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Gibson EA. Augmenting Veterinary Minimally Invasive Surgery: Evidence-based Review of Foundational and Novel Devices and Technology. Vet Clin North Am Small Anim Pract 2024; 54:721-733. [PMID: 38519369 DOI: 10.1016/j.cvsm.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Veterinary minimally invasive surgery continues to grow as a specialty. With increasing experience in this field, comes improved accessibility as well as progressive complexity of procedures performed. Advancement in technology has been both a response to the growth and a necessary driver of continued refinement of this field. Innovative research leading to advancements in surgical equipment has led to the development of novel image acquisition platforms, cannulas, smoke evacuation systems, antifog devices, instrumentation, and ligating/hemostatic devices. These innovations will be reviewed and potential clinical applications are discussed.
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Affiliation(s)
- Erin A Gibson
- University of Pennsylvania, Matthew J. Ryan Veterinary Hospital, Department of Clinical Sciences and Advanced Medicine, 3900 Delancey Street, Philadelphia, PA 19104, USA.
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da Silva PHS, Lopes CEB, Stallmach LB, Ferreira LDO, Pimentel PAB, Giuliano A, Freitas PMC, Horta RDS. Comparison of Different Pneumorrhaphy Methods after Partial Pulmonary Lobectomy in Dogs. Animals (Basel) 2023; 13:2732. [PMID: 37684995 PMCID: PMC10486489 DOI: 10.3390/ani13172732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Pulmonary loborraphy can be performed using manual sutures and staples, although other methods, such as tissue adhesives, are also cited in the veterinary literature. Although the surgery is well tolerated in the canine species, failure in pulmonary aerostasis is still a reality since all the methods described so far eventually lead to air leakage after the use of the partial lobectomy technique in the lungs. Within this context, the aim of this research was to compare the effectiveness of different hermetic sealing methods after partial lobectomy of the right caudal lung lobe (RCLL) in dogs. 30 cadavers models were divided in 6 groups: G1-cobbler suture associated with simple continuous; G2-overlapping continuous suture associated with simple continuous suture; G3-Ford interlocking suture; G4-Stapling device; G5-Tissue glue (cyanoacrylate). After performing the sealing techniques, the lungs were submerged in water and inflated with oxygen at positive ventilatory pressures at physiological (up to 14.7 mmHg, which is equivalent to up to 20 cmH2O) and supraphysiological levels (above 14.7 mmHg) to evaluate the performance of the sealing methods. At physiological ventilatory pressure levels, there was no difference between groups. Sealing with surgical glue was superior to interlocking sutures and stapling devices at supraphysiological levels of ventilatory pressure.
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Affiliation(s)
- Paloma Helena Sanches da Silva
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Carlos Eduardo Bastos Lopes
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Larissa Bueno Stallmach
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Lucas de Oliveira Ferreira
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Pedro Antônio Bronhara Pimentel
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Antonio Giuliano
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Patrícia Maria Coletto Freitas
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Rodrigo dos Santos Horta
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
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Falerno I, Tamburro R, Collivignarelli F, Della Salda L, Navas L, Terragni R, Crisi PE, Paolini A, Simeoni F, Vignoli M. Comparison between Image-Guided Transbronchial Cryobiopsies and Thoracoscopic Lung Biopsies in Canine Cadaver: A Pilot Study. Animals (Basel) 2022; 12:ani12111388. [PMID: 35681852 PMCID: PMC9179493 DOI: 10.3390/ani12111388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary A definitive diagnosis for most pulmonary diseases is possible only through histopathological examination. The literature describes different methods of lung biopsy sampling depending on the case. However, for the diagnosis of diffuse interstitial pulmonary diseases and some peripheral neoplasms, the gold standard is represented by surgical lung biopsies. Given their invasiveness and the high percentage of risk for the patient, in most cases they are not carried out, resulting in a serious diagnostic gap. In human medicine, transbronchial lung cryobiopsies have been introduced as an alternative, which have shown high efficacy and reduced invasiveness. This study aims to evaluate the feasibility of the new technique in dogs by subjecting dog cadavers to pulmonary cryobiopsy and surgical lung biopsies, and to compare the samples obtained for histopathological quality. In total, 42 tissue samples were compared. Pulmonary cryobiopsies were smaller than surgical biopsies but with high levels of agreement upon histological evaluation. This study demonstrates the feasibility of the technique in dogs and the collection of specimens with size and histological features comparable to those from surgical biopsies. Abstract To date, the only method of sampling lung tissue with a high diagnostic yield is represented by surgical lung biopsies (SLB), which are highly invasive and have a high risk/benefit ratio. In humans, transbronchial lung cryobiopsies (TBLC) have recently been introduced, which are described to be less invasive and able to significantly increase diagnostic confidence in most patients with interstitial lung diseases. The aim of this study was to evaluate the feasibility and diagnostic yield of TBLC compared to SLB in small animals. A total of 21 pulmonary cryobiopsies under fluoroscopic and real-time CT fluoroscopic guidance and 21 video-assisted thoracoscopic surgery (VATS) lung biopsies were collected from three dog cadavers. Upon histological examination, cryobiopsy samples were smaller than VATS biopsies, but were still large enough to reach a specific diagnosis or to allow pattern recognition. Morphological features on TBLC and SLB were concordant in all cases. Cryobiopsy samples showed fewer artifacts and a higher percentage of alveolar tissue than VATS samples. TBLC is a feasible and useful alternative to SLB for lung histopathological examination in dogs. The effectiveness and reduced invasiveness of TBLC compared to SLB could represent many advantages in the diagnosis of diffuse lung diseases in small animals.
