The effect of laparoscopic versus open ovariectomy on postsurgical activity in small dogs

Laparoscopy and thoracoscopy in small animal surgery: A 2020 survey of small animal diplomate and resident veterinary surgeons

OBJECTIVE

To document the utilization and training of laparoscopic and thoracoscopic minimally invasive surgery (MIS) techniques within the American, European, Australian and New Zealand Colleges of Small Animal Veterinary Surgeons (ACVS, ECVS, and ANZCVS) in 2020.

STUDY DESIGN

Observational study.

SAMPLE POPULATION

Diplomates and residents of the ACVS, ECVS, and FANZCVS.

METHODS

An electronic survey was sent using veterinary list servers. Questions were organized into categories evaluating (1) the demographics of the study population and the caseload, (2) comfort level with specific procedures, (3) motivating factors and limitations, and (4) surgical training and the role of the governing bodies.

RESULTS

Respondents included 111 practicing surgeons and 28 residents. Respondents' soft-tissue MIS caseloads had increased since they first started performing MIS; however, most respondents were only comfortable performing basic laparoscopy. Over half of the respondents agreed on the patient benefits and high standard of care provided by MIS. Perceived adequate soft-tissue training in MIS during residency was strongly associated with perceived proficiency at the time of survey response. Most respondents agreed that the specialty colleges should take a more active role in developing standards for soft-tissue MIS, with residents agreeing that a required standardized course would be beneficial.

CONCLUSION

Soft-tissue MIS is widely performed by diplomates and residents. Perceived adequate soft-tissue MIS training was strongly associated with perceived proficiency.

CLINICAL SIGNIFICANCE

There is substantial underutilization of advanced MIS techniques in veterinary specialty surgical practice, which might be improved by a stronger focus on MIS training during residency.

Postoperative pain in dogs undergoing either laparoscopic or open ovariectomy

A prospective, quasi-experimental, clinical trial was performed to assess acute postoperative pain in healthy female dogs following elective ovariectomy by either laparoscopy (n=13) or laparotomy (n=14). Pain was assessed by both a veterinarian at the hospital, and by the owner once the patient was discharged. The Spanish version of the short form of the Glasgow Composite Measuring Pain Scale (CMPS-SF) was used. Pain scores were assessed by the veterinarian preoperatively and at 1, 2, 4, and 6h after extubation, whilst owner-assessed scores were performed preoperatively and at postoperative days 0, 1, 2, 3, 5 and 7. Data were compared with Mann-Whitney-U test. Veterinarian-assessed CMPS-SF scores were different between both groups at all postoperative times but not at baseline, being below 6/24 in all dogs in the laparoscopy group, but equal to or greater than 6/24 in the laparotomy group at 1h (n=12), and 4h (n=4) (P<0.001 and P=0.029, respectively). There were also differences in pain scores between both groups at 2h (P=0.012) and 6h (P=0.007), being below 6/24 in all of them. However, there were no differences in owner assessments between groups. In conclusion, ovariectomy performed by laparoscopy induced lower pain scores that were below the pain threshold set by the CMPS-SF during the first 6h postoperatively. After discharge, and up to one week later, ongoing owner-assessed scores suggest no pain was induced with neither of the techniques. Owners were proactive allowing real-time pain assessment to be reported. The development and validation of instruments for acute pain assessment by owners is warranted, as these tools are currently lacking.

Effect of preoperative ondansetron on postoperative nausea in healthy dogs undergoing laparoscopic gastropexy and castration

OBJECTIVE

To investigate if preoperative ondansetron reduces postoperative nausea associated with laparoscopic gastropexy and castration in dogs.

STUDY DESIGN

Prospective clinical study.

ANIMALS

Twenty client-owned, healthy male dogs.

METHODS

Dogs were premedicated with dexmedetomidine (2-5 mcg kg-1) and methadone (0.2-0.5 mg kg-1) intramuscularly. General anesthesia was induced with propofol and maintained with an inhalant anesthetic agent. Dogs were randomized into group S (saline 0.1 mL kg-1, intravenously) or group O (ondansetron 0.2 mg kg-1, intravenously). Plasma and serum were collected before premedication and 3 hours postextubation to measure arginine vasopressin (AVP) and cortisol concentrations. Nausea scoring occurred before and 10 minutes after premedication, immediately after extubation, and at 1, 2 and 3 hours postextubation. Data were analyzed by mixed and split-plot anova with Bonferroni adjustment for the number of group comparisons. Significance was set at p < 0.05.

RESULTS

Nausea scores increased over time at 1 (p = 0.01) and 2 (p < 0.001) hours postextubation in both groups compared with before premedication. Median nausea score (0-100 mm) for groups S and O before premedication were 2.5 and 0.5 mm, respectively. At 1 and 2 hours postextubation, group S scored 7.5 and 4.0 mm and group O scored 6.0 and 5.0 mm, respectively. No significant differences in nausea scores within or between groups were observed before premedication and 3 hours postextubation. Cortisol concentrations increased significantly 3 hours postextubation in both groups (p < 0.001) compared with before premedication, with no differences between groups. AVP concentrations showed no significant differences within or between groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Preoperative intravenous administration of ondansetron (0.2 mg kg-1) did not impact postoperative nausea after laparoscopic gastropexy and castration. Investigation of higher doses of ondansetron on the incidence of postoperative nausea and vomiting in dogs after surgery is warranted.

Feasibility of laparoscopic stapled partial cystectomy in canine cadavers

OBJECTIVE

To describe a technique for laparoscopic partial cystectomy and evaluate sealing of canine urinary bladder tissue with an endoscopic stapler.

STUDY DESIGN

Prospective, cadaveric study.

SAMPLE POPULATION

Eleven canine cadavers.

METHODS

Laparoscopic partial cystectomy was performed with an endoscopic gastrointestinal anastomosis (GIA) stapler. Leak testing and urodynamic evaluation was performed to measure intravesical pressure at initial leakage and catastrophic failure or the maximum pressure at which intravesical pressure plateaued. Surgical time, complications, and site of leakage were also recorded.

RESULTS

Laparoscopic partial cystectomy was successfully performed in 10 of 11 cadavers. Median procedure time was 13.6 min (10.1-15.2 min). Median intravesical pressure at initial leakage was 31 mmHg (28-56 mmHg) with a median increase from initial pressure of 15 mmHg (11-37 mmHg). No catastrophic failure of the cystectomy site was observed during leak testing. Intravesical pressure plateaued at a median of 52 mmHg (39-73 mmHg), which was a median of 13 mmHg (8-23 mmHg) higher than intravesical pressure at initial leakage. The median total volume infused at the time of plateau of intravesical pressure was 89 mL (58-133 mL).

CONCLUSION

Laparoscopic stapled partial cystectomy was feasible in canine cadavers. Endoscopic GIA staplers appear to seal the canine urinary bladder with minimal leakage.

CLINICAL SIGNIFICANCE

Use of an endoscopic GIA stapler may provide a minimally invasive option for partial cystectomy in dogs. Further evaluation for application to clinical cases is warranted.

Intraoperative and early postoperative pain in cats that underwent ovariohysterectomy using a spay hook: a randomised, masked, experimental study

BACKGROUND

This study aimed to compare the feasibility and practicality of the ovariohysterectomy (OHE) technique in cats with or without a spay hook with respect to the incision size, surgical time, surgical variables, and intra- and postoperative pain. Twenty-nine female cats underwent OHE using a spay hook (spay hook group [SHG], n = 15) or without using a spay hook (control group [CG], n = 14) to achieve the ovaries and cervix. Physiological parameters were monitored during the intraoperative period, and postoperative pain was assessed using a multidimensional composite and visual analogue pain scales.

RESULTS

The SHG had a significantly shorter operative time than the CG. The variables in the intraoperative period showed no statistically significant difference between both groups, as well as the early postoperative pain.

