Prospective Evaluation of Two Intracorporeally Sutured Prophylactic Laparoscopic Gastropexy Techniques Compared with Laparoscopic-Assisted Gastropexy in Dogs

Development and validation of a composed canine simulator for advanced veterinary laparoscopic training

The development of innovative simulation models for veterinary laparoscopic surgery training is a priority today. This study aimed to describe a didactic simulation tool for the training of total laparoscopic gastropexy (TLG) with intracorporeal sutures in dogs. CALMA Veterinary Lap-trainer composite simulator (CLVTS) was developed from a plaster cast of 2 Great Dane canines mimicking the space and the correct position to carry out a TLG. After video instruction, 16 veterinarians with different degrees of experience in minimally invasive surgery (Experts, n = 6 and intermediates, n = 10) evaluated four sequential simulating TLG with intracorporeal suturing in the CLVTS. Subsequently, they completed an anonymous questionnaire analyzing the realism, usefulness, and educational quality of the simulator. The CLVTS showed a good preliminary acceptance (4.7/5) in terms of the usefulness and adequacy of the exercises that, in the participants' opinion, are appropriate and are related to the difficulty of the TLG. In addition, both experienced and intermediate surgeons gave high marks (4.5/5) to the feeling of realism, design, and practicality. There were no significant differences between the responses of the two groups. The results suggest that the CVLTS has both face and content validity. Where it can be practiced in a structured environment for the development of a total laparoscopic gastropexy with intracorporeal suture and without compromising patient safety, but still has some limitations of the scope of the study. Further studies are needed to establish the ability to assess or measure technical skills, including the degree of transferability to the actual surgical environment.

Initial exploration of the discriminatory ability of the PetPace collar to detect differences in activity and physiological variables between healthy and osteoarthritic dogs

Background

Accelerometry has been used to evaluate activity in dogs with osteoarthritis (OA) pain, especially in relation to effect of treatment; however no studies have compared accelerometry-measured activity in dogs with OA-pain and healthy dogs. The aims of this study were to (1) compare activity output from the PetPace collar with the validated Actical monitor and (2) determine if PetPace collar outputs (overall activity, activity levels, body position, and vital signs) differed between healthy dogs and dogs with OA-pain.

Methods

This was an observational, non-interventional study in healthy dogs and dogs with OA-pain. All dogs were outfitted with the PetPace collar and the Actical monitor simultaneously for 14 days. Output from these devices was compared (correlations), and output from the PetPace device was used to explore differences between groups across the activity and vital sign outputs (including calculated heart rate variability indices).

Results

There was moderate correlation between the PetPace collar and Actical monitor output (R² = 0.56, p < 0.001). Using data generated by the PetPace collar, OA-pain dogs had lower overall activity counts and spent less time standing than healthy dogs. Healthy dogs spent more time at higher activity levels than OA-pain dogs. Certain heart rate variability indices in OA-pain dogs were lower than in healthy dogs.

Conclusions and clinical relevance

The results of this study suggest that the PetPace collar can detect differences between healthy dogs and those with OA-pain, and that OA-pain negatively impacts overall activity levels in dogs, and especially higher intensity activity.

A randomized controlled trial of three-dimensional versus two-dimensional imaging system on duration of surgery and mental workload for laparoscopic gastropexies in dogs

OBJECTIVE

To evaluate the effect of three-dimensional (3D) laparoscopy compared to two-dimensional (2D) laparoscopy when evaluating duration of surgery for canine intracorporeally sutured gastropexy.

STUDY DESIGN

Randomized controlled clinical trial.

ANIMALS

Thirty client-owned dogs.

METHODS

Dogs were randomized into 2D or 3D groups and underwent a three-port laparoscopic intracorporeally sutured incisional gastropexy with barbed suture. Procedures were performed by a single board-certified surgeon. Duration of surgery was recorded and workload was assessed immediately after surgery using the NASA Task Load Index (TLX).

RESULTS

Median duration of surgery was 3 min shorter for 3D versus 2D (95%CI -10 to 13; p = .51). Surgical component durations, total and component TLX scores, and intraoperative complications also did not differ between groups. In a subgroup analysis excluding the first eight cases due to presumption of a learning curve with suturing technique, total TLX score (p = .004) and all component scores were lower for 3D as compared to 2D laparoscopy, although duration of surgery did not differ (p = .20).

CONCLUSION

The use of 3D laparoscopy was not associated with shorter duration of surgery when compared to 2D laparoscopy.

CLINICAL SIGNIFICANCE

3D laparoscopy requires further investigation in veterinary medicine to determine its utility in decreasing surgical duration, surgical complications or surgeon mental or physical workload.

