New Training Options for Minimally Invasive Surgery Skills.

Veterinary minimally invasive surgery (MIS) training options are becoming more available. This article reviews new developments in this area and the current evidence for manual skills and cognitive training of MIS.

Augmenting Veterinary Minimally Invasive Surgery: Evidence-based Review of Foundational and Novel Devices and Technology.

Veterinary minimally invasive surgery continues to grow as a specialty. With increasing experience in this field, comes improved accessibility as well as progressive complexity of procedures performed. Advancement in technology has been both a response to the growth and a necessary driver of continued refinement of this field. Innovative research leading to advancements in surgical equipment has led to the development of novel image acquisition platforms, cannulas, smoke evacuation systems, antifog devices, instrumentation, and ligating/hemostatic devices. These innovations will be reviewed and potential clinical applications are discussed.

Looking to the Future; Veterinary Robotic Surgery.

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

Protocol for in vivo and ex vivo assessments of glucose-stimulated insulin secretion in mouse islet ß cells.

Pancreatic islet ß cells secrete insulin in a biphasic manner when sensing high blood glucose level. This protocol describes the evaluation of different phases of insulin secretion, as well as basal, glucose-stimulated and total insulin secretion abilities, thereby enabling precise assessment of ß cell function both in vivo and ex vivo. The in vivo assay consists of intravenous tube imbedding surgery and hyperglycemic clamp. The ex vivo assay consists of islet isolation, dynamic perfusion and static immersion. For complete details on the use and execution of this protocol, please refer to Sun et al. (2021).

Electrophysiological and anatomical characterization of synaptic remodeling in the mouse whisker thalamus.

In the central nervous system, developmental and pathophysiologic conditions cause a large-scale reorganization of functional connectivity of neural circuits. Here, by using a mouse model for peripheral sensory nerve injury, we present a protocol for combined electrophysiological and anatomical techniques to identify neural basis of synaptic remodeling in the mouse whisker thalamus. Our protocol provides comprehensive approaches to analyze both structural and functional components of synaptic remodeling. For complete details on the use and execution of this protocol, please refer to Ueta and Miyata, (2021).

Reparo de ruptura crônica do ligamento patelar em um felino / Repair of chronic patelar ligament rupture in a cat

Relata-se o caso de uma felina, sem raça definida, de oito meses de idade e 3,6 kg, com queixa de impotência funcional completa do membro pélvico esquerdo após trauma. A paciente apresentava aumento de volume em região do joelho, dor à palpação e instabilidade patelar. O diagnóstico de ruptura do ligamento patelar foi realizado com base nos resultados do exame ortopédico, juntamente com exame radiográfico e ultrassonográfico do joelho. O método utilizado para reparo da lesão foi a sutura em oito com fio de tetrafluorcabono associado à sutura interrompida simples para aproximação das bordas do ligamento. Durante a reavaliação de trinta dias pós-operatório, a paciente já apresentava melhora significativa, com atividade funcional completa do membro e ausência de dor.

We report the case of an eight-month-old, 3.6 kg, crossbred feline, complaining of complete functional impotence of the left pelvic limb after trauma. The patient presented swelling in the knee region, pain on palpation and patellar instability. The diagnosis of patellar ligament rupture was based on the results of the orthopedic examination, together with radiographic and ultrasound examinations of the knee. The method used to repair the lesion was eight-point suture with tetrafluorocabono thread associated with simple interrupted suture for approximation of the ligament edges. During the thirty-day postoperative reassessment, the patient already presented significant improvement, with complete functional activity of the limb. and absence of pain.

Three-dimensional printed guides for screw placement in equine navicular bones.

