the right aortic arch (83%), segmental esophageal constriction (100%), and variable degrees of dilation cranial to the heart base, and marked tracheal luminal compression (median percent change: -55%; 100%) and leftward curvature of the trachea at the level of the bifurcation of the aortic arches (100%). All dogs underwent successful surgical correction with only minor postoperative complications. Due to the similarity of clinical and imaging characteristics described to that of other forms of vascular ring anomalies (VRA), CTA is vital for the specific diagnosis of DAA in dogs.

Use of a Harmonic scalpel for laparoscopic adrenalectomy in two cats.

Case series summary: Adrenal tumors are rare in cats and reports of laparoscopic adrenalectomy in cats are limited. This case series describes two cats that underwent laparoscopic adrenalectomy using a Harmonic scalpel for dissection and coagulation. Both surgeries were successful, with minimal hemorrhage, smoke production and lateral thermal damage. Vessels were appropriately sealed and surgical times were appropriate. Both cats recovered without complications postoperatively. Relevance and novel information: To our knowledge, this is the first veterinary report to describe the use of the Harmonic scalpel for laparoscopic adrenalectomy as the sole device in cats. Owing to the absence of hemorrhage, there was no indication for irrigation, suction or hemostatics. The Harmonic scalpel is an ultrasonic vessel-sealing device with benefits over conventional electrosurgery, including less lateral thermal damage, less smoke production and improved safety due to the lack of an electrical current. This case report aims to highlight the usefulness of ultrasonic vessel-sealing devices for laparoscopic adrenalectomy in cats.

Laparoscopic or laparoscopic-assisted cystopexy for pelvic bladder in 3 dogs.

The techniques and clinical outcomes of laparoscopic or laparoscopic-assisted cystopexy in 3 dogs diagnosed with pelvic bladder are reported herein. The medical records of 2 dogs with pelvic bladder which underwent laparoscopic cystopexy, and 1 dog which underwent laparoscopic-assisted cystopexy were reviewed. Data retrieved included signalment, clinical signs, diagnostic imaging, surgical technique, and clinical outcome. Long-term follow-up was obtained by verbal interviews with owners. Laparoscopic or laparoscopic-assisted cystopexy was successfully performed to reposition the urinary bladder within the abdominal cavity in all dogs. An intracorporeal suture technique was used in 2 dogs, whereas an extracorpreal technique was used in 1 dog. Two dogs with stranguria experienced complete resolution immediately following surgery and remained disease-free at 18 mo after cystopexy. A third dog with urinary incontinence subjectively improved (according to the owner) but had not resolved completely 2 d following surgery. Key clinical message: Laparoscopic or laparoscopic-assisted cystopexy may be an effective treatment for pelvic bladder in dogs and may offer a minimally invasive alternative to laparotomy. Male dogs with stranguria as the primary clinical sign may experience complete resolution following cystopexy.

Cystopexie laparoscopique ou assistée par laparoscopie pour une vessie pelvienne chez trois c hiens. Les techniques et les résultats cliniques de la cystopexie laparoscopique ou assistée par laparoscopie chez trois chiens diagnostiqués avec une vessie pelvienne sont rapportés ici.Les dossiers médicaux de deux chiens ayant une vessie pelvienne ayant subi une cystopexie laparoscopique et d'un chien ayant subi une cystopexie assistée par laparoscopie ont été examinés. Les données récupérées comprenaient le signalement, les signes cliniques, l'imagerie diagnostique, la technique chirurgicale et les résultats cliniques. Le suivi à long terme a été obtenu par des entrevues verbales avec les propriétaires.La cystopexie laparoscopique ou assistée par laparoscopie a été réalisée avec succès pour repositionner la vessie dans la cavité abdominale chez tous les chiens. Une technique de suture intracorporelle a été utilisée chez deux chiens, tandis qu'une technique extracorporelle a été utilisée chez un chien. Deux chiens atteints de strangurie ont connu une résolution complète immédiatement après la chirurgie et sont restés sans maladie à 18 mois après la cystopexie. Un troisième chien souffrant d'incontinence urinaire s'est amélioré subjectivement (selon le propriétaire) mais celle-ci n'a pas complètement disparu 2 jours après la chirurgie.Message clinique clé :La cystopexie laparoscopique ou assistée par laparoscopie peut être un traitement efficace pour une vessie pelvienne chez le chien et peut offrir une alternative peu invasive à la laparotomie. Les chiens mâles atteints de strangurie comme signe clinique principal peuvent connaître une résolution complète après la cystopexie.(Traduit par Dr Serge Messier).

