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- Author or Editor: Ameet Singh x
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To compare intraoperative and short-term postoperative variables pertaining to laparoscopic ovariectomy (LapOVE) and open ovariectomy (OVE) in rabbits (Oryctolagus cuniculus).
Twelve 4− to 5-month-old female New Zealand White rabbits.
Rabbits were randomly assigned to undergo LapOVE (n = 6) or OVE (6), with a vessel-sealing device used to seal and transect the ovarian pedicles. Laparoscopic ovariectomy was performed with a 3-port approach. Variables were measured during surgery (surgery and anesthesia times and incision lengths) and for up to 7 days after surgery (food consumption, feces production, body weight, vital parameters, blood glucose and cortisol concentrations, abdominal palpation findings, facial grimace scale scores, and ethograms).
Mean surgery (43.2 vs 21.7 minutes) and anesthesia (76.2 vs 48.8 minutes) times were longer and mean incision length was shorter (24.0 vs 41.5 mm) for LapOVE versus OVE. No significant differences in postoperative variables were identified between groups. During LapOVE, small intestinal perforation occurred in 1 rabbit, which was then euthanized. Postoperative complications for the remaining rabbits included superficial incisional dehiscence (LapOVE, 1/5; OVE, 2/6), subcutaneous emphysema (LapOVE, 1/5; OVE, 0/6), and seroma formation (LapOVE, 1/5; OVE, 0/6).
CONCLUSIONS AND CLINICAL RELEVANCE
Surgery time for LapOVE was twice that of OVE, and LapOVE resulted in unique complications in rabbits. No evidence of a reduction in pain or faster return to baseline physiologic status was found for LapOVE. Further evaluation of LapOVE in rabbits is warranted, with modification to techniques used in this study or a larger sample size.
OBJECTIVE To evaluate adherence of methicillin-resistant Staphylococcus pseudintermedius (MRSP) to 5 suture materials commonly used in small animal surgery.
SAMPLE 10 epidemiologically unrelated MRSP isolates (obtained from dogs with clinical infections) that had strong biofilm-forming ability and 5 types of suture.
PROCEDURES The 5 types of suture evaluated were monofilament polyglecaprone 25, monofilament polydioxanone, triclosan-coated (TC)–monofilament polydioxanone, braided polyglactin 910, and barbed monofilament polydioxanone. Suture segments were incubated in standard suspensions of MRSP for 2 minutes. Segments were then placed in tryptone soy broth and incubated overnight. After incubation, segments were rinsed with PBS solution and sonicated to dislodge adherent bacteria. Resulting suspensions were used to create serial dilutions that were plated, incubated overnight, and counted the following day. Bacterial adherence to 1 segment of each suture type was assessed by use of scanning electron microscopy.
RESULTS There was significantly less adherence of MSRP to TC–monofilament polydioxanone than to polyglecaprone 25, polyglactin 910, barbed monofilament polydioxanone, and monofilament polydioxanone. There was significantly less adherence of MSRP to polyglecaprone than to polyglactin 910.
CONCLUSIONS AND CLINICAL RELEVANCE Barbed suture had a bacterial adherence profile comparable to that for monofilament suture. Adherence of MRSP was greatest for braided polyglactin 910. Use of TC–monofilament polydioxanone can be considered for patients that are at high risk of developing surgical site infections and for which a surgeon chooses a multifilament suture. (Am J Vet Res 2016;77:194–198)
To assess the effects of 3 intra-abdominal pressures (IAPs) on pneumoperitoneal (laparoscopic working space) volume in domestic rabbits (Oryctolagus cuniculus).
6 female New Zealand White rabbits.
A Latin-square design was used to randomly allocate sequences of 3 IAPs (4, 8, and 12 mm Hg) to each rabbit in a crossover study. Rabbits were anesthetized, subumbilical cannulae were placed, and CT scans were performed to obtain baseline measurements. Each IAP was achieved with CO2 insufflation and maintained for ≥ 15 minutes; CT scans were performed with rabbits in dorsal, left lateral oblique, and right lateral oblique recumbency. The abdomen was desufflated for 5 minutes between treatments (the 3 IAPs). Pneumoperitoneal volumes were calculated from CT measurements with 3-D medical imaging software. Mixed linear regression models evaluated effects of IAP, rabbit position, and treatment order on working space volume.
