Hybrid natural orifice transluminal endoscopy surgery (NOTES) to perform bilateral ovariectomy in mares.

OBJECTIVES: To combine laparoscopic techniques with natural orifice transluminal endoscopic surgery (hybrid NOTES) to minimize number and enlargement of paralumbar laparoscopic portals for bilateral ovariectomy in standing, sedated mares. STUDY DESIGN: Case series. ANIMALS: Six horses. MATERIALS AND METHODS: Six mares with palpably normal ovaries were restrained in stocks, sedated, and had caudal epidural anesthesia performed. A 7.5 MHz ultrasound probe was used transvaginally to select placement of vaginotomy. An attempt was made to remove both ovaries with 70 cm esophageal forceps through the vaginotomy, while visualized and transected via ipsilateral paralumbar fossa laparoscopic portals. Surgical time, intraoperative, and postoperative complications were recorded. Vaginoscopy was performed at days 0, 3, 7, and 14 postoperatively. After 14 days, mares were euthanized and necropsied. RESULTS: Hybrid NOTES allowed successful bilateral ovariectomy in all six mares, with a mean surgical time of 70 ± 25 min. In two mares, one ovary was dislodged from the forceps during vaginotomy extraction. Abdominal retrieval of the ovary was successful with reapplication of forceps or a surgeon's hand via vaginotomy. At necropsy, five mares had no adhesions within the abdominal cavity or at the vaginotomy site. One mare in which hand retrieval of the ovary was necessary, developed an adhesion between the bladder and the vaginotomy. CONCLUSIONS: This technique appears to offer a safe alternative for bilateral ovariectomy with minimal postoperative complications. CLINICAL SIGNIFICANCE: Decreased number and size of paralumbar laparoscopic incisions could decrease complications associated with exteriorization of ovaries through the flank.

Canine ovariectomy by hybrid or total natural orifice transluminal endoscopic surgery: technical feasibility study and pain assessment.

OBJECTIVE: To compare technical feasibility, surgical time, surgical complications, and postoperative pain in ovariectomy (OVE) by hybrid and total natural orifice transluminal endoscopic surgery (NOTES). STUDY DESIGN: Prospective randomized clinical trial. ANIMALS: Sixteen healthy and sexually intact bitches. METHODS: Dogs were randomly assigned to the hybrid NOTES group (HNG; n = 8) and the total NOTES group (TNG; n = 8) to compare surgical time, pain scores and complications. Pain was assessed by using the visual analog scale (VAS) and the Melbourne pain scale (MPS). RESULTS: Surgical time did not differ between the experimental groups (HNG = 46.3 ± 18.5 minutes, TNG = 54.6 ± 31.1 minutes). Exteriorization of the ovaries through the vaginal wound was the major difficulty. Complications were minor in both groups and occurred intraoperatively only in the HNG, and in both groups post operatively. No dogs required rescue analgesia in the intraoperative or postoperative period. There were no differences in VAS or MPS scores between the groups for any surgical times except for the VAS assessment at 72 hours after extubation (HNG = 1.1 ± 0.3, TNG = 0.7 ± 0.4, P = .0221). CONCLUSION: Both NOTES techniques were comparable for canine OVE, with no requirement for additional analgesia in the postoperative periods. It was not possible to determine whether there was a clear advantage of one technique rather than the other. CLINICAL SIGNIFICANCE: The minimally invasive techniques proposed for laparoscopic OVE are feasible for dogs with low pain scores and low rates of complications for both groups.

Comparison of two techniques for transpharyngeal endoscopic auditory tube diverticulotomy in the horse.

Auditory tube diverticula, also known as guttural pouches, are naturally occurring dilations of the auditory tube in horses that communicate with the nasopharynx through a small ostium. Infection and select other conditions can result in inflammation and narrowing of the nasopharyngeal ostium, which prevents drainage of fluid or egress of air and can lead to persistent infection or guttural pouch tympany. Auditory tube diverticulotomy allows continuous egress from the auditory tube diverticula and is a feature of disease treatment in horses, in which medical treatment alone is not successful. Transpharyngeal endoscopic auditory tube diverticulotomy was performed using a diode laser either at a single dorsal pharyngeal recess location or bilaterally caudal to the nasopharyngeal ostium in 10 horse head specimens. Both methods resulted in clear communication between the nasopharynx and auditory tube diverticula. Diverticulotomy performed in the dorsal pharyngeal recess required less laser energy and activation time and had a shorter surgical duration than diverticulotomy performed caudal to the nasopharyngeal ostium. Further study related to the clinical application of both techniques is warranted.

Evaluation of pet owner preferences for operative sterilization techniques in female dogs within the veterinary community.