Percutaneous transvenous coil embolization of an extrahepatic portosystemic shunt in a cat.

Case summary: A 10-month-old male domestic shorthair cat presented for surgical treatment of a congenital portosystemic shunt. The cat had a history of lethargy and ptyalism. Pre- and postprandial bile acids were markedly elevated. CT was performed, which revealed a single, congenital, left gastrophrenic, extrahepatic portosystemic shunt. A minimally invasive surgical approach was considered by transjugular percutaneous coil embolization of the venous shunt, which was performed without complications. Follow-up protein C and serum biochemical analyses were performed at 1, 2 and 5 months postoperatively, and were improved. The cat is alive and clinically normal 11 months postoperatively. Relevance and novel information: This is the first report of percutaneous transvenous coil embolization for the treatment of an extrahepatic portosystemic shunt in a cat. The outcome was excellent in this patient, with no complications and complete resolution of clinical signs.

Percutaneous transvenous coil embolization of congenital intrahepatic portosystemic shunts in small- and toy-breed dogs: 20 cases (2015-2021).

OBJECTIVE: To describe outcomes of small- and toy-breed dogs with a congenital intrahepatic portosystemic shunt (IHPSS) treated with percutaneous transvenous coil embolization (PTCE). ANIMALS: 20 small- and toy-breed dogs with an IHPSS. PROCEDURES: All dogs underwent CT angiography for shunt evaluation as well as PTCE. Medical records were reviewed for pertinent data, and owners and primary veterinarians were contacted for long-term follow-up information. RESULTS: Dogs ranged from 1.5 to 10.0 kg (mean ± SD, 6.32 ± 2.57 kg) in weight. The equipment used to perform PTCE tended to be smaller than that previously described for larger breed dogs. Intra- and postoperative complication rates were 20% (4/20) and 5% (1/20), respectively, and included hypotension, bradycardia, hypercapnia, ventricular premature contractions, hypothermia, and regurgitation. Dogs were discharged a median of 3 days (range, 1 to 3 days) after surgery, and all dogs survived to discharge. Clinical signs resolved in 95% (19/20) of the dogs a median of 21 days after the procedure. One- and 2-year survival rates were 92%. Three dogs had died by the time of data collection; 2 of these dogs died of causes related to the IHPSS 267 and 1,178 days, respectively, after the procedure. CLINICAL RELEVANCE: Percutaneous transvenous coil embolization was a safe and effective option for treatment of IHPSS in small- and toy-breed dogs and offered a minimally invasive alternative to open surgical techniques. Complication and survival rates in this cohort were similar to or better than those reported in previous studies evaluating PTCE and open surgical techniques for treatment of IHPSS in dogs.

Prospective evaluation of lymphatic embolization as part of the treatment in dogs with presumptive idiopathic chylothorax.

