Objective—To determine whether scores for basic laparoscopic skills were significantly associated with extent of laparoscopic experience and compare basic laparoscopic skill scores obtained before and after 2 laparoscopic training sessions incorporating a canine abdominal model.
Sample Population—8 experienced and 25 novice individuals.
Procedures—Novice participants were randomly assigned to control (n = 10) and training (15) groups. Individuals in the experienced and novice training groups were required to undergo 2 training sessions with a canine abdominal model. Basic laparoscopic skills were assessed twice on the basis of 3 tasks included in the McGill Inanimate Simulator for Training and Evaluation of Laparoscopic Skills (MISTELS).
Results—For the novice training group, laparoscopic skills scores were significantly higher after training than before, but for individuals in the novice control group, scores did not differ significantly between the first and second assessments. The increase in score for the novice training group was significantly higher than increases for the experienced group and for the novice control group, but the increase in score for the experienced group was not significantly different from the increase in score for the novice control group.
Conclusions and Clinical Relevance—Results suggested that basic laparoscopic skills scores obtained with the MISTELS were associated with extent of laparoscopic experience and that training with a canine abdominal model could increase skills scores for individuals without previous laparoscopic experience.
Objective—To describe clinical and physiologic changes during lift laparoscopy in dogs and cats and determine immediate surgical outcome.
Design—Retrospective case series.
Animals—Client-owned dogs (n = 7) and cats (5).
Procedures—A custom-made lift device was used to retract the abdominal wall for laparoscopic instrumentation. The lift device was used first in 3 dog cadavers to assess the risk of complications. Thereafter, the device was used for routine laparoscopic procedures in client-owned animals. Data collected from medical records included signalment, body weight, clinical signs, diagnosis, surgery type and duration, conversion from laparoscopic to open surgery, preoperative American Society of Anesthesiologists score, mean intraoperative respiratory rate, mean and peak end-tidal partial pressure of CO2 during the laparoscopic surgery, ventilation method, mean saturation of hemoglobin with O2, mean and systolic arterial pressures during the laparoscopic surgery, total anesthesia time, signs of pain immediately after recovery, duration of hospitalization, and postoperative complications.
Results—Lift laparoscopy was successfully performed in 10 of the 12 patients. No adverse effects were noted with the use of this technique. However, in 1 dog and 1 cat, conversion to laparotomy was necessary because of poor visualization.
Conclusions and Clinical Relevance—Results suggested that lift laparoscopy is feasible in dogs and cats and is an option that can be used in clinical practice, especially if creation of positive-pressure pneumoperitoneum is not desirable.
OBJECTIVE To develop and evaluate a high-fidelity simulated laparoscopic ovariectomy (SLO) model for surgical training and testing.
DESIGN Evaluation study.
SAMPLE 15 veterinary students (novice group), 5 veterinary surgical interns or residents (intermediate group), and 6 veterinary surgeons (experienced group).
PROCEDURES Laparoscopic surgery experience was assessed by questionnaire and visual analog scales. Basic laparoscopic skills were assessed with a commercial training model. A commercial canine abdomen model was customized with a high-fidelity simulated canine female genital tract. Each subject's SLO performance (laparoscopic entry, dissection along marked planes, and left ovariectomy) was evaluated by measurement of surgical time and errors (splenic puncture and deviation from dissection marks) and with global and operative component rating scales. Construct and concurrent validity were assessed by correlation of SLO results with self-estimated measures of experience level and with basic laparoscopic skills test results, respectively. Face validity was assessed with a questionnaire completed by intermediate and experienced group participants.
RESULTS 13 participants (3/15, 5/5, and 5/6 in the novice, intermediate, and experienced groups, respectively) completed SLO within the preset time. No difference in errors was found among groups. Completion time was significantly correlated with self-estimated experience level (r = −0.626), confirming construct validity, and with basic laparoscopic skills scores (r = −0.552) and global (r = −0.624) and operative component (r = −0.624) rating scale scores, confirming concurrent validity. Overall mean face validity score was low (64.2/100); usefulness of the model for surgical training received the highest score (8/10).
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested the SLO model may be a useful surgical training tool. Further studies are needed to confirm usefulness of the model in veterinary laparoscopy training.