OBJECTIVE: To determine the influence of a custom 3D-printed guide for placement of cortical bone screws in the equine navicular bone. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Eight pairs of normal adult equine forelimbs. METHODS: A 3.5 × 55 mm cortical screw was placed in the longitudinal axis of each intact navicular bone. Screws were placed with a 3D-printed guide (3D) in one bone and with a traditional aiming device (AD) in the contralateral bone within each pair. Duration of surgery and the number of fluoroscopy images were compared between techniques. Screw placement was subjectively evaluated by gross examination and scored by three boarded veterinary surgeons. RESULTS: The use of a 3D-printed guide reduced the duration of surgery by 6.6 min (±1.5 min) compared to traditional screw placement (20.7 min ± 4.8 min, p < .01). Fewer peri-operative fluoroscopic images were obtained when the 3D guide was used (18 images ± 2.6 images vs. 40 images ± 5.1, p < .01). No difference was detected in navicular screw placement. CONCLUSION: The use of a 3D guide decreased the time required to place screws and the number of intraoperative images taken without affecting screw placement in intact navicular bones. CLINICAL RELEVANCE: 3D-printed guides can aid in the study, practice, and execution of surgical procedures reducing surgical time and radiation exposure throughout the operative period achieving similar results to those obtained with a conventional approach.

Celiotomia e gastrotomia para remoção cirúrgica de corpos estranhos em axolote (Ambystoma mexicanum): relato de caso / Celiotomy and gastrotomy for surgical removal of foreign bodies in axolotl (Ambystoma mexicanum): case report

A ingestão de corpos estranhos em aquários artificiais é uma ocorrência frequente observada na clínica cirúrgica de anfíbios criados como pets, o que inclui os axolotes (Ambystoma mexicanum). O presente relato descreve um caso de ingestão de sete corpos estranhos em um axolote macho, de cinco meses de idade, com histórico de abaulamento irregular e irredutível da superfície corpórea ventral, de consistência firme. Na anamnese foi informado que o animal habitava um aquário com substrato de cascalhos. Ao exame físico, o axolote apresentou bom estado geral e parâmetros vitais dentro da normalidade para a espécie. Os materiais deglutidos foram identificados em região gástrica por meio de exame radiográfico corpóreo total, e suas características condiziam com o substrato utilizado no aquário do paciente. Como protocolo anestésico, foi priorizada a imersão em Isofluorano e gás oxigênio, com o objetivo de atingir a via branquial e, ocasionalmente, transdérmica. A remoção cirúrgica foi feita através de celiotomia e gastrotomia em ambiente aquático com temperatura, pH e coleção bacteriana controlados, conforme literatura disponível e tendo em consideração a natureza, diâmetro e localização dos corpos estranhos. Após cinco e quinze dias do procedimento, acompanhou-se a cicatrização da ferida cirúrgica, sendo possível constatar bom restabelecimento da continuidade dos tecidos e bom estado geral do paciente.

The ingestion of foreign bodies in artificial aquariums is a frequent occurrence observed in the surgical clinic of amphibians raised as pets, which includes axolotls (Ambystoma mexicanum). The present report describes a case of ingestion of seven foreign bodies in a male axolotl, five months old, with a history of irregular and irreducible bulging of the ventral body surface, with firm consistency. In the anamnesis, it was reported that the animal inhabited an aquariums with gravel substrate. On physical examination, the axolotl showed good general condition and vital parameters within the normal range for the species. The swallowed materials were identified in the gastric region by means of total body radiographic examination, and their characteristics were consistent with the substrate used in the patient's aquarium. As anesthetic protocol, immersion in Isofluorane and oxygen gas was prioritized, in order to reach the branchial and, occasionally, transdermal route. Surgical removal was performed through celiotomy and gastrotomy in an aquatic environment with controlled temperature, pH and bacterial collection, according to available literature and taking into account the nature, diameter and location of foreign bodies. After five and fifteen days of the procedure, the healing of the surgical wound was monitored, showing a good restoration of tissue continuity and a good general condition of the patient.