OBJECTIVE: To describe pet owner preferences within the veterinary community when choosing operative techniques for canine spay. STUDY DESIGN: Prospective survey. SAMPLE POPULATION: 1234 respondents from 5 veterinary university teaching hospitals in North America. METHODS: An electronic survey was distributed to faculty, students, and staff that currently are or previously were dog owners. Responses were analyzed to determine what spay technique respondents would choose for their own dogs. Surgical options offered included open celiotomy, 2-port (TP) laparoscopy, single-port (SP) laparoscopy, and natural orifice transluminal endoscopic surgery (NOTES). RESULTS: TP laparoscopic ovariectomy (OVE) was the most popular choice, followed by SP laparoscopic OVE; NOTES was the least popular technique when all surgical options were available. If only minimally invasive surgeries were offered, 0.3% of respondents would refuse surgery. Nearly half (48%) of respondents were willing to spend between $100 and $200 more for a minimally invasive OVE than for an open celiotomy. CONCLUSION: Minimally invasive OVE is an acceptable operative approach to those in the veterinary community. Additional study is required to correlate these findings with the general veterinary client population.

Ovariossalpingo-histerectomia em cadelas: comparação da dor e análises cardiorrespiratória, pressórica e hemogasométrica nas abordagens convencional, por NOTES híbrida e NOTES total / Ovariosalpingohisterectomy in bitches: comparison of pain, cardiopulmonary, pressure and arterial blood gas analysis of the conventional approaches, by NOTES hybrid and NOTES pure

A cirurgia endoscópica por orifícios naturais (NOTES) é um novo conceito de abordagem videocirúrgica, que surge como alternativa à cirurgia convencional, eliminando incisões abdominais e as possíveis complicações relacionadas a ela. A proposta deste artigo foi comparar técnicas de ovariossalpingo-histerectomia (OSH) em cadelas, buscando determinar o procedimento que oferece menores alterações hemodinâmicas e menos estímulos dolorosos trans e pós-operatório. Para tanto, foram utilizadas 21 cadelas alocadas em três grupos. No primeiro, os pacientes foram submetidos à OSH por celiotomia (GC), no segundo por meio da técnica de NOTES híbrida (GNH) e no terceiro (GNT), utilizando-se a técnica de NOTES total. O tempo cirúrgico do GNH foi significativamente maior que nos demais grupos. Em ambos os grupos de cirurgia NOTES, verificou-se diminuição das pressões arteriais médias e diastólicas no transoperatório. Apenas o grupo GNH desenvolveu acidose severa no transoperatório. Levando-se em consideração as avaliações da dor, apenas o grupo convencional necessitou de analgesia resgate transcirúrgica. No pós-operatório, observou-se que os cães do GC apresentaram índices mais elevados na escala visual analógica e na escala de Melbourne que os animais dos demais grupos, sendo necessária analgesia resgate em 100% deles. Em contraste, no GNT nenhum dos cães requereram complementação analgésica pós-operatória. Conclui-se que a técnica de OSH por NOTES total apresenta parâmetros cardiorrespiratórios e hemogasométricos semelhantes à técnica convencional e mais estáveis que a técnica de NOTES híbrida, bem como resulta em menor dor trans e pós-operatória que a técnica convencional...

The aim of the present study was to perform bacteriological and molecular methods for identification of Mycobacterium bovis in lesions derived from bovine carcasses detected during routine post-mortem examination in officially inspected slaughterhouses. We checked the slaughter and inspection of 825,394 bovines, health upon ante-mortem examination, by the official service in 10 slaughterhouses of Bahia state from April, 2009 to April 2012. Lesions suggestive of tuberculosis were collected from 180 bovines and further evaluated by bacteriology and multiplex PCR. The majority of lesions were located in the respiratory tract lymph nodes and 71% were from male bovines up to 32 months old. 13.9% of samples presented small, granular and creamy-yellowish colonies after being cultured in Stonebrink-Leslie with an average growth time of 34 days. All smears from the isolated samples were Acid Fast Bacilli (AFB) and among them 56% were identified by mPCR as M. bovis. Thus, the association between post-mortem examination, culture and multiplex PCR allowed the bacillus identification in a reduced time and in regions of low prevalence, pointing out its importance for bovine tuberculosis detection and as a supportive tool for the tuberculosis control and eradication program...

Incorporating oral photography and endoscopy into the equine dental examination.

This article discusses the significant features and use of digital cameras, intraoral cameras, and oral endoscopes in equine dental practice. Although system features believed to be important have been listed, specific system recommendations have been omitted, since each veterinarian must individually determine the best system to meet practice clinical needs and budget. Veterinarians are encouraged to thoroughly research not only the camera/endoscope purchase but also the capabilities of the entire system, the compatibility of the system with different computer software programs, the reputation and service policies of the manufacturers, and references from other colleagues.

