Effect of conventional multilevel brachycephalic obstructive airway syndrome surgery on clinical and videofluoroscopic evidence of hiatal herniation and gastroesophageal reflux in dogs.

OBJECTIVE: To evaluate the effect of conventional multilevel surgery (CMS) for brachycephalic obstructive airway syndrome (BOAS) on associated sliding hiatal hernia (SHH) and/or gastroesophageal reflux (GER). STUDY DESIGN: Prospective clinical trial. ANIMALS: Sixteen client-owned dogs with clinical signs consistent with BOAS and associated SHH and GER. METHODS: All dogs were treated with 1 or more components of CMS including soft palate resection, laryngeal ventriculectomy, and alaplasty. A standardized Dog Swallowing Assessment Tool (Dog SAT) questionnaire was completed by owners preoperatively and postoperatively. Videofluoroscopic swallow studies (VFSS) were used to evaluate esophageal motility, gastroesophageal reflux, and hiatal herniation preoperatively, and in a subset of dogs postoperatively. Upper gastrointestinal endoscopic studies were performed to document esophagitis and lower esophageal sphincter pathology. RESULTS: All dogs were discharged from the hospital. One dog experienced aspiration pneumonia immediately postoperatively. Owner-assigned clinical scores improved in scores related to regurgitation after eating and regurgitation (P = .012) during increased activity/exercise (P = .002) between preoperative and postoperative time points. However, no improvement was detected in masked assessment of preoperative and postoperative VFSS studies in terms of GER frequency (P = .46) or severity (P = .79), SHH frequency (P = .082) or severity (P = .34) scores. CONCLUSION: Owners of dogs treated with CMS perceived an improvement in clinical signs of SHH and GER that was not confirmed by VFSS studies. CLINICAL SIGNIFICANCE: Conventional multilevel surgery in dogs with BOAS does not appear to consistently resolve SHH and GER, although clinical signs may improve.

Thoracoscopic detection of thoracic ducts after ultrasound-guided intrahepatic injection of indocyanine green detected by near-infrared fluorescence and methylene blue in dogs.

OBJECTIVE: To describe and compare onset and intensity of thoracic duct (TD) coloration in healthy dogs after intrahepatic injection of either indocyanine green (ICG) visualized by intraoperative near-infrared fluorescence lymphography (NIRFL) or direct thoracoscopic visualization of methylene blue dye (MB). STUDY DESIGN: Prospective study. ANIMALS: Healthy adult Beagle dogs (n = 5). METHODS: All dogs had biochemical panels and complete blood counts preoperatively. Computed tomography lymphography (CTL) was performed prior to a standard 3-port thoracoscopic approach. A mixture of MB and ICG was injected by ultrasound-guided percutaneous injection into right or left-sided hepatic lobes. Data collected included dose of contrast agent (MB vs. ICG), injection site, timing, and quality of operative TD identification. Potential hepatic injury was assessed by repeat laboratory evaluation and abdominal ultrasound 14 days postoperatively. RESULTS: Preoperative CTL provided a diagnostic study in 5/5 dogs. After intrahepatic injection of combined dyes, NIRFL allowed visualization of TDs in 5/5 dogs, but MB did not result in visible TD coloration in any dog. Intrahepatic injection of ICG achieved successful NIRFL in a median time of 6 minutes and persisted for the 20 minute observation period in all five dogs. All dogs recovered without complication and were subsequently adopted. CONCLUSION: NIRFL of the TD can be achieved with intraoperative hepatic injection of ICG. Intrahepatic injection of MB did not result in visible TD coloration. CLINICAL SIGNIFICANCE: Hepatic intra-parenchymal injection is a reliable alternative portal into the TD system for intraoperative visualization of TD anatomy using ICG in dogs.

A randomized controlled trial of three-dimensional versus two-dimensional imaging system on duration of surgery and mental workload for laparoscopic gastropexies in dogs.