OBJECTIVE: To describe the embolization technique and short-term clinical outcome in dogs undergoing lymphatic embolization (LE) as part of treatment for presumptive idiopathic chylothorax (IC). Additionally, to document findings in computed tomography lymphangiography (CTLa) following embolization. STUDY DESIGN: Prospective case series. ANIMALS: Eight client-owned dogs. METHODS: Dogs underwent CTLa followed by thoracic duct ligation (TDL), pericardiectomy (PC) and LE. A mixture of 3:1 lipiodol: n-butyl cyanoacrylate embolic solution was injected through a catheterized mesenteric lymphatic vessel via limited abdominal approach using intraoperative fluoroscopy. CTLa was scheduled for 12 weeks postoperatively, and long-term follow-up was obtained via telephone contact. RESULTS: LE was technically successful in six of the eight dogs; and clinically successful in five of the six dogs. In the unsuccessful dog, a diagnosis of lymphangiosarcoma was determined, and the owners elected for euthanasia. Five dogs who underwent successful LE underwent CTLa at 12 weeks. Complete resolution of pleural effusion occurred in three dogs and scant pleural effusion in two dogs. A robust lymphatic embolus preventing antegrade continuation of radiocontrast was documented in all five dogs. Five of the six dogs that underwent LE, were alive and clinically normal at 358-960 days postoperatively. CONCLUSIONS: LE is a feasible part of treatment for dogs with IC. Additionally, a robust lymphatic embolus and lack of radiocontrast flow past the embolus was documented at 12 weeks following surgery. CLINICAL SIGNIFICANCE: LE has the potential to reduce surgical failure by reducing efferent lymphatic chyle flow, occluding missed lymphatic branches and preventing the development of collateral branches.

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.

Surgical management and outcome of dogs with primary spontaneous pneumothorax: 110 cases (2009-2019).

OBJECTIVE: To describe surgical management and associated outcomes for dogs with primary spontaneous pneumothorax. ANIMALS: 110 client-owned dogs with primary spontaneous pneumothorax that underwent surgical management. PROCEDURES: Medical records at 7 veterinary teaching hospitals were reviewed. Data collected included signalment, history, clinical signs, radiographic and CT findings, surgical methods, intraoperative and postoperative complications, outcomes, and histopathologic findings. Follow-up information was obtained by contacting the referring veterinarian or owner. RESULTS: 110 dogs were included, with a median follow-up time of 508 days (range, 3 to 2,377 days). Ninety-nine (90%) dogs underwent median sternotomy, 9 (8%) underwent intercostal thoracotomy, and 2 (2%) underwent thoracoscopy as the sole intervention. Bullous lesions were most commonly found in the left cranial lung lobe (51/156 [33%] lesions) and right cranial lung lobe (37/156 [24%] lesions). Of the 100 dogs followed up for > 30 days, 13 (13%) had a recurrence of pneumothorax, with median time between surgery and recurrence of 9 days. Recurrence was significantly more likely to occur ≤ 30 days after surgery, compared with > 30 days after surgery. Recurrence > 30 days after surgery was rare (3 [3%]). No risk factors for recurrence were identified. CONCLUSIONS AND CLINICAL RELEVANCE: Lung lobectomy via median sternotomy resulted in resolution of pneumothorax in most dogs with primary spontaneous pneumothorax. Recurrence of pneumothorax was most common in the immediate postoperative period, which may have reflected failure to identify lesions during the initial thoracic exploration, rather than development of additional bullae.

Clinical and videofluoroscopic outcomes of laparoscopic treatment for sliding hiatal hernia and associated gastroesophageal reflux in brachycephalic dogs.

OBJECTIVE: To describe a laparoscopic technique for treatment of sliding hiatal hernia (SHH) and associated gastroesophageal reflux (GER) in brachycephalic dogs and document clinical and videofluoroscopic outcomes postoperatively. STUDY DESIGN: Prospective clinical trial. ANIMALS: Eighteen client-owned dogs. METHODS: A three-port laparoscopic approach was used. Intracorporeal suturing was used for hiatal plication and esophagopexy, and left-sided laparoscopic or laparoscopic-assisted gastropexy was performed. A standardized canine dysphagia assessment tool (CDAT) questionnaire was completed by owners pre- and postoperatively. Videofluoroscopic swallow studies (VFSS) were used to evaluate esophageal function, and impedance planimetry was used to assess lower esophageal sphincter geometry preoperatively and in a subset of dogs postoperatively. RESULTS: Median age was 27.5 (range 5-84) months. Conversion to open surgery was necessary in 1 (5.5%) of 18 dogs. Regurgitation after eating, and associated with activity/exercise, improved significantly when comparing pre- and postoperative CDAT assessments. Hiatal hernia and GER severity scores improved significantly between pre- and postoperative VFSS assessments, whereas SHH and GER frequency scores did not. One dog developed pneumothorax intraoperatively, underwent cardiopulmonary arrest, and died. Minor complications included splenic (n = 6) and hepatic lacerations (n = 3) that did not require specific therapy. CONCLUSION: A laparoscopic approach to treatment of SHH and GER led to improvements in clinical and VFSS indices in the majority of brachycephalic dogs. However, a subset of dogs still demonstrated some clinical signs postoperatively. CLINICAL RELEVANCE: In experienced hands, laparoscopic treatment of SHH and GER offers a minimally invasive alternative to open surgery.

