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OBJECTIVE: The aim of the study was to determine receiver operating characteristics (ROC) of computed tomographic excretory urography (CTEU) in predicting cystoscopic findings of ureteral anatomy. STUDY DESIGN: Retrospective cohort study. ANIMALS: Thirty-five client-owned dogs. METHODS: The medical records of dogs referred for suspected ectopic ureters were reviewed. Inclusion criteria included CTEU findings reported by board-certified radiologists, followed by rigid cystoscopy with or without ureteral cystoscopic laser ablation (CLA). Data included signalment, urinary incontinence degree, body condition score, weight, degree of colon distension, CTEU and cystoscopy findings. ROC analysis was used to compare CT-predicted ureteral orthotopia/ectopia to cystoscopy findings. Additionally, ROC of CT predicted ureteral orifice locations was analyzed. Regression covariate analysis was performed to identify factors that may have influenced accuracy of diagnosis. RESULTS: The ability of CT to identify a normal and intra-or extramural ectopic ureters conclusively and correctly was 13/26 (50%) and 32/41(78%), respectively. Sensitivity and specificity of identifying extramural versus intramural ureters was 2/7 versus 30/46 (29 vs. 65%) and 61/63 versus 17/24 (97 vs. 71%), respectively. Ectopic orifice determination sensitivity and specificity varied widely depending on location from 0% to 76% and 67% to 97%, respectively. Covariate analysis failed to identify interfering factors. CONCLUSIONS: CT did not accurately predict anatomy of ureters; CT findings may need confirmation by cystoscopy and possibly intraoperative fluoroscopy prior to determining if CLA is indicated or not. CLINICAL SIGNIFICANCE: Our results may be of importance for surgeons interpreting the CTEU findings. CTEU prediction of the location of the ureteral orifice shows low sensitivity especially in or close to the urethral sphincter area.
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Doenças do Cão , Gastroenteropatias , Ureter , Obstrução Ureteral , Humanos , Cães , Animais , Ureter/cirurgia , Cistoscopia/métodos , Cistoscopia/veterinária , Curva ROC , Estudos Retrospectivos , Doenças do Cão/cirurgia , Obstrução Ureteral/veterinária , Gastroenteropatias/veterinária , Tomografia Computadorizada por Raios X/veterináriaRESUMO
OBJECTIVE: To analyze risk factors for complicated perioperative recovery of dogs undergoing either staphylectomy or folded flap palatoplasty. STUDY DESIGN: Retrospective study. ANIMALS: Seventy-six client-owned dogs. METHODS: Medical records of dogs that underwent either staphylectomy or folded flap palatoplasty were reviewed for signalment, brachycephalic risk (BRisk) score, history of gastrointestinal signs, laryngeal collapse grade, presence of preoperative aspiration pneumonia, intraoperative respiratory and cardiovascular complications, length of general anesthesia, number of corrected brachycephalic obstructive airway syndrome (BOAS) components, and gastrointestinal and respiratory postoperative complications. Complicated recovery was defined as requirement for prolonged oxygen treatment and/or tracheostomy or perioperative death. Penalized logistic regression was used to identify risk factors. RESULTS: Seventy-six dogs were enrolled in the study. Multivariate penalized logistic regression identified four risk factors for complicated recovery. These include surgery type (p = .0002), age (p = .0113), laryngeal collapse grade >2 (p < .0001) and length of general anesthesia (p = .0051). CONCLUSIONS: In this population, dogs that had staphylectomy, increasing age, laryngeal collapse grade >2 and increasing length of general anesthesia were at increased risk for perioperative complicated recovery. CLINICAL SIGNIFICANCE: The results of this study identified risk factors for perioperative complicated recovery in dogs undergoing elongated soft palate correction and may assist in surgical planning and early prediction of complications.