OBJECTIVE: To evaluate the effect of three-dimensional (3D) laparoscopy compared to two-dimensional (2D) laparoscopy when evaluating duration of surgery for canine intracorporeally sutured gastropexy. STUDY DESIGN: Randomized controlled clinical trial. ANIMALS: Thirty client-owned dogs. METHODS: Dogs were randomized into 2D or 3D groups and underwent a three-port laparoscopic intracorporeally sutured incisional gastropexy with barbed suture. Procedures were performed by a single board-certified surgeon. Duration of surgery was recorded and workload was assessed immediately after surgery using the NASA Task Load Index (TLX). RESULTS: Median duration of surgery was 3 min shorter for 3D versus 2D (95%CI -10 to 13; p = .51). Surgical component durations, total and component TLX scores, and intraoperative complications also did not differ between groups. In a subgroup analysis excluding the first eight cases due to presumption of a learning curve with suturing technique, total TLX score (p = .004) and all component scores were lower for 3D as compared to 2D laparoscopy, although duration of surgery did not differ (p = .20). CONCLUSION: The use of 3D laparoscopy was not associated with shorter duration of surgery when compared to 2D laparoscopy. CLINICAL SIGNIFICANCE: 3D laparoscopy requires further investigation in veterinary medicine to determine its utility in decreasing surgical duration, surgical complications or surgeon mental or physical workload.

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

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

Bilateral intracorporeally sutured inguinal herniorrhaphy using 3-dimensional laparoscopy in a dog.

A 7-month-old, intact male, mixed breed dog with bilateral inguinal hernias underwent general anesthesia for laparoscopic bilateral inguinal herniorrhaphy via a 3-port approach. A 3-dimensional laparoscopic system was used to perform the procedure immediately following prescrotal open castration. Intracorporeal suturing with polypropylene was performed, and 2 cruciate sutures were placed to close each inguinal ring. The caudal aspect of each inguinal ring was left slightly open so as not to disrupt the passage or patency of vessels and nerves. No intra- or post-operative complications occurred. One year after surgery, the dog has no evidence of recurrence of the inguinal hernias. Key clinical message: This case report demonstrates a novel minimally invasive approach to inguinal herniorrhaphy in a dog with no reported complications and a good long-term outcome. Intracorporeally sutured inguinal herniorrhaphy is feasible in dogs with good results, although additional cases are needed to gain experience with this technique in dogs with varying presentations of inguinal hernias.

Herniorraphie inguinale bilatérale suturée intra-corporellement par laparoscopie tridimensionnelle chez un chien. Un chien de race mixte, mâle, intact, âgé de 7 mois, avec une hernie inguinale bilatérale, fut mis sous anesthésie générale pour une herniorraphie inguinale bilatérale laparoscopique via une approche à trois voies. Un système laparoscopique tridimensionnel a été utilisé pour effectuer la procédure immédiatement après la castration préscrotale ouverte. Une suture intracorporelle avec du polypropylène a été réalisée et deux sutures croisées ont été effectuées pour fermer chaque anneau inguinal. L'aspect caudal de chaque anneau inguinal a été laissé légèrement ouvert afin de ne pas perturber le passage ou la fonctionnalité des vaisseaux et des nerfs. Aucune complication per- ou postopératoire n'est survenue. Un an après la chirurgie, le chien ne présente aucun signe de récidive des hernies inguinales.Message clinique clé :Ce rapport de cas démontre une nouvelle approche minimalement invasive de la herniorraphie inguinale chez un chien sans complications signalées et un bon résultat à long terme. Une herniorraphie inguinale suturée de manière intracorporelle est réalisable chez les chiens avec de bons résultats, bien que des cas supplémentaires soient nécessaires pour acquérir de l'expérience avec cette technique chez les chiens présentant des présentations variables de hernies inguinales.(Traduit par Dr Serge Messier).

Gender differences in academic rank among faculty surgeons at US veterinary schools in 2019.