Mean working space volume at an IAP of 8 mm Hg was significantly greater (a 19% increase) than that at 4 mm Hg, and was significantly greater (a 6.9% increase) at 12 mm Hg than that at 8 mm Hg. Treatment order, but not rabbit position, also had a significant effect on working space. Minor adverse effects reported in other species were observed in some rabbits.
CONCLUSIONS AND CLINICAL RELEVANCE
A nonlinear increase in abdominal working space was observed with increasing IAP. Depending on the type of procedure and visual access requirements, IAPs > 8 mm Hg may not provide a clinically important benefit for laparoscopy in rabbits.
A 12-year-old spayed female Chinese Crested was referred because of a mass detected in the gallbladder during ultrasonographic evaluation of the abdomen, which had been prompted by a history of high serum liver enzyme activities.
Serum biochemical analysis revealed mild hypoglobulinemia and high alkaline phosphatase, γ-glutamyltransferase, and alanine aminotransferase activities. Abdominal ultrasonography revealed diffuse hepatopathy and multiple pedunculated mucosal structures within the gallbladder.
TREATMENT AND OUTCOME
Following initial treatment with ursodiol (11.4 mg/kg [5.18 mg/lb], PO, q 12 h) and S-adenosylmethionine (30 mg/kg [13.6 mg/lb], PO, q 24 h) for 1 month to address possible cholestasis, no change was noted in ultrasonographic or serum biochemical findings. Consequently, laparoscopic cholecystectomy was performed concurrently with laparoscopic liver biopsy. Histologic evaluation of resected gallbladder tissue and the liver biopsy specimen revealed evidence of multifocal to coalescing leiomyomas of the gallbladder and multifocal lipogranulomas of the liver. Eleven days after the dog was discharged from the hospital, it was taken to an emergency clinic because of anorexia, vomiting, and diarrhea. Mild pancreatitis or gastroenteritis was suspected, supportive treatment was provided, and ursodiol and S-adenosylmethionine administration was reinitiated. At the time of follow-up telephone contact with the owner 234 days after surgery, the dog continued to receive ursodiol and S-adenosylmethionine and had no clinical signs associated with hepatobiliary disease.
Leiomyomas, although rare, can develop in dogs and should be considered as a differential diagnosis for intramural gallbladder lesions. Laparoscopic cholecystectomy served as a minimally invasive surgical treatment for this benign neoplasia.
OBJECTIVE To compare perioperative characteristics of dogs with cystic calculi treated via open versus laparoscopic-assisted cystotomy (LAC).
DESIGN Retrospective case series.
ANIMALS 89 client-owned dogs that underwent open cystotomy (n = 39) or LAC (50).
PROCEDURES Medical records of dogs that underwent cystotomy between 2011 and 2015 were reviewed. History, signalment, surgery date, results of physical examination, results of preoperative diagnostic testing, details of surgical treatment, duration of surgery, perioperative complications, treatment costs, and duration of hospitalization were recorded.
RESULTS 5 of 50 (10%) dogs required conversion from LAC to open cystotomy (OC). There was no significant difference between the LAC (1/50) and OC (2/39) groups with regard to percentage of patients with incomplete removal of calculi. Duration of surgery was not significantly different between the LAC (median, 80 min; range, 35 to 145 min) and OC (median, 70 min; range, 45 to 120 min) groups. Postoperative duration of hospitalization was significantly shorter for dogs that underwent LAC (median, 24 hours; range, 12 to 48 hours) versus OC (median, 26 hours; range, 12 to 63 hours). Surgical and total procedural costs were significantly higher for patients undergoing LAC.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that LAC may be an acceptable minimally invasive technique for treatment of cystic calculi in dogs. Surgery times were similar to those for dogs undergoing OC; however, surgical and total procedural costs were higher. Further investigation is suggested to determine which patients may benefit from LAC versus traditional OC.
Objective—To describe the technique and evaluate the outcome of laparoscopic treatment of ovarian remnant syndrome (ORS) in dogs and cats.
Design—Retrospective case series.
Animals—7 client-owned dogs and cats.