Objective—To compare laparoscopic skills among veterinarians before and after undertaking 1 of 2 programs of simulation training.
Sample Population—17 veterinarians at 1 institution.
Procedures—Basic skills were tested by use of the McGill inanimate system for training and evaluation of laparoscopic skills (MISTELS). Surgical performance was assessed through an objective structured assessment of technical skills (OSATS). Both tests were performed prior to and after a 12-session training program, consisting of MISTELS exercises (curriculum A) or a variety of exercises (curriculum B).
Results—Curriculum B led to improvement of scores obtained with both the MISTELS and the OSATS. Curriculum A did not result in higher scores obtained with the MISTELS, compared with curriculum B. Curriculum A did not lead to an improvement of scores obtained with the OSATS. Participant-perceived value of the training program was correlated positively with the improvement of scores for MISTELS suturing tasks and scores obtained with the OSATS. Time spent in clinical laparoscopic surgery and curriculum B training were both positively correlated with the post-training OSATS scores but not with post-training MISTELS scores. Conversely, simulation training time correlated with an increase in MISTELS scores but not OSATS scores.
Conclusions and Clinical Relevance—MISTELS training resulted in significant improvement of basic laparoscopic skills but not in the assessment used for surgical performance. This may have been due to the small number of study participants, the assessment tool, or the method of training. A varied curriculum may be advantageous when training veterinarians for clinical laparoscopic practice.
CASE DESCRIPTION A 2-year-old castrated male mixed-breed dog was evaluated because of a 1-week history of respiratory distress and abdominal distension. Thoracic radiography and echocardiography at that time revealed an enlarged cardiac silhouette and pericardial effusion; abdominal radiography and ultrasonography revealed ascites.
CLINICAL FINDINGS At the initial referral examination 5 weeks later, the dog weighed 37.5 kg (82.5 lb) and appeared clinically normal. The only abnormality detected was a grade I/VI systolic murmur on the left side of the thorax. Echocardiography revealed a large fat- and fluid-filled cystic structure located next to the right ventricle with scant pericardial effusion. Computed tomography revealed a bilobed peripherally contrast-enhancing structure within the right ventral aspect of the pericardium; the right ventricle appeared compressed by the cyst.
TREATMENT AND OUTCOME Initial treatment consisted of pericardiocentesis and abdominocentesis to alleviate clinical signs. Thoracoscopic subtotal pericardectomy was performed 6 weeks after the initial treatment. The cyst was completely excised, and multiple adhesions between the visceral and parietal pericardium were transected, without surgical or anesthetic complications. Histologic examination of the cyst revealed chronic inflammation with histiocytic infiltration, suggesting possible foreign body reaction or chronic inflammation and hemorrhage. These findings supported a diagnosis of cystic hematoma of the pericardium. The dog remained clinically normal for at least 16 months after surgery.
CLINICAL RELEVANCE This report represents a rare case of intrapericardial cystic hematoma in a dog. Minimally invasive surgery was performed without complications, suggesting that thoracoscopic subtotal pericardectomy is a feasible treatment option for affected dogs.
Objective—To compare bursting pressures in canine jejunum, measured by use of an in vitro and an in situ bursting pressure technique.
Study Population—Cadavers of 3 healthy adult dogs.
Procedures—54 enterotomies were performed on 3 canine cadavers immediately after euthanasia. After completion of enterotomy closure, bursting pressure was measured on 9 jejunal segments by use of an in situ technique and on 9 jejunal segments by use of an in vitro technique for each canine cadaver. Bursting pressure testing time was recorded for both in situ and in vitro techniques. Techniques were compared by means of randomized block ANOVA.
Results—The mean ± SE in vitro and in situ bursting pressures were 93.63 ± 24.10 mm Hg and 141.19 ± 38.10 mm Hg and were not significantly different. Mean in situ testing time was 40.7 min/cadaver; mean in vitro testing time was 50.3 min/cadaver.
Conclusions and Clinical Relevance—The in situ bursting pressure testing technique yielded results similar to those of the in vitro method, was somewhat less labor-intensive, and may be applicable to future studies of live dogs.