Evaluation of the FitBark Activity Monitor for Measuring Physical Activity in Dogs

Accelerometers track changes in physical activity which can indicate health and welfare concerns in dogs. The FitBark 2 (FitBark) is an accelerometer for use with dogs; however, no studies have externally validated this tool. The objective of this study was to evaluate FitBark criterion validity by correlating FitBark activity data to dog step count. Dogs (n = 26) were fitted with a collar-mounted FitBark and individually recorded for 30 min using a three-phase approach: (1) off-leash room explore; (2) human-dog interaction; and (3) on-leash walk. Video analysis was used to count the number of times the front right paw touched the ground (step count). Dog step count and FitBark activity were moderately correlated across all phases (r = 0.65, p < 0.001). High correlations between step count and FitBark activity were observed during phases 1 (r = 0.795, p < 0.001) and 2 (r = 0.758, p < 0.001), and a low correlation was observed during phase 3 (r = 0.498, p < 0.001). In conclusion, the FitBark is a valid tool for tracking physical activity in off-leash dogs; however, more work should be done to identify the best method of tracking on-leash activity.

Comparison of intra- and postoperative variables between laparoscopic and open ovariectomy in rabbits (Oryctolagus cuniculus)

OBJECTIVE

To compare intraoperative and short-term postoperative variables pertaining to laparoscopic ovariectomy (LapOVE) and open ovariectomy (OVE) in rabbits (Oryctolagus cuniculus).

ANIMALS

Twelve 4- to 5-month-old female New Zealand White rabbits.

PROCEDURES

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).

RESULTS

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.

Comparison of total laparoscopic gastropexy with the Ethicon Securestrap fixation device versus knotless barbed suture in dogs

BACKGROUND

This study evaluated the feasibility and efficacy of a laparoscopic absorbable fixation device (Securestrap) in total laparoscopic gastropexy in dogs susceptible to gastric dilatation-volvulus (GDV) compared to laparoscopic gastropexy performed with a barbed suture. We hypothesised that both techniques provide suitable gastropexy.

METHODS

The gastropexy was performed by straps (TLG-SS group, n = 6) or with a barbed suture (TLG-Vloc group, n = 6). The total surgery time, gastropexy time, the number of straps used and suture bites were recorded. Clinical and ultrasound investigations were performed during follow-up.

RESULTS

The total surgery time was 30 minutes in the TLG-SS, while it was 46.66 minutes in the TLG-Vloc. In the TLG-SS group, gastropexy time was 13 minutes, while 36.3 minutes in the TLG-Vloc. The number of straps employed in TLG-SS was 9, while seven bites were employed in TLG-Vloc. Linear regression analysis of gastropexy time versus the number of procedures was highly correlated (r² = 0.84) in the TLG-SS. Complications, clinical and ultrasound findings did not differ between the two techniques at 90 days post-surgery.

CONCLUSION

TLG-SS laparoscopic technique can be employed safely and effectively in less time and is associated with a relatively short learning curve, which could encourage the widespread use of prophylactic laparoscopic gastropexy.

Outcomes and Complications in a Case Series of 39 Total Laparoscopic Prophylactic Gastropexies Using a Modified Technique

Simple Summary

Gastric dilatation and volvulus is a very severe condition that is most commonly seen in large and giant deep-chested dogs, although any dog may be affected. Recently, an increasing number of breeders and owners have become aware of the benefits of prophylactic gastropexy. Many techniques have been developed to perform gastropexy, but laparoscopic surgery, having very low levels of morbidity and invasiveness, fits well with the concept of prevention. The aim of this study is to validate a rapid, modified total laparoscopic prophylactic gastropexy technique with a low rate of complications. The results show that this procedure is safe and effective. Using this technique, it is possible to respect animal welfare and prevent the development of a life-threatening syndrome.

Abstract

Laparoscopic-assisted, laparoscopic, and endoscopic gastropexy techniques have been proven successful in recent years. Thanks to minimal invasiveness, low morbidity, and fast recovery, total laparoscopic gastropexy techniques have been gaining popularity. The objective of this study was to describe the use of a modified minimally invasive technique to perform prophylactic gastropexy in dogs. A case series study of 39 client-owned dogs was undertaken from June 2019 to August 2020. Each dog underwent total laparoscopic prophylactic gastropexy using a simple continuous barbed suture line and two laparoscopic needle holders without incising the seromuscular layer of the stomach and the abdominal wall. Surgical time, the number of stitches, and the length of suture were recorded. Telephone checks, owner questionnaires, and ultrasonographic exams were used to evaluate the effectiveness of the procedure after surgery. The median gastropexy surgical time was 12 min (range 4–30 min), and the median length of the suture line was 3 cm (range 2–4 cm). The last follow-up check was carried out 9 months (mean, range 3–14 months) after surgery, and all ultrasonographic exams (n = 29) showed an intact gastropexy. Intraoperative and postoperative complications were noted. This total laparoscopic gastropexy technique was found to be safe, fast, simple, and with a low morbidity rate. It appears to be a new alternative to other methods of prophylactic gastropexy; however, further research in this area is warranted.

Absorbable fixation straps for laparoscopic gastropexy in dogs

OBJECTIVE

To evaluate the feasibility and efficacy of laparoscopic absorbable fixation straps (AFS) for laparoscopic gastropexy in dogs.

STUDY DESIGN

Cadaveric and prospective clinical study.

ANIMALS

Five dog cadavers for the cadaveric study; 12 dogs for the clinical study.