Congenital elbow luxation grade I treated by radial head ostectomy in an English Bulldog / Luxação congênita de cotovelo grau I tratada por ostectomia da cabeça do rádio em um Bulldog Inglês

The aim of this study is to report a long term follow up of a congenital luxation of the radial head (CLRH) case of a young Bulldog treated by radio head ostectomy (RHO). CLRH is an uncommon condition in dogs, but it is the most commom form of elbow dislocation (grade I). An English Bulldog, male, 6 months, 14 kilograms, was suspected of elbow dislocation. Physical examination revealed a lateral proeminence on the lateral surface of the right elbow, as well as grade I lameness and mild pain. Range of motion was normal. Previous radiographs and tomography confirmed CLHR. RHO was chosen instead of corrective techniques, due to the age of the animal at the time of the procedure and the difficulty in repositioning the radial head in the joint. Three and a half years after surgery, new clinical and radiographic examaminations were performed. The patient had no pain, good limb support and good range of motion, allowing good elbow movement. There was a partial regrowth of the proximal segment of the radial head causing better readjustment of it in the joint. Mild signs of joint degeneration were present. RHO proved to be effective in this case, proving to be a good technique to be used in cases of CLRH when conservative treatment or reduction techniques can no longer be used.

O objetivo deste relato foi o de apresentar o acompanhamento tardio de um caso de luxação congênita de cabeça de rádio (LCCR) em um Buldog Inglês jovem, tratada por ostectomia da cabeça radial (OCR). A LCCR é uma condição incomum nos cães, mas é a forma mais comum de luxação de cotovelo nos mesmos (grau I). Um Bulldog Inglês, macho, 6 meses, 14 quilos, foi atendido com suspeita de luxação do cotovelo. Exame físico revelou uma proeminência na superfície lateral do cotovelo direito, além de claudicação grau I e dor leve. Amplitude de movimento apresentava-se normal. Radiografias e tomografia prévias confirmaram LCCR. Optou-se pela OCR ao invés de técnicas corretivas, devido à idade do animal à época do procedimento e à dificuldade no reposicionamento do rádio na articulação. Após 3 anos e meio de pós-operatório, foram realizados novos exames clínicos e radiográficos. O paciente não apresentava dor, apresentava bom apoio do membro e boa amplitude de movimento, permitindo bom movimento do cotovelo. Houve um novo crescimento parcial do segmento proximal da cabeça do rádio ocasionando melhor readequamento do mesmo na articulação. Sinais leves de degeneração articular estavam presentes. A OCR se mostrou efetiva neste caso, provando ser uma boa técnica a ser utilizada nos casos de LCCR quando tratamento conservativo ou técnicas de redução já não podem ser mais utilizados.

Comparing the accuracy of freehand, fluoroscopically guided and aiming device-assisted drilling in veterinary orthopaedic surgery.

BACKGROUND: Drilling accuracy is essential in the correct positioning of implants and avoidance of iatrogenic damage to surrounding tissues. The use of augmented drilling methods has been documented as an approach to improving the accuracy of drilling. The aim of this study was to compare the accuracy of two augmented drilling methods (fluoroscopically guided and aiming device) to freehand (FH) drilling. METHODS: Three experienced specialist surgeons and three veterinary surgeons without primary orthopaedic experience drilled into synthetic bone towards a target using the three different methods at three different angles (0°, 10° and 20°). The duration of drilling was recorded, and the accuracy of drilling was measured using photographs before and after drilling. RESULTS: The two augmented methods were more accurate than FH drilling in synthetic bone, with the aiming device producing the greatest accuracy. Increased angulation of drilling decreased the drilling accuracy. Surgeon experience did not impact on drilling accuracy. Surgeon inexperience and augmented drilling methods both increased the time taken to drill. CONCLUSION: The use of augmented drilling methods improved the accuracy of drilling, and surgeons should consider their use when drilling in anatomical regions where the margin of error is small.

A retrospective comparison of carbon dioxide surgical laser and non-laser excision for removal of cutaneous and subcutaneous soft-tissue sarcomas in dogs.