Procedures—Medical records of dogs and cats with ORS that were treated laparoscopically at 3 large veterinary teaching hospitals were reviewed. Laparoscopic ovarian remnant resection was performed by means of either a 3-port or single-port technique with the patient in dorsal recumbency. The area caudal to both kidneys was thoroughly inspected for evidence of ovarian tissue by tilting the patient laterally. Any ovarian remnant tissue in these areas was resected with a bipolar vessel sealer.
Results—5 female dogs and 2 female cats that had previously undergone ovariectomy or ovariohysterectomy were included in the study. Six procedures were performed with a standard 3-port technique, and 1 was performed with a single-port technique. Median surgery time was 90 minutes (range, 50 to 150 minutes). No patient required conversion to laparotomy. Six of the 7 patients had complete resolution of clinical signs after surgery. One patient underwent laparotomy 7 weeks after surgery for management of stump pyometra, but no further ovarian tissue was detected.
Conclusions and Clinical Relevance—Laparoscopic management of ORS in this cohort of dogs and cats was associated with minimal morbidity. Laparoscopic treatment of ORS in dogs and cats may be recommended for appropriately selected patients.
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.
OBJECTIVE To describe the operative technique and perioperative outcome for laparoscopic-assisted splenectomy (LAS) in dogs.
DESIGN Retrospective case series.
ANIMALS 18 client-owned dogs.
PROCEDURES Medical records of dogs with naturally occurring disease of the spleen treated by means of LAS between 2012 and 2014 were reviewed. History, signalment, results of physical examination, results of preoperative diagnostic testing, details of surgical technique, intraoperative findings including results of abdominal exploration and staging, concurrent surgical procedures, complications, histopathologic diagnoses, duration of postoperative hospitalization, and perioperative outcome were recorded. The perioperative period was defined as the time from hospital admission for LAS until discharge or death (within the same visit).
RESULTS All dogs underwent initial abdominal exploration and staging via multiple 5-mm laparoscopic ports (n = 2) or a single commercially available multichannel port (16), followed by minilaparotomy with insertion of a wound retraction device, progressive exteriorization of the spleen, sealing of hilar vessels, and splenectomy. Splenectomy was performed for treatment of a splenic mass (n = 15), suspected neoplasia (2), or refractory immune-mediated disease (1). Median size (width × length) of splenic masses was 5 × 5 cm (range, 1.6 to 11.0 cm × 1.5 to 14.5 cm). Complications were limited to minor intraoperative hemorrhage in 1 dog; no patient required conversion to open laparotomy.
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that LAS was technically feasible in dogs and not associated with major complications. Further evaluation is required; however, in appropriately selected patients, LAS may offer the benefits of a minimally invasive technique, including a smaller incision and improved illumination and magnification during exploration and staging.
OBJECTIVE To determine whether simulator-assessed laparoscopic skills of veterinary students were associated with training level and prior experience performing nonlaparoscopic veterinary surgery and other activities requiring hand-eye coordination and manual dexterity.
SAMPLE 145 students without any prior laparoscopic surgical or fundamentals of laparoscopic surgery (FLS) simulator experience in years 1 (n = 39), 2 (34), 3 (39), and 4 (33) at a veterinary college.
PROCEDURES A questionnaire was used to collect data from participants regarding experience performing veterinary surgery, playing video games, and participating in other activities. Participants performed a peg transfer, pattern cutting, and ligature loop-placement task on an FLS simulator, and FLS scores were assigned by an observer. Scores were compared among academic years, and correlations between amounts of veterinary surgical experience and FLS scores were assessed. A general linear model was used to identify predictors of FLS scores.
RESULTS Participants were predominantly female (75%), right-hand dominant (92%), and between 20 and 29 years of age (98%). No significant differences were identified among academic years in FLS scores for individual tasks or total FLS score. Scores were not significantly associated with prior surgical or video game experience. Participants reporting no handicraft experience had significantly lower total FLS scores and FLS scores for task 2 than did participants reporting a lot of handicraft experience.
CONCLUSIONS AND CLINICAL RELEVANCE Prior veterinary surgical and video game experience had no influence on FLS scores in this group of veterinary students, suggesting that proficiency of veterinary students in FLS may require specific training.