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Doenças do Cão , Complicações Pós-Operatórias , Cães , Animais , Fatores de Risco , Estudos Retrospectivos , Masculino , Feminino , Complicações Pós-Operatórias/veterinária , Doenças do Cão/cirurgia , Palato Mole/cirurgia , Retalhos Cirúrgicos/veterinária , Procedimentos de Cirurgia Plástica/veterinária , Procedimentos de Cirurgia Plástica/métodos , Anestesia Geral/veterinária , Anestesia Geral/efeitos adversosRESUMO
OBJECTIVE: To evaluate the outcomes and complications of video-assisted thoracoscopic (VATS) treatment of chylothorax in cats. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Fifteen client-owned cats. METHODS: The medical records of cats undergoing thoracoscopic thoracic duct ligation (TDL) for treatment of idiopathic chylothorax were reviewed. Cats undergoing additional procedures including thoracoscopic pericardectomy and/or laparoscopic cisterna chyli ablation (CCA)_were included. Follow up was obtained through communication with the referring veterinarian or owner. RESULTS: All cats underwent thoracoscopic TDL. Thirteen cats underwent simultaneous pericardectomy and two cats underwent laparoscopic CCA without pericardectomy. Conversion from a thoracoscopic to open approach was necessary in 2/15 (13%) of thoracic duct ligations and 1/11 (9%) of pericardectomies. The most common postoperative complication was persistent pleural effusion in five cats (33%). Four of 15 cats (27%) died or were euthanized prior to hospital discharge following surgery. Recurrence of effusion occurred in 1/7 (14%) of cats that sustained resolution of the effusion at the time of surgery with a median follow up of 8 months. The overall mortality attributed to chylothorax was 47%. CONCLUSION: Thoracoscopic treatment of idiopathic chylothorax resulted in a low incidence of intraoperative complications or conversion in the study population; however, mortality related to feline idiopathic chylothorax remained high. CLINICAL SIGNIFICANCE: While VATS treatment of idiopathic chylothorax is technically feasible, further consideration of the underlying pathology and current treatment algorithm is needed to improve outcomes as this remains a frustrating disease to treat in the feline population.
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Doenças do Gato , Quilotórax , Cirurgia Torácica Vídeoassistida , Animais , Quilotórax/veterinária , Quilotórax/cirurgia , Gatos , Doenças do Gato/cirurgia , Cirurgia Torácica Vídeoassistida/veterinária , Cirurgia Torácica Vídeoassistida/métodos , Estudos Retrospectivos , Masculino , Feminino , Resultado do Tratamento , Ducto Torácico/cirurgia , Complicações Pós-Operatórias/veterináriaRESUMO
A 3.5-year-old intact male Labrador retriever was seen for hematuria. The results of clinical pathology tests were unremarkable. However, urinalysis revealed dark, cloudy, alkalotic, and isosthenuric urine containing red and white blood cells, epithelial cells, and struvite crystals. Severe bilateral enlargement of ureters and markedly enlarged kidneys were identified on abdominal radiographs. Computerized tomography revealed extensive bilateral hydroureteronephrosis with no definitive cause of obstruction. The dog underwent bilateral ureteral tapering with bilateral neoureterocystostomy and placement of temporary bilateral ureteral stents and a cystostomy tube. The dog was monitored in the intensive care unit for 7 d after surgery and was discharged 9 d after surgery and after the stent and cystostomy tube were removed. The dog remained clinically normal and was reported to have been euthanized at 11 y of age (2021) due to unspecified causes. Key clinical message: There are several potential causes of severe bilateral hydroureteronephrosis in animals. Based on this case report, dogs with severe bilateral hydroureteronephrosis that are clinically asymptomatic may have favorable outcomes following bilateral ureteral reconstruction and neoureterocystostomy, even if a definitive cause is not identified.
Néourétérocystostomie bilatérale avec effilement urétéral chez un chien avec hydrourétéronéphrose bilatérale sévère. Un labrador mâle non-castré âgé de 3,5 ans a été vu pour hématurie. Les résultats des tests de pathologie clinique ne présentaient pas d'anomalie. Toutefois, l'analyse d'urine a mis en évidence une urine foncée, trouble, alcaline et isosthénurique, contenant des globules rouges et blancs, des cellules épithéliales et des cristaux de struvite. Une augmentation bilatérale sévère de la taille des urètres ainsi qu'une augmentation de la taille des reins ont été notées lors des radiographies abdominales. Un examen par tomodensitométrie a révélé une hydrourétéronéphrose bilatérale marquée sans cause identifiable d'obstruction. On procéda à un effilement urétéral bilatéral avec néourétérocystostomie bilatérale et mise en place de stents urétéraux bilatéraux temporaires et un tube à cystotomie. Le chien a été sous surveillance à l'unité des soins intensifs pendant 7 j après la chirurgie et a obtenu son congé 9 j après la chirurgie, après que les stents et le tube à cystotomie aient été retirés. Le chien est demeuré cliniquement normal jusqu'à son euthanasie à l'âge de 11 ans (2021) pour des raisons non-spécifiées.Message clinique clé :Il y a plusieurs causes potentielles d'hydrourétéronéphrose bilatérale chez les animaux. Sur la base de ce rapport de cas, les chiens avec hydrourétéronéphrose bilatérale sévère qui sont cliniquement asymptomatique un résultat favorable peut être obtenu à la suite d'une reconstruction urétérale bilatérale et une néourétérocystostomie même si une cause définitive n'est pas identifiée.(Traduit par Dr Serge Messier).