CONCLUSIONS

Less invasive OHE using a spay hook could potentially be a viable and feasible technique when performed by an inexperienced surgeon with appropriate training, especially in sterilisation campaigns, reducing the time to perform the procedure and increasing the number of animals spayed per time.

Using complete blood count-derived inflammatory markers to compare postoperative inflammation in dogs undergoing open or laparoscopic ovariectomy

BACKGROUND

The inflammatory response triggered in dogs after laparoscopic ovariectomy (LapOV) or ovariectomy through mini-celiotomy (COV) has never been compared using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic inflammatory index (SII).

METHODS

Bitches underwent LapOV (n = 25) or COV (n = 25). NLR, PLR and SII were calculated 1 hour before ovariectomy (T0) and 2-3, 6-8 and 20-24 hours (T1-T3) after surgery.

RESULTS

Surgical time was longer in the LapOV group. Changes over time were observed in the NLR, PLR and SII in both groups (p < 0.001). PLR at baseline and T1 (p = 0.03 and 0.01) and NLR, PLR and SII at T2 (p = 0.01, 0.01 and 0.009) were higher in the LapOV group than in the COV group, but they did not differ at T3.

LIMITATIONS

The overrepresentation of Greyhounds in the LapOV group and the short-term follow-up are the study's main limitations.

CONCLUSION

Although an inflammatory peak was observed 6-8 hours after COV or LapOV, it was higher after the laparoscopy. However, there was no difference in the bitches' inflammatory status 24 hours after surgery.

A 20-year scoping review of the veterinary interventional radiology and interventional endoscopy literature (2000-2019)

BACKGROUND

Interventional radiology (IR) and interventional endoscopy (IE) have broad potential for minimally invasive therapy in veterinary patients, but the scope of original peer-reviewed veterinary IR/IE research publications has not been described.

OBJECTIVES

Catalogue published applications and indications for noncardiac therapeutic IR/IE in animals and describe type and quality of veterinary IR/IE research over 20 years.

METHODS

Highly-cited veterinary journals were searched to identify articles published 2000 to 2019 involving therapeutic IR/IE applications for clinical veterinary patients. Articles were assigned a level of evidence (LOE) according to published standards. Authorship, animal data, study design, and interventions were described. Change in publication rate, study size, and LOE of IR/IE articles over time was analyzed.

RESULTS

One hundred fifty-nine of 15 512 (1%) articles were eligible, including 2972 animals. All studies were low LOE and 43% were case reports with ≤5 animals. Number of IR/IE articles per year (P < .001), proportion of journals' articles pertaining to IR/IE (P = .02), and study size (P = .04) all increased over time, but LOE (P = .07) did not. Common target body systems were urinary (40%), digestive (23%) respiratory (20%), and vascular (13%). Common indications were nonvascular luminal obstructions (47%), object retrieval (14%), and congenital anomalies (13%). Most procedures involved indwelling medical devices or embolic agents, whereas tissue resection and other procedures were less common. Procedures utilized fluoroscopy (43%), endoscopy (33%), ultrasound (8%), digital radiography (1%), or fluoroscopy in combination with other modalities (16%).

CONCLUSIONS

Treatments involving IR/IE have wide applicability in veterinary medicine but large, rigorous, and comparative studies describing these procedures are lacking.

Premedication with acetazolamide: Is its use for postoperative pain and stress control after laparoscopic ovariectomy in dogs ruled out?

BACKGROUND

Studies in human medicine have concluded that acetazolamide reduces pain associated with carbon dioxide insufflation during laparoscopic surgery. However, there are no published reports regarding the use of acetazolamide for this purpose in companion animals, despite the increasing popularity of laparoscopic techniques in veterinary medicine due to their advantages over open surgeries.

OBJECTIVES

Thirty mixed-breed female dogs were included in the study and randomly assigned to one of three groups: OVE (median celiotomy ovariectomy; n = 10), OVEL (laparoscopic ovariectomy, n = 10) and OVELA (laparoscopic ovariectomy with acetazolamide preoperative administration; n = 10). Experienced surgeons performed all procedures, and the anaesthetic and analgesic protocols were identical for all animals. Acetazolamide was administered orally (at a dose of 25 mg/kg) 2 h prior to induction in the OVELA group. Postoperative pain was evaluated using serum cortisol, salivary cortisol, and the University of Melbourne Pain Scale (UMPS) Score.

RESULTS

Any statistical differences were observed in the UMPS scores when the OVELA group was compared to the OVEL group at 1 h after surgery (p = 0.515), 12 h (p = 0.375) and 24 h (p = 0.242). Animals undergoing open surgery (OVE group) had significantly higher pain scores at all times after surgery when compared with OVEL and OVELA groups. A high positive correlation (r = 0.792; p = 0.01) was found between serum and saliva cortisol concentrations. Mean saliva cortisol concentration was not significantly lower for the OVELA group compared to the other groups.

CONCLUSIONS

This study found evidence that preoperative administration of acetazolamide may be beneficial in managing postoperative pain in dogs after laparoscopic surgeries. However, further research with a larger sample size is needed to confirm this and to determine if acetazolamide should be included in a multimodal postoperative analgesia protocol for laparoscopic ovariectomy in dogs.

Laparoscopic Salpingectomy and Vasectomy to Inhibit Fertility in Free-Ranging Nutrias (Myocastor coypus)

The nutria (Myocastor coypus), an invasive alien species, is widely spread in Europe. Pursuant to regulation (EU) no. 1143/2014, the nutria is subject to management programs to reduce its spread. Surgical fertility control is considered an acceptable method, particularly in urban circumstances, avoiding euthanasia. To maintain the hormonal patterns and the social and behavioral dynamics, surgical infertilization preserving the gonads (i.e., salpingectomy and vasectomy) is recommended. Mini-invasive surgery is an eligible choice when dealing with wildlife, allowing reduced captivation time. For these reasons, 77 free-ranging nutrias, captured in urban nuclei in Italy, underwent infertilization under general anesthesia; laparoscopic salpingectomy and vasectomy were performed on 32 animals and traditional surgery on the remainder, leaving the gonads in place. A three-port technique was used, with two paramedian trocars (5 mm) for the instruments and a median one for the telescope. Ablation was obtained through Onemytis® plasma device, allowing a rapid surgical time with no need to place visceral sutures; the skin was surgically closed. After recovery, the animals were released, and no overt complications were noted. No modification of the behavioral patterns was noted, and the population decreased during the following months.

Some cardiopulmonary effects of capnoperitoneum in anesthetized guinea pigs (Cavia porcellus): spontaneous ventilation versus intubation and mechanical ventilation

OBJECTIVE

To compare cardiopulmonary variables and blood gas analytes in guinea pigs (Cavia porcellus) during anesthesia with and without abdominal carbon dioxide (CO₂) insufflation at intra-abdominal pressures (IAPs) 4 and 6 mmHg, with and without endotracheal intubation.

STUDY DESIGN

Prospective experimental trial.

ANIMALS

A total of six intact female Hartley guinea pigs.

METHODS

A crossover study with sequence randomization for IAP and intubation status was used. The animals were sedated with intramuscular midazolam (1.5 mg kg^-1) and buprenorphine (0.2 mg kg^-1) and anesthetized with isoflurane, and an abdominal catheter was inserted for CO₂ insufflation. Animals with endotracheal intubation were mechanically ventilated and animals maintained using a facemask breathed spontaneously. After 15 minutes of insufflation, the following variables were obtained at each IAP: pulse rate, respiratory rate, rectal temperature, oxygen saturation, end-tidal CO₂ (intubated only), peak inspiratory pressure (intubated only), noninvasive blood pressure and blood gas and electrolyte values, with a rest period of 5 minutes between consecutive IAPs. After 4 weeks, the procedure was repeated with the guinea pigs assigned the opposite intubation status.