METHODS

The pyloric antrum was affixed to the abdominal wall laparoscopically by applying a series of straps. The cadaveric study assessed potential challenges during the procedure and stomach mucosal penetration. For the clinical study, the total duration of surgery, time to complete the gastropexy, and the number of straps used were recorded. Ultrasound evidence of adhesion, complications, and weight were monitored at 7, 30, and 90 days after surgery. Owner satisfaction was evaluated at the 6-month follow-up.

RESULTS

The total duration of surgery was 25.8 minutes (range, 19-39; SD, 6.7), and the time to complete the gastropexy was 10.1 minutes (range, 7-19; SD, 3.9). The linear regression analysis revealed an inverse correlation between the time to complete the gastropexy and the order of the surgeries (r²  = 0.75, P < .05). No complications were recorded. Ultrasound examination was used to confirm gastropexy at all follow-ups.

CONCLUSION

Laparoscopic gastropexy with AFS was performed in both cadavers and clinical animals with minimal complications. Persistent adhesion was demonstrated during ultrasound evaluations and in one postmortem evaluation.

CLINICAL SIGNIFICANCE

This novel laparoscopic technique can be employed safely, effectively, and reasonably quickly, and the learning curve is expected to be relatively short.

Novel use of an activity monitor to model jumping behaviors in cats

OBJECTIVE

To develop methods to identify and characterize activity monitor (AM) data signatures for jumps performed by cats.

ANIMALS

13 healthy, client-owned cats without evidence of osteoarthritis or degenerative joint disease.

PROCEDURES

Each cat was fitted with the same AM, individually placed in an observation room, then simultaneously recorded by 3 video cameras during the observation period (5 to 8 hours). Each cat was encouraged to jump up (JU), jump down (JD), and jump across (JA) during the observation period. Output from the AM was manually annotated for jumping events, each of which was characterized by functional data analysis yielding relevant coefficients. The coefficients were then used in linear discriminant analysis to differentiate recorded jumps as JUs, JDs, or JAs. To assess the model's ability to distinguish among the 3 jump types, a leave-one-out cross-validation method was used, and the misclassification error rate of the overall categorization of the model was calculated.

RESULTS

Of 731 jumping events, 29 were misclassified. Overall, the mean misclassification error rate per cat was 5.4% (range, 0% to 12.5%), conversely indicating a correct classification rate per cat of 94.6%.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that the model was successful in correctly identifying JUs, JDs, and JAs in healthy cats. With advancements in AM technology and data processing, there is potential for the model to be applied in clinical settings as a means to obtain objective outcome measures.

Biomechanical evaluation of an absorbable fixation strap for use in total laparoscopic gastropexy in dogs

OBJECTIVE

To compare load-to-failure results for laparoscopic absorbable fixation straps (AFSs) deployed at various angles and for AFSs versus absorbable knotless (barbed) suture when used in simulated total laparoscopic gastropexy (TLG) in specimens from cadaveric dogs.

SAMPLE

30 stomach and abdominal body wall specimens.

PROCEDURES

Specimens were assigned to 1 of 3 groups for use in simulated TLG constructs for comparisons of load-to-failure results for single AFSs deployed at 30°, 60°, or 90° (AFS-angle group; n = 10) or for a gastropexy span of 4 to 5 cm achieved with 3-0 absorbable knotless (barbed) monofilament suture applied in a simple continuous pattern (TLG-1; 10) versus 8 AFSs applied with a deployment angle > 30° (TLG-2; 10). A 1-way ANOVA was used to compare results among AFS deployment angles (30°, 60°, or 90°) and between TLG-1 and TLG-2.

RESULTS

Mean ± SD load to failure for the AFS-angle group was significantly higher for the AFS deployment angles of 60° (8.00 ± 3.90 N) and 90° (12.71 ± 8.00 N), compared with 30° (5.17 ± 1.90 N). However, no substantial difference was detected in the mean ± SD load to failure for TLG-1 (39.18 ± 7.1 N) versus TLG-2 (31.43 ± 10.86 N).

CONCLUSIONS AND CLINICAL RELEVANCE

Results of the present study supported the potential use of AFSs in gastropexy in dogs; however, prospective clinical research with adequate long-term follow-up is warranted before recommendations can be made.

A systematic review of complications related to laparoscopic and laparoscopic-assisted procedures in dogs

OBJECTIVE

To evaluate and report the quality of the scientific literature reporting complications associated with laparoscopic and laparoscopic-assisted procedures in client-owned or healthy research dogs and to report and illustrate laparoscopic complications related to individual organ systems.

STUDY DESIGN

Systematic review.

ANIMALS

Client-owned or healthy research dogs.

METHODS

A literature review was performed by using PubMed and CAB abstracts for English-language studies providing descriptions of complications related to laparoscopic and laparoscopic-assisted procedures in dogs. Study selection used PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment was performed by using a MINORS (Methodological Items for Non-Randomized Studies) scoring system and a grading scale of level of evidence. Descriptive statistics were used.

RESULTS

In total, 741 manuscripts were identified, with 64 manuscripts eligible for data extraction and quality assessment. The most represented organ system was the female genital tract, represented by 22 (34.4%) studies. The most commonly reported intraoperative and postoperative complications were related to abdominal entry and portal incisions, respectively. In 53 of 54 non-randomized studies, high risk of bias was found. Forty-eight (75%) studies provided level III or IV evidence.