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Doenças do Cão , Procedimentos de Cirurgia Plástica , Ureter , Obstrução Ureteral , Cães , Masculino , Animais , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Obstrução Ureteral/veterinária , Stents/veterinária , Procedimentos de Cirurgia Plástica/veterinária , Tomografia Computadorizada por Raios X , Doenças do Cão/cirurgiaRESUMO
A 5-month-old Pembroke Welsh corgi dog was presented with a 3-month history of lethargy, inappetence, polyuria/polydipsia, and neurological signs. A diagnosis of a complex multiple intrahepatic portosystemic shunt (IHPSS) configuration was obtained by computed tomography angiogram, abdominal ultrasonography, and perioperative fluoroscopic angiography. The IHPSS was successfully attenuated by shunt embolization with a vascular plug, using a direct percutaneous hepatic approach under ultrasonographic and fluoroscopic guidance. Long-term (4 y) follow-up revealed resolution of all clinical signs. The owner elected to continue dietary modification and lactulose treatment indefinitely and the outcome was considered good. Key clinical message: Direct percutaneous hepatic approach could be considered for IHPSS attenuation in select cases where traditional transvenous approach access is considered challenging.
Atténuation percutanée trans-hépatique guidée par échographie et fluoroscopie d'un shunt porto-systémique intrahépatique canin complexe à l'aide d'un bouchon vasculaireUn chien Pembroke Welsh corgi âgé de 5 mois a été présenté avec des antécédents de léthargie, d'inappétence, de polyurie/polydipsie et de signes neurologiques depuis 3 mois. Un diagnostic de configuration complexe de shunt porto-systémique intrahépatique multiple (IHPSS) a été obtenu par angiographie par tomodensitométrie, échographie abdominale et angiographie fluoroscopique périopératoire. L'IHPSS a été atténué avec succès par embolisation du shunt avec un bouchon vasculaire, en utilisant une approche hépatique percutanée directe sous guidage échographique et fluoroscopique. Un suivi à long terme (4 ans) a révélé une résolution de tous les signes cliniques. Le propriétaire a choisi de poursuivre indéfiniment la modification du régime alimentaire et le traitement au lactulose et le résultat a été considéré comme bon.Message clinique clé :Une approche hépatique percutanée directe pourrait être envisagée pour l'atténuation de l'IHPSS dans certains cas où l'accès par voie trans-veineuse traditionnelle est considéré comme difficile.(Traduit par Dr Serge Messier).
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Doenças do Cão , Embolização Terapêutica , Cães , Animais , Doenças do Cão/cirurgia , Doenças do Cão/diagnóstico por imagem , Fluoroscopia/veterinária , Embolização Terapêutica/veterinária , Embolização Terapêutica/métodos , Masculino , Ultrassonografia/veterinária , FemininoRESUMO
Surgical training of students is one of the most difficult aspects of veterinary medical education. Competing interests of house officers, owner's wishes, and ethical concerns have led to increasing use of inanimate models for basic surgical skills training. Robotic simulators have benefits for psychomotor training but have not been previously investigated in veterinary medicine. Understanding the necessary practice time for new training devices is important when determining their potential value. The aim of this study was to compare the number of attempts needed for veterinary students to reach proficiency in both a basic and advanced robotic simulator task, and to assess the predictive nature of performance variables. Each student performed a basic and advanced tasks on the Mimic dV-Trainer™ until proficiency was reached. Students required a median of eight attempts (95% CI = 7-8, range: 6-11) to reach proficiency for the basic task versus 22 attempts (95% CI = 20-26, range: 11-62) for the advanced task. The median time required to complete training for the basic and advanced task was 13.5 minutes (range: 8-24 minutes) and 26.5 minutes (range: 11-82 minutes) respectively. The difference in task attempts supports the training protocol and confirms proficiency can be attained in a short period of time. The number of attempts to reach proficiency correlated with specific performance variables which can be used by educators to aid in training students on a robotic simulator. Continued investigations on robotic simulators should be performed to investigate their use in improving psychomotor skills in veterinary students.