OBJECTIVE: To describe academic rank, gender, surgical career length, and publication record of academic veterinary surgeons and to estimate the association between gender and higher academic rank. STUDY DESIGN: Cross-sectional study. SAMPLE: Residency-trained surgeons at US veterinary schools in 2019. METHODS: Surgeons were identified via institutional websites. Data including surgeon gender, academic title, and year of board certification were collected from public resources. Publication record was measured by using author h-indices obtained from Scopus. Data were analyzed with descriptive and inferential statistics. RESULTS: Three hundred eighteen surgeons were identified from 30 institutions, including 162 (51%) women and 156 (49%) men. Women represented 66% of instructors and assistant professors, and men represented 60% of associate and full professors. This distribution differed significantly (P < .001). Author h-index was associated with career length but not gender. Men were 2.5 times more likely than women to be associate or full professors (odds ratio 2.52, 95% CI 1.03-6.14, P = .042) after adjustment for career length and h-index. CONCLUSION: Female surgery faculty at US veterinary schools in 2019 were concentrated in lower academic ranks and were less likely than male surgery faculty to be associate or full professors after adjustment for career length and publication record. IMPACT: A gender gap exists in academic veterinary surgery in the United States. It is critical to recognize that women's increasing participation in veterinary medicine has not been matched by equal representation in all areas. Additional efforts are warranted to identify contributing factors and implement strategies to improve gender inclusion.

Perceptions and experience of veterinary surgery residents with minimally invasive surgery simulation training.

OBJECTIVE: To determine access to and use of minimally invasive surgery (MIS) simulators among American College of Veterinary Surgeons (ACVS) small animal residents and to identify barriers to simulator use and perceptions of simulator training. STUDY DESIGN: Voluntary online survey. SAMPLE POPULATION: One hundred forty-one ACVS small animal residents. METHODS: American College of Veterinary Surgeons residents were identified by contacting ACVS residency program directors. An emailed online survey was sent to residents along with a reminder email 2 weeks later. All surveys were collected within 1 month. Participation was voluntary but incentivized. RESULTS: Response rate to the survey was 79 of 141 (56%) residents. Twenty-eight of 77 (36%) residents have access to a simulator, with box simulators being most common. Lack of time was the most frequent reason for not using the simulator more. Sixty-eight of 77 (88%) and 65 of 77 (65%) residents agreed or strongly agreed that simulator-based training improves laparoscopic skills and that simulator skills are transferable to the operating room, respectively. Residents with access to a simulator were more comfortable with basic laparoscopic surgeries at the end of their residency than those without such access (P = .04). CONCLUSION: There is substantial room for improved access to and use of MIS simulator training in ACVS residency programs. Despite lack of simulator access, residents believed that simulator training improved their skill and comfort level with basic laparoscopic procedures. CLINICAL SIGNIFICANCE: The results of this study inform us about access to and perceptions of MIS simulator training among residents. This information is important to surgeons responsible for training residents and may help guide the creation of a surgical skills curriculum.

Evaluation of transanal minimally invasive surgery for submucosal rectal resection in cadaveric canine specimens.

OBJECTIVE: To evaluate the feasibility of transanal minimally invasive surgery (TAMIS) for submucosal rectal resection in large breed dogs. STUDY DESIGN: Cadaveric study. SAMPLE POPULATION: Canine cadavers (n = 6) weighing between 37.5 and 60 kg. METHODS: Dogs were positioned in sternal recumbency. After rectal cleansing, a transanal access platform was placed in the rectum, and a pneumorectum was established. An area of ventral rectal wall approximately 2 × 2 cm was resected in a submucosal plane by using laparoscopic instruments and submitted for histopathological evaluation. The rectal wall defect was closed with a single-layer continuous suture pattern with barbed suture. Postoperatively, the rectum was removed en bloc and evaluated for suture or surgical penetration of the serosal surface. RESULTS: Submucosal rectal resection was successfully completed by using TAMIS in all dogs. The median length of resected specimens after fixation was 24.5 mm (range 9.8-26.5). In two of six dogs, suture was macroscopically visible on the serosal surface, but no dogs had evidence of iatrogenic full-thickness surgical penetration of the rectum. The median distance from the aborad extent of the suture closure line to the anocutaneous junction was 35 mm (range, 35-105). CONCLUSION: Submucosal resection of the canine rectal wall was feasible in large breed dogs by using TAMIS. No evidence of full-thickness penetration of the rectal wall was seen in these cadaveric specimens. CLINICAL SIGNIFICANCE: Transanal minimally invasive surgery may provide an alternative minimally invasive approach for resection for benign adenomatous rectal polyps in large breed dogs that might otherwise require a rectal pull-through.

