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- Author or Editor: Claude A. Ragle x
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Abstract
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.
Abstract
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.
Design—Evaluation study.
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.
Abstract
CASE DESCRIPTION 2 fillies, aged 3 months and 1 month, were examined because of urinary incontinence and urine scalding.
CLINICAL FINDINGS In horse 1, ultrasonography did not reveal any structural abnormalities of the kidneys; however, unilateral ureteral ectopia was diagnosed cystoscopically. In horse 2, CT revealed bilateral nephropathy, bilateral distended ureters (up to 3.6 cm in diameter), and bilateral ureteral ectopia. Cystoscopy revealed intramural ureteral ectopia with abnormally caudally positioned ureteral ostia in both horses.
TREATMENT AND OUTCOME Ureteral ostioplasty was performed under cystoscopic guidance. Laparoscopic scissors (horse 1) or a vessel-sealing device (horse 2) was introduced, and the tissue separating the intramural portion of the ureter from the urethra and bladder was cut longitudinally in a cranial direction toward the trigone. After surgery, both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 20 and 9 months for horse 1 and horse 2, respectively.
CLINICAL RELEVANCE Cystoscopically guided ureteral ostioplasty provided an effective and minimally invasive surgical treatment option for correction of ureteral ectopia in 2 fillies.
Abstract
Case Description—A 4-year-old castrated Arabian horse was evaluated for a history of a right-sided nonstrangulating inguinal hernia that was manually reducable.
Clinical Findings—Physical examination revealed a right-sided hydrocele and bilateral enlargement of the inguinal rings detectable by both external digital and rectal palpation.
Treatment and Outcome—Biportal laparoscopic internal inguinal ring closure was performed with a continuous suture line of unidirectional barbed suture applied with a mechanical suturing instrument. The barbed suture contributed to a secure closure with the added benefit of not requiring knots to be tied at either the beginning or end of the suture line. Follow-up physical examination and laparoscopy confirmed healing of the surgical sites and a reduction in size of the inguinal rings. The horse exercised for 20 months following surgery without recurrence of the inguinal hernia.
Clinical Relevance—In horses, laparoscopic application of unidirectional barbed sutures should be considered among the treatment options for recurrent inguinal herniation. This technique was accomplished with only 2 portals/side, in contrast to the additional 3 to 4 portals that are most commonly required. The use of a barbed suture with a mechanical suturing instrument offered added security to the closure. The difficulties of dual instrument suturing and intracorporeal knot tying were eliminated, dramatically reducing the challenges of performing suture reduction of the internal inguinal ring.
Abstract
Case Description—An 18-year-old Paint stallion (horse 1) and a 17-year-old Morgan gelding (horse 2) were evaluated because of an acute onset of severe unilateral forelimb lameness.
Clinical Findings—Both horses were unable to bear weight on the affected forelimb and had a dropped elbow appearance. Radial nerve paralysis, triceps myopathy, and fractures of the humerus and ulna were ruled out. The caudal aspect of the affected antebrachium of each horse was very firm to palpation and became firmer when weight was shifted onto the limb. Ultrasonographic examination revealed swelling and suspected intramuscular hemorrhage of the caudal antebrachial muscles. On the basis of clinical examination and diagnostic imaging findings, both horses had antebrachial compartment syndrome diagnosed. Lameness did not substantially improve with medical treatment in either horse.
Treatment and Outcome—Caudal antebrachial fasciotomy was performed in each horse. Following sedation and local anesthetic administration, a bistoury knife was inserted through small incisions to perform fasciotomy. Horses remained standing throughout the procedure and were immediately able to bear weight on the affected limb without signs of discomfort. Horse 1 developed colitis and horse 2 developed a mild incisional infection, but both fully recovered and returned to their previous activities.
Clinical Relevance—Antebrachial compartment syndrome is a rare cause of severe unilateral forelimb lameness and should be considered as a differential diagnosis in horses with a dropped elbow appearance. Both horses of this report had a successful outcome following antebrachial fasciotomy.
Abstract
Objective—To compare laparoscopic skills among veterinarians before and after undertaking 1 of 2 programs of simulation training.
Design—Evaluation study.
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.
Abstract
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.
Abstract
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.
Abstract
Case Description—An 11-year-old Arabian gelding was evaluated for hematuria, stranguria, and pollakiuria that had been observed for 1 week.
Clinical Findings—Transrectal palpation revealed a 5-cm firm round mass in the urinary bladder. Cystoscopy and transrectal ultrasonography confirmed the diagnosis of urinary bladder urolithiasis.
Treatment and Outcome—A multiportal transparalumbar fossa laparoscopic approach was selected for cystotomy and urolith removal. Cystotomy and urolith removal was performed with sedation and local anesthesia with the horse standing. No perioperative complications were observed. Urination returned to normal 5 days after surgery. The horse returned to its previous level of activity at 3 weeks after surgery.
Clinical Relevance—Findings suggested that minimally invasive transparalumbar fossa laparoscopic approach can be successfully used for cystotomy and urolith extraction in standing horses; this avoids the disadvantages of conventional laparocystotomy for removal of large uroliths in male equids and the potential complications of general anesthesia and recovery. The technique provided excellent viewing and access to the bladder, permitting extraction of the urolith and secure closure of the cystotomy with minimal tension and tissue trauma to the bladder.