RESULTS

Intubated guinea pigs had significantly higher pH and lower partial pressure of CO₂ in cranial vena cava blood (PvCO₂) than nonintubated guinea pigs. An IAP of 6 mmHg resulted in a significantly higher PvCO₂ (65.9 ± 19.0 mmHg; 8.8 ± 2.5 kPa) than at 0 (53.2 ± 17.2 mmHg; 7.1 ± 2.3 kPa) and 4 mmHg (52.6 ± 10.8 mmHg; 7.01 ± 1.4 kPa), mean ± standard deviation, with intubated and nonintubated animals combined.

CONCLUSIONS AND CLINICAL RELEVANCE

Although the oral anatomy of guinea pigs makes endotracheal intubation difficult, capnoperitoneum during anesthesia induces marked hypercapnia in the absence of mechanical ventilation. An IAP of 4 mmHg should be further evaluated for laparoscopic procedures in guinea pigs because hypercapnia may be less severe than with 6 mmHg.

Evaluation of the Two-Point Ultrasound-Guided Transversus Abdominis Plane Block for Laparoscopic Canine Ovariectomy

The transversus abdominis plane (TAP) block causes desensitization of the abdominal wall and peritoneum. Of all the approaches proposed to perform it, the two-injection-point TAP showed the best results in terms of the area reached by the anesthetic solution. However, to date, no clinical data exist. The aim of this study was to evaluate the intra- and postoperative analgesic efficacy of a two-injection-point TAP block in dogs undergoing laparoscopic ovariectomy. A total of 26 animals were assigned to receive general inhalation anesthesia (control group), and 26 dogs were assigned to general inhalation anesthesia combined with TAP block (TAP group). The ultrasound-guided TAP block was carried out with a subcostal and cranial-to-ilium injection per hemiabdomen. The end-tidal concentration of isoflurane (EtISO) was recorded at different moments during the surgery. Postoperative pain was assessed at different time points during the first 24 h after surgery. The control group required significantly higher EtISO concentration during the ovarian resection and showed higher postoperative pain scores than the TAP group. Fewer dogs in the TAP group required intra- or postoperative rescue analgesia. TAP block can be implemented to improve postoperative pain management after laparoscopy, reducing the dosage of the systemic drugs used and, hence, their possible side effects.

Tissue sealing versus suture ligation in open canine ovariectomy: Surgical times, intraoperative nociceptive response and frequency of complications

BACKGROUND

In this study, we compared two different techniques currently used for open canine ovariectomy: traditional method utilising absorbable suture and vessel sealing device (ENSEAL^® Ethicon Endo-Surgery, Cincinnati, OH).

OBJECTIVES

The aim of this study was to compare the surgical times, intraoperative nociceptive response and the frequency of intraoperative complications in the canine ovariectomy procedure using these two techniques.

METHODS

Forty bitches were randomly divided into two groups. The Control Group (C) will use a classic open surgery approach using ligatures with absorbable suture and ovarian resection with a scalpel blade. In the Group E, resection of ovarian structures was performed with ENSEAL^® tissue sealer device. For each dog the surgical times, the intraoperative nociceptive response (measuring heart rate, respiratory rate and non-invasive blood pressure) and the intraoperative complications were measured to compare the effectiveness of the two techniques.

RESULTS

The results of this study showed that the procedures performed using ENSEAL^® were faster than the traditional techniques using surgical suture. Instead, the results regarding the nociception and the safety of the two procedures are similar.

CONCLUSIONS

The present study shows that the use of ENSEAL^® significantly shortened the surgical time. Meanwhile, its use was found to be similarly safe and efficient in terms of intra-operative nociception, as the classical techniques with absorbable suture. Canine ovariectomy using ENSEAL^® device is more practical and faster than the traditional technique; the routine use of this device is considered a useful alternative for the canine neutering.

Laparoscopic cholecystectomy using the subserosal layer dissection technique in dogs: 34 cases (2015‐2021)

OBJECTIVES

To describe a standardised subserosal layer dissection technique and evaluate its outcomes in canine laparoscopic cholecystectomy.

MATERIALS AND METHODS

Medical records of dogs undergoing laparoscopic cholecystectomy using the standardised subserosal layer dissection technique for the treatment of cholecystolithiasis, cholecystitis, and gall bladder mucocele at a single veterinary hospital from January 2015 to September 2021 were extracted. Operative time, subserosal layer dissection achievement rate, open conversion rate, and complication rate were evaluated.

RESULTS

Thirty-four dogs were included. The most common preoperative diagnosis was cholecystolithiasis (n=29). Operative time was 190 minutes (range: 110 to 330 minutes). Subserosal layer dissection of more than 90% of the gall bladder bed was achieved in 27 (79%) dogs. Conversion to open surgery was required in three (8.8%) dogs. There were no cases of intraoperative bleeding, bile duct injury, or reoperation.

CLINICAL SIGNIFICANCE

This study showed that laparoscopic cholecystectomy using the standardised subserosal layer dissection technique could be performed successfully in dogs. Future prospective clinical studies are needed to determine safety and effectiveness of this technique compared to standard techniques.

Retrospective comparison of open vs minimally invasive cystotomy in 28 cats using a composite outcome score

OBJECTIVES

The aim of this study was to compare the outcomes of cats undergoing open cystotomy with those undergoing minimally invasive surgery (MIS) for removal of cystic calculi by use of a composite outcome score.

METHODS

Twenty-eight cats were retrospectively enrolled and divided into two groups: open cystotomy (n = 14) and MIS (n = 14). The primary outcome measure was a composite outcome score, including three variables: pain scores ⩾2 at either 6 or 12 h postoperatively; failure to remove all stones as determined by postoperative radiographs; and postoperative complications requiring a visit to the hospital separate from the planned suture removal appointment. Other data collected included signalment, history, other procedures performed during anesthesia, willingness to eat the day after surgery and the financial cost of the procedures.

RESULTS

There was no significant difference in age, weight, sex or breed between the two groups. The risk of experiencing the composite outcome was 3/14 (21.4%) in the MIS group and 10/14 (71%) in the open procedure group (P = 0.02). The cats in the open surgery group had 8.3 times greater odds of developing the composite outcome than cats in the MIS group (odds ratio 8.3, 95% confidence interval 1.3-74.4; P = 0.02). In the MIS group, 10/14 cats were eating the day after surgery vs 3/14 in the open procedure group (P = 0.02). The procedural cost was higher in the MIS group, with a median cost of US$945 (interquartile range [IQR] US$872-1021) vs US$623 (IQR US$595-679) in the open group (P <0.01).

CONCLUSIONS AND RELEVANCE

In this study the composite outcome score provided evidence to support the use of MIS techniques in cats with cystic calculi. The composite outcome score should be considered in future veterinary studies as a promising method of assessing clinically relevant outcomes.

Laparoscopic attenuation of a congenital extrahepatic portosystemic shunt in a dog—a thin-film banding for splenophrenic shunt: A case report

A 6-year-old castrated male Shih-Tzu dog weighing 6. 5 kg presented with chief complaints of pollakiuria and urine dribbling. He had a history of urolithiasis for 3 years, which was confirmed by the presence of ammonium urate in the urinary stone analysis, performed 2 years prior to the presentation. Blood examination showed high values of fasting ammonia, post-prandial bile acid, and low blood urea nitrogen. Microhepatica and urolithiasis were identified on plain radiography and ultrasonography. A computed tomography angiography demonstrated a shunting vessel, diameter up to 9.6 mm, originated from the splenic vein, and linked with the phrenic vein. A surgical attenuation with a thin-film banding was performed under laparoscopic visualization. Left triangular ligament was incised, and one stay suture was placed to the stomach to expose the vessel. The shunting vessel was dissected before it entered the diaphragm, and a thin-film band was applied around the vessel. The patient recovered uneventfully without post-attenuation neurologic signs. Portal vein diameter increased with time, and complete closure of the shunting vessel was identified on computed tomography angiography performed at 14 months after attenuation. The patient was doing well for 31 months after surgery without protein restriction. This is a report of laparoscopic attenuation for splenophrenic type of canine congenital extrahepatic portosystemic shunt with a favorable outcome using thin-film banding.