Percutaneous radiologically guided gastrostomy tubes: Procedural description and biomechanical comparison in a canine model.

OBJECTIVE: To describe the novel placement of percutaneous radiologically guided gastrostomy (PRG) tubes in a canine cadaveric model and to biomechanically compare PRG and percutaneous endoscopic gastrostomy (PEG) tube constructs. STUDY DESIGN: Descriptive and biomechanical experimental study. ANIMALS: Fifteen large breed (>25 kg) canine cadavers. METHODS: Percutaneous endoscopic gastrostomy tubes, low-profile PRG tubes, and standard PRG tubes were each placed in five canine cadavers. Body wall and stomach (with attached gastrostomy tube constructs) were harvested and biomechanically tested. Data regarding the maximal load to failure and procedure time were statistically analyzed. RESULTS: Percutaneous endoscopic gastrostomy and PRG tube placement was successful in all cadavers with no procedure-related complications. Gastrostomy tube placement time was longer for the PEG group vs the low-profile PRG (P = .005) and standard PRG (P = .037) groups. Peak construct strength was lower for the PEG group vs the low-profile PRG (P = .002) and standard PRG (P = .010) groups. The site of failure varied among groups. CONCLUSION: Percutaneous radiologically guided gastrostomy tubes were successfully placed in all cases with shorter placement time and greater peak construct strength compared with PEG tubes. CLINICAL SIGNIFICANCE: Due to the increased load to failure as well as decreased placement time recorded for PRG tubes relative to PEG tubes, PRG tubes may be considered as an alternative minimally invasive gastrostomy option in large breed canine patients. Further evaluation in clinical animals is required. Results of this work were presented at the 2019 American College of Veterinary Surgeons Surgery Summit; October 16-19, 2019; Las Vegas, Nevada.

A systematic review of criteria used to report complications in soft tissue and oncologic surgical clinical research studies in dogs and cats.

OBJECTIVE: To evaluate reporting of surgical complications and other adverse events in clinical research articles describing soft tissue and oncologic surgery in dogs and cats. STUDY DESIGN: Systematic literature review. SAMPLE: English-language articles describing soft tissue and oncologic surgeries in client-owned dogs and cats published in peer-reviewed journals from 2013 to 2016. METHODS: CAB, AGRICOLA, and MEDLINE databases were searched for eligible articles. Article characteristics relevant to complications were abstracted and summarized, including reported events, definitions, criteria used to classify events according to severity and time frame, and relevant citations. RESULTS: One hundred fifty-one articles involving 10 522 animals were included. Canine retrospective case series of dogs predominated. Ninety-two percent of articles mentioned complications in study results, but only 7.3% defined the term complication. Articles commonly described complications according to time frame and severity, but terminology and classification criteria were highly variable, conflicting between studies, or not provided. Most (58%) reported complications could have been graded with a published veterinary adverse event classification scheme, although common intraoperative complications were notable exceptions. CONCLUSION: Definitions and criteria used to classify and report soft tissue and oncologic surgical complications are often absent, incomplete, or contradictory among studies. CLINICAL SIGNIFICANCE: Lack of consistent terminology contributes to inadequate communication of important information about surgical complications. Standardization of terminology and consistency in severity scoring will improve comparative evaluation of clinical research results.

Outcome after surgical and conservative treatments of canine peritoneopericardial diaphragmatic hernia: A multi-institutional study of 128 dogs.