Feasibility of laparoscopic liver lobectomy in dogs.

OBJECTIVE: To determine the feasibility of laparoscopic liver lobectomy (LLL) in dogs by using canine cadavers and to describe the clinical application in dogs with liver disease. STUDY DESIGN: Ex vivo experiment and descriptive case series. SAMPLE POPULATION: Twelve canine cadavers and six client-owned dogs. METHODS: Cadavers underwent LLL with an endoscopic stapler. The percentage of liver lobe resected was determined by volume. The distance from the staple line to hilus was measured. Medical records of dogs undergoing LLL were reviewed. RESULTS: In cadavers ≤15 kg, left lateral lobectomy completeness was 87.3% (84.6%-96.6%), and remaining median (interquartile range) hilar length was 1 cm (0.25-1.75). Left medial lobectomy completeness was 72.5% (66.7%-80%), and remaining hilar length was 1.6 cm (0.47-1.75). Central division resection completeness was 68.3% (60%-92.9%), and remaining hilar length was 2.7 cm (0.8-5). Laparoscopic liver lobectomy was not feasible for right division lobes and in cadavers >15 kg. Five dogs with peripheral quadrate or left lateral lobe masses underwent stapled, partial laparoscopic lobectomy (30%-90%). One dog underwent stapled, left lateral lobectomy (90%) after open procedure conversion. Histopathological diagnoses included hepatocellular carcinoma (3), nodular hyperplasia (1), biliary cyst adenoma (1), and fibrosis (1). CONCLUSION: Laparoscopic liver lobectomy of the left and central divisions is feasible in cadavers ≤15 kg with an endoscopic stapler. Partial LLL of the left and central divisions is feasible in select dogs with liver disease. CLINICAL SIGNIFICANCE: Laparoscopic liver lobectomy may be a viable alternative to laparotomy in small-to-medium size dogs with peripheral liver masses of the left and central divisions.

Ligation of the ligamentum arteriosum and aberrant left subclavian artery in five dogs in which persistent right aortic arch had been diagnosed.

OBJECTIVE: To determine and report the diagnosis, treatment, and outcome in dogs with persistent right aortic arch (PRAA) with an aberrant left subclavian artery (ALS) that underwent thoracoscopic surgery. ANIMALS: Dogs with PRAA and an ALS (n = 5). STUDY DESIGN: Short case series. METHODS: Medical records were reviewed from 2014 to 2019. Dogs that underwent thoracoscopy for PRAA with an ALS at an academic referral hospital were included. Signalment, clinical signs, diagnostic imaging, surgical approach, complications, and short- and long-term outcomes were recorded. RESULTS: Persistent right aortic arch with an ALS was identified in five dogs. Dogs initially underwent a three-port intercostal thoracoscopic approach, and an intercostal thoracotomy was performed in converted cases. In all five dogs, the ligamentum arteriosum (LA) and ALS were divided; three were performed by a thoracoscopy alone. Two cases were converted because of poor exposure (1) and requirement to temporary occlude an ALS (1). The ALS was ligated and divided in all dogs without apparent negative effects. No intraoperative or postoperative complications occurred. Four dogs had resolution of regurgitation, three of which required diet modification. One dog had reported regurgitation when it was excited. Median follow-up was 188 days (range, 150-1133). CONCLUSION: Ligation and division of both the LA and the ALS in all dogs in this case series was safe and allowed for improvement in clinical signs and good to excellent long-term outcomes. In addition, both thoracoscopy and thoracotomy were used safely and successfully for ligation and transection of the LA and ALS in all dogs.

