Evaluation of a laparoscopically assisted ovariectomy technique in cats.

OBJECTIVE: To describe a laparoscopically assisted ovariectomy (LAO) technique in the cat with a bipolar vessel sealing device (BVSD) or suture ligation and to compare the outcomes to open ovariohysterectomy (OO). STUDY DESIGN: Randomized prospective study ANIMALS: Healthy, adult, sexually intact female cats (n = 30). METHODS: Ten cats were assigned to each group: LAO with BVSD (group A), LAO with ligation (group B), and OO with ligation (group C). Surgical times and complications were assessed. Serum glucose and cortisol were measured prior to surgery and at 1, 2, 4, 6, 12, and 24 hours after surgery. Pain was scored by using an interactive visual analog scale (IVAS) at 0, 1, 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours after surgery. Rescue analgesia was provided when IVAS score was 4 or more. Physiological and serum values and IVAS scores were compared among groups with area under the curve (AUC) by using a 1-way ANOVA. RESULTS: Surgical time was shortest for group C (19.1 ± 5.2 minutes; P < .0002); there was no significant difference between groups A (27.7 ± 6.6 minutes) and B (33.2 ± 8.2 minutes). All procedures were completed successfully. No significant differences among groups were found in IVAS scores (P = .36), rescue analgesia (P = .22), glucose AUC (P = .53), or cortisol AUC (P = .27). CONCLUSION: The LAO technique was accomplished as described in all cats with no complications or failures. Pain scores were not different from cats undergoing OO. LAO can be performed efficiently to maximize the benefits of minimally invasive surgery and is amenable to clinical practice.

Impact of Expert Commentary and Student Reflection on Veterinary Clinical Decision-Making Skills in an Innovative Electronic-Learning Case-Based Platform.

One challenge in veterinary education is bridging the divide between the nature of classroom examples (well-defined problem solving) and real world situations (ill-defined problem solving). Solving the latter often relies on experiential knowledge, which is difficult to impart to inexperienced students. A multidisciplinary team including veterinary specialists and learning scientists developed an interactive, e-learning case-based module in which students made critical decisions at five specific points (Decision Points [DPs]). After committing to each decision (Original Answers), students reflected on the thought processes of experts making similar decisions, and were allowed to revise their decisions (Revised Answers); both sets of answers were scored. In Phase I, performance of students trained using the module (E-Learning Group) and by lecture (Traditional Group) was compared on the course final examination. There was no difference in performance between the groups, suggesting that the e-learning module was as effective as traditional lecture for content delivery. In Phase II, differences between Original Answers and Revised Answers were evaluated for a larger group of students, all of whom used the module as the sole method of instruction. There was a significant improvement in scores between Original and Revised Answers for four out of five DPs (DP1, p =.004; DP2, p =.04; DP4, p <.001; DP5, p <.001). The authors conclude that the ability to rehearse clinical decision making through this tool, without direct individual feedback from an instructor, may facilitate students' transition from problem solving in a well-structured classroom setting to an ill-structured clinical setting.

Epicardial exposure provided by a novel thoracoscopic pericardectomy technique compared to standard pericardial window.

OBJECTIVE: (1) To describe a novel technique for thoracoscopic pericardectomy using a pericardial window with vertical pericardial fillets (PW+F). (2) To compare epicardial exposure between a standard pericardial window (PW) and PW+F. STUDY DESIGN: Experimental study. ANIMALS: Purpose-bred research dogs (n = 12). METHODS: PW was performed through a 3-port subxiphoid thoracoscopic approach. After PW, vertical fillets were made in the pericardium for PW+F. Thoracoscopic images from 3 views were acquired after each procedure, and percentage of epicardial surface exposed (PESE) was compared. Epicardial exposure and iatrogenic damage to surrounding structures were directly assessed via postmortem gross examination. RESULTS: The exposed epicardial surface (PESE) was increased with our novel compared to the standard technique. Median surgery time for PW+F was 25 minutes. The procedure was performed in 11 of 12 dogs without iatrogenic damage to surrounding structures. In 1 dog, the electrosurgery device contacted the epicardium and caused fatal ventricular fibrillation while performing PW+F. Based on postmortem assessment in all dogs with PW+F, the pericardium could move freely away from the heart, exposing the majority of the epicardial surface. CONCLUSION: Thoracoscopic PW+F is a novel technique that improves the exposure of the epicardium compared to standard PW. While PW+F can be performed successfully and in an efficient manner, the surgeon must be aware of the risk of iatrogenic trauma to thoracic structures when using electrosurgery. CLINICAL RELEVANCE: PW+F offers a relatively safe, efficient, and effective minimally invasive method that improves the exposure of the epicardium compared to PW.