OBJECTIVE: To compare demographics and disease characteristics in dogs in which peritoneopericardial diaphragmatic hernia (PPDH) had been diagnosed and report outcomes after surgical treatment (ST) or conservative treatment (CT). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: One hundred twenty-eight dogs (91 ST, 37 CT) in which PPDH had been diagnosed. METHODS: Medical records were reviewed for demographics, perioperative findings, and outcomes. Follow-up was obtained via telephone interview and email correspondence with owners and referring veterinarians. Baseline variables were compared between treatment groups. RESULTS: Dogs treated surgically were younger (P < .001), more likely to be sexually intact (P = .002), more likely to have clinical signs from PPDH vs an incidental diagnosis (P < .001), and more likely to have other congenital abnormalities (P = .003) compared with dogs treated conservatively. Ninety-seven percent of ST dogs were discharged from hospitals. Intraoperative and postoperative complications were reported in 22% and 41% of dogs, respectively, although most complications were classified as low grade (75% and 83%, respectively). Follow-up was available in 87 dogs, at a median of 1062 days. Hernia recurrence was not reported in any surgically treated dog. The deaths of nine dogs (five ST, four CT) could be attributed to PPDH, and long median survival times were observed in both the ST and CT groups (8.2 and 5 years, respectively). CONCLUSION: Preoperative characteristics differed between dogs treated conservatively vs surgically. Surgical treatment was associated with low operative mortality, and both ST and CT dogs had good long-term survival. CLINICAL SIGNIFICANCE: A diagnosis of PPDH can confer a good long-term prognosis for both ST and CT dogs.

Utility of bronchoscopy combined with surgery in the treatment and outcomes of dogs with intrathoracic disease secondary to plant awn migration.

OBJECTIVE: To evaluate the diagnostic and therapeutic utility of bronchoscopy in dogs undergoing computed tomography (CT) and surgery for intrathoracic disease (pyothorax and pneumothorax) secondary to migrating plant awns (MPA) and to report outcomes in dogs that did and did not undergo bronchoscopy in addition to CT and surgery. STUDY DESIGN: Retrospective case series. ANIMALS: Thirty-seven client-owned dogs. METHODS: Medical records from 2008 to 2017 were reviewed for dogs with documented MPA in the thoracic cavity treated with CT and surgery with or without bronchoscopy. Information regarding diagnostics, treatments, complications, and outcomes relating to hospitalization was evaluated. RESULTS: At least one abnormal lung lobe was identified by CT in all dogs. Bronchial abnormalities were identified with bronchoscopy in 21 of 22 dogs (95.4%) with available reports. Agreement between CT and bronchoscopy findings ranged from 50% to 81.8%, depending on lung lobe. Thirty-six dogs had one or more lung lobes surgically removed. Thirty-seven MPA were retrieved via bronchoscopy in 10 of 27 (37%) dogs, and 39 MPA were retrieved at surgery in 26 of 37 (70.3%) dogs. Actinomyces spp. were cultured from surgical samples in 7 of 33 (21.2%) dogs. Thirty-five of 37 (94.6%) dogs survived to discharge. CONCLUSION: Migrating plant awns were successfully retrieved via bronchoscopy. Agreement between CT findings and bronchoscopy was inconsistent, so there may be roles for both modalities. Short- and long-term survival was excellent in this cohort. CLINICAL SIGNIFICANCE: Bronchoscopy may allow for diagnostic and therapeutic advantages compared with CT in dogs with endobronchial MPA. Actinomyces spp appear to be variably present in surgically acquired bacterial cultures in dogs with MPA.

Long-term outcome of video-assisted thoracoscopic thoracic duct ligation and pericardectomy in dogs with chylothorax: A multi-institutional study of 39 cases.