CONCLUSION

This report provides an updated review of complications related to laparoscopic and laparoscopic-assisted procedures in dogs, classified by organ system. The overall quality of evidence was low, limiting direct comparison of complication rates between studies.

CLINICAL SIGNIFICANCE

There is a need for implementation of standardized criteria for defining complications, study time frames and greater numbers of high quality prospective randomized trials in veterinary laparoscopy to permit comparison of complication and conversion rates between published studies and across organ systems.

Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy versus combined laparoscopic ovariectomy and total laparoscopic gastropexy: A comparison of surgical time, complications and postoperative pain in dogs

The trend in laparoscopy is to develop easy and rapid techniques associated with reduced intraoperative complications and decreased postoperative pain. The aim of this study was to compare combined laparoscopic ovariectomy (OIE) and laparoscopic‐assisted incisional gastropexy (LAG) with combined laparoscopic OIE and total laparoscopic gastropexy (TLG) for surgical time, incidence of complications and postoperative pain. Twenty‐eight female dogs were randomly assigned to the LAG group (n = 14) or the TLG group (n = 14). All laparoscopic procedures were performed using a three‐port technique. The gastropexy was located 3 cm caudal to the 13th rib and 4 cm lateral to the rectus abdominis muscle. Surgical time (minutes [min]), intraoperative complications and postoperative complications were recorded. The Glasgow pain score (GPS) (short form) was calculated before surgery and at 1, 6, 12, 18 and 24 hr after extubation. Surgical time was significantly longer in the TLG group (48 ± 2 min) compared with the LAG group (39 ± 2 min). Minor postoperative complications occurred in both groups and included swelling (n = 2) and subcutaneous emphysema (n = 1). No significant differences regarding the GPS were recorded between groups. The GPS was significantly higher in both groups at 1 hr and 6 hr than before surgery. Two dogs in each group required rescue analgesia. Combined laparoscopic OIE and TLG require more time to perform than combined laparoscopic OIE and LAG. Neither procedure results in significant surgical complications. Postoperative pain for 24 hr was mild and comparable in both groups.

Paramedian incisional complications after prophylactic laparoscopy-assisted gastropexy in 411 dogs

OBJECTIVE

To determine the frequency and types of paramedian incisional complications after prophylactic laparoscopy-assisted gastropexy (LAG) in dogs and to evaluate potential risk factors for complications.

STUDY DESIGN

Multi-institutional retrospective study.

ANIMALS

Client-owned dogs (N = 411).

METHODS

Records for dogs that underwent single-incision-port laparoscopy-assisted gastropexy (SIPLAG) or multiple-port laparoscopy-assisted gastropexy (MPLAG) at five veterinary referral hospitals were reviewed. Information regarding signalment, surgical procedures, perioperative care, and incisional complications was collected. Follow-up information was obtained by review of medical records and/or communication with owners. Potential risk factors for complications were examined statistically.

RESULTS

Paramedian incisional complications were observed in 78 of 411 (19%) dogs. The most common complication was seroma formation, which occurred in 51 (12.4%) dogs. Surgical site infections were observed in 16 (3.9%) dogs, and dehiscence or development of excessive scar tissue at the incision site were each observed in nine (2.2%) dogs. Complications resolved with conservative treatment in 75 of 78 (96.2%) dogs and with surgical treatment in three of 78 (3.8%) dogs. The odds of complications were approximately twice as high in dogs undergoing SIPLAG than in dogs undergoing MPLAG (odds ratio, 2.03; P = .006).

CONCLUSION

Minor paramedian incisional complications, particularly seroma formation, were frequently observed after LAG. Most complications were successfully managed conservatively. Single-incision-port laparoscopy-assisted gastropexy was associated with a higher complication rate compared with MPLAG.

CLINICAL SIGNIFICANCE

Owners should be informed that there is a relatively high rate of minor paramedian incisional complications after LAG. The risk of complications appears to be higher for SIPLAG than for MPLAG.

Laparoscopic resection of bilateral perinephric pseudocyst in a pediatric feline patient

Case summary

A 6-month-old male domestic shorthair cat presenting with abdominal distension and an acute history of renal azotemia was diagnosed with bilateral perinephric pseudocysts and International Renal Interest Society (IRIS) grade 3 acute kidney injury. Ultrasound-guided drainage of the cysts was performed initially; bilateral subtotal resection of the perinephric pseudocysts was later performed using laparoscopy as a more long-term solution. There was no regrowth or reformation of the perinephric pseudocysts 1 year after the procedure, and the cat remained in IRIS stage 2 chronic kidney disease 1 year postoperatively.

Relevance and novel information

Compared with traditional surgical approaches, laparoscopic resection of perinephric pseudocysts provides a less invasive approach. Bilateral perinephric pseudocyst in a pediatric feline patient (and associated treatment) has not previously been documented in the literature.

Influence of length of incision and number of suture lines on the biomechanical properties of incisional gastropexy

OBJECTIVE

To determine the effect of the length of incision and of the number of suture lines on the load to failure of incisional gastropexy in an ex vivo model.

