Evaluation of a laparoscopic abdominal simulator assessment to test readiness for laparoscopic ovariectomy in live dogs.

OBJECTIVE: To predict readiness for laparoscopic ovariectomy of live dogs on the basis of performance on a high-fidelity laparoscopic abdominal simulator and to determine interrater reliability of the assessment. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Seventeen fourth-year veterinary students. METHODS: After a standardized laparoscopic training course, each participant performed a laparoscopic ovariectomy with a simulator. This performance was scored in real time by two evaluators using a rubric. Participants achieving a score of 112 of 160 performed a laparoscopic ovariectomy in a live dog, supervised by an instructor in the room. Two evaluators scored video recordings of each procedure using the rubric. Participants' opinions about the simulator were collected with a survey. RESULTS: All participants scored above the threshold (range, 126-151) and successfully completed laparoscopic ovariectomy in a live dog, with an average of 10 of 17 participants requiring verbal guidance and 5 of 17 participants requiring intervention from the instructor. Interrater concordance was excellent for the rubrics used to score performance on the simulator (R = 0.91) and in vivo (R = 0.81). All participants agreed that the simulator should be used to assess trainee readiness prior to surgery in a live dog. CONCLUSION: Participants achieving a score of at least 126 of 160 on the simulator were able to perform a laparoscopic ovariectomy in a live dog under supervision. The scoring system for the simulator had excellent interrater concordance. CLINICAL SIGNIFICANCE: This simulator and scoring system can be used in laparoscopic training programs to assess readiness for progression to the operative setting.

Effect of Short- Versus Long-Term Video Game Playing on Basic Laparoscopic Skills Acquisition of Veterinary Medicine Students.

The objective of this study was to investigate the effect of playing video games on the performance of basic laparoscopic skills. The study was an experimental pre-test-post-test comparison group design. Fifty-two students (31 from the Western University of Health Sciences College of Veterinary Medicine and 21 from the Colorado State University College of Veterinary Medicine) completing their first or second year of the veterinary curriculum were randomized into two intervention groups. The intervention consisted of playing the video game Marble Mania on a Nintendo Wii. group L (long) played 18 hours over 6 weeks and group S (short) played 3 hours during the last week of the 6-week intervention period. Before and after the intervention, basic laparoscopic skills for both groups were assessed using a modified McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) instrument. Participants performed two laparoscopic tasks. Results showed that the performance of students improved in both group S and L (p < .05) on both laparoscopic tasks. Both groups showed statistically significant improvement in their post-intervention scores (group L, N = 25, z = -3.711, p < .001, r = 0.742; group S, N = 27, z = -3.016, p < .003, r = 0.580). There was no significant difference in the degree of improvement between group S and group L. The results suggest that playing Marble Mania on a Wii for any time duration could be an effective method for veterinary medicine students to improve basic laparoscopic skills, and indicate the needs for additional studies.

Pressure Mat Analysis of Walk and Trot Gait Characteristics in 66 Normal Small, Medium, Large, and Giant Breed Dogs.

Objectives: To document temporospatial variables and gait symmetry measured by the GAITRite® system for normal, healthy dogs at the walk and trot with the leash side recorded. Study Design: Observational, prospective, cohort study. Sample Population: 66 healthy dogs of various common breeds with no evidence of lameness that were small (< 10 kg), medium (10- < 25 kg), large (25- < 40 kg), or giant (≥40 kg). Methods: Dogs walked and trotted at their preferred velocity on a pressure sensing walkway system. Video observation confirmed inclusion criteria were met for three valid trials at each gait for each dog. Coefficients of variance were used to summarize the data for analysis. Fore and hindlimb ratios were compared. Gait symmetry was assessed with the leash on the left and right side. Results: Coefficients of variation for gait parameters ranged from 20 to 28% for all except velocity and hind reach. There was no statistically significant difference in differences in fore and hindlimb ratios for stance %, GLS, TPI, or step:stride ratio, across weight categories or between walk and trot. Less than 8% of normal dogs had a GLS score < 90 (indicating lameness). Leash side did influence gait symmetry, since GLS, TPI, and step:stride all had statistically significant differences in means between leash side, irrelevant of the weight category or gait. Conclusions and Clinical Relevance: This system allowed simple, reliable gait assessment and values reported may be considered normal reference ranges for temporospatial variables collected with this system within the weight ranges and gaits reported. Controlling leash side and patient size is recommended for therapeutic intervention studies.

Major complications of tibial tuberosity advancement in 1613 dogs.