Aims: To compare the duration of anaesthesia, surgery, and postoperative hospitalisation, the proportion of tumours excised with complete histologic margins and immediate postoperative surgical site complications in dogs undergoing removal of cutaneous or subcutaneous soft tissue sarcomas (STS) by either carbon dioxide (CO2) laser or non-laser surgical excision methods. Methods: Medical records of dogs that underwent surgical excision of cutaneous and subcutaneous STS at the University of Missouri between December 2004 and May 2018 were evaluated. The study population consisted of client-owned dogs that underwent CO2 laser (n = 4) or non-laser (n = 20) excision of a single STS. Data recorded included: signalment, duration of anaesthesia, surgery and postoperative hospitalisation, tumour characteristics, completeness of histologic margins, postoperative complications, adjunctive therapy, and other procedures at the time of surgery. Results: There was no evidence of a difference in mean age, body weight or tumour size between groups. Similarly there was no evidence of a difference in the duration of anaesthesia or surgery, or in the proportion of dogs whose STS were removed with complete histologic margins between dogs whose STS was removed using laser or non-laser surgical excision methods. However, the duration of postoperative hospitalisation trended towards being longer for the laser excision group (p = 0.061). Conclusions: These data provide preliminary evidence that excision of cutaneous or subcutaneous STS with CO2 surgical laser is comparable to non-laser methods for the measured outcomes.

A survey of work-related musculoskeletal disorders associated with performing laparoscopic veterinary surgery.

OBJECTIVE: To assess the prevalence of work-related musculoskeletal disorders (WRMD) associated with laparoscopy in veterinary surgery. STUDY DESIGN: Cross-sectional survey. SAMPLE POPULATION: Veterinary surgeons who perform laparoscopy. METHODS: Responses were collected with data regarding laparoscopic activities and experience as well as whether the respondents experienced pain as a result of laparoscopy and, if so, additional information on this topic. Variables associated with the risk of experiencing pain were determined by using χ2 tests and odds ratios (OR). RESULTS: There were 149 respondents, an estimated 6% response proportion. Forty percent experienced pain that they attributed to the use of laparoscopic instruments during or after laparoscopic surgery. Surgeons who perform laparoscopic surgery frequently (at least monthly) were more likely to experience pain as a result of laparoscopic surgery compared with those who perform laparoscopic surgery infrequently (OR 2.25; 95% confidence interval 1.07-4.75; P = .033). Pain during or after laparoscopic surgery was most often experienced in the neck (81%), back (77%), and shoulders (75%), with 90% of respondents reporting that surgery exacerbated their pain. Fifty-four percent of respondents experienced the pain at home, 64% had taken painkillers for the pain, and 46% had sought other treatment for the pain such as physiotherapy, chiropractic treatment, or seeing a doctor. CONCLUSION: Laparoscopic surgery was a potential source of pain in a proportion of surgeons. Surgeons who frequently perform laparoscopic surgery were more likely to experience a WRMD. CLINICAL SIGNIFICANCE: Work-related musculoskeletal disorders may occur as a result of performing laparoscopic surgery.

Flap bipedicular no tratamento de lesão cutânea traumática em membro torácico de gato: relato de caso / Bipedicular flap in the treatment of traumatic skin injury in cat thoracic member: case report

O objetivo do presente estudo é relatar a construção de um retalho direto de bolsa bipediculada com fixação apendicular à região torácica para o tratamento de lesões extensas no membro torácico direito de um gato. Foi tratado no Hospital Veterinário Unicesumar Maringá - Paraná, um felino de 1 ano de idade, apresentando lesão no membro torácico, após história de briga com outro animal da mesma espécie. Ao exame físico, apresentava fístula e edema no membro torácico direito. O paciente foi anestesiado e foi realizado o desbridamento das áreas desvitalizadas. Como terapia inicial, a lesão foi tratada como ferida aberta, até a formação de tecido de granulação, para posterior correção do defeito empregando retalho bipediculado em bolsa direta, com fixação temporária do membro à parede torácica. Após duas semanas, o membro foi desimplantado e os pontos foram removidos 21 dias após a aplicação do retalho. O uso do retalho permitiu completa cicatrização da ferida, sem ocorrência de hematomas, necrose ou deiscência de sutura. Conclui-se que a utilização do retalho bipedicular é aplicável ao tratamento de feridas traumáticas em membro torácico de felinos.