Evaluation of Gastroesophageal Reflux in Anesthetized Dogs with Brachycephalic Syndrome.

Brachycephalic airway syndrome may predispose to gastroesophageal reflux (GER) because of the high negative intrathoracic pressures required to overcome conformational partial upper airway obstruction. To investigate this, 20 dogs presenting for elective correction of brachycephalic airway syndrome (cases) and 20 non-brachycephalic dogs (controls) undergoing other elective surgeries were prospectively enrolled. Dogs underwent a standardized anesthetic protocol, and esophageal pH was monitored. Signalment, body weight, historical gastrointestinal and respiratory disease, complete blood count, serum biochemical values, radiographic findings, and anesthetic and surgical time were compared between cases and controls, and dogs that did and did not have basic (pH > 7.5), acidic (pH < 4), or any GER. Controls had higher mean esophageal pH (6.3) compared to cases (5.6, P = .019), but there was no difference in % with GER (cases 60%, controls 40%, P = .34). When all dogs were evaluated, dogs with GER had increased creatinine (P = .01), % positive for esophageal fluid on radiographs (P = .05), and body weight (P = .04) compared to those without GER. GER was common in both cases and controls, and cases had lower esophageal pH; however, greater numbers are required to determine if a true difference exists in % GER.

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery.

OBJECTIVE: To investigate the frequency, source, and risk factors of intraoperative (IO) surgeon and patient bacterial contamination during clean orthopedic surgeries, and to investigate the relationship between IO contamination and surgical site infection (SSI) in dogs. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Client-owned dogs undergoing stifle surgery (n = 100). METHODS: IO cultures were taken in each case from surgical foot wrap, peri-incisional skin, surgical gloves, and the surgical team's hands. The environment (operating room [OR] lights, computers, scrub sink faucet, anesthesia gurney, and radiology table) was sampled every 5 months. Bacteria were identified and the contamination of each case was categorized. All gloves from the surgical team were collected and tested for perforations using a water infusion test. Cases were followed for at least 8 weeks to determine the presence or absence of SSI. Perioperative variables were evaluated for association with IO contamination and SSI. RESULTS: Bacterial isolates were yielded from 81% of procedures from 1 or more sources; 58% had positive hand cultures, 46% had positive glove cultures, 23% had positive patient skin cultures, and 12% had positive foot wrap cultures. Staphylococcus spp. was the most commonly recovered bacteria. There was no apparent association between IO contamination and SSI. The highest level of environmental contamination was associated with the scrub sink faucet, followed by the radiology table, anesthesia gurney, and OR computers. The IO glove perforation rate was 18%. CONCLUSION: Clean orthopedic procedures commonly had clinically insignificant bacterial contamination. In our study, bacteria responsible for SSI did not appear to colonize the patient in the OR.

Complications and Conversion from Endoscopic to Open Surgery.

Endoscopic surgery is a rapidly expanding modality of diagnosis and treatment of small animal patients. The development of skills, equipment, and minimally invasive means of correcting complications may be of great importance in decreasing the incidence of conversion from endoscopic to open surgery; however, conversion to an open approach should never be seen as a failure. Conversion should be considered at any time that it is of the greatest benefit for the patient. This concept is important enough to warrant discussion with the owner before surgery and acceptance of the need to convert without further consultation during the procedure.

Advances in Otoscopy.

Ear disease is a common condition in dogs and cats, and otoscopy should be performed on every case. Video-otoscopy is an incredible tool for the diagnosis, treatment, and management of ear disease. It may serve as a form of positive reinforcement, because the client can readily see progress made with treatment. This article focuses on the proper use of video-otoscopy for the diagnosis, treatment, and management of ear diseases in dogs and cats. Proper anatomy, equipment, and diagnostic understanding are required to minimize the risk of recurrent or chronic otitis, which is a source of discomfort for the patient and frustration for the owner and the clinician.