Healthy nonobese bitches maintain acceptable spontaneous ventilation during laparoscopic ovariectomies

OBJECTIVE

To determine whether end-tidal CO2 (Petco2), tidal volume (Vt), inspiratory minute volume (i), and respiratory rate (RR) remain within reference limits for spontaneously breathing dogs undergoing laparoscopic ovariectomy; characterize changes in these variables over time; and record the proportion of dogs requiring mechanical ventilation on the basis of predetermined criteria.

ANIMALS

22 client-owned dogs.

PROCEDURES

Between January and June 2019, dogs were anesthetized for abdominal insufflation (CO2; 10 mm Hg) and laparoscopic ovariectomy. Respiratory variables (Petco2, Vt, i, and RR) were recorded at 5 time points: preinsufflation (T2), immediately after insufflation (T3), immediately after first ovary extraction (T4), immediately after second ovary extraction (T5), and after abdominal deflation (T6). Results for variables were assessed to identify differences with reference limits and between time points.

RESULTS

At all time points (T2 to T6), Petco2 was within or above the reference limit, Vt was below or within reference limits, and i was either within or above reference limits. Significant temporal changes were detected in all recorded parameters. One dog had to be ventilated prior to abdominal insufflation due to inappropriately low Vt (< 6 mL/kg) and was excluded from further analysis. One of the 21 remaining dogs required rescue ventilation.

CLINICAL RELEVANCE

Following insufflation, there was a tendency toward inadequate ventilation over time characterized by increased Petco2. Twenty of 21 dogs maintained Petco2 within tolerance via a mild increase in RR and did not require assisted ventilation. Dogs undergoing short surgeries may not require assisted ventilation. Clinicians are advised to monitor for hypercapnia and be prepared to assist ventilation if required.

Laparoscopic versus Open Ovariectomy in Bitches: Changes in Cardiorespiratory Values, Blood Parameters, and Sevoflurane Requirements Associated with the Surgical Technique

The aim of this study was to examine the cardiorespiratory and blood changes associated with pneumoperitoneum (PNP) in laparoscopic ovariectomy (LAP Ove), as well as sevoflurane requirements, comparing them to those determined in open surgery (LPT Ove). The study was performed in 16 bitches submitted to LAP or LPT Ove. The cardiorespiratory and end-tidal sevoflurane concentration values were recorded as follows: at the beginning of surgery (T1), after the right ovary resection (T2), after the left ovary resection (T3), and after surgical closure (T4). Blood samples were taken before and after PNP. Among the cardiorespiratory parameters, no differences were observed in the values of end-tidal CO2, minute volume, and heart rate. In the LAP Ove group, a significant increase in inspiratory pressures and a decreased compliance were identified at T2 and T3. Significant higher arterial pressure values were observed in both groups at T2 and T3, with this increase especially marked at T2 in the LPT Ove group. Sevoflurane requirements were significantly higher in the LPT group during ovarian resection. Finally, in terms of the hematochemical parameters, statistical differences were recorded between pre- and post-operative assessments, but not between both surgical groups. The pathophysiological effects associated with PNP seemed to be transient and well-tolerated by healthy dogs.

Laparoscopic portosystemic shunt attenuation in two cats

Case series summary

Gradual attenuation of an extrahepatic portosystemic shunt using cellophane banding was achieved with a laparoscopic technique in two cats. The portosystemic shunts were treated via a right or left lateral laparoscopic approach. Ultrasonography or CT angiography were used to verify the results of surgery. The success of the procedure was confirmed by normalisation of serum bile acid concentrations and clinical signs at the final re-evaluation.

Relevance and novel information

The aim of this case series was to determine the feasibility and outcome of laparoscopy for portosystemic shunt attenuation in two cats. Laparoscopic portosystemic shunt attenuation appeared to be a feasible, safe and effective procedure in cats.

2022 AAHA Pain Management Guidelines for Dogs and Cats

These updated guidelines present a practical and logical approach to the assessment and management of acute and chronic pain in canine and feline patients. Recognizing pain is fundamental to successful treatment, and diagnostic guides and algorithms are included for assessment of both acute and chronic pain. Particularly for chronic pain, capturing owner evaluation is important, and pain-assessment instruments for pet owners are described. Expert consensus emphasizes proactive, preemptive pain management rather than a reactive, "damage control" approach. The guidelines discuss treatment options centered on preemptive, multimodal analgesic therapies. There is an extensive variety of pharmacologic and nonpharmacologic therapeutic options for the management of acute and chronic pain in cats and dogs. The guidelines include a tiered decision tree that prioritizes the use of the most efficacious therapeutic modalities for the treatment of acute and chronic pain.

Laparoscopic portosystemic shunt attenuation in 20 dogs (2018-2021)

OBJECTIVE

To describe the technique, complications, and outcome of laparoscopic portosystemic shunt attenuation (LPSSA) in dogs.

STUDY DESIGN

Retrospective study.

ANIMALS

Twenty client-owned dogs.

METHODS

Medical records were searched for dogs with a single congenital extrahepatic portosystemic shunt (CEPSS) that was treated with LPSSA. Signalment, clinical signs, CEPSS location, diagnostic imaging, laparoscopic approach, operative technique, complications, and clinical outcome were reviewed.

RESULTS

Fourteen dogs with CEPSS located in the epiploic foramen had a right (13/14) or left (1/14) paramedian approach. In 6 dogs a CEPSS was not located in the epiploic foramen, and a left paramedian approach was used. A 3 or 4-port technique was used in 7 and 13 dogs, respectively. A thin film band was used for CEPSS attenuation in all dogs. The median operating time for LPSSA was 62 min (range 27-98 min). Intraoperative complications requiring conversion to an open technique occurred in 5 dogs. Mild perioperative self-limiting portal hypertension occurred in 3 dogs, while severe portal hypertension with surgical revision occurred in 1 case. The complications were resolved, and all dogs had a good outcome.

CONCLUSION

Laparoscopic portosystemic shunt attenuation can be performed in dogs, in particular for a CEPSS located in the epiploic foramen using a right paramedian approach. For CEPSS not located in the epiploic foramen, a left paramedian approach is recommended. Conversion to open celiotomy was required in around a third of cases.

CLINICAL SIGNIFICANCE

Laparoscopic attenuation of CEPSSs can be performed in dogs and has a good clinical outcome, particularly for CEPSS located in the epiploic foramen.