The aim of the present study is to report the construction of a direct bipedicled pouch flap with appendicular fixation to the thoracic region for the treatment of extensive lesions in the right thoracic limb of a cat. He was treated on Hospital Veterinário Unicesumar Maringá - Paraná, a 1-year-old feline, presenting injury to the thoracic limb after a history of fighting with another animal of the same species. On physical examination, he presented fistula and edema in the right thoracic limb. The patient was anesthetized and debridement of the devitalized areas was performed. As an initial therapy, the lesion was treated as an open wound until granulation tissue was formed for subsequent correction of the defect using a direct pouch bipedicled flap, with temporary fixation of the limb to the chest wall. After two weeks, the limb was unimplanted and the stitches were removed 21 days after flap application. The use of the flap allowed complete wound healing without bruising, necrosis or suture dehiscence. It is concluded that the use of bipedicular flap is applicable to the treatment of traumatic wounds in feline thoracic limb.

Resolução cirúrgica de pólipo inflamatório em ouvido médio de felino através da técnica de avulsão e tração por abordagem lateral: relato de caso / Surgical resolution of feline middle ear inflammatory polyp by lateral approach traction and avulsion technique: case report

O objetivo desse trabalho foi descrever um caso de pólipo inflamatório em ouvido médio de um felino e sua resolução cirúrgica através da avulsão e tração da massa após abordagem lateral. Um felino, fêmea, de 2 anos de idade, foi atendido no Hospital Veterinário Professor Sylvio Barbosa Cardoso, apresentando prurido intenso, dor e secreção fétida em região auricular. Pelo exame físico foi possível observar um nódulo em região de ouvido médio esquerdo. Associado a isso, o animal apresentava "headtilt" (inclinação da cabeça para o lado afetado). Foram solicitados exames hematológicos, radiografia de crânio e citologia da massa. O animal foi encaminhado para cirurgia de extirpação da massa. Foi feita uma incisão na pele sob o canal auditivo vertical palpável. A cartilagem foi liberada até o nível da junção entre as cartilagens auricular e anular. Com o auxílio de um fórceps, o pólipo foi agarrado e delicadamente girado até ser completamente extirpado de sua origem. A cartilagem e o subcutâneo foram fechados com material de sutura monofilamentar 4-0 e a pele foi fechada em um padrão de sutura subdérmica usando o mesmo material. A peça foi encaminhada para exame histopatológico, pelo qual confirmou-se a suspeita de pólipo inflamatório, através da observação de epitélio colunar ciliado. Utilizando a técnica cirúrgica TALA (avulsão e tração após abordagem lateral) foi possível obter melhora do quadro clínico do animal referido, rápida recuperação pós-cirúrgica e sem nenhuma complicação decorrente da técnica. Essa técnica, portanto, se mostrou satisfatória, melhorando significativamente a qualidade de vida do animal.

The aim of this study was to describe a case of inflammatory polyp in the middle ear of a cat and its surgical resolution through avulsion and mass traction after lateral approach. A female feline, two year old, was admitted at the Hospital Veterinário Professor Sylvio Barbosa Cardoso, presenting intense itching, pain and fetid discharge in the ear region. Physical examination revealed a nodule in the left middle ear region. Associated with this, the animal presented head tilt (inclination of the head to the affected side). Hematological examinations, skull radiography and mass cytology were requested. The animal was referred for polyp removal surgery. A skin incision was made under the palpable vertical ear canal. The cartilage was released to the level of the junction between the auricular and annular cartilages. With the help of a forceps, the polyp was grasped and gently rotated until completely removed from its origin. The cartilage and subcutaneous tissue were closed with 4-0 monofilament suture material and the skin was closed in a subdermal suture pattern using the same material. The piece was referred for histopathological examination, which confirmed the suspicion of inflammatory polyp by observing ciliated columnar epithelium. Using the TALA surgical technique (avulsion and traction after lateral approach) it was possible to obtain improvement of the clinical 3 picture of the referred animal, rapid postoperative recovery and without any complications resulting from the technique. This technique therefore proves satisfying, significantly improving the quality of life of the animal.

ANESTHESIA AND SURGERY PROTOCOLS FOR INTRA-ABDOMINAL TRANSMITTER PLACEMENT IN FOUR SPECIES OF WILD ARMADILLO.