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BACKGROUND: Veterinary minimally invasive surgery (MIS) is rapidly developing, and most surgeons are performing MIS in their clinical practice. The technical skills of presented surgical techniques are increasingly complex. Required training of American College of Veterinary Surgeons (ACVS) surgical residents in soft tissue MIS (laparoscopy/thoracoscopy) are limited to traditional apprentice training. Unfortunately, such training has been found insufficient to create competent MIS surgeons. AIM OF THE REVIEW: This review discusses development of MIS training for Doctor of Medicine (M.D.) residents in context of veterinary applicability and investigates comparative evidence for how to best train veterinary residents in soft tissue MIS. CONCLUSIONS: A structured curriculum, with validated tasks and clear training goals have been found imperative for training success. Such a curriculum includes both didactic sessions and manual skills training, with video tutorials and reading material to inform and motivate the residents. IMPLICATIONS OF KEY FINDINGS: ACVS residents and diplomates may benefit if a MIS curriculum was developed and made available to all training programs.
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Internato e Residência , Laparoscopia , Cirurgiões , Animais , Competência Clínica , Currículo , Humanos , Laparoscopia/educação , Laparoscopia/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Estados UnidosRESUMO
Veterinary resident training in minimally invasive surgery is currently inconsistent and depends on innate psychomotor skills. Simulation training has been shown to effectively increase basic skills, but demonstration of simulation training effects on advanced skills in the operating room is sparse. We aimed to determine if simulation-trained novice surgeons were able to perform laparoscopic suture ligation in live dogs. Three novice laparoscopic surgeons underwent a 12-session simulation training program with subsequent laparoscopic skills testing to demonstrate competency. The median skills scores of trainees and of one experienced surgeon were 417 and 472, respectively. Eighteen healthy client-owned (shelter) dogs were operated on by four surgeons: one experienced American College of Veterinary Surgeons (ACVS) diplomate, two novice ACVS residents, and one novice ACVS diplomate. Laparoscopic ovariectomy was performed with suture ligation of the ovarian pedicles. Successful surgery was defined as no evidence of ovarian vessel bleeding after transection of the pedicles. Simulation-trained novices performed successful suture-ligated ovariectomies in 11/13 dogs (85%), and the experienced surgeon in 5/5 (100%) dogs. Median total ligation time was 30 minutes (range: 17-57), which was not different among surgeons (p = .118). Median total surgery time was 105 minutes (range: 69-156) for novices and 89 minutes (range: 65-99) for the experienced surgeon (p = .038). Extensive simulation training including suturing may contribute toward surgery residents being able to perform complex laparoscopic procedures. These results need to be confirmed in larger numbers of trainees.
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OBJECTIVE: To compare the influence of extracorporeal and intracorporeal ligations on the duration of and complications associated with laparoscopic ovariectomy in dogs. STUDY DESIGN: Prospective randomized experimental study. ANIMALS: Healthy intact female dogs (n = 18). METHODS: The left and right ovarian pedicles of dogs undergoing laparoscopic ovariectomy were randomly assigned to intracorporeal (n = 18) or extracorporeal (n = 18) ligation groups. Surgeries were performed by two American College of Veterinary Surgeons (ACVS) diplomates and two ACVS residents. The time required to place extracorporeal and intracorporeal ligations, duration of surgery, and intraoperative complications were compared between ligation techniques. Postoperative complications were recorded. RESULTS: The time required for intracorporeal ligation (17.3 ± 8.7 minutes) did not differ from that required for extracorporeal ligation (15.1 ± 6.1 minutes; P = .38). The total duration of surgery was 102.7 ± 28.7 minutes including portal placement and veterinary student closure of incisions. Ligation of the ovarian pedicle was successful in 16 of 17 dogs. Intraoperative hemorrhage occurred in three dogs, and postoperative complications were noted in three dogs, without apparent difference between ligation techniques. CONCLUSION: No difference was identified between extracorporeal and intracorporeal ligations of ovarian pedicles. CLINICAL SIGNIFICANCE: This study does not provide evidence to support one ligation technique rather than the other.