OBJECTIVE: To evaluate the long-term outcome of video-assisted thoracoscopic (VATS) thoracic duct ligation (TDL) and pericardectomy for treatment of chylothorax in dogs. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Thirty-nine client-owned dogs. METHODS: Dogs were included if they had undergone a VATS TDL and pericardectomy and had at least 1-year follow-up or had died within 1 postoperative year. Medical records were evaluated, and recorded data included clinicopathological and diagnostic imaging results, surgical findings, complications, conversion rates, and long-term resolution and recurrence rates. RESULTS: Thirty-nine dogs met the inclusion criteria. Two dogs died intraoperatively; 1 was euthanized after severe restrictive pleuritis was diagnosed intraoperatively, and 1 underwent ventricular fibrillation and cardiac arrest during pericardectomy and could not be resuscitated. Conversion to an open approach was required in 1 of 39 (3%) dogs for TDL and 4 of 36 (11%) dogs for pericardectomy. Overall follow-up time was median 38 months (range, 3-115). Resolution of pleural effusion occurred in 35 of 37 (95%) dogs that survived the perioperative period. Late recurrence of pleural effusion was seen at 12, 12, and 19 months postoperatively in 3 of 35 (9%) dogs that survived the perioperative period and in which chylothorax had initially resolved. CONCLUSION: Successful long-term resolution of chylothorax was seen in a high proportion of dogs that underwent VATS TDL and pericardectomy, although late recurrence was sometimes seen. CLINICAL SIGNIFICANCE: Video-assisted thoracoscopic thoracic duct ligation and pericardectomy are highly successful in dogs with chylothorax. Future studies should evaluate whether pericardectomy is required in dogs without evidence of pericardial disease.

Perioperative morbidity and mortality in dogs with invasive adrenal neoplasms treated by adrenalectomy and cavotomy.

OBJECTIVE: To report the morbidity and mortality associated with adrenalectomy with cavotomy for resection of invasive adrenal neoplasms in dogs and evaluate risk factors for perioperative outcomes. STUDY DESIGN: Retrospective study. ANIMALS: Forty-five client-owned dogs. METHODS: Dogs that underwent open adrenalectomy with cavotomy for resection of adrenal masses with tumor thrombus extending into the vena cava were included. Clinicopathologic data were harvested from medical records. Selected clinical, imaging, and operative variables were statistically evaluated as risk factors for packed red blood cell transfusion, nephrectomy, perioperative death, and overall survival. RESULTS: Thirty-six of 45 masses were pheochromocytomas, 7 were adrenocortical carcinomas, and 2 were unknown type. Caval thrombus terminated prehepatically in 21 of 45 dogs and extended beyond the porta hepatis but terminated prediaphragmatically (intrahepatic prediaphragmatic location) in 15 dogs and thrombi extended postdiaphragmatically in 5 dogs. Thirty-four (76%) dogs were discharged from the hospital, and 11 (24%) dogs died or were euthanized prior to discharge. Median overall survival time for all 45 dogs was 547 days (95%CI 146-710). Bodyweight, tumor type, and size and extent of caval thrombus did not affect survival to discharge, but postdiaphragmatic (rather than prediaphragmatic) thrombus termination was associated with a greater risk of death. CONCLUSION: Long-term survival was common in dogs that survived the perioperative period. Postdiaphragmatic thrombus extension affected the prognosis for overall survival. CLINICAL SIGNIFICANCE: Findings of this study help to stratify operative risk in dogs with adrenal neoplasia and caval invasion.

Phrenicoabdominal venotomy for tumor thrombectomy in dogs with adrenal neoplasia and suspected vena caval invasion.

OBJECTIVE: To describe a technique for tumor thrombectomy by phrenicoabdominal venotomy in dogs with adrenal neoplasia and suspected caval invasion and to report complications and outcomes associated with the procedure. STUDY DESIGN: Retrospective case series. ANIMALS: Eight client-owned dogs with invasive adrenal tumors. METHODS: Medical records of dogs diagnosed with adrenal tumors with extension of thrombus into the phrenicoabdominal vein (PAV) and vena cava were reviewed. Cases where phrenicoabdominal venotomy without cavotomy for thrombus resection was performed were included. Data collected from the medical records included signalment, clinical signs, physical examination findings, diagnostic imaging results, preoperative laboratory testing, surgical technique, surgical and postoperative complications and outcome. RESULTS: Phrenicoabdominal venotomy was successful in removal of vena caval thrombosis in 7 of 8 dogs. In one case, an attempt was made to remove a large vena caval thrombus through a distended PAV resulting in fragmentation of the thrombus and the need to extend the incision into the vena cava. In all dogs, complete removal of tumor thrombus was achieved. Two dogs died in the perioperative period, one from cardiopulmonary arrest and a second from bronchopneumonia and pancreatitis. The remaining 6 dogs were discharged from the hospital. CONCLUSION: Thrombectomy through a phrenicoabdominal venotomy may obviate the need for a cavotomy in a subset of dogs with invasive adrenal neoplasia.