STUDY DESIGN

Ex vivo study.

SAMPLE POPULATION

Thirty-six hound-mix fresh canine cadavers.

METHODS

Specimens were randomly divided into four groups of incisional gastropexies varying in length of incision (2 or 4 cm) and number of suture lines (one or two). Load to failure was measured. Number of suture bites on each side of the gastropexy and number of inadvertent full thickness gastric suture bites were recorded.

RESULTS

Incisional gastropexies performed with one or two suture lines sustained loads to failure of 53.80 ± 12.10 N and 53.30 ± 10.60 N (P = .887), respectively. Loads to failure equal to 49.70 ± 10.80 N and 57.30 ± 10.60 N (P = .048) were measured on incisional gastropexies performed with 2- or 4-cm-suture lines, respectively. There was no interaction between the length of the incision and the number of suture lines (P = .634).

CONCLUSION

Length of incision but not number of suture lines influenced the biomechanical properties of gastropexies in this acute cadaveric model.

CLINICAL SIGNIFICANCE

According to this acute in vitro experiment, gastropexy can be performed with either one or two suture lines.

Simplified Minimally Invasive Surgical Approach for Prophylactic Laparoscopic Gastropexy in 21 Cases

The objective of this study was to describe the operative technique and outcome of a simplified laparoscopic gastropexy approach in dogs. Twenty-one dogs undergoing prophylactic laparoscopic gastropexy with a simple continuous barbed suture without incising the seromuscular layer of the stomach and transversus abdominis muscle were reviewed. In 20 cases, additional procedures were performed (18 ovariectomies and 2 prescrotal castrations); 1 dog had two prior episodes of gastric dilation without volvulus and underwent gastropexy with a prophylactic intent. The gastropexy procedure had a median duration of 33 min (range 19-43 min). V-Loc 180 absorbable and the V-Loc PBT nonabsorbable suturing devices were used in 8 and 13 dogs, respectively. Minor intraoperative complications occurred in four cases: broken suture (1), needle dislodgement (2), and folded needle (1). Minor complications included self-limiting wound complications (3), abdominal discomfort (2), vomiting (1), and inappetence (2). Postoperative abdominal ultrasound performed after a median of 8 mo (6-36 mo) confirmed permanent adhesion at the gastropexy site in all dogs. One dog developed a fistula (1 yr postoperatively) and another a granuloma (3 mo postoperatively), both at the gastropexy site. Prophylactic laparoscopic gastropexy may be performed with knotless unidirectional barbed suture without creating an incision on the abdominal wall and stomach.

Initial evaluation of PetPace activity monitor

Mobility is considered a vital component of health and quality of life in humans and companion animals. Wearable devices for pets that can monitor activity and other aspects of health are increasingly being marketed to veterinarians and owners, with claims around their ability to monitor aspects of health. However, there is little scientific evidence to support the validity of these claims. To address this, the objective of this study was to assess the correlation of the activity measurement from the PetPace device compared to activity output from Actigraph and the validated Actical device. Ten client-owned, healthy dogs were used for the study. The three devices were mounted simultaneously on a dedicated collar and activity was recorded during a period of 7 days. There were moderate correlations between the Actical and the PetPace (r²=0.59, P=<0.001). There was high correlation between the PetPace and the Actigraph (r²=0.85, P=<0.001) and between the Actical and the Actigraph (r²=0.72, P=<0.001). If the Actical activity counts were limited under 50,000 per hour, there was strong correlation between the Actical and the PetPace (r²=0.71, P=<0.001) and between the Actical and the Actigraph (r²=0.86, P=<0.001). PetPace has a moderate correlation with the most validated activity monitor that has been used in veterinary medicine. Its real-time data acquisition, user friendly interface for owners and cost make this device an attractive tool for monitoring activity in dogs. Further studies maybe needed to evaluate its performance, validity and clinical utility in the field.

Effect of Laparoscopic-assisted Gastropexy on Gastrointestinal Transit Time in Dogs

Background

Prophylactic gastropexy has been promoted as a means of preventing gastric volvulus during gastric dilatation and volvulus (GDV) syndrome. Little is known about the impact of gastropexy on gastrointestinal transit time.

Hypothesis

Laparoscopic‐assisted gastropexy (LAG) will not alter gastrointestinal transit times when comparing gastric (GET), small and large bowel (SLBTT), and whole gut transit times (TTT) before and after surgery.

Animals

10 healthy client‐owned large‐breed dogs.

Methods

Prospective clinical trial. Before surgery, all dogs underwent physical examination and diagnostic evaluation to ensure normal health status. Dogs were fed a prescription diet for 6 weeks before determination of gastrointestinal transit with a wireless motility capsule. LAG was then performed, and dogs were fed the diet for 6 additional weeks. Measurement of transit times was repeated 6 weeks after surgery.