The anatomy and physiology of armadillos make anesthetic procedures and the placement of telemetry devices challenging. From June 2011 to November 2019, a total of 73 free-living armadillos were captured and anesthetized in the Pantanal, Brazil. Giant (Priodontes maximus), six-banded (Euphractus sexcinctus), southern naked-tailed (Cabassous unicinctus), and nine-banded (Dasypus novemcinctus) armadillos were divided into two groups. In group 1, 30 armadillos were anesthetized for collection of biological samples, body measurements, and placement of a microchip tag. Anesthetic combination BDM was applied: butorphanol tartrate, detomidine hydrochloride, and midazolam hydrochloride, each at 0.1 mg/kg. In group 2, 43 armadillos received ketamine hydrochloride at 10 mg/kg 20 min after BDM injection, and intra-abdominal radio transmitters were surgically implanted. The transmitter was inserted freely into the abdominal cavity. Vital signs were monitored during anesthesia every 10 min and varied within species and between groups. Rectal temperature varied from 33.1 ± 1.36 to 35.34 ± 1.21°C, heart rate (beats/min) from 19 ± 2.14 to 84.71 ± 9.25, respiratory rate (breaths/min) from 11 ± 4.16 to 31 ± 2.82, and oxygen saturation values (SPO2%) from 84.17% ± 2.39 to 98% ± 1.20. Both groups received the antagonist combination NYF: naloxone hydrochloride (0.02 mg/kg), yohimbine hydrochloride (0.125 mg/kg), and flumazenil (0.01 mg/kg). Recovery varied according to intravenous or intramuscular injection from 2 ± 4 to 8.08 ± 2.93 min respectively. BDM protocol was considered satisfactory and provided enough time to complete the procedures (60 ± 85 to 133.20 ± 9.12 min) according to the species and group. Ketamine added to the BDM provided enough time and a surgical plane of anesthesia (97 ± 22 to 137 ± 39.5 min). The surgical procedure technique chosen did not appear to have a negative impact on armadillos studied. Implantable transmitters provide a cost-effective method for long-term monitoring of wild individuals.

Appraisal of the Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery in dogs and cats.

The Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery on dogs and cats are evidence-based guidelines for veterinary practitioners. Validation of these guidelines is necessary to ensure quality and implementability. Two validated tools, used for medical guideline appraisal, were chosen to assess the guidelines. The terminology from the GuideLine Implementability Appraisal (GLIA) and the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) were adapted for use by veterinarians. A two-phase evaluation approach was conducted. In the first phase of the evaluation, the GLIA tool was used by two specialist veterinary surgeons in clinical practice. The results of this phase were then used to modify the guidelines. In the second phase, the AGREE II tool was used by 6 general practitioners and 6 specialists to appraise the guidelines. In phase 1, the specialist surgeons either agreed or strongly agreed that the guidelines were executable, decidable, valid and novel, and that the guidelines would fit within the process of care. The surgeons were neutral on flexibility and measurability. Additional clarity around one common surgical procedure was added to the guidelines, after which the surgeons agreed that the guidelines were sufficiently flexible. In phase 2, 12 veterinarians completed the assessment using the AGREE II tool. In all sections the scaled domain score was greater than 70%. The overall quality of the guidelines was given a global scaled score of 76%. This assessment has demonstrated that the guidelines for antimicrobial prophylaxis for companion animal surgery are valid and appear implementable.

Suture length to wound length ratio in 175 small animal abdominal midline closures.

Experimental and human studies have reported the advantages of a suture length to wound length (SL:WL) ratio greater than 4:1 in midline abdominal closure. This is achieved when the tissue bite (TB) is equal to or larger than the stitch interval (SI). Although TB and SI values are recommended in some textbooks, SL:WL ratios are rarely reported in veterinary textbooks. Additionally, no clinical data regarding these parameters could be found in small animals. Therefore, the aim of this study was to evaluate the SL:WL ratio of midline laparotomy closure in dogs and cats performed by surgeons with different levels of expertise and to compare the findings with current textbook recommendations. Midline laparotomy incisions of 100 dogs and 75 cats were closed in continuous pattern by diplomates and residents of both the European College of Veterinary Surgeons (ECVS) and the European College of Animal Reproduction (ECAR). The mean SL:WL ratio was 2.5 ± 0.7:1. The surgeons´ level of experience and the species and body weights of the animals did not have any significant influence on the SL:WL ratio. A moderate negative correlation was observed between the mean SI to mean TB (SI:TB) ratio and the SL:WL ratio. In this study, the mean SI matched the textbook recommendations both in feline and canine species, whereas the TB in cats was different. In this study, the SL:WL ratio was less than 4:1 without apparent complications. Because of the low prevalence of incisional hernia in dogs and cats larger studies are necessary to evaluate clinical significance of the presented data.