Comparison of transvaginal natural orifice transluminal endoscopic surgery (NOTES®) and laparoscopy for elective bilateral ovariectomy in standing mares.

OBJECTIVE: To compare surgical trauma, perioperative pain, surgical time, and complication rate in mares undergoing standing bilateral ovariectomy by natural orifice transluminal endoscopic surgery (NOTES) or laparoscopy. STUDY DESIGN: Experimental study. ANIMALS: Healthy mares (n = 12). METHODS: Ovariectomy was performed with a vessel-sealing device by transvaginal NOTES (n = 6) using a flexible endoscope and specialized instruments or by bilateral flank laparoscopy (n = 6). Preoperative and postoperative complete blood count (CBC), plasma fibrinogen concentration, serum amyloid A concentration, peritoneal nucleated cell count, and total protein concentration were compared using repeated measures ANOVA. Surgical times were compared using an unpaired t-test. Mares were monitored for 2 weeks postoperatively and necropsy was performed at 3 weeks (n = 6) or 3 months (n = 6) to assess short- and medium-term effects of each procedure. Complication rate, necropsy, and bacteriology findings were compared using a Fishers exact test. Significance was set at P < .05. RESULTS: All surgical procedures were performed successfully and all but one laparoscopy mare were bright, alert, and maintained a good appetite until euthanasia. Mean ± SD surgical time was similar between groups (NOTES: 100 ± 40 minutes; laparoscopy: 107 ± 47 minutes). There were no significant temporal differences in vital parameters, CBC, plasma fibrinogen concentration, serum amyloid A concentration, peritoneal nucleated cell count, and total protein concentration between groups. CONCLUSIONS: Bilateral ovariectomy by transvaginal NOTES or laparoscopy resulted in minimal inflammation and surgical trauma.

Natural orifice transluminal endoscopic surgery (NOTES) in animals.

Natural orifice transluminal endoscopic surgery (NOTES) is a modern technique of performing surgical procedures developed worldwide. In the last few years, series of NOTES operations were performed in animals and humans. This article describes some surgical procedures performed in animals with use of this new technique.

Standing ovariectomy in mares using a transvaginal natural orifice transluminal endoscopic surgery (NOTES®) approach.

OBJECTIVE: To develop and assess the feasibility of standing transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES®) ovariectomy in the mare. STUDY DESIGN: Descriptive study. ANIMALS: Mares (n=10). METHODS: The technique was developed in 6 mares and then evaluated in a short-term study in 4 mares. Abdominal access was developed using controlled access vaginal cannula placement under endoscopic guidance. With viewing provided by a flexible endoscope, hemostasis, and transection of ovarian pedicles was performed using a customized bipolar vessel-sealing device. The ovaries were retrieved and the colpotomy was sutured. Surgical time, intra-, and postoperative complications were recorded. Necropsy was performed immediately after surgery in 6 mares and 15 days after surgery in 4 mares to assess short-term complications. RESULTS: After the instruments and techniques were developed, transvaginal NOTES® ovariectomy was successfully performed. Analgesia during the procedure was adequate in all cases. The visual field provided by the endoscope was acceptable. The customized 60 cm vessel-sealing device provided good hemostasis and a comfortable working length. Intraoperative complications included difficult viewing that prolonged operative time and inability to remove the second ovary in 1 mare. Postoperative recovery was excellent. Postmortem findings of 1 true positive microbial culture, elevated cell counts in abdominal fluid, and adhesion formation raise questions that must be addressed in future studies. CONCLUSION: Using specialized instruments, transvaginal NOTES® ovariectomy is technically feasible in mares.

Nasal hydropulsion: a novel tumor biopsy technique.

Intranasal tumors of dogs and cats pose a diagnostic and therapeutic challenge for small animal practitioners. Multiple nasal biopsy techniques have been described in the past. This report describes a simplified flushing technique to biopsy and debulk nasal tumors, which often also results in immediate clinical relief for the patient. Based on the results of this retrospective study, the authors recommend high-pressure saline hydropulsion as a minimally invasive diagnostic, and potentially therapeutic, technique for nasal tumors in dogs and cats.

Evaluation of the learning curve for natural orifice transluminal endoscopic surgery: bilateral ovariectomy in dogs.