Results

Ten dogs of various breeds at‐risk for GDV were enrolled. No complications were encountered associated with surgery or capsule administration. There were no significant differences in GET 429 [306–1,370] versus 541 [326–1,298] (P = 0.80), SLBTT 1,243 [841–3,070] versus 1,540 [756–2,623] (P = 0.72), or TTT 1,971 [1,205–3,469] versus 1,792 [1,234–3,343] minutes (median, range) (P = 0.65) before and after LAG.

Conclusions and Clinical Importance

An effect of LAG on gastrointestinal transit time was not identified, and wireless motility capsule can be safely administered in dogs after LAG.

Comparison of laparoscopic gastropexy performed via intracorporeal suturing with knotless unidirectional barbed suture using a needle driver versus a roticulated endoscopic suturing device: 30 cases

OBJECTIVE

To compare two suturing techniques for prophylactic laparoscopic gastropexy in healthy dogs.

STUDY DESIGN

Retrospective case series.

ANIMALS

Thirty healthy client-owned dogs from breeds predisposed to gastric dilation volvulus.

METHODS

Medical records of dogs presented for prophylactic laparoscopic gastropexy performed with knotless unidirectional barbed suture were reviewed. Dogs were grouped based on the device used for suturing, consisting of an endoscopic needle driver (END) vs an endoscopic suturing device (ESD). Signalment, weight, surgery time, number of suture bites per side of gastropexy, and intraoperative complications were compared between groups.

RESULTS

The END group consisted of 10 dogs, with a median age of 1.09 years (range 0.5-2.67), weight of 41.5 kg (range 25-66), surgical time of 49.5 minutes (range 35-77), and a median of 5 suture bites per side (range 4-6). The ESD group included 20 dogs, with a median age of 1.75 years (range 0.6-8.75, P = .0944), weight was 37.5 kg (range 20-62, P = .5823), surgical time of 55 minutes (range 30-76, P = .808), and a median of 6 suture bites for the first side (range 4-7, P = .072) and 7 for the second side (range 4-8, P = .003). No major complications and no conversion to open celiotomy occured in either group. Minor complications occurred in 3 dogs in the ESD group, all related to device dysfunction and suture breakage.

CONCLUSION

Laparoscopic gastropexy may be performed effectively with either of these suturing techniques.

Evaluation of the economic and clinical feasibility of introducing rigid endoscopy and laparoscopy to a small animal general practice

OBJECTIVE To evaluate the economic and clinical feasibility of introducing rigid endoscopy and laparoscopy to a small animal general practice. DESIGN Prospective study. SAMPLE A single 2-veterinarian small animal practice in southern California. PROCEDURES In early 2012, endoscopic equipment was purchased, and both veterinarians in the practice undertook training in rigid endoscopic and laparoscopic procedures. Subsequently, information for client-owned animals that underwent endoscopic and laparoscopic procedures during a 12-month period (2012 to 2013) was collected. Cost of equipment and training, revenue generated, specific procedures performed, surgery time, complications, and client satisfaction were evaluated. RESULTS 78 endoscopic procedures were performed in 73 patients, including 71 dogs, 1 cat, and 1 rabbit. Cost of endoscopic and laparoscopic equipment and training in the first year was $14,809.71; most equipment was financed through a 5-year lease at a total cost of $57,507.70 ($ 10,675.20/y). Total revenue generated in the first year was $50,423.63. The most common procedures performed were ovariectomy (OVE; n = 49), prophylactic gastropexy (6), and video otoscopy (12). Mean ± SD surgery times for OVE (n = 44) and for OVE with gastropexy (5) were 63.7 ± 19.7 minutes and 73.0 ± 33.5 minutes; respectively. Twelve of 54 patients undergoing laparoscopic procedures experienced minor intraoperative complications. Conversion to laparotomy was not required in any patient. There were no major complications. All 49 clients available for follow-up were satisfied. CONCLUSIONS AND CLINICAL RELEVANCE With appropriate training and equipment, incorporation of basic rigid endoscopy and laparoscopy may be feasible in small animal general practice. However, results of the present study are not applicable to all veterinarians and practice settings, and patient safety considerations should always be paramount.

Laparoscopic Gastropexy Using Knotless Unidirectional Suture and an Articulated Endoscopic Suturing Device: Seven Cases

OBJECTIVE

To describe a technique for laparoscopic incisional gastropexy using an articulated endoscopic suturing device with knotless unidirectional barbed suture in healthy large breed dogs.

STUDY DESIGN

Prospective case series.

ANIMALS

Healthy client-owned dogs presented for prophylactic gastropexy and weighing >20 kg (n=7).

METHODS

Incisional gastropexy was performed using a single port access system with an articulated endoscopic suturing device. An additional 5 mm cannula was placed in the right caudal abdomen. A 2-0 knotless unidirectional barbed suture was used to complete the gastropexy with 2 separate simple continuous suture lines. All dogs underwent a focal abdominal ultrasound to evaluate the gastropexy site 3-12 months postoperatively.

RESULTS

Median weight of the dogs was 33.5 kg (range, 20-51 kg) and the median age was 2 years (range, 0.6-8.5 years). Median surgical time was 60 minutes (range, 39-88). The articulated suturing device malfunctioned twice. On abdominal ultrasound between 3 and 12 months, all gastropexy sites were intact. No motion was detected between the stomach and body wall during distal antral contractions or respiratory motion and a focal thickening of the gastric wall was present in dog. No complications were reported in the postoperative periods as of the 2 week suture removal visit or as of the time of their ultrasound appointment.