Evaluation of Pharyngeal Function in Dogs with Laryngeal Paralysis Before and After Unilateral Arytenoid Lateralization.

OBJECTIVE: To evaluate pharyngeal and laryngeal function using esophagography, topical pharyngeal/laryngeal sensitivity testing, and electromyography (EMG) in normal and dogs with idiopathic laryngeal paralysis (ILP) before and after unilateral arytenoid lateralization. STUDY: Prospective controlled cohort study. ANIMALS: Dogs with laryngeal paralysis (ILP; n = 8) and age/breed-matched (AB, n = 8) and young breed-matched dogs (B, n = 8) were recruited. METHODS: Evaluation consisted of esophagography, topical pharyngeal/laryngeal sensitivity testing, and electrodiagnostic testing. Esophagography was performed with liquid and canned phases. Pharyngeal and laryngeal sensitivity was tested by applying a cotton-tipped applicator to the mucosa of pharynx/larynx at anesthetic induction. In all dogs, electrophysiological testing included EMG, direct evoked muscle potentials, motor nerve conduction velocities, and F wave testing. These were performed in the thoracic/pelvic limbs, extrinsic laryngeal muscles, epaxial, and masticatory muscles. RESULTS: Topical pharyngeal and laryngeal sensitivity testing was decreased in LP dogs compared with age-matched healthy control dogs. Esophagram showed dysmotility in the cranial and caudal esophagus. Gastroesophageal reflux was significantly higher in ILP dogs compared with the other 2 groups (P < .03). In all affected dogs, EMG abnormalities were limited to the interosseous muscles of both pelvic and thoracic limbs bilaterally. CONCLUSION: Dogs with ILP not only have recurrent laryngeal nerve (RLN) and pararecurrent laryngeal nerve (pRLN) dysfunction, but may also have concurrent cranial laryngeal nerve dysfunction.

Use of a Nitinol Wire Stent for Management of Severe Tracheal Stenosis in an Eclectus Parrot (Eclectus roratus).

A 25-year-old, female eclectus parrot (Eclectus roratus) presented for dyspnea 3 weeks after anesthesia and surgery for egg yolk coelomitis. Radiography, computed tomography, and tracheoscopy revealed multiple tracheal strictures spanning a length of 2.6 cm in the mid to distal trachea. Histopathologic examination revealed mild fibrosis, inflammation, and hyperplasia consistent with acquired tracheal strictures. Tracheal resection was not considered possible because of the length of the affected trachea. The strictures were resected endoscopically, and repeated balloon dilation under fluoroscopic guidance over the course of 10 months resulted in immediate but unsustained improvement. Computed tomography was used to measure the stenotic area. A 4 × 36-mm, custom-made, nitinol wire stent was inserted into the trachea under fluoroscopic guidance. After stent placement, intermittent episodes of mild to moderate dyspnea continued, and these responded to nebulization with a combination of saline, acetylcysteine, and dexamethasone. Multiple attempts to wean the patient off nebulization therapy and to switch to a corticosteroid-free combination were unsuccessful. The parrot eventually developed complications, was euthanatized, and necropsy was performed. Histologically, the tracheal mucosa had widespread erosion to ulceration, with accumulation of intraluminal exudate and bacteria, severe degeneration of skeletal muscle and tracheal rings, prominent fibrosis, and mild to moderate, submucosal inflammation. Clinicopathologic findings in this case suggested tracheomalacia, which has not been previously described in birds. Custom-made tracheal stents can be used for severe tracheal stenosis in birds when tracheal resection and anastomosis is not possible. Complications of tracheal stent placement in birds may include tracheitis and tracheomalacia. To our knowledge, this is the first report of tracheal stent placement in an avian species.

Outcomes of dogs undergoing limb amputation, owner satisfaction with limb amputation procedures, and owner perceptions regarding postsurgical adaptation: 64 cases (2005-2012).