Laparoscopic gonadectomy in a dog with 78,XX/78,XY chimerism and underdeveloped reproductive organs.

CASE DESCRIPTION: A 1-year-old externally sexually intact female Great Dane was referred for further evaluation of abnormal and underdeveloped internal reproductive organs. CLINICAL FINDINGS: Physical examination findings included a cranioventrally displaced vulva and a grade 2/6 left apical systolic heart murmur. No uterus or ovaries were identified during abdominal ultrasonography. Computed tomography with retrograde vaginourethrography revealed an underdeveloped uterus and possible left intra-abdominal gonad. Karyotyping revealed mixed sex chromosomes (70% XY and 30% XX). Analysis of a serum sample yielded positive results for anti-Müllerian hormone; other findings included mid range estradiol concentration (48.2 pg/mL [within reference intervals for sexually intact and neutered males and females]), low progesterone concentration (< 0.2 ng/mL [within reference intervals for anestrous females]), and low testosterone concentration (< 20 ng/dL [similar to the expected concentration in neutered males]). Overall, the results of the sex hormone analyses were consistent with findings for either a sexually intact female or a neutered male dog. The dog's cardiac structure and function were echocardiographically normal. TREATMENT AND OUTCOME: The dog was anesthetized and underwent laparoscopic gonadectomy. The gonads, although abnormal and underdeveloped, were readily identified intraoperatively and successfully removed. On the basis of histologic findings, the removed gonads were confirmed to be rudimentary testicles. The dog recovered from anesthesia and surgery without complications. CLINICAL RELEVANCE: Laparoscopic surgery was effective for visualization of abnormal and hypoplastic reproductive organs when abdominal ultrasonography and CT were of limited diagnostic usefulness, and laparoscopic surgery allowed straightforward gonadectomy in a 78,XX/78,XY chimeric dog.

Feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation of clinically normal canine ovaries.

OBJECTIVE: To determine the optimal energy profile for and to assess the feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation (MWA) of clinically normal canine ovaries. SAMPLE: 44 extirpated ovaries from 22 healthy dogs. PROCEDURES: In the first of 2 trials, 13 dogs underwent oophorectomy by routine laparotomy. Extirpated ovaries underwent MWA at 45 W for 60 (n = 11) or 90 (12) seconds; 3 ovaries did not undergo MWA and served as histologic controls. Ovaries were histologically evaluated for cell viability. Ovaries without viable cells were categorized as completely ablated. Histologic results were used to identify the optimal MWA protocol for use in the subsequent trial. In the second trial, the ovaries of 9 dogs underwent MWA at 45 W for 90 seconds in situ. Ultrasonographic guidance for MWA was deemed unfeasible after evaluation of 1 ovary. The remaining 17 ovaries underwent MWA with laparoscopic guidance, after which routine laparoscopic oophorectomy was performed. Completeness of ablation was histologically assessed for all ovaries. RESULTS: 2 ovaries were excluded from the trial 1 analysis because of equivocal cell viability. Six of 11 ovaries and 10 of 10 ovaries that underwent MWA for 60 and 90 seconds, respectively, were completely ablated. In trial 2, laparoscopic-guided MWA resulted in complete ablation for 12 of 17 ovaries. Dissection of the ovarian bursa for MWA probe placement facilitated complete ablation. CONCLUSIONS AND CLINICAL RELEVANCE: Laparoscopic-guided MWA at 45 W for 90 seconds was feasible, safe, and effective for complete ablation of clinically normal ovaries in dogs.