CONCLUSION

This technique using an endoscopic articulated suturing device with a knotless unidirectional barbed suture provides a feasible technique to perform laparoscopic gastropexy.

Laparoscopic Cholecystoduodenostomy in Dogs: Canine Cadaver Feasibility Study

OBJECTIVE

To evaluate the feasibility of laparoscopic cholecystoduodenostomy in canine cadavers using barbed self-locking sutures.

STUDY DESIGN

In vivo experimental study.

ANIMALS

Fresh male Beagle cadavers (n=5).

METHODS

Surgery was performed by a single veterinary surgeon. Dogs were placed in dorsal recumbency and 15° reverse Trendelenburg position. The surgical procedure was performed with four 5 mm entry ports and a 5 mm 30° telescope. The cholecystoduodenostomy technique included dissection, incision of the gallbladder, and lavage, followed by gallbladder transposition over the duodenum, incision of the duodenum, and anastomosis. The latter was performed with a 4-0 barbed self-locking suture (V-Loc^® 180). Subsequently, a leak test was performed by submerging the anastomosis in saline and insufflating air into the duodenum through a catheter. Total operative time and completion times for each procedural step were recorded.

RESULTS

The median total operative time was 151 minutes (range, 129-159). One conversion to open surgery occurred because of vascular hemorrhage. The 3 longest intraoperative steps were posterior wall anastomosis, gallbladder dissection, and anterior wall anastomosis. Intraoperative anastomotic leakage sites were identified in 3 of 5 dogs. Leaks were managed by placement of a single reinforcing conventional intracorporeal suture, which was adequate to obtain a watertight anastomosis.

CONCLUSION

This technique cannot be recommended in clinical practice until further studies are performed and the technique is further refined.

Description and Biomechanical Comparison of a Percutaneous Radiologic Gastropexy Technique in a Canine Cadaver Model

OBJECTIVE

To describe a novel percutaneous radiologic gastropexy (PRG) technique in a canine model and to biomechanically compare this technique to open incisional gastropexy (OIG) and laparoscopic-assisted incisional gastropexy (LAG).

STUDY DESIGN

Randomized ex vivo biomechanical study.

ANIMALS

Canine cadavers.

METHODS

Fifteen cadavers were randomized to 1 of 3 surgical interventions: OIG, LAG, and PRG. For the PRG procedure, the stomach was distended with air, and a preloaded T-fastener device was utilized to attach the stomach to the body wall with fluoroscopic-guidance. The procedural times of the 3 techniques were recorded. After completion of the procedure, the stomach and body wall overlying the stomach wall were harvested and the maximum tensile strength of the gastropexies was determined.

RESULTS

The maximal tensile strength was not significantly different between groups. The total procedural time for the PRG procedure (5 minutes) was significantly shorter than both OIG (28 minutes) and LAG (20 minutes) procedures.

CONCLUSION

The PRG technique described in this study demonstrated a similar maximal tensile strength to commonly employed gastropexy techniques (OIG and LAG) in an acute canine model. Additionally, the PRG procedure was significantly faster to perform. The clinical relevance of this technique will be determined by further study to assess the applicability and efficacy of this procedure in clinical patients by determining the likelihood of adhesion development and the ability of the adhesion to prevent gastric volvulus.

Laparoscopic-Assisted Surgical Procedures

Laparoscopic-assisted procedures allow a balance between the improved patient recoveries often associated with smaller incisions and the need for appropriate visualization of visceral organs/identification of lesions. The organ systems of small animal veterinary patients that are highly amenable to laparoscopic-assisted procedures include the urinary bladder, the gastrointestinal tract, and the reproductive tracts. Laparoscopic-assisted procedures are especially beneficial in the approach to luminal organs, allowing the organ incision to be exteriorized through the body wall, protecting the peritoneal cavity from contamination from luminal contents. Procedure-specific morbidities and patient selection should be considered when choosing between assisted laparoscopic and open approaches.

Experimental laparoscopic pyloromyotomy in pigs

The objective of this study was to evaluate and compare laparoscopic pyloromyotomy methods involving the laparoscopic scalpel and the harmonic scalpel in pigs. The experiment was conducted on 4 subgroups of 12 animals subjected to laparoscopic-assisted pyloromyotomy with a surgical scalpel and the harmonic scalpel, as well as laparoscopic pyloromyotomy with Berci's laparoscopic scalpel and the harmonic scalpel. No postsurgical complications were observed. Four weeks after the surgery, the animals were sacrificed and autopsy was performed. In one animal peritoneal adhesions between the intestines and the mini-laparotomy incision were found. Laparoscopic pyloromyotomy and laparoscopic-assisted pyloromyotomy performed in pigs enabled the selection of laparoscopic entry sites, instruments for pyloromyotomy and evaluation of the applied surgical procedures in animals. The results of this study indicate that the methods applied can be safely used in clinical practice in dogs and cats due to minimal post-operative complications and fast healing of laparoscopic incisions in comparison with classical surgical wounds, and that the harmonic scalpel is a safe surgical instru- ment.