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Cães/cirurgia , Complicações Intraoperatórias/veterinária , Laparoscopia/veterinária , Ovariectomia/veterinária , Complicações Pós-Operatórias/veterinária , Animais , Feminino , Complicações Intraoperatórias/etiologia , Laparoscopia/estatística & dados numéricos , Ligadura/estatística & dados numéricos , Ligadura/veterinária , Modelos Animais , Ovariectomia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos ProspectivosRESUMO
OBJECTIVE: To describe the morphology of the lymphatics in the region of the cisterna chyli in healthy dogs and in dogs with idiopathic chylothorax by using computed tomographic lymphangiography. STUDY DESIGN: Retrospective study. ANIMALS: Nine dogs with idiopathic chylothorax and six healthy dogs. METHODS: Computed tomographic lymphangiograms were reviewed to evaluate the number of cisterna chyli branches, total cross-sectional area of the branches normalized to the cross-sectional area of the aorta, number of branches with cross-sectional area greater than 25% of the aorta cross-sectional area, and ratio of the total perimeter to the total cross-sectional area of the branches. Data (mean ± SD) were compared between unaffected dogs and dogs with idiopathic chylothorax. RESULTS: The cisterna chyli included more branches in dogs with chylothorax (4.30 ± 1.57) than in unaffected dogs (1.67 ± 0.56, P = .02), occupying a relative perimeter approximately double that in unaffected dogs (P < .001). The relative cross-sectional area of the cisterna chyli was approximately twofold smaller in affected (0.73 ± 0.35) than in unaffected (1.63 ± 0.91, P = .02) dogs. The fraction of dogs with branches greater than 25% of the cross-sectional area of the aorta tended to be larger in unaffected dogs (P = .07). Most larger branches were located dorsal or to the right of the aorta. CONCLUSION: The cisterna chyli of dogs with idiopathic chylothorax contained smaller and more numerous branches compared with that of unaffected dogs. CLINICAL SIGNIFICANCE: Altered cisterna chyli morphology may impact the surgical approach for cisterna chyli ablation in dogs with idiopathic chylothorax.
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Quilotórax/veterinária , Doenças do Cão/cirurgia , Linfografia/veterinária , Ducto Torácico/cirurgia , Tomografia Computadorizada por Raios X/veterinária , Animais , Quilotórax/cirurgia , Cães , Estudos RetrospectivosRESUMO
A 2-year-old intact female Alaskan husky sled dog was presented with a history of chronic exercise-induced regurgitation refractory to medical management. Previous diagnostics were unremarkable except for an endoscopic examination and histopathologic evaluation of the upper gastrointestinal tract that revealed the presence of Helicobacter spp. and mild non-specific inflammation of the proximal duodenum. A laparoscopic hiatal herniorrhaphy, esophagopexy, fundopexy, and ovariectomy were performed without complications in anesthesia or surgery and clinical improvement was observed with continued follow-up for 8 months after surgery. Key clinical message: Surgical treatment for hiatal hernia may be considered in racing Alaskan sled dogs with regurgitation refractory to gastric protectant therapy.
Oesophagopexie laparoscopique, fundopexie et herniorraphie hiatale pour régurgitation réfractaire chez un chien de course de traîneau husky de l'Alaska. Une chienne de traîneau husky de l'Alaska, âgée de 2 ans, a présenté des antécédents de régurgitation chronique induite par l'effort réfractaire à la prise en charge médicale. Les diagnostics antérieurs n'étaient pas remarquables, sauf pour un examen endoscopique et une évaluation histopathologique du tractus gastro-intestinal supérieur qui a révélé la présence d'Helicobacter spp. et une légère inflammation non spécifique du duodénum proximal. Une herniorraphie hiatale laparoscopique, une oesophagopexie, une fundopexie et une ovariectomie ont été réalisées sans complications sous anesthésie ou en chirurgie et une amélioration clinique a été observée avec un suivi continu pendant 8 mois après la chirurgie.Message clinique clé :Un traitement chirurgical de la hernie hiatale peut être envisagé chez les chiens de traîneau de course de l'Alaska présentant une régurgitation réfractaire au traitement protecteur gastrique.(Traduit par Dr Serge Messier).
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Doenças do Cão , Laparoscopia , Condicionamento Físico Animal , Animais , Doenças do Cão/cirurgia , Cães , Esôfago , Feminino , Herniorrafia/veterinária , Laparoscopia/veterináriaRESUMO
OBJECTIVE: To evaluate the feasibility of stem cell isolation from falciform fat harvested via laparoscopic morcellation. STUDY DESIGN: Pilot study. ANIMALS: Eleven client-owned dogs. METHODS: Falciform was harvested traditionally via laparotomy and laparoscopically via tissue morcellation. Harvested tissue was processed with a commercially available adipose tissue dissociation kit to obtain a stromal vascular fraction (SVF). Cells were subsequently labeled for CD90, CD45, and CD44 cell surface antigens by using magnetic-activated cell sorting (MACS) and fluorescence-activated cell sorting flow cytometry. CD90+ cells were quantitated, and their viability was assessed with a hemocytometer and a trypan blue exclusion test of cell viability. RESULTS: No perioperative complications occurred in dogs undergoing laparoscopic morcellation. Laparoscopically and traditionally harvested samples yielded an average of 0.39 (±0.1) × 106 and 0.33 (±0.1) × 106 CD90+ cells, respectively, per 10 million SVF cells. CD90+ cell viability after MACS was 89% (±11%) for morcellated and 86% (±7%) for traditionally harvested samples. Neither CD90+ cell quantity nor viability was different between samples obtained via traditional laparotomy vs laparoscopic morcellation (P = .38 and P = .63, respectively). Populations of CD90+ cells isolated with each harvest technique had similar CD44 and CD45 expression profiles. CONCLUSION: Viable populations of CD90+ cells with similar CD44/CD45 expression profiles were isolated from laparoscopically morcellated and traditionally harvested falciform tissue. No appreciable morbidity was associated with laparoscopic falciform morcellation. CLINICAL SIGNIFICANCE: Laparoscopic morcellation is a safe and effective minimally invasive approach to falciform tissue harvest for adipose-derived mesenchymal stem cell isolation.