OBJECTIVE: Study the learning curve for canine Natural Orifice Transluminal Endoscopic Surgery (NOTES) ovariectomy by evaluating operative times and complications. STUDY DESIGN: Preclinical research study. ANIMALS: Adult female dogs (n=20). METHODS: NOTES ovariectomy procedures were performed as follows: Feasibility Group 1 (n=5), Feasibility Group 2 (n=5), and Early Clinical Group 3 (n=10). Six steps of the procedure were identified, timed separately, and the overall time was recorded from introduction to removal of the endoscope. Complications were recorded. Repeated measures analysis of variance using ranked data compared the effect of group (3 levels) on the time for each step. Nonlinear regression using an exponential model with nonzero asymptote was used to model the operative time-procedure number relationship. RESULTS: Overall median operative time was significantly longer for Group 1 (195 minutes; range, 160-265 minutes) than Group 2 (108 minutes; range, 81-148 minutes; P=.048) and Group 3 (77 minutes; range, 41-136 minutes; P=.0008). The estimated asymptotic operative time was 71 minutes (95% confidence interval, 41-100 minutes); this time was reached after 10 procedures. Gastric cleansing and removing the left ovary took significantly longer in Group 1 than in Group 2 or 3. Operative complications included incomplete ovarian excision, dropping an ovary during retrieval, and conversion to an open procedure. No intraoperative complications occurred in Group 3. CONCLUSION: NOTES procedures result in longer operative times in the early part of the learning curve and require considerable experience before reaching proficiency.

Evaluation of a transvaginal laparoscopic natural orifice transluminal endoscopic surgery approach to the abdomen of mares.

OBJECTIVE: To report natural orifice transluminal endoscopic surgery (NOTES) using laparoscopic and endoscopic instrumentation transvaginally into the mare's abdomen and identify structures visible using this approach. DESIGN: Descriptive experimental study. ANIMALS: Mares (n=8). METHODS: A standing, transvaginal approach was made in the cranial vaginal vault at either the 1 (right; 4 mares) or 11 (left; 4 mares) o'clock position relative to the cervix. The abdomen was visually explored and the viscera evaluated using a 2 m flexible endoscope followed by a 62 cm laparoscope. Incisional healing was monitored by vaginoscopy at days 3 and 7. RESULTS: Abdominal exploration was adequate through either a left or a right transvaginal approach. Endoscopically, the left kidney, spleen, nephrosplenic space, stomach, cecum, duodenum, left and right ovaries, diaphragm, and caudal peritoneal reflection were consistently observed and the liver inconsistently. Similar views of the caudal abdomen were obtained with the laparoscope; however, we were unable to view cranially beyond the nephrosplenic space or base of the cecum and lateral mobility of the laparoscope was limited. Incisional closure was evident at 3 days. Complications in 1 mare included mild colic behavior that resolved with conservative treatment. CONCLUSIONS: The NOTES transvaginal approach is seemingly well tolerated and safe and provides adequate observation of most structures within the dorsal caudal region of the abdomen on the side of endoscope or laparoscope insertion. CLINICAL RELEVANCE: NOTES transvaginal approach may be a useful tool in the diagnosis of intraabdominal disorders in mares.

NOTES transvaginal em égua: estudo preliminar / Transvaginal NOTES in mares: preliminar study

A cirurgia endoscópica por orifícios naturais é um novo conceito de abordagem endoscópico-cirúrgica, que surge comoalternativa à cirurgia convencional, eliminando incisões abdominais e complicações relacionadas. Ela é realizada pororifícios como estômago, ânus e vagina. A proposta deste estudo foi descrever nova técnica cirúrgica minimamente invasivapara acesso à cavidade abdominal, por NOTES (Natural Orifice Transluminal Endoscopic Surgery) transvaginal em éguas.Foi realizado o acesso através do fórnix vaginal para um inventário da cavidade abdominal em duas éguas. Para tal foirealizada uma sedação prévia com Detomidina intravenosa e lidocaína pela via epidural. O acesso foi feito com auxílio de umtrocater-cânula dorsolateral direita a cérvix; que em seguida foi substituído por um overtube e o endoscópio flexível foiinserido através deste. Foi realizada exploração seriada da cavidade abdominal. O acesso foi realizado facilmente semcomplicações de trans e pós-operatórios. Foi visualizado o antímero direito da cavidade abdominal e suas estruturasanatômicas. O método evidenciou eficiência e mínima invasibilidade para exploração de vísceras abdominais em fêmeasequinas, ficando clara sua grande relevância para diagnóstico de patologias abdominais como seu uso para realização debiópsias.

NOTES, an acronym for Natural Orifice Transluminal Endoscopic Surgery, is a new endoscopic surgery alternative approach which eliminates abdominal incisions and their related complications. NOTES techniques are usually performed through orifices like stomach, anus and vagina. This study aimed the description of a new minimally invasive technique for transvaginal access to abdominal cavity in fowls. Two fowls had its abdominal cavity accessed through their vaginal fórnix. The anesthesia was realized with E.V. Detomidine and lidocaine via epidural. The access was done by a canule-trocater inserted at the right dorso-lateral region of the cervix. The canule was replaced with the aid of an overtube, after what the endoscope was inserted through it. The abdominal cavity was fully inspected.