OBJECTIVES: To report major postoperative complications in 1613 dogs with tibial tuberosity advancement (TTA). STUDY DESIGN: Retrospective case series. SAMPLE POPULATION: Dogs (n = 1613) with cranial cruciate ligament deficiency treated with TTA. METHODS: Medical records of TTAs performed between December 2007-2013 were reviewed for age, sex, weight, contralateral stifle surgery, surgical approach, duration of preoperative lameness, presence of meniscal damage, concurrent patellar luxation and simultaneous bilateral TTA. Major postoperative complications were defined as surgical site infection (SSI) (superficial, deep, or organ/space), implant failure, fracture, patellar luxation, and meniscal tear. RESULTS: Major complications were recorded in 13.4% of cases. Superficial SSI (incisional irritation) was diagnosed in 6.9% cases, requiring only antimicrobial therapy. Other complications included postliminary medial meniscal tear (2% incidence), deep SSI (incisional dehiscence, 1.1%), implant failure (1%), patellar luxation (1.2%), fracture (0.9%), and organ/space SSI (septic arthritis, 0.4%). Dogs with normal menisci were less likely to develop postliminary meniscal tears if the medial meniscus was released at the time of TTA (P < .0001). No association was detected between recorded parameters and complications, although dogs >8 years old approached significance (P = .05) in terms of predisposition to major complications. CONCLUSIONS: Major complications after TTA are uncommon, even in dogs with concurrent patellar luxation or bilateral simultaneous procedures. In spite of its morbidity, medial meniscal release may prevent postliminary meniscal tears.

In Vitro Biomechanical Testing of the Tube Knot.

OBJECTIVE: To compare in vitro biomechanical properties of the tube knot (TB) to a crimp clamp (CC) system, and square knot (SQ) using 3 monofilament materials. STUDY DESIGN: In vitro biomechanical study. SAMPLE POPULATION: Suture loops (n=20 per material/knot construct). METHODS: Monotonic tensile loading (300 mm/min single pull to failure) was performed on knots tied using 3 knots (TB, 5-throw SQ, and CC system) with each of 3 materials (40# Securos® nylon, #2 polypropylene, and #2 nylon). Ultimate tensile strength, elongation, and stiffness were measured and compared by sequential 1- and 2-way ANOVA. RESULTS: Ultimate tensile strength was greatest with 40# nylon CC (mean ± SD, 293.6 ± 26.2 N), followed by TB (289.8 ± 9.2 N) and SQ (252.2 ± 8.5 N) with no significant difference between CC and TB. TB with #2 polypropylene (158.1 ± 7.4 N) and #2 nylon (126.3 ± 5.5 N) had significantly greater tensile strength than SQ with #2 polypropylene (143.6 ± 5.3 N) and #2 nylon (110.7 ± 6.2 N). Elongation at failure was significantly greater in 40# nylon TB (25.3 ± 3.2 mm) and SQ (10.8 ± 1.6 mm) compared to CC (5.3 ± 1.0 mm). Both material and knotting method had an effect on ultimate tensile strength, elongation at failure, and stiffness, based on 2-way ANOVA. CONCLUSION: Ultimate tensile strength of TB was equivalent to that of CC; however, elongation at failure was greatest for TB, which may be of concern for clinical applications.

A randomized controlled trial of the efficacy of autologous platelet therapy for the treatment of osteoarthritis in dogs.

OBJECTIVE: To determine efficacy of a single intra-articular injection of an autologous platelet concentrate for treatment of osteoarthritis in dogs. DESIGN: Randomized, controlled, 2-center clinical trial. ANIMALS: 20 client-owned dogs with osteoarthritis involving a single joint. PROCEDURES: Dogs were randomly assigned to a treatment or control group. In all dogs, severity of lameness and pain was scored by owners with the Hudson visual analog scale and the University of Pennsylvania Canine Brief Pain Inventory, respectively, and peak vertical force (PVF) was determined with a force platform. Dogs in the treatment group were then sedated, and a blood sample (55 mL) was obtained. Platelets were recovered by means of a point-of-use filter and injected intra-articularly within 30 minutes. Control dogs were sedated and given an intra-articular injection of saline (0.9% NaCl) solution. Assessments were repeated 12 weeks after injection of platelets or saline solution. RESULTS: Dogs weighed between 18.3 and 63.9 kg (40.3 and 140.6 lb) and ranged from 1.5 to 8 years old. For control dogs, lameness scores, pain scores, and PVF at week 12 were not significantly different from pretreatment values. In contrast, for dogs that received platelet injections, lameness scores (55% decrease in median score), pain scores (53% decrease in median score), and PVF (12% increase in mean PVF) were significantly improved after 12 weeks, compared with pretreatment values. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that a single intra-articular injection of autologous platelets resulted in significant improvements at 12 weeks in dogs with osteoarthritis involving a single joint.

Evidence-based wound management: a systematic review of therapeutic agents to enhance granulation and epithelialization.

Successful management of open wounds in dogs requires knowledge of the physiology of wound healing and application of that knowledge to choose appropriate therapeutic intervention. The authors' objective was to investigate whether or not there are any available therapeutic agents that enhance granulation or epithelialization of open wounds in dogs. Based on the literature identified in the authors' review, there is insufficient evidence to make a recommendation for or against any of the topical wound agents or procedures studied.

Healing, diagnosis, repair, and rehabilitation of tendon conditions.

Management of tendon conditions can be frustrating due to difficulty with diagnosis, choice of treatment or repair technique, prolonged tissue healing, and potential for permanent compromise of limb function after surgery. This article reviews tendon healing and reported tendon conditions, focusing on bicipital tenosynovitis and common calcaneal tendon injuries. Surgical management options, research in enhancement of tendon healing, and postoperative rehabilitation are also reviewed.