A Comparison of Times Taken for the Placement of the First Portal and Complication Rates between the Veress Needle Technique and the Modified Hasson Technique in Canine Ovariectomy Laparoscopic Surgery

Minimally invasive surgery is increasingly being used in veterinary medicine. Laparoscopic procedures have several advantages compared with open surgery. These include the magnification of the field of surgery, reduced post-surgical pain and associated stress, reduced post-operative infection rates, and decreased hospitalization time. The establishment of a pneumoperitoneum is a critical step; however, this procedure can prolong the operation time, and most of the complications associated with laparoscopic surgery have been attributed to the insertion of devices into the abdominal cavity. Two main techniques have been employed to create pneumoperitoneum: the closed-entry method using the Veress needle and the open Hasson technique. The first portal is necessary to start insufflation and, subsequently, to realize the operative channel to insert the laparoscopic instruments into the abdomen. Many authors have compared the time necessary to create the first portal using different techniques in human medicine, but studies on this topic in veterinary medicine are lacking. In the veterinary medicine literature, complications associated with the creation of a pneumoperitoneum and the placement of ports include spleen, bowel, or bladder injuries; pneumothorax; and subcutaneous emphysema. The aim of the present study was to compare the times required for the placement of the first portal and the creation of pneumoperitoneum, and the rates of intraoperative complications using the Veress needle technique (VNT) and the open modified Hasson technique (MHT). The sample population comprised 30 female dogs who underwent laparoscopic ovariectomies. The dogs were randomly organized into two groups and two different entry techniques were used: Veress needle (VNT = group A) and the modified Hasson technique (MHT = group B). Complications related to abdominal entry were classified as major, in cases of organ perforation, and minor, in cases of subcutaneous emphysema and gas leakage. The VNT and MHT required 374.0 s and 242.9 s, respectively, for the placement of the first portal and for establishing pneumoperitoneum (p < 0.05). Their major complications rates were 20% and 0%, respectively (p < 0.05). Their minor complications rates were 20% and 35%, respectively (p < 0.05). No surgical procedures required laparotomy. The MHT was associated with a lower major complication rate and required less time to create the first portal, compared with the Veress needle technique.

Accelerometric Evaluation of the Locomotor Pattern After Administration of Morphine in Conscious Healthy Horses

The objective of the present study was to compare, using accelerometry, the gait changes produced after administration of a dose of 0.2 mg/kg of morphine at the walk in healthy horses. Six mature horses were used, and all animals received two different treatments with, at least, two weeks interval in between. Treatments administered consisted of a single dose of 10 ml of saline solution or a total of 0.2 mg/kg of morphine diluted in 10 ml of saline solution. A three-dimensional accelerometric device was used to collect data continuously while horses were walking. The walking test was performed 10 min prior to injection, and then at 5, 10, 15 and 20 min after injection and then every 10 min for 3 h. Eight variables were calculated including stride kinematic, coordination and energetic parameters. Additionally, the force of acceleration and three components of the power were calculated. Significant interaction was only observed for stride length, propulsion power and the propulsive part of the total power with a reduction in values after morphine administration. Compared to baseline values, stride length values were significantly reduced for 80 min and again 110 min after injection of the opioid and at 5, 15, 20, 30 and 40 min in the case of propulsion power values. For the propulsion component of power, these differences were observed for 20 min when compared to baseline values. The administration of 0.2 mg/kg of morphine to conscious healthy horses produces limited effects on the gait pattern of horses and the effects on locomotor activity are minimal at this dose, not being an important concern for the administration of analgesia in a clinical setting.

Surgical treatment of uterine neoplasia in 13 production size pigs with a comparison to pot-bellied pigs

OBJECTIVES

The primary objective of this study was to describe the clinical management and surgical treatment of production size pigs (PrdP) with uterine neoplasia. A secondary objective was to compare tumor diagnoses as well as short- and long-term survival between PrdP and a published report of pot-bellied pigs (PBP) following surgical intervention.

STUDY DESIGN

Retrospective clinical study.

ANIMALS OR SAMPLE POPULATION

Client-owned PrdP (n = 13) treated with exploratory celiotomy ±ovariohysterectomy for uterine neoplasia.

METHODS

Medical records from a university hospital were reviewed for historical treatment, presenting complaint, clinical signs, diagnostics, surgical intervention, pathology, and outcome. An online owner survey was performed for follow-up. The novel PrdP cohort was compared to a previously published PBP cohort for differences in tumor diagnoses, surgical complications, and survival. Descriptive statistics, Fischer's exact tests and odds ratios were reported.

RESULTS

PrdP were affected by uterine leiomyoma (4/11), leiomyosarcoma (2/11), adenoma (1/11), adenocarcinoma (3/11), and carcinosarcoma (1/11) with no difference in tumor types between PrdP and PBP. PrdP surviving to hospital discharge (6/13) survived at least 1 year postoperatively, with median follow-up of 16 months (14-60 months). PrdP were less likely than PBP to survive in the short-term despite similar frequencies of marked intraoperative hemorrhage. PrdP and PBP had comparable rates of long-term survival following hospital discharge.

CONCLUSION

PrdP are afflicted by similar uterine neoplasia diagnoses as PBP, but they have lower rates of short-term survival to hospital discharge with surgical treatment.

CLINICAL SIGNIFICANCE/IMPACT

PrdP have a guarded prognosis for survival to hospital discharge when operated for uterine neoplasia.

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 between intracorporeal and extracorporeal ligations in a laparoscopic ovariectomy model in dogs

OBJECTIVE

To compare the influence of extracorporeal and intracorporeal ligations on the duration of and complications associated with laparoscopic ovariectomy in dogs.

STUDY DESIGN

Prospective randomized experimental study.

ANIMALS

Healthy intact female dogs (n = 18).

METHODS

The left and right ovarian pedicles of dogs undergoing laparoscopic ovariectomy were randomly assigned to intracorporeal (n = 18) or extracorporeal (n = 18) ligation groups. Surgeries were performed by two American College of Veterinary Surgeons (ACVS) diplomates and two ACVS residents. The time required to place extracorporeal and intracorporeal ligations, duration of surgery, and intraoperative complications were compared between ligation techniques. Postoperative complications were recorded.

RESULTS

The time required for intracorporeal ligation (17.3 ± 8.7 minutes) did not differ from that required for extracorporeal ligation (15.1 ± 6.1 minutes; P = .38). The total duration of surgery was 102.7 ± 28.7 minutes including portal placement and veterinary student closure of incisions. Ligation of the ovarian pedicle was successful in 16 of 17 dogs. Intraoperative hemorrhage occurred in three dogs, and postoperative complications were noted in three dogs, without apparent difference between ligation techniques.

CONCLUSION

No difference was identified between extracorporeal and intracorporeal ligations of ovarian pedicles.

CLINICAL SIGNIFICANCE

This study does not provide evidence to support one ligation technique rather than the other.

Evaluation of a laparoscopic abdominal simulator assessment to test readiness for laparoscopic ovariectomy in live dogs

OBJECTIVE

To predict readiness for laparoscopic ovariectomy of live dogs on the basis of performance on a high-fidelity laparoscopic abdominal simulator and to determine interrater reliability of the assessment.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Seventeen fourth-year veterinary students.

METHODS

After a standardized laparoscopic training course, each participant performed a laparoscopic ovariectomy with a simulator. This performance was scored in real time by two evaluators using a rubric. Participants achieving a score of 112 of 160 performed a laparoscopic ovariectomy in a live dog, supervised by an instructor in the room. Two evaluators scored video recordings of each procedure using the rubric. Participants' opinions about the simulator were collected with a survey.

RESULTS

All participants scored above the threshold (range, 126-151) and successfully completed laparoscopic ovariectomy in a live dog, with an average of 10 of 17 participants requiring verbal guidance and 5 of 17 participants requiring intervention from the instructor. Interrater concordance was excellent for the rubrics used to score performance on the simulator (R = 0.91) and in vivo (R = 0.81). All participants agreed that the simulator should be used to assess trainee readiness prior to surgery in a live dog.

CONCLUSION

Participants achieving a score of at least 126 of 160 on the simulator were able to perform a laparoscopic ovariectomy in a live dog under supervision. The scoring system for the simulator had excellent interrater concordance.

CLINICAL SIGNIFICANCE

This simulator and scoring system can be used in laparoscopic training programs to assess readiness for progression to the operative setting.

Feasibility of laparoscopic liver lobectomy in dogs

OBJECTIVE

To determine the feasibility of laparoscopic liver lobectomy (LLL) in dogs by using canine cadavers and to describe the clinical application in dogs with liver disease.

STUDY DESIGN

Ex vivo experiment and descriptive case series.

SAMPLE POPULATION

Twelve canine cadavers and six client-owned dogs.