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Tecido Adiposo/citologia , Cães/anatomia & histologia , Laparoscopia/veterinária , Células-Tronco Mesenquimais/citologia , Coleta de Tecidos e Órgãos/veterinária , Animais , Células Cultivadas , Cães/cirurgia , Citometria de Fluxo , Humanos , Laparoscopia/métodos , Células-Tronco Mesenquimais/fisiologia , Morcelação , Projetos Piloto , Coleta de Tecidos e Órgãos/métodosRESUMO
In this work, contributions of extracellular polymeric substances (EPS) to the nanoscale mechanisms through which the multidrug-resistant Acinetobacter baumannii responds to antimicrobial and hyperosmotic treatments were investigated by atomic force microscopy. Specifically, the adhesion strengths to a control surface of silicon nitride (Si3N4) and the lengths of bacterial surface biopolymers of bound and loose EPS extracted from A. baumannii biofilms were quantified after individual or synergistic treatments with hyperosmotic agents (NaCl and maltodextrin) and an antibiotic (tobramycin). In the absence of any treatment, the loose EPS were significantly longer in length and higher in adhesion to Si3N4 than the bound EPS. When used individually, the hyperosmotic agents and tobramycin collapsed the A. baumannii bound and loose EPS. The combined treatment of maltodextrin with tobramycin collapsed only the loose EPS and did not alter the adhesion of both bound and loose EPS to Si3N4. In addition, the combined treatment was not as effective in collapsing the EPS molecules as when tobramycin was applied alone. Finally, the effects of treatments were dose-dependent. Altogether, our findings suggest that a sequential treatment could be effective in treating A. baumannii biofilms, in which a hyperosmotic agent is used first to collapse the EPS and limit the diffusion of nutrients into the biofilm, followed by the use of an antibiotic to kill the bacterial cells that escape from the biofilm because of starvation.
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OBJECTIVE: To report the frequency and risk factors of complications related to 3 entry techniques for laparoscopy in small animals. STUDY DESIGN: Single-institution retrospective case series. ANIMALS: 159 client-owned dogs and cats. METHODS: Medical records were reviewed for dogs and cats undergoing laparoscopic surgery with carbon dioxide (CO2 ) insufflation between 2006 and 2018. Data including entry site, entry technique, signalment, body conformation, complications, and operating surgeon/resident were analyzed by univariate regression analysis. Factors with P < .25 were included in multivariate regression analysis. RESULTS: Complications occurred in 33 of 159 (21%) surgeries and were considered minor (CO2 leaks, omental insufflation, repeated entry) in 30 of 33 (91%) cases. The Ternamian visual entry, modified Hasson, and Veress needle entry techniques were associated with complications in 7 (9%), 17 (26%), and 9 (60%) surgeries, respectively. Major complications occurred in 3 of 159 (2%) surgeries, in which entry-related hemorrhage prompted conversion to an open technique (2 [13%] entries with Veress needle) and 1 [1%] with the Ternamian visual). Entry location and entry technique remained significant in the final multivariate model. Complications were 11.7 times more likely after a paramedian entry than after a midline entry; the odds ratio of complications were 5 and 28 times higher after modified Hasson and Veress needle entries, respectively, than after Ternamian visual entry. CONCLUSION: In this study, a Ternamian visual entry technique and midline entry site appeared associated with fewer complications than 2 other techniques. CLINICAL SIGNIFICANCE: The findings in this study are preliminary, and superiority of any entry technique must be reevaluated in a prospective randomized controlled study.