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Affiliation(s)
- Ilaria Falerno
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
- Correspondence: (I.F.); (L.D.S.)
| | - Roberto Tamburro
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Francesco Collivignarelli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Leonardo Della Salda
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
- Correspondence: (I.F.); (L.D.S.)
| | - Luigi Navas
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy;
| | | | - Paolo Emidio Crisi
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Andrea Paolini
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Francesco Simeoni
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
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Scharf VF. Updates in Thoracoscopy. Vet Clin North Am Small Anim Pract 2022; 52:531-548. [DOI: 10.1016/j.cvsm.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bonnet B, Tabiai I, Rakovich G, Gosselin FP, Villemure I. Air leaks: Stapling affects porcine lungs biomechanics. J Mech Behav Biomed Mater 2021; 125:104883. [PMID: 34678619 DOI: 10.1016/j.jmbbm.2021.104883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/28/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022]
Abstract
During thoracic operations, surgical staplers resect cancerous tumors and seal the spared lung. However, post-operative air leaks are undesirable clinical consequences: staple legs wound lung tissue. Subsequent to this trauma, air leaks from lung tissue into the pleural space. This affects the lung's physiology and patients' recovery. The objective is to biomechanically and visually characterize porcine lung tissue with and without staples in order to gain knowledge on air leakage following pulmonary resection. Therefore, a syringe pump filled with air inflates and deflates eleven porcine lungs cyclically without exceeding 10 cmH2O of pressure. Cameras capture stereo-images of the deformed lung surface at regular intervals while a microcontroller simultaneously records the alveolar pressure and the volume of air pumped. The raw images are then used to compute tri-dimensional displacements and strains with the Digital Image Correlation method (DIC). Air bubbles originated at staple holes of inner row from exposed porcine lung tissue due to torn pleural on costal surface. Compared during inflation, left upper or lower lobe resections have similar compliance (slope of the pressure vs volume curve), which are 9% lower than healthy lung compliance. However, lower lobes statistically burst at lower pressures than upper lobes (p-value<0.046) in ex vivo conditions confirming previous clinical in vivo studies. In parallel, the lung deformed mostly in the vicinity of staple holes and presented maximum shear strain near the observed leak location. To conclude, a novel technique DIC provided concrete evidence of the post-operative air leaks biomechanics. Further studies could investigate causal relationships between the mechanical parameters and the development of an air leak.
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Affiliation(s)
- Bénédicte Bonnet
- Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
| | - Ilyass Tabiai
- Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
| | - George Rakovich
- Department of Thoracic Surgery, University of Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
| | - Frédérick P Gosselin
- Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
| | - Isabelle Villemure
- Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
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Cronin AM, Pustelnik SB, Owen L, Hall JL. Evaluation of a pre-tied ligature loop for canine total lung lobectomy. Vet Surg 2019; 48:570-577. [PMID: 30888076 DOI: 10.1111/vsu.13194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the ability of a pre-tied ligature loop (PLL) to create a seal against physiological airway pressures after total lung lobectomy and report outcomes in dogs requiring lung lobectomy. STUDY DESIGN Ex vivo experimental randomized study and clinical