METHODS

Cadavers underwent LLL with an endoscopic stapler. The percentage of liver lobe resected was determined by volume. The distance from the staple line to hilus was measured. Medical records of dogs undergoing LLL were reviewed.

RESULTS

In cadavers ≤15 kg, left lateral lobectomy completeness was 87.3% (84.6%-96.6%), and remaining median (interquartile range) hilar length was 1 cm (0.25-1.75). Left medial lobectomy completeness was 72.5% (66.7%-80%), and remaining hilar length was 1.6 cm (0.47-1.75). Central division resection completeness was 68.3% (60%-92.9%), and remaining hilar length was 2.7 cm (0.8-5). Laparoscopic liver lobectomy was not feasible for right division lobes and in cadavers >15 kg. Five dogs with peripheral quadrate or left lateral lobe masses underwent stapled, partial laparoscopic lobectomy (30%-90%). One dog underwent stapled, left lateral lobectomy (90%) after open procedure conversion. Histopathological diagnoses included hepatocellular carcinoma (3), nodular hyperplasia (1), biliary cyst adenoma (1), and fibrosis (1).

CONCLUSION

Laparoscopic liver lobectomy of the left and central divisions is feasible in cadavers ≤15 kg with an endoscopic stapler. Partial LLL of the left and central divisions is feasible in select dogs with liver disease.

CLINICAL SIGNIFICANCE

Laparoscopic liver lobectomy may be a viable alternative to laparotomy in small-to-medium size dogs with peripheral liver masses of the left and central divisions.

Changes in Acute Phase Proteins in Bitches after Laparoscopic, Midline, and Flank Ovariectomy Using the Same Method for Hemostasis

Simple Summary

Ovariectomy is a common surgical procedure in veterinary medicine, with many techniques involved. The aim of this study is to objectively evaluate the acute phase response by measuring the changes in a panel of acute phase proteins after applying three different ovariectomy techniques. C-reactive protein values showed increases of lower magnitude after laparoscopic ovariectomy compared with other techniques, indicating that this surgical technique induces a reduced inflammatory response and tissue damage. The use of this procedure is in agreement with the current tendency to use minimally invasive procedures for ovariectomy.

Abstract

Acute phase proteins (APP) are biomarkers of systemic inflammation, which allow monitoring the evolution of diseases, the response to treatments, and post-operative complications. Ovariectomy (OVE) is frequently performed in veterinary medicine and can be a useful model to evaluate surgical trauma and inflammation in the bitch. The objective was to investigate and compare the acute phase response (APR) after applying three different OVE techniques by measuring serum levels of C-reactive protein (CRP), haptoglobin (Hp), albumin (Alb), and paraoxonase-1 (PON-1). Forty-five intact bitches were included in the study, being randomly distributed into three groups: laparoscopic OVE (L), midline OVE (M), and flank OVE (F). Serum CRP, Hp, Alb, and PON-1 were measured before surgery, 1, 24, 72, and 168 h post-intervention. CRP levels increased significantly 24 h post-surgery in the M and F groups, but no significant variation was observed in the L group at any time of the study period. Hp was significantly higher in group L than in group F 72 h post-surgery. Alb and PON-1 showed no statistical difference among groups or among sampling periods. CRP response suggests that the use of laparoscopic procedures produce lower inflammation compared to open conventional approaches when performing OVE in the bitch.

Feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation of clinically normal canine ovaries

OBJECTIVE

To determine the optimal energy profile for and to assess the feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation (MWA) of clinically normal canine ovaries.

SAMPLE

44 extirpated ovaries from 22 healthy dogs.

PROCEDURES

In the first of 2 trials, 13 dogs underwent oophorectomy by routine laparotomy. Extirpated ovaries underwent MWA at 45 W for 60 (n = 11) or 90 (12) seconds; 3 ovaries did not undergo MWA and served as histologic controls. Ovaries were histologically evaluated for cell viability. Ovaries without viable cells were categorized as completely ablated. Histologic results were used to identify the optimal MWA protocol for use in the subsequent trial. In the second trial, the ovaries of 9 dogs underwent MWA at 45 W for 90 seconds in situ. Ultrasonographic guidance for MWA was deemed unfeasible after evaluation of 1 ovary. The remaining 17 ovaries underwent MWA with laparoscopic guidance, after which routine laparoscopic oophorectomy was performed. Completeness of ablation was histologically assessed for all ovaries.

RESULTS

2 ovaries were excluded from the trial 1 analysis because of equivocal cell viability. Six of 11 ovaries and 10 of 10 ovaries that underwent MWA for 60 and 90 seconds, respectively, were completely ablated. In trial 2, laparoscopic-guided MWA resulted in complete ablation for 12 of 17 ovaries. Dissection of the ovarian bursa for MWA probe placement facilitated complete ablation.

CONCLUSIONS AND CLINICAL RELEVANCE

Laparoscopic-guided MWA at 45 W for 90 seconds was feasible, safe, and effective for complete ablation of clinically normal ovaries in dogs.

Computed tomography in two recumbencies aides in the identification of pulmonary bullae in dogs with spontaneous pneumothorax

Spontaneous pneumothorax presents a unique diagnostic and therapeutic challenge in veterinary medicine, specifically with regard to accurate identification of bullous lesions. Positioning of dogs with spontaneous pneumothorax during CT has not previously been evaluated. This retrospective, diagnostic accuracy study was performed to evaluate the sensitivity, positive predictive value (PPV), and interobserver variability for detection of pulmonary bullae with dogs positioned in multiple recumbencies. Dogs underwent CT in sternal and dorsal recumbency followed by thoracic exploration via median sternotomy. Three American College of Veterinary Radiology-certified veterinary radiologists blinded to surgical findings reviewed dorsal and sternal images simultaneously. Severity of pneumothorax, degree of atelectasis, lesion location and size, and view in which lesions were most confidently identified were compared to surgical and histologic findings. Sensitivities and PPVs for bulla detection ranged from 57.7% to 69.2% and 62.1% to 78.9%, respectively. For two of the 3 radiologists, the location of bullae in the thorax was significantly associated with the recumbency in which the lesion was best identified. Degree of atelectasis was found to be associated with the ability to identify lesions (P ≤ .02). The interobserver variability for identification was good (κ = 0.670). The sensitivity of CT when performed in both sternal and dorsal recumbency is similar to that previously reported. Because the distribution of bullae is unknown prior to advanced imaging and bulla location affects which recumbency is most useful for identification, acquisition of CT images in both sternal and dorsal recumbency may improve detection of bullous lesions and aid surgical planning.

Use of a T'LIFT transabdominal organ retraction device in two-portal laparoscopic ovariectomy in dogs

OBJECTIVE

To describe the use of the T'LIFT transabdominal organ retraction device to suspend ovaries during canine laparoscopic ovariectomy (LapOVE) and compare its use to a transabdominal suspension suture (TSS).

DESIGN

Randomized clinical trial.

ANIMALS

Client-owned intact bitches (n = 30).

METHODS

Dogs were randomly assigned either to group T, in which LapOVE was performed with the T'LIFT, or to group S, in which a TSS was used. Laparoscopic ovariectomy was performed by using a standard two-portal protocol. Signalment (age, weight, body condition score [BCS], fat score of the ovarian pedicle [FSOP]), overall operative time, ovarian resection time, and perioperative complications were compared between groups.

RESULTS

No significant differences were found between groups regarding age, weight, BCS, or FSOP. Surgical times were not significantly different between groups. No significant differences in major or minor complications were recorded. Overall operative time was significantly shorter for the last half of the cases compared with the first half, for the overall population, and within each group. Ovarian resection time for the last cases was significantly shorter compared with that for the first ones only in group T.

CONCLUSION

The T'LIFT was used to suspend ovaries for two-portal LapOVE, with no major complications noted. There was no significant difference in surgical times or complications compared with transabdominal suturing.