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Doenças do Gato/etiologia , Doenças do Cão/etiologia , Laparoscopia/veterinária , Complicações Pós-Operatórias/veterinária , Animais , Doenças do Gato/patologia , Doenças do Gato/cirurgia , Gatos , Doenças do Cão/patologia , Doenças do Cão/cirurgia , Cães , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Análise Multivariada , Razão de Chances , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To compare the maximum pressure sustained by airways sealed with a resorbable ligation device (LigaTie) and with thoracoabdominal (TA) staples during thoracoscopic-assisted hilar lung lobectomies. STUDY DESIGN: In situ cadaveric study. ANIMALS: Ten feline cadavers. METHODS: Twenty lung lobectomies were performed with either a LigaTie or a TA stapler (n = 10 per group) by using a thoracoscopic-assisted technique. Procedures were randomly performed on the cranial lung lobes only. The distance between the ligation and the hilus was measured on each specimen. Airway pressures were tested to a maximum pressure of 40 cmH2 O. RESULTS: All LigaTie sites reached a maximum airway pressure without leaking and were easily placed at the hilus. Four of 10 TA stapled sites leaked at a mean pressure of 22 cmH2 O (P = .010). All leaks occurred when the TA staple line was >5 mm from the hilus; no leaks occurred when the TA staple line was ≤5 mm from the hilus (P < .001). No difference was found between fresh and frozen cadavers (P = .483) or right vs left lung lobe (P = .284). CONCLUSION: Lung lobectomies were consistently performed at the hilus only when the LigaTie was used. Lung lobectomies were less likely to leak when performed with the LigaTie rather compared with TA staples. CLINICAL SIGNIFICANCE: The LigaTie may be an effective alternative for lung lobectomies at the pulmonary hilus in cats and small breed dogs. Our findings provide justification for additional clinical testing.
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Gatos , Pulmão/cirurgia , Pneumonectomia/veterinária , Grampeamento Cirúrgico/veterinária , Animais , Materiais Biocompatíveis , Cadáver , Humanos , Ligadura/instrumentação , Ligadura/métodos , Ligadura/veterinária , Pneumonectomia/métodos , PressãoRESUMO
OBJECTIVE: To compare airway leak pressures after sealing peripheral lung biopsy sites with a resorbable ligation device (LigaTie) or thoracoabdominal (TA) staples. STUDY DESIGN: Ex vivo study. ANIMALS: Four normal caprine cadavers. METHODS: Twelve lung lobes were harvested from 4 goats immediately after euthanasia. Each lobe was inflated to 20 cm H2 O to test for leaks prior to biopsy. Pressure was then maintained at 10 cm H2 O. Biopsy samples were obtained 3 cm from the periphery with a resorbable ligation device or a TA stapler (n = 6 per group). After biopsy, inflation pressure was slowly increased to 40 cm H2 O while lungs were submerged in water. The pressure at which bubbles were first seen was recorded as the airway leak pressure. The length, width, volume, and weight were recorded for each biopsy sample. RESULTS: Five of 6 LigaTie biopsy sites sustained the maximum pressure of 40 cm H2 O without leaking. One site leaked at 24 cm H2 O. The TA-stapled sites sustained airway pressure to median 25.5 cm H2 O (interquartile range, 23.5-26 cm H2 O), and none of them reached the maximum pressure (P = .015). There were no differences in biopsy length, volume, or weight between groups. CONCLUSION: Biopsy sites sealed with LigaTie withstood higher airway pressure without leaking compared with TA-stapled biopsy sites in normal cadaveric specimens. CLINICAL SIGNIFICANCE: The LigaTie may be an alternative technique for sealing peripheral lung biopsy sites.
Assuntos
Cabras , Ligadura/veterinária , Pulmão/patologia , Animais , Biópsia/instrumentação , Biópsia/métodos , Biópsia/veterinária , Cadáver , Ligadura/instrumentação , PressãoRESUMO
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.