OBJECTIVE: To evaluate outcomes of dogs and owner satisfaction and perception of their dogs' adaptation following amputation of a thoracic or pelvic limb. DESIGN: Retrospective case series. ANIMALS: 64 client-owned dogs. Procedures-Medical records of dogs that underwent limb amputation at a veterinary teaching hospital between 2005 and 2012 were reviewed. Signalment, body weight, and body condition scores at the time of amputation, dates of amputation and discharge from the hospital, whether a thoracic or pelvic limb was amputated, and reason for amputation were recorded. Histologic diagnosis and date of death were recorded if applicable. Owners were interviewed by telephone about their experience and interpretation of the dog's adaptation after surgery. Associations between perioperative variables and postoperative quality of life scores were investigated. RESULTS: 58 of 64 (91%) owners perceived no change in their dog's attitude after amputation; 56 (88%) reported complete or nearly complete return to preamputation quality of life, 50 (78%) indicated the dog's recovery and adaptation were better than expected, and 47 (73%) reported no change in the dog's recreational activities. Body condition scores and body weight at the time of amputation were negatively correlated with quality of life scores after surgery. Taking all factors into account, most (55/64 [86%]) respondents reported they would make the same decision regarding amputation again, and 4 (6%) indicated they would not; 5 (8%) were unsure. CONCLUSIONS AND CLINICAL RELEVANCE: This information may aid veterinarians in educating clients about adaptation potential of dogs following limb amputation and the need for postoperative weight control in such patients.

Current concepts in minimally invasive surgery of the thorax.

Thoracoscopy is a technique that has been shown to decrease patient morbidity and is rapidly becoming more diversely applied for diagnostic and therapeutic interventions in veterinary medicine. This article describes the basic equipment and application of thoracoscopy in small animal surgery. The diagnostic and therapeutic applications are introduced and briefly described.

Description of the Anatomy, Surgical Technique, and Outcome of Hemipelvectomy in 4 Dogs and 5 Cats.

OBJECTIVE: To provide (1) a comprehensive description of hemipelvectomy; and (2) report clinical application and outcome of hemipelvectomy in dogs and cats. STUDY DESIGN: Descriptive report and retrospective case series. ANIMALS: Dogs (n = 4) and 5 cats. METHODS: Cadaveric dissection was performed for imaging purposes using 4 mixed breed dogs euthanatized for reasons unrelated to this study. Medical records (2005-2012) were reviewed for dogs and cats that had hemipelvectomy. Data collected included signalment, body weight, body condition score, clinical presentation, diagnostic imaging findings, location and extent of tumor, definitive diagnosis, use of adjuvant therapy, ability to ambulate postoperatively, complications, and survival. RESULTS: The most common indication for hemipelvectomy in cats was injection site sarcoma (ISS) and in dogs, osteosarcoma or peripheral nerve sheath tumor (PNST). Complete tumor excision was achieved in 6 (67%) cases. Incomplete excision occurred in 2 dogs with lumbosacral PNST and 1 cat having a 2nd surgery for ISS. Complications included intraoperative hemorrhage (n = 2), postoperative soft tissue infection (2), and discharge from the incision site (1). All but 1 animal were ambulatory at the time of discharge. Hospitalization ranged from 1-10 days (median, 4 days). Survival after surgery was individually assessed. CONCLUSION: With in-depth anatomic familiarity, hemipelvectomy can be successful for excision of neoplastic lesions of the proximal aspect of the pelvic limb, with only minor complications.

Prevalence and risk factors for canine post-anesthetic aspiration pneumonia (1999-2009): a multicenter study.