CLINICAL SIGNIFICANCE

The T'LIFT can be considered as an alternative to transabdominal suture for ovarian suspension in dogs undergoing LapOVE.

Pressure-Volume Curve during Capnoperitoneum in Cats

Laparoscopy is a growing field in veterinary medicine, although guidelines are lacking. The objective of this study was to evaluate the pressure-volume curve during capnoperitoneum in cats. A total of 59 female cats were scheduled for routine laparoscopy. Pressure and volume data were recorded and processed, and the yield point of the curve was calculated using a method based on a capacitor discharging function. For the remaining 40 cats, a linear-like pressure-volume curve was observed until a yield point with a mean cutoff pressure (COP) of 6.44 ± 1.7 mmHg (SD) (range, 2.72-13.00 mmHg) and a mean cutoff volume (COV) of 387 ± 144.35 mL (SD) (range, 178.84-968.43 mL) was reached. The mean mL/kg CO₂ value in cats was 208 ± 34.69 mL/kg (range, 100.00-288.46 mL/kg). The COV correlated with COP and body weight but not with body condition score (BCS). COP correlated only with the COV. This study suggests that feline patients have a pressure-volume curve similar to that of canine patients, and the same pressure limit recommendations can be used for both species. After a yield point of 6.44 mmHg is reached, the increment in volume decreases exponentially as the intra-abdominal pressure (IAP) increases.

Laparoscopic gonadectomy in dogs with ovotesticular disorder of sexual development

Disorders of sexual development (DSD) in dogs involve most commonly an XX sex reversal syndrome, treated conventionally by gonadohysterectomy. The objective of the present case series is to describe the surgical treatment and long-term follow-up of dogs undergoing laparoscopic gonadectomy without hysterectomy for treatment of ovotesticular DSD. Six female dogs clinically diagnosed with DSD were retrospectively included in the study when laparoscopic gonadectomy was performed and histology confirmed the presence of abnormal gonads. The dogs were evaluated by ultrasound after 6 months, and owners were contacted by phone for the long-term reevaluation. Laparoscopic gonadectomy was performed using 2- or 3-portal midline techniques with 3- and/or 5-mm instruments. Additional procedures were performed in 5 dogs, including os clitoris removal in 4 dogs and vulvoplasty in 1 dog. Histological analysis of the gonads reported 11 ovotestes and 1 testis. No major or minor complications occurred perioperatively. Ultrasonographic reevaluation was performed in 5/6 dogs and the remaining abdominal genital system was considered normal. Median long-term follow-up was 617 days (range, 265-1597) with none of the dogs having any symptom related to DSD. Therefore, laparoscopic gonadectomy is a valid alternative for dogs with ovotesticular DSD and is less invasive than conventional open techniques. Removal of the gonads avoids future development of hormone-related diseases of the remaining genital tract.

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.

Evaluation of minimally invasive small intestinal exploration and targeted abdominal organ biopsy with use of a wound retraction device in dogs: 27 cases (2010-2017)

OBJECTIVE

To describe surgical technique, biopsy sample quality, and short-term outcome of minimally invasive small intestinal exploration and targeted abdominal organ biopsy (MISIETB) with use of a wound retraction device (WRD) in dogs.

ANIMALS

27 client-owned dogs that underwent MISIETB with a WRD at 1 of 4 academic veterinary hospitals between January 1, 2010, and May 1, 2017.

PROCEDURES

Medical records were retrospectively reviewed, and data collected included signalment; medical history; findings from physical, ultrasonographic, laparoscopic, cytologic, and histologic evaluations; surgical indications, procedures, duration, and complications; and short-term (14-day) outcomes. The Shapiro-Wilk test was used to evaluate the normality of continuous variables, and descriptive statistics were calculated for numeric variables.

RESULTS

Laparoscopic exploration was performed through a multicannulated single port (n = 18), multiple ports (5), or a single 6-mm cannula (4). Median length of the incision for WRD placement was 4 cm (interquartile [25th to 75th percentile] range, 3 to 6 cm). All biopsy samples obtained had sufficient diagnostic quality. The 2 most common histologic diagnoses were lymphoplasmacytic enteritis (n = 14) and intestinal lymphoma (5). Twenty-five of 27 (93%) dogs survived to hospital discharge, and 3 (12%) dogs had postsurgical abnormalities unrelated to surgical technique.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that MISIETB with WRD was an effective method for obtaining diagnostic biopsy samples of the stomach, small intestine, pancreas, liver, and mesenteric lymph nodes in dogs. Prospective comparison between MISIETB with WRD and traditional laparotomy for abdominal organ biopsy in dogs is warranted.

A comparison of the rates of postoperative complications between dogs undergoing laparoscopic and open ovariectomy

OBJECTIVES

To investigate whether dogs undergoing laparoscopic ovariectomy might have a lower overall and wound-healing complication rate than those undergoing an open surgical approach.

MATERIALS AND METHODS

A retrospective study of dogs that underwent laparascopic or open surgical ovariectomy between January 1, 2013 and January 1, 2018 by the same team of similarly experienced surgeons using standard practice anaesthetic, theatre and perioperative protocols. General complications were described and graded using the Clavien-Dindo system. Complication rates were compared between the two groups of dogs. Wound complications were further subdivided using the U.S. Centers for Disease Control guidelines.

RESULTS

According to the Clavien-Dindo system, 46 of 106 (44%) dogs undergoing open ovariectomy developed a complication. Thirty dogs (28.3%) had wound healing complications, the majority of which were minor and self-limiting. Superficial site infections occurred in 50 (5%) cases and deep surgical site infections in one dog (1%). Incisional herniation occurred in four (4%) cases. Thirty-one (20%) of 154 dogs undergoing laparoscopic ovariectomy developed a complication. Seventeen (11%) developed wound healing complications, most of which were minor; five (3%) developed superficial surgical site infections and none had deep surgical site infections. Incisional herniation occurred in none of the laparoscopic cases.

CLINICAL SIGNIFICANCE

The rates of overall and wound healing complications were lower for the laparascopic group than the open surgical group in this non-randomised study. Laparoscopy might be considered preferable for ovariectomy in dogs but confirmation requires a randomised trial.

Evaluation of combined assessments of serum anti-Müllerian hormone and progesterone concentrations for the diagnosis of ovarian remnant syndrome in dogs

OBJECTIVE

To determine the usefulness of combined assessments of serum anti-Müllerian hormone (AMH) and progesterone (P4) concentrations for diagnosis of ovarian remnant syndrome (ORS) in dogs.

DESIGN

Prospective case series.

ANIMALS

602 bitches that had previously undergone ovariohysterectomy or ovariectomy without hysterectomy and that were being evaluated for ORS.

PROCEDURES

Serum AMH and P4 concentrations were measured in a single serum sample obtained from each of the 602 dogs; results were classified as positive, negative, or inconclusive. Following AMH testing, submitting veterinarians were offered reimbursement for shipping and histologic evaluation of any tissue removed during treatment of dogs for which serum samples had been assessed.

RESULTS

Tissue samples were provided from 53 of 55 dogs that underwent surgical abdominal exploration. Of 48 dogs with histologically confirmed ORS, 25 were positive for both AMH and P4 and 23 were positive for AMH or P4 or test results were inconclusive. No dogs with histologically confirmed ORS were negative for both AMH and P4. Tissue samples that included no ovarian tissue were obtained from 5 dogs that were positive for both AMH and P4. In 2 dogs that were negative for both AMH and P4, no ovarian remnant was identified and no tissue was removed at the time of exploratory surgery.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that combined determination of AMH and P4 concentrations in a single serum sample can be an effective diagnostic test for spayed dogs suspected to have ORS. Histologic analysis of excised tissues to assess the completeness of surgical treatment in dogs with ORS is warranted.

