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Abstract

Objective—To evaluate the exposure obtained for minimally invasive abdominal organ biopsy (MIOB) from 3 access incisions in cats.

Design—Prospective experimental study and clinical case series.

Animals—6 purpose-bred research cats and 6 feline clinical patients with indications for abdominal organ biopsy.

Procedures—Three 3-cm incisions into the peritoneal cavity were created at different locations along the linea alba in research cats in randomized order. A wound retraction device was inserted in each incision. Ability to exteriorize various abdominal organs to the extent required to reasonably perform a surgical biopsy was recorded, and results were compared among incision sites. On the basis of results obtained, the access incision that provided exposure of the most frequently biopsied abdominal organs was used to perform MIOB in 6 feline clinical patients with various underlying pathological conditions.

Results—On the basis of experiments with research cats, a 3-cm access incision centered midway between the caudal margin of the xiphoid cartilage and the umbilicus was found to provide access for MIOB for most organs. In 5 of 6 clinical patients, all of the organs of interest were biopsied successfully via this incision location, although access to all hepatic lobes and all parts of the pancreas was inconsistent. In 1 cat, conversion to an open approach was performed because a palpable mass was detected in the area of the duodenocolic ligament.

Conclusions and Clinical Relevance—Optimization of access incision location for MIOB allowed biopsy specimen collection from organs of interest to be performed in a minimally invasive manner in cats.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To describe the operative technique for single-port laparoscopic cryptorchidectomy (SPLC) in dogs and cats and evaluate clinical outcome for patients that underwent the procedure.

Design—Retrospective case series.

Animals—25 client-owned dogs (n = 22) and cats (3).

Procedures—Dogs and cats that underwent SPLC with 3 commercially available single-port devices between 2009 and 2014 were retrospectively identified through a multi-institutional medical records review. Surgery was performed via a single-port device placed through a 1.5- to 3.0-cm abdominal incision either at the region of the umbilicus or caudal to the right 13th rib. The cryptorchidectomy was performed with graspers, a bipolar vessel sealing device, and a 30° telescope.

Results—SPLC was performed with a single-incision laparoscopic surgery port (n = 15), a multitrocar wound-retractor access system (8), or a metal resterilizable single-port access device (2). Median age was 365 days (range, 166 to 3,285 days). Median body weight was 18.9 kg (41.6 lb; range, 1.3 to 70 kg [2.9 to 154 lb]). Median surgical time was 38 minutes (range, 15 to 70 minutes). Thirty-two testes were removed (12 left, 6 right, and 7 bilateral). Four patients had 1 additional abdominal surgical procedure performed concurrently during SPLC. No intraoperative or postoperative complications were encountered.

Conclusions and Clinical Relevance—Results suggested that SPLC can be performed in a wide range of dogs and cats with cryptorchidism and can be combined with other elective laparoscopic surgical procedures. The SPLC technique was associated with a low morbidity rate and provided a potentially less invasive alternative to traditional open and multiport laparoscopic techniques.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To describe clinicopathologic features of dogs that underwent lung lobectomy for resection of primary lung tumors via video-assisted thoracoscopic surgery (VATS) or open thoracotomy (OT) and to compare short-term outcomes for dogs following these procedures.

Design—Retrospective cohort study.

Animals—46 medium- to large-breed dogs with primary lung tumors.

Procedures—Medical records of dogs that underwent a lung lobectomy via VATS (n = 22) or OT (24) for resection of primary lung tumors between 2004 and 2012 were reviewed. Dogs were included if they weighed > 10 kg (22 lb) and resection of a primary lung tumor was confirmed histologically. Tumor volumes were calculated from preoperative CT scans where available. Surgical time, completeness of excision, time in the ICU, indwelling thoracic drain time, postoperative and total hospitalization time, incidence of major complications, and short-term survival rate were evaluated.

Results—VATS was performed with a 3-port (n = 12) or 4-port (10) technique and 1-lung ventilation (22). In 2 of 22 (9%) dogs, VATS was converted to OT. All dogs survived to discharge from the hospital. There were no significant differences between the VATS and OT groups with regard to most variables. Surgery time was significantly longer for VATS than for OT (median, 120 vs 95 minutes, respectively).

Conclusions and Clinical Relevance—In medium- to large-breed dogs, short-term outcomes for dogs that underwent VATS for lung lobectomy were comparable to those of dogs that underwent OT. Further studies are required to evaluate the effects of surgical approach on indices of postoperative pain and long-term outcomes.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To describe the clinicopathologic features of a cohort of dogs with adrenocortical masses that underwent laparoscopic adrenalectomy and to compare perioperative morbidity and mortality rates in these dogs with rates for dogs that underwent open adrenalectomy for resection of similarly sized (maximal diameter, ≤ 5 cm) adrenocortical masses.

Design—Retrospective case series.

Animals—48 client-owned dogs that underwent laparoscopic (n = 23) or open (25) adrenalectomy for noninvasive tumors (ie, tumors that did not invade the vena cava or other surrounding organs).