Assuntos
Quilotórax/veterinária , Doenças do Cão/cirurgia , Pericardiectomia/veterinária , Ducto Torácico/cirurgia , Cirurgia Torácica Vídeoassistida/veterinária , Animais , Quilotórax/cirurgia , Cães , Feminino , Ligadura/veterinária , Masculino , Pericardiectomia/métodos , Período Perioperatório , Derrame Pleural/veterinária , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/veterinária , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the effects of 2 training curricula on laparoscopic skills and performance of simulated surgery in veterinary students. STUDY DESIGN: Prospective study. SAMPLE POPULATION: Veterinary students (n = 33) with no prior hands-on experience in minimally invasive surgery. METHODS: Basic laparoscopic skills (BLS) were assessed based on 5 modified McGill inanimate system for training and evaluation of laparoscopic skills. Motion metrics and an objective structured assessment of technical skills (OSATS) were used to evaluate surgical skills during a simulated laparoscopic cholecystectomy performed in an augmented reality simulator. Students were randomly assigned to either skill-based (group A) or procedural-based (group B) training curriculum. Both tests were performed prior to and after a 10-session training curriculum. RESULTS: Post-training BLS results were improved in both training groups (P < .001). Seven participants completed both presimulated and postsimulated laparoscopic cholecystectomy, preventing paired analysis. Based on motion metrics analysis, participants completed tasks in a shorter time (P = .0187), and with better economy of movement (P = .0457) after training. No difference was detected in OSATS before and after training. CONCLUSION: Both training curricula improved BLS, but significant differences were not detected between the procedural-based training program and basic skills training alone in veterinary students. Motion metrics such as time, economy of movement, and instrument path were superior to an OSATS, when assessing surgical performance. Further studies are needed to compare the effects of different simulators on the training of veterinarians with diverse laparoscopic surgical experience.
Assuntos
Colecistectomia Laparoscópica/veterinária , Competência Clínica/estatística & dados numéricos , Currículo/estatística & dados numéricos , Faculdades de Medicina Veterinária , Estudantes de Ciências da Saúde/estatística & dados numéricos , Análise e Desempenho de Tarefas , Colecistectomia Laparoscópica/estatística & dados numéricos , Projetos PilotoRESUMO
OBJECTIVE: To determine the influence of preoperative computed tomography (CT) versus magnetic resonance (MR) on hemilaminectomies planned to treat thoracolumbar (TL) intervertebral disc (IVD) extrusions in chondrodystrophic dogs. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Forty chondrodystrophic dogs with TL IVD extrusion and preoperative CT and MR studies. METHODS: MR and CT images were randomized and reviewed by 4 observers masked to the dog's identity and corresponding imaging studies. Observers planned the location along the spine, side, and extent (number of articular facets to be removed) based on individual reviews of CT and MR studies. Intra-observer agreement was determined between overall surgical plan, location, side, and size of the hemilaminectomy planned on CT versus MR of the same dog. RESULTS: Similar surgical plans were developed based on MR versus CT in 43.5%-66.6% of dogs, depending on the observer. Intra-observer agreement in location, side, and size of the planned hemilaminectomy based on CT versus MR ranged between 48.7%-66.6%, 87%-92%, and 51.2%-71.7% of dogs, respectively. Observers tended to plan larger laminectomy defects based on MR versus CT of the same dog. CONCLUSION: Findings from this study indicated considerable differences in hemilaminectomies planned on preoperative MR versus CT imaging. Surgical location and size varied the most; the side of planned hemilaminectomies was most consistent between imaging modalities.
Assuntos
Doenças do Cão/cirurgia , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/veterinária , Laminectomia/veterinária , Imageamento por Ressonância Magnética/veterinária , Animais , Cães , Disco Intervertebral/patologia , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/métodos , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Tomografia Computadorizada por Raios X/veterináriaRESUMO
OBJECTIVE: To determine the construct and concurrent validity of instrument motion metrics for laparoscopic skills assessment in virtual reality and augmented reality simulators. STUDY DESIGN: Evaluation study. SAMPLE POPULATION: Veterinarian students (novice, n = 14) and veterinarians (experienced, n = 11) with no or variable laparoscopic experience. METHODS: Participants' minimally invasive surgery (MIS) experience was determined by hospital records of MIS procedures performed in the Teaching Hospital. Basic laparoscopic skills were assessed by 5 tasks using a physical box trainer. Each participant completed 2 tasks for assessments in each type of simulator (virtual reality: bowel handling and cutting; augmented reality: object positioning and a pericardial window model). Motion metrics such as instrument path length, angle or drift, and economy of motion of each simulator were recorded. RESULTS: None of the motion metrics in a virtual reality simulator showed correlation with experience, or to the basic laparoscopic skills score. All metrics in augmented reality were significantly correlated with experience (time, instrument path, and economy of movement), except for the hand dominance metric. The basic laparoscopic skills score was correlated to all performance metrics in augmented reality. The augmented reality motion metrics differed between American College of Veterinary Surgeons diplomates and residents, whereas basic laparoscopic skills score and virtual reality metrics did not. CONCLUSION: Our results provide construct validity and concurrent validity for motion analysis metrics for an augmented reality system, whereas a virtual reality system was validated only for the time score.