Anatomic site and etiology of hemorrhage in small versus large dogs with spontaneous hemoperitoneum.

OBJECTIVE: To compare anatomic sources and underlying etiology of hemorrhage in small vs large dogs with spontaneous hemoperitoneum (SH). STUDY DESIGN: Retrospective cross-sectional study. ANIMALS: Client-owned dogs with SH at 2 academic institutions. METHODS: Medical records were reviewed for age, breed, sex, weight, and results of imaging, surgery, necropsy, cytology, and histopathology. Dogs were divided according to body weight (≤ 20 kg = small, > 20 kg = large). Confidence intervals were calculated to estimate rates of splenic and hepatic hemorrhage in small and large dog SH populations. Multivariable regression was used to compare prevalence of anatomic sources of hemorrhage and etiology in small vs large dogs. RESULTS: We identified 742 dogs with SH, including 637 in which the anatomic site of hemorrhage was investigated. Splenic hemorrhage was diagnosed in 43.2% (95% CI, 34.3-52.4) of small dogs and 61.3% (95% CI, 57.0-65.6) of large dogs. Small dogs had lower prevalence of splenic hemorrhage (prevalence ratio, 0.70; 95% CI, 0.58-0.87; P < .001) and higher prevalence of hemorrhage from liver (prevalence ratio, 1.72; 95% CI, 1.20-2.47; P = .003) or from another location such as retroperitoneal mass, kidney, or adrenal (prevalence ratio, 2.73; 95% CI, 1.66-4.47; P < .001) vs large dogs. Hemangiosarcoma was associated with splenic hemorrhage and occurred more frequently in large vs small dogs (P = .011). CONCLUSION: Small dogs had a lower rate of splenic hemorrhage and higher rates of hemorrhage from liver and other sites compared to large dogs. Etiologies other than splenic hemangiosarcoma were common, particularly among dogs weighing ≤ 20 kg. CLINICAL SIGNIFICANCE: Clinicians should perform diagnostics and consider body size before making presumptive diagnoses in dogs with SH.

Efficacy of Two Radiologic-Assisted Prophylactic Gastropexy Techniques.

OBJECTIVE: To describe the technique and clinical outcome of prophylactic percutaneous radiologic-assisted gastropexy (PRG) and radiologic-assisted incisional gastropexy (RIG) in client-owned dogs. STUDY DESIGN: Prospective, nonrandomized clinical trial. ANIMALS: Fourteen client-owned, large, and giant breed dogs. METHODS: Four dogs underwent PRG with fluoroscopic guidance to place 2 T-fasteners into the pyloric antrum and secure it to the right body wall. Ten dogs underwent RIG, which was a modification of PRG. For RIG, the T-fasteners were first used to approximate the pyloric antrum and body wall, then a full thickness incision through the body wall was made and the pyloric antrum was sutured to the internal abdominal wall. The duration and complications of each procedure were recorded. The gastropexy was assessed by abdominal ultrasound at day 1, week 2, and week 8 postoperative and by barium gastrogram at week 8 postoperative. RESULTS: No dogs undergoing PRG had a gastropexy present at week 2. All dogs undergoing RIG had ultrasonographic evidence of gastropexy at day 1, week 2, and week 8 postoperative. Gastrograms in 9/9 dogs were consistent with an intact gastropexy, appropriate gastric positioning and appropriate gastric emptying began. No major complications were noted. CONCLUSION: The PRG was unsatisfactory and did not result in a permanent gastropexy. The RIG was safe and created a gastropexy that remained intact at 8 weeks postoperative. The RIG should be considered as a minimally invasive option for prophylactic gastropexy in dogs of at-risk breeds.