OBJECTIVE: To determine the incidence of canine post-anesthetic aspiration pneumonia (AP) and to identify anesthetic agents, procedures and management factors associated with the development of AP. STUDY DESIGN: Multicenter, randomized, case-controlled retrospective study. ANIMALS: Two hundred and forty dogs affected with AP and 488 unaffected control dogs. METHODS: Electronic medical record databases at six Veterinary colleges were searched for dogs, coded for anesthesia or sedation and pneumonia from January 1999 to December 2009. The resultant 2158 records were hand-searched to determine eligibility for inclusion. Diagnosis of AP was made radiographically. Two unaffected control dogs were randomly selected for each affected dog, from a list of dogs that underwent sedation or anesthesia in the same time period and did not develop aspiration pneumonia. Fifty-seven factors were then evaluated for association with aspiration pneumonia. Data analysis was performed using univariate Chi-square or student t-tests, then multivariate logistic regression. RESULTS: Incidence of post-anesthetic AP was 0.17%, from 140,711 cases anesthetized or sedated over the 10 year period. Two anesthesia-related events were significantly associated with development of AP: regurgitation and administration of hydromorphone at induction. Administration of anticholinergics was not associated with AP. Procedures associated with increased odds of aspiration pneumonia included laparotomy, upper airway surgery, neurosurgery, thoracotomy and endoscopy. Orthopedic surgery, ophthalmologic surgery, dental procedures, MRI, CT, bronchoscopy, cystoscopy, tracheoscopy and neutering were not associated with development of AP. Three patient factors were associated with the development of AP: megaesophagus, and a history of pre-existing respiratory or neurologic disease. Sixty-nine% of dogs with two or more of the above independent predictive variables developed AP. CONCLUSION AND CLINICAL RELEVANCE: Most anesthetic agents and procedures were not associated with the development of AP. We need to devise and evaluate strategies to protect at risk patients.

Thoracoscopy in the cat: an up-and-coming diagnostic and therapeutic procedure.

PRACTICAL RELEVANCE: Thoracoscopy provides a minimally invasive means of diagnosis and offers many important benefits when compared with open thoracotomy. CLINICAL CHALLENGES: The expense of the equipment, the steep learning curve required to gain proficiency in thoracoscopic surgery, and the limitations imposed by the feline thoracic cavity, in terms of working and viewing space, are some of the challenges that have limited its uptake to date. However, it is envisaged that it will increase as a technique in feline medicine, in much the same way as laparoscopy has. AUDIENCE: This article is directed at veterinarians currently performing open thoracic surgery and the associated aftercare who concurrently are adept at endoscopic surgery. EVIDENCE BASE: The article draws on the small body of literature that is available on thoracoscopy in cats, which includes reports of its use for evaluation and management of undiagnosed pleural effusion, lung lobe torsion, persistent right aortic arch and chylothorax.

Modified-closed castration: a novel technique for sea otter (Enhydra lutris nereis) orchiectomies.

A novel surgical technique was used in the routine castrations of two intact male southern sea otters, Enhydra lutris nereis, housed at the Georgia Aquarium (Atlanta, Georgia, USA). This technique involved incising the parietal vaginal tunic to allow placement of double ligation of the ductus deferens, testicular artery, and pampiniform plexus en masse. After ligating and transecting these structures, they were introduced back into the tunic, which was closed with a circumferential ligature. The incision site was closed in a routine manner. Both otters recovered well from the procedure. One otter had mild cutaneous dehiscence postoperatively, and the other had no obvious complications. Benefits of this procedure include reduced risk of ligature slippage or loosening and resultant hemorrhage, as provided by the traditional open portion of the castration, and decreased postoperative swelling, as provided by the closed part of the castration. To the authors' knowledge, this is the first time this technique has been described for use in sea otters.

Innovative approach to laparoscopic adrenalectomy for treatment of unilateral adrenal gland tumors in dogs.

OBJECTIVE: To report a technique for, and short-term outcome of unilateral laparoscopic adrenalectomy in dogs positioned in sternal recumbency without abdominal support. STUDY DESIGN: Experimental and prospective clinical study. ANIMALS: Healthy dogs (n = 5) and dogs with unilateral adrenal gland tumor (n = 9). METHODS: Anesthetized dogs were positioned in sternal recumbency with 2 cushions placed under the dog to elevate the chest and pelvic area so that the abdomen was not in contact with the surgical table allowing gravitational displacement of the abdominal viscera. Three 5-mm portals were located in the paralumbar fossa. Adrenal glands were carefully dissected and surrounding tissues sealed and cut using a vessel-sealing device. A retrieval bag or part of a surgical glove finger was used to remove the adrenal gland from the abdomen. Surgical time and complications were recorded, and short-term outcome assessed. RESULTS: Adrenal glands in normal dogs and unilateral adrenal tumors (8 left, 1 right) not involving the caudal vena cava in affected dogs were successfully removed laparoscopically. There were no major intraoperative complications. Of the dogs with adrenal tumors, 1 dog died within 24 hours of surgery from unrelated causes. Eight dogs recovered within 1 day and were discharged within 72 hours. Surgical times ranged from 42 to 117 minutes and were significantly shorter than those reported previously. CONCLUSIONS: Positioning anesthetized dogs in sternal recumbency with the abdomen suspended to facilitate gravitational displacement of the abdominal viscera improves access to, and visibility of, the adrenal gland for laparoscopic removal.