Ex vivo biomechanical comparison of V-LOC 180® absorbable wound closure device and standard polyglyconate suture for diaphragmatic herniorrhaphy in a canine model

OBJECTIVE

To compare 2-0 polyglyconate barbed suture (V-LOC™ 180 Absorbable Wound Closure Device, Covidien, Mansfield, MA) to standard 2-0 monofilament absorbable polyglyconate suture (Maxon™, Covidien) for maximum load to failure and failure mode when used to appose standardized defects in canine diaphragm muscle.

STUDY DESIGN

Randomized, cadaveric ex vivo mechanical testing.

SAMPLE POPULATION

Canine cadaveric hemi-diaphragmatic specimens (n = 32 pairs).

METHODS

Thirty-two cadaveric diaphragm specimens were collected and divided to obtain 64 muscle specimens (9 cm × 4 cm). Paired specimens were bisected in the midpoint of their 9 cm length in the direction of the muscle fibers and apposed using either 2-0 polyglyconate or 2-0 barbed polyglyconate (V-LOC™ 180 Absorbable Wound Closure Device) in a simple continuous pattern. Increasing tension was applied perpendicular to the suture line until specimen failure. Failure mode and maximum load to failure were recorded for each specimen.

RESULTS

Mean ± SD failure load of simulated herniorrhaphies performed with barbed polyglyconate suture (54.5 ± 10.27 N) was not significantly different than repair with polyglyconate (56.9 ± 10.87 N). Failure mode for both construct types was suture tear out rather than suture failure.

CONCLUSIONS

Clinical application of 2-0 barbed polyglyconate suture can be considered as an alternative to the use of 2-0 polyglyconate for diaphragmatic herniorrhaphy.

The future: taking veterinary laparoscopy to the next level

PRACTICAL RELEVANCE

Laparoscopic surgery minimizes tissue trauma and speeds recovery, but its uptake into veterinary clinical practice has been slow.

CLINICAL CHALLENGES

Laparoscopy is distinctly different from traditional open surgery and a reduced working area and loss of depth perception are among the challenges that the surgeon must get to grips with. Indeed, it is often lack of the necessary skills, rather than the cost of equipment, that presents the greatest obstacle.

AUDIENCE

This article is aimed at practitioners keen to embrace minimally invasive surgery and advises on how to develop excellence in laparoscopic skills. It makes the case for simulation training and outlines methods that can be instituted in practice at low cost and with comparatively little time expenditure. It also describes technological advances that have already increased the success of veterinary 'keyhole' surgery, as well as those that look promising for the future.

EVIDENCE BASE

Simulation training has been an intense area of research and publication within the past 15 years. This article draws on that evidence base and the experience gained by the author and her research team, which is at the forefront of efforts to develop laparoscopic training for veterinarians.

Laparoscopic colopexy in dogs

Colopexy was accomplished in eight healthy mixed-breed dogs by use of a 3-portal laparoscopic technique without major intraoperative and postoperative complications. A permanent adhesion between the colon and the abdominal wall was observed. Concentrations of acute-phase C-reactive protein (CRP) were measured in serum as a marker of systemic inflammation postoperatively, and no relevant increase in CRP concentrations was found.

Diagnostic accuracy of tissue impedance measurement interpretation for correct Veress needle placement in feline cadavers

OBJECTIVE

To determine the diagnostic accuracy of tissue impedance measurement interpretation (TIMI) for determining correct versus incorrect Veress needle placement in feline cadavers.

STUDY DESIGN

Prospective, randomized, blinded trial.

STUDY POPULATION

Cat cadavers (n = 24).

METHODS

Two laparoscopists (1 experienced, 1 novice), blinded to TIMI, placed reusable Veress needles in study subjects in a randomized order. A third individual interpreted impedance measurements as consistent with correct versus incorrect placement. Veress needle tip locations were marked by injecting contrasting colors of India ink. Tissue dissection was performed to localize ink. Sensitivity, specificity, accuracy, precision, and kappa statistics for TIMI for placements by the experienced and novice laparoscopist were determined. P < .05 was considered significant.

RESULTS

TIMI identified 36/38 correct and 2/10 incorrect placements. TIMI identified 2/2 bowel perforations but was unable to identify 8 inappropriate placements in the retroperitoneal fat pad. Impedance measurement interpretation had 94.7% sensitivity, 20% specificity, 79.2% accuracy, and 81% precision overall. Agreement between TIMI and Veress needle location was absent (kappa = -0.15, P = .01) for placements by the experienced laparoscopist and substantial (kappa = 0.78, P < .01) for the novice laparoscopist.

CONCLUSIONS

Failure of TIMI to identify placement in the retroperitoneal fat pad resulted in poor accuracy. Small cat size limited the number of appropriate placement sites, perhaps resulting in excessively dorsal placements. Use of TIMI may increase detection of clinically significant inappropriate Veress needle placements, like bowel perforations, and decrease installment phase complications. Further evaluation of Veress needle placement with and without TIMI is warranted.