Procedures—Medical records were reviewed. History, clinical signs, physical examination findings, clinicopathologic findings, imaging results, and surgical variables were recorded. A 3- or 4-port approach was used for laparoscopic adrenalectomy. Surgical time, perioperative complications, postoperative and overall hospitalization times, and perioperative deaths were recorded and compared between groups.

Results—The surgical method for 1 dog was converted from a laparoscopic to an open approach. Perioperative death occurred in no dogs in the laparoscopic group and 2 dogs in the open adrenalectomy group. Surgical time was shorter for laparoscopic (median, 90 minutes; range, 40 to 150 minutes) than for open (median, 120 minutes; range, 75 to 195 minutes) adrenalectomy. Laparoscopic adrenalectomy was associated with shorter hospitalization time and more rapid discharge from the hospital after surgery, compared with the open procedure.

Conclusions and Clinical Relevance—With careful patient selection, laparoscopic adrenalectomy was associated with a low complication rate and low conversion rate for resection of adrenocortical masses as well as shorter surgical and hospitalization times, compared with open adrenalectomy.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine the frequency and severity of complications after corrective surgery in dogs with lateral patellar luxation (LPL) and identify risk factors for reluxation.

Design—Retrospective case series.

Animals—36 client-owned dogs with 47 affected stifle joints.

Procedures—Medical records of dogs that underwent surgical correction of LPL at 1 of 2 veterinary teaching hospitals between 2000 and 2011 were reviewed. Data analyzed included signalment, grade of luxation, orthopedic comorbidities, surgical procedures performed, frequency and type of complications, and whether a second surgery was performed.

Results—A total of 36 dogs with 47 affected stifle joints met the inclusion criteria. Complications were recorded for 24 of 47 (51.1%) stifle joints; there were major complications for 18 of 47 (38.3%) stifle joints. All complications were confirmed through examination by a veterinarian. The most frequent complication was reluxation, which was detected in 10 of 47 (21.3%) stifle joints. Dogs that underwent bilateral surgical repair during a single anesthetic episode had odds of reluxation that were 12.5 times the odds of reluxation for dogs that underwent unilateral surgical repair.

Conclusions and Clinical Relevance—Complication rate after corrective surgery for LPL was high, with reluxation being the most common complication in this population of dogs. Performing staged bilateral surgeries may decrease the risk of reluxation.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine clinicopathologic features, surgical management, complications, and long-term outcome associated with diseases of the extrahepatic portion of the biliary tract treated via choledochal stent placement in dogs.

Design—Retrospective case series.

Animals—13 dogs.

Procedure—Data were obtained from medical records, and follow-up information was obtained via reexamination or telephone interview with owners or referring veterinarians.

Results—10 dogs had extrahepatic biliary obstruction (EHBO), 6 as a result of pancreatitis. Two dogs had rupture of the common bile duct associated with cholelithiasis. In 1 dog, a stent was placed prophylactically after gastroduodenostomy was performed for a perforated duodenal ulcer. Nine of 13 dogs survived the perioperative period and were discharged. No recurrence of EHBO or other complications developed in the discharged dogs while the stents were in place. Median follow-up period from surgery to last owner contact was 13.3 months. In 1 dog, the stent was removed endoscopically 10 months after surgery and EHBO recurred 9 months after stent removal because of cholangitis. In 4 of 5 dogs that were discharged from the hospital, in which the fate of the stent could be confirmed and the stent was secured to the duodenal wall with absorbable suture materials, the stents were passed in the feces 1 to 11 months after surgery.

Conclusions and Clinical Relevance—Choledochal tube stenting is an effective method of decompression of the extrahepatic portion of the biliary tract in dogs and provides a less complex alternative to traditional cholecystoenterostomy techniques in select cases.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine outcome associated with intramural ureteral ectopia treated with 1 of 2 surgical techniques (neoureterostomy with ligation of the distal ureteral segment vs neoureterostomy with resection of the distal ureteral segment) and compare results of these 2 techniques in dogs.

Design—Multicenter retrospective case series.

Animals—36 dogs (15 treated with the ligation technique and 21 treated with the resection technique).

Procedures—Information was obtained from medical records. Long-term follow-up information was obtained by owner questionnaire.

Results—15 of 21 (71%) dogs in the resection group and 7 of 14 (50%) dogs in the ligation group still had urinary incontinence after surgery. Three of 20 (15%) dogs in the resection group and 4 of 14 (29%) dogs in the ligation group reportedly had multiple episodes of urinary tract infection following surgery. The outcome of surgery was judged to be excellent by the owners of 10 of 18 (56%) dogs in the resection group and 9 of 14 (64%) dogs in the ligation group. No significant differences were found between surgery treatment groups.