Efficacy of serosal patching in dogs with septic peritonitis.

The objective of this study was to evaluate the correlation of serosal patching in dogs with existing septic peritonitis with continued postoperative septic peritonitis and death. Records were collected from dogs that underwent intestinal surgery from 1998 to 2007 at four veterinary teaching hospitals and one private referral clinic. Dogs were included if they were diagnosed with septic peritonitis and had subsequent surgery of either the small intestine or cecum. Eighty-two surgeries were evaluated. Eighteen dogs (22%) received a serosal patch during surgery. Of those, three dogs (16.7%) had septic peritonitis postoperatively. Sixty-four dogs (78%) did not receive a serosal patch, and 19 of those dogs (29.7%) had postoperative septic peritonitis (P = 0.27). Of the 18 cases with serosal patching, 6 (33.3%) died prior to discharge. Of the 63 cases that did not receive a patch and had information regarding survival, 14 (22.2%) died prior to discharge (P = 0.34). Use of a serosal patch did not protect dogs from either postoperative septic peritonitis or failure to survive.

Postoperative complications associated with caudectomy in brachycephalic dogs with ingrown tails.

Surgical correction of an ingrown tail is indicated to relieve clinical signs of intertriginous dermatitis. The objective of this retrospective study was to identify the type and frequency of complications following caudectomy in dogs with ingrown tails. Medical records of dogs with ingrown tails treated with caudectomy from 2000 to 2010 at the University of Georgia Veterinary Teaching Hospital were reviewed. Data collected included signalment, preoperative infection status, surgical procedures performed, prophylactic antibiotic use, complications noted both during hospitalization and at suture removal, treatments instituted, and owner satisfaction. Seventeen dogs were identified for inclusion. At presentation, 4 of the 17 dogs (23.5%) were receiving antibiotics. Infection was present in 7 of the 17 dogs (41%), and 6 of the 7 cases resolved immediately postoperatively. All dogs received perioperative antimicrobial therapy, and 13 of the 17 dogs (76%) received antibiotics after surgery for an average of 13.5 days ± 5.2 days. Complications occurred in 2 of the 17 cases (12%) immediately after surgery, including decreased rectal sensation with adequate anal tone, failure to posture to defecate, and postoperative draining tracts. Complications were reported in 2 of 15 dogs (13%) at suture removal, including delayed wound healing and wound inflammation, persistent tail chasing behavior, and temporary changes in defecation habits. Caudectomy provided resolution of clinical signs with no long-term complications.

Efficacy of incisional gastropexy for prevention of GDV in dogs.

Incisional gastropexy (IG) is routinely performed as either a prophylactic procedure to prevent occurrence of gastric dilatation-volvulus (GDV) or at the time of surgical correction of GDV to prevent recurrence. Despite its common use, the long-term efficacy of the IG procedure has not been reported. The hypothesis of this study was that IG performed either during surgical treatment of GDV or as a prophylactic measure would effectively prevent GDV. Medical records of 61 dogs undergoing IG following either gastric derotation for treatment of GDV or as a prophylactic procedure were evaluated retrospectively. Median follow-up time for all dogs was 717 days (range, 49-2,511 days). Of the 61 dogs, 27 had prophylactic IG performed. The remaining 34 dogs presented for GDV and had an IG performed during surgical treatment of GDV. No dog experienced GDV after IG. Recurrence of gastric dilatation (GD) alone was noted in 3 of 34 patients (8.8%) undergoing IG during surgery for GDV and in 3 of 27 patients (11.1%) treated prophylactically with IG. This study confirmed the efficacy of IG for the long-term prevention of GDV in dogs.