Survey of clinician and student impressions of a synthetic canine model for gastrointestinal surgery training.

OBJECTIVE: To evaluate the perceived efficacy of a high-fidelity synthetic canine model for simulating common gastrointestinal surgical procedures. STUDY DESIGN: Survey of students and experienced clinicians. SAMPLE POPULATION: Twelve clinicians with >2 years of postgraduate experience in the field of small animal surgery and 102 senior year veterinary students. METHODS: The model was subjectively evaluated by 12 clinicians with >2 years of postgraduate experience in the field of small animal surgery. Senior year veterinary students (n = 102) were asked to complete questionnaires before and after a laboratory on common gastrointestinal surgical procedures that included rating of perceived proficiency, anatomical knowledge, and the use of synthetic models compared with live animals. RESULTS: Clinicians assessed most aspects of the model as moderately realistic and unanimously agreed that it would be helpful for students to train on this model prior to live surgery. Student survey response rates were 91% and 99% before and after the laboratory, respectively. The proportion of students that felt moderately-to-highly proficient with the procedures increased from 8% prior to the laboratories to 59% after the laboratories (P < .001). The proportion of students that felt that they had superior-to-excellent knowledge of abdominal surgical anatomy increased from 16% prior to the laboratories to 44% after the laboratories (P < .001). The proportion of students that were satisfied with synthetic models instead of live animals increased from 52% prior to the laboratories to 74% after the laboratories (P = .014). CONCLUSION: Experienced clinicians considered the model to have moderate realism. A positive shift in the students' self-perceived proficiency with gastrointestinal surgery was evident after the use of the model. CLINICAL IMPACT: This synthetic model should be considered for training of veterinary gastrointestinal surgery. However, comparison studies are recommended to ascertain the relative educational value of this model.

Evaluation of different methods of securing cellophane bands for portosystemic shunt attenuation.

OBJECTIVE: To compare mechanisms of and pressures at failure of 4 methods of securing 2 types of cellophane bands around a vein. STUDY DESIGN: Ex vivo mechanical evaluation. METHODS: Cellophane bands composed of 3 or 4 layers were applied around a cadaveric external jugular vein (EJV) to create 25% or 50% attenuation. These bands were secured with a medium or medium-large polymer locking ligation clip (PLLC), or a medium or medium-large titanium ligation clip (TLC). Sterile saline 0.9% was instilled into the lumen of the EJV until a pressure of 100 mm Hg was reached. Failure mechanism and luminal pressure at failure were compared between groups. RESULTS: Medium clips failed less often than medium-large clips (P < .001) and consistently sustained 100 mm Hg without failing. Three-layer cellophane bands were 4.1 times more likely to fail than 4-layer bands (P = .003, CI 1.6-10.2) and failed at lower pressures (28.32 ± 3.59 mm Hg and 44.81 ± 6.51 mm Hg, respectively, P = .027). Failure rates of the cellophane band constructs did not differ whether secured with PLLC or with TLC (P = .635) or with 25% vs 50% attenuation (P = .780). CONCLUSION: A single medium clip withstood physiological forces and secured a cellophane band at up to 50% attenuation. A 3-layer cellophane band was more likely to fail compared with a 4-layer cellophane band. CLINICAL SIGNIFICANCE: These ex vivo results provide evidence to support the application of a 4-layer cellophane band secured with a single medium PLLC or TLC for portosystemic shunt attenuation. A single medium PLLC should be used to eliminate computed tomography artifacts during postoperative evaluation of shunt closure.