Conclusions and Clinical Relevance—Results of the present study suggest that although most owners of dogs that undergo surgery for treatment of intramural ureteral ectopia consider the outcome of surgery to be excellent, substantial proportions of dogs will continue to have urinary incontinence and recurrent urinary tract infections after surgery. Findings do not provide any support to the hypothesis that the resection technique is superior to the ligation technique for management of dogs with intramural ureteral ectopia.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To determine the optimal intercostal space (ICS) for thoracoscopic-assisted pulmonary surgery for lung lobectomy in cats.

SAMPLE

8 cat cadavers.

PROCEDURES

Cadavers were placed in lateral recumbency. A 5-cm minithoracotomy incision was made in the middle third of ICS 4 through 7 on the left side and 4 through 8 on the right side, and a wound retractor device was placed. A camera port was made in the middle third of ICS 9. Each lung lobe was sequentially exteriorized at each respective ICS. A thoracoabdominal stapler was placed to simulate a lung lobectomy, and distance from the stapler anvil to the hilus was measured.

RESULTS

For the left cranial lung lobe, there was no significant difference in median distance from the stapler anvil to the pulmonary hilus for ICS 4 through 6. Simulated lobectomy of the left caudal lung lobe performed at ICS 5 and 6 resulted in a significantly shorter distance, compared with lobectomy performed at ICS 4 and 7. Simulated lobectomy of the right cranial and right middle lung lobes performed at ICS 4 and 5 resulted in a significantly shorter distance, compared with lobectomy performed at ICS 7. Simulated lobectomy of the accessory and right caudal lung lobes at ICS 5 and 6 resulted in a significantly shorter distance than for lobectomy performed at ICS 8.

CONCLUSIONS AND CLINICAL RELEVANCE

An optimal ICS for a minithoracotomy incision was determined for thoracoscopic-assisted lung lobectomy in cats.

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE

To compare a ventral and a left lateral endoscopic approach to coelioscopy in bearded dragons (Pogona vitticeps).

ANIMALS

18 adult bearded dragons.

PROCEDURES

In a randomized crossover design involving 2 surgical approaches, anesthetized bearded dragons first underwent coelioscopy with a ventral approach (left lateral of midline next to the umbilicus; animal positioned in dorsal recumbency) or left lateral approach (intercostal; animal positioned in right lateral recumbency) and then with the alternate approach. A 2.7-mm × 18-cm, 30° oblique telescope with a 4.8-mm operating sheath and CO2 insufflation at 2 to 5 mm Hg were used. Ease of entry into the coelom and ease of visual examination of visceral structures were scored.

RESULTS

Both approaches were straightforward, with the left lateral approach requiring significantly more time than the ventral approach. Scores for ease of visual examination for the heart, lungs, liver, stomach, intestines, pancreas, gallbladder, left kidney, gonads, and fat body were good to excellent. Visual examination of the spleen and adrenal glands was difficult in most animals via either approach. The left kidney, testis, and vas deferens were easier to see with the left lateral approach, whereas the pancreas in females and gallbladder in both sexes were easier to see with the ventral approach. All bearded dragons recovered without complications from the procedures, except for one with nephritis, renal gout, and hepatic necrosis.

CONCLUSIONS AND CLINICAL RELEVANCE

Both coelioscopy approaches could be safely and effectively used in bearded dragons. Choice of approach should be based on the coelomic structures requiring evaluation.

Full access
in American Journal of Veterinary Research

Abstract

Objective—To describe and evaluate the short- and long-term outcomes in female dogs after cystoscopic-guided laser ablation of ectopic ureters (CLA-EU).

Design—Prospective case series.

Animals—32 incontinent female dogs with intramural ectopic ureters.

Procedures—A diagnosis of intramural ectopic ureters was made via cystoscopy and fluoroscopy in all patients. Transurethral CLA-EU (via diode laser [n = 27] or Holmium:yttrium aluminum garnet laser [3]) was performed to relocate the ectopic ureteral orifice cranially into the urinary bladder. All vaginal anomalies were treated with the laser concurrently. Follow-up evaluation was standardized and included urinary continence scoring, serial bacteriologic culture of urine samples, and a follow-up cystoscopy 6 to 8 weeks after CLA-EU.

Results—Ectopic ureteral orifices of all dogs were initially located in the urethra. Eighteen of 30 dogs had bilateral ectopic ureters, and 12 had unilateral ectopic ureters. All dogs had other concurrent urinary anomalies. At the time of last follow-up (median, 2.7 years after CLA-EU, [range, 12 to 62 months]), 14 of 30 (47%) dogs did not require any additional treatments following CLA-EU to maintain urinary continence. For the 16 residually incontinent dogs, the addition of medical management, transurethral bulking-agent injection, or placement of a hydraulic occluder was effective in 3, 2, and 4 dogs, respectively, improving the overall urinary continence rate to 77% (23/30 dogs). One dog had evidence of polypoid cystitis at the neoureteral orifice 6 weeks after CLA-EU that was resolved at 3 months.

Conclusions and Clinical Relevance—CLA-EU provided an effective, safe, and minimally invasive alternative to surgery for intramural ectopic ureters in female dogs.

Full access
in Journal of the American Veterinary Medical Association