Gallbladder leiomyoma treated by laparoscopic cholecystectomy in a dog

CASE DESCRIPTION

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.

CLINICAL FINDINGS

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.

CLINICAL RELEVANCE

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.

Pneumoperitoneum in Veterinary Laparoscopy: A Review

Objective: To review the effects of carbon dioxide pneumoperitoneum during laparoscopy, evaluate alternative techniques to establishing a working space and compare this to current recommendations in veterinary surgery. Study Design: Literature review. Sample Population: 92 peer-reviewed articles. Methods: An electronic database search identified human and veterinary literature on the effects of pneumoperitoneum (carbon dioxide insufflation for laparoscopy) and alternatives with a focus on adaptation to the veterinary field. Results: Laparoscopy is the preferred surgical approach for many human and several veterinary procedures due to the lower morbidity associated with minimally invasive surgery, compared to laparotomy. The establishment of a pneumoperitoneum with a gas most commonly facilitates a working space. Carbon dioxide is the preferred gas for insufflation as it is inert, inexpensive, noncombustible, colorless, excreted by the lungs and highly soluble in water. Detrimental side effects such as acidosis, hypercapnia, reduction in cardiac output, decreased pulmonary compliance, hypothermia and post-operative pain have been associated with a pneumoperitoneum established with CO₂ insufflation. As such alternatives have been suggested such as helium, nitrous oxide, warmed and humidified carbon dioxide and gasless laparoscopy. None of these alternatives have found a consistent benefit over standard carbon dioxide insufflation. Conclusions: The physiologic alterations seen with CO₂ insufflation at the current recommended intra-abdominal pressures are mild and of transient duration. Clinical Significance: The current recommendations in veterinary laparoscopy for a pneumoperitoneum using carbon dioxide appear to be safe and effective.

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.

Single-Port Laparoscopic Treatment and Outcome of Dogs with Ovarian Remnant Syndrome: 13 Cases (2010-2018)

Ovarian remnant syndrome (ORS) is a condition resulting from incomplete removal of ovarian tissue during ovariectomy and/or ovariohysterectomy. Single-port laparoscopy (SPL) is an alternative to ventral midline laparotomy for treatment of ORS. Medical records of 13 client-owned female dogs who underwent SPL for the treatment of ORS were retrospectively reviewed to evaluate surgical technique and outcome. Dogs who had undergone a previous attempt at open ovariectomy or ovariohysterectomy were included. Major intraoperative complications did not occur and conversion to open laparotomy was not required. In 1 dog, an SPL + 1 technique was used, in which an additional port was placed cranial to the single-port device to aid in dissection and tissue manipulation. Median surgical time was 45 min (range, 30-90 min). Clinical signs related to estrus had resolved in 11 of 13 dogs with a median follow-up time of 18 mo. Two of 13 dogs were lost to follow-up at 3 mo postoperatively; however, signs of estrus had resolved at time of last follow-up. SPL treatment for ORS was feasible and successful in this cohort of dogs. Reduced surgical time was found in this study compared with previous reports investigating multiple-port laparoscopic treatment of ORS.

Desexing Dogs: A Review of the Current Literature

Background: Desexing dogs is promoted for population control, preventative healthcare, and behavior modification. Common methods are orchiectomy and ovariectomy/ovariohysterectomy. GnRH superagonist implants are available in some areas. Alternative methods like vasectomy and salpingectomy/hysterectomy are uncommon. The terminology used to describe desexing is inconsistent and contradictory, showing a need for the adaption of standardized terminology. Population Control: Surprisingly, empirical studies show no effects of desexing on population control in companion and shelter dogs despite desexing being consistently recommended in the literature. There is evidence for a population control effect in free-roaming dogs, where desexing also has benefits on zoonotic disease and bite risk. Population control in free-roaming dogs is mostly correlated with female, not male desexing. Health and Lifespan: Desexing affects numerous disease risks, but studies commonly neglect age at diagnosis and overall lifespan, age being by far the most important risk factor for most diseases. We argue that lifespan is a more important outcome than ultimate cause of death. A beneficial effect of desexing on lifespan is consistently demonstrated in females, while evidence for a beneficial effect in males is inconsistent. Studies are likely biased in desexing being a proxy for better care and desexed dogs having already lived to the age of desexing. Desexing reduces or eliminates common life-limiting diseases of the female reproductive system such as pyometra and mammary tumors, while no analogous effect exists in males. Disease risks increases across sexes and breeds include cruciate ligament rupture, various cancers, and obesity. Urinary incontinence risk is increased in females only. Various other disease risk changes show considerable variability between breeds and sexes. Behavioral Effects: Desexed males show reduced libido, roaming, conspecific mounting, and urinary marking frequency, as well as reduced male dog-directed aggression in a majority of males desexed for behavioral reasons. There is a detrimental effect on the risk and progression of age-related cognitive dysfunction. Desexed dogs may be less likely to cause bite injuries across sexes. The evidence for other effects such as human-directed aggression, human or object mounting, resource guarding, or shyness and anxiety is inconsistent and contradictory. There are few studies specific to females or individual breeds. Conclusions: The evidence for a beneficial effect of desexing is stronger in female than in male dogs; however, there is significant variation between breeds and sexes, and more research is needed to further elucidate these differences and to arrive at individualized evidence-based recommendations for clinical practice.

Do prevalence rates and severity of acquired urinary incontinence differ between dogs spayed by laparoscopy or laparotomy? Comparing apples with apples with a matched-pair cohort study

OBJECTIVE

To compare the prevalence rates and severity of acquired urinary incontinence (AUI) between dogs spayed with laparoscopic and open laparotomy approaches.

STUDY DESIGN

Retrospective matched-pair cohort study.

ANIMALS

In total, 1285 privately owned dogs spayed >5 years previously were included in the study.

METHODS

Laparoscopically spayed dogs were matched with dogs spayed by traditional laparotomy. Matching variables were breed, bodyweight, age at spaying, time of spaying in relation to the onset of puberty, time interval since spaying, and age. In 400 matched-paired dogs, the outcome of AUI was assessed by using an owner questionnaire. A conditional logistic regression for matched pairs was performed on the data of 308 dogs.

RESULTS

Among 308 dogs, 30 and 29 dogs spayed by laparotomy and laparoscopy, respectively, were affected by AUI. The identified risk factors for AUI were age and time interval since spaying. The surgical approach (laparoscopy or laparotomy) was neither revealed as a risk factor nor did it influence the severity of AUI.

CONCLUSION

The risk of AUI after spaying is not influenced by the surgical approach, (laparoscopy or laparotomy). Nearly every fifth dog spayed by laparotomy or by laparoscopy was affected by AUI. A relatively longer time interval since spaying and increased age of the dog increased the risk for AUI.

CLINICAL SIGNIFICANCE

Owners of dogs with a predisposition for AUI must be counseled about this risk when they present their dogs for spaying, regardless of surgical approach chosen.

A Modern Approach to Minimally Invasive Surgery and Laparoscopic Sterilization in a Chimpanzee

We present the case of Ruby, a 21-year-old hand-reared chimpanzee (Pan troglodytes) who had an obstetric history significant for a premature stillborn infant that was conceived while on oral contraceptive pills, followed by a full term healthy delivery complicated by neonatal demise attributed to inappropriate maternal care. She was recommended for permanent sterilization due to her history of conception while on oral contraceptives. She underwent uncomplicated laparoscopic bilateral tubal ligation. Due to the similar anatomy to humans, human OB/GYN surgical consultants were used. The objective of this case report is to describe a modern technique for approaching and employing laparoscopic surgery in primates. Minimally invasive surgery allows for faster recovery and fewer complications, and has become the preferred approach for surgical intervention in many animals. The information presented in this case report can be expanded to benefit not only Chimpanzees but other large primate species as well. However, subtle anatomical differences among species must be recognized in order to be carried out safely.