Description and Biomechanical Comparison of a Percutaneous Radiologic Gastropexy Technique in a Canine Cadaver Model.

OBJECTIVE: To describe a novel percutaneous radiologic gastropexy (PRG) technique in a canine model and to biomechanically compare this technique to open incisional gastropexy (OIG) and laparoscopic-assisted incisional gastropexy (LAG). STUDY DESIGN: Randomized ex vivo biomechanical study. ANIMALS: Canine cadavers. METHODS: Fifteen cadavers were randomized to 1 of 3 surgical interventions: OIG, LAG, and PRG. For the PRG procedure, the stomach was distended with air, and a preloaded T-fastener device was utilized to attach the stomach to the body wall with fluoroscopic-guidance. The procedural times of the 3 techniques were recorded. After completion of the procedure, the stomach and body wall overlying the stomach wall were harvested and the maximum tensile strength of the gastropexies was determined. RESULTS: The maximal tensile strength was not significantly different between groups. The total procedural time for the PRG procedure (5 minutes) was significantly shorter than both OIG (28 minutes) and LAG (20 minutes) procedures. CONCLUSION: The PRG technique described in this study demonstrated a similar maximal tensile strength to commonly employed gastropexy techniques (OIG and LAG) in an acute canine model. Additionally, the PRG procedure was significantly faster to perform. The clinical relevance of this technique will be determined by further study to assess the applicability and efficacy of this procedure in clinical patients by determining the likelihood of adhesion development and the ability of the adhesion to prevent gastric volvulus.

Advances in Minimally Invasive Procedures of the Thoracic Cavity.

Significant advances in veterinary minimally invasive surgeries and procedures have occurred in the past 10 years. These advances have been allowed due to continual research into optimizing working space through one-lung ventilation techniques and carbon dioxide insufflation. Additionally, minimally invasive surgery enthusiasts have joined forces with interventionalists and, in many cases, physicians to push the boundaries, minimize pain, suffering, and time away from owners with advances in a variety of procedures. Several larger multi-institutional retrospective studies on various disease processes allow veterinarians and owners to understand that minimally invasive approaches allow for outcomes comparable to traditional open surgery and, in some cases, may now be considered the standard of care in canine and feline patients.

Thoracoscopic resection of lung masses is associated with excellent survival to discharge and good long-term outcomes.

OBJECTIVE: To report and evaluate risk factors for conversion and perioperative and long-term outcomes in dogs undergoing thoracoscopic lung lobectomy for resection of lung masses. ANIMALS: 61 client-owned dogs. METHODS: This retrospective cohort study (June 11, 2008, to February 14, 2020) of data collected from medical records included signalment, results of diagnostic imaging, surgical technique, surgical and anesthesia time, mass location and size, hospitalization time, histopathologic findings, and long-term outcome. Follow-up was obtained from medical records and telephone contact with owners or referring veterinarians. RESULTS: Histopathology results were available for 60 of 61 tumors. Fifty-seven (95%) were considered primary lung tumors, of which 46 (81%) were carcinomas. Clean surgical margins were achieved in 46 of 52 (88%) dogs. Conversion from thoracoscopy to thoracoscopic-assisted or open surgery occurred in 16 of 61 (26%) dogs. Larger tumor diameter (≥ 5 cm) and lymphadenopathy detected by preoperative CT scan were significantly associated with increased risk of conversion. There was no association between conversion and patient weight, body condition score, and tumor location. All 61 dogs survived to discharge, and 56 of 57 were alive 1 month postoperatively. Median overall survival time was 311 days (95% CI, 224 to 570 days). Tracheobronchial lymphadenopathy on preoperative CT scans was associated with shorter postoperative survival (P < .001). Patient age, tumor diameter, adjuvant chemotherapy following surgery, and incomplete margins were not associated with survival time. CLINICAL RELEVANCE: Dogs had high survival to discharge and good long-term prognosis following thoracoscopic lung lobectomy. However, larger tumor size and tracheobronchial lymphadenopathy may increase the likelihood of conversion.