To investigate the prophylactic effectiveness of preoperative administration of maropitant citrate and metoclopramide hydrochloride in preventing postoperative clinical gastroesophageal reflux (GER) in dogs and to identify risk factors for clinical postoperative GER in dogs.
93 client-owned dogs undergoing surgery at the Washington State University Veterinary Teaching Hospital between March 2016 and February 2017.
Dogs were randomly assigned to either the intervention group (preoperatively received maropitant and metoclopramide) or the control group (did not preoperatively receive maropitant and metoclopramide). After surgery, all dogs were recovered and monitored, and occurrences of GER were noted. The prophylactic effectiveness of maropitant and metoclopramide was evaluated, and univariate and multivariate logistic regression analyses were performed to identify variables associated with postoperative clinical GER in dogs.
No meaningful difference in the incidence of clinical GER during the postoperative period was detected between the control and intervention groups. Results indicated that variables associated with significantly increased odds of postoperative clinical GER included the male sex (OR, 9.2; 95% confidence interval [CI], 1.26 to 195.0), an overweight BCS (OR, 12.3; 95% CI, 2.1 to 135.1), gastrointestinal surgery (OR, 30.5; 95% CI, 3.0 to 786.9), and requirement for a dexmedetomidine constant rate infusion after surgery (OR, 9.6; 95% CI, 1.3 to 212.5).
CONCLUSIONS AND CLINICAL RELEVANCE
Findings indicated that incidence of clinical GER during the postoperative period was not lower for dogs that received preoperative prophylactic administration of metoclopramide and maropitant, compared with incidence dogs that did not receive the prophylactic treatment. Further research is required into alternative measures to prevent postoperative clinical GER in dogs.
OBJECTIVE To determine whether basic laparoscopic skills acquired during training in the horizontal plane would transfer to the vertical plane and vice versa.
DESIGN Evaluation study.
SAMPLE POPULATION 26 first- and second-year veterinary students with no prior laparoscopic skills training or surgical experience.
PROCEDURES Participants were nonrandomly assigned to 2 groups. Group 1 (n = 15) underwent laparoscopic skills training in the horizontal plane, and group 2 (17) underwent laparoscopic skills training in the vertical plane. Following training, participants were tested on their ability to perform 5 laparoscopic tasks, first in the horizontal plane and then the vertical plane (group 1) or first in the vertical plane and then in the horizontal plane (group 2). All training and testing were performed with an augmented-reality laparoscopic simulator.
RESULTS 3 participants in each group did not complete the study. For group 1, scores for 3 of the 5 tasks were significantly worse when tested in the vertical plane than when tested in the horizontal plane. For group 2, scores for 2 of the 5 tasks were significantly worse when tested in the horizontal plane than when tested in the vertical plane. For 3 tasks, the difference in scores for the training versus orthogonal plane was significantly lower for group 2 than for group 1.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that basic laparoscopic skills acquired in 1 plane frequently did not transfer to the orthogonal plane. Because veterinary surgeons may be required to treat patients in various positions, development of laparoscopic training models to simulate the vertical plane is recommended.
OBJECTIVE To develop and validate a simulation model for laparoscopic ovariectomy in standing horses.
DESIGN Prospective cohort study.
SAMPLE 15 third-year veterinary students and 4 equine surgeons with experience in laparoscopy.
PROCEDURES A simulation model that mimicked laparoscopic ovariectomy in standing horses was developed. Face validity of the model was determined with a questionnaire completed by the equine surgeons. Construct validity was determined by comparing performance scores (based on time to completion and accuracy completing various operative tasks) for simulated laparoscopic ovariectomy performed in the model for the students with scores for the equine surgeons. Concurrent validity was assessed by comparing performance scores with scores obtained with the validated McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS).
RESULTS Questionnaire responses indicated that the simulation model replicated the operative experience to a high degree (face validity). Performance scores for simulated laparoscopic ovariectomy performed in the model were significantly different between the students and the equine surgeons (construct validity). Performance scores for the simulation model were significantly correlated with scores for the MISTELS (concurrent validity).
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the simulation model had face, construct, and concurrent validity, suggesting that it may be useful when training students to perform laparoscopic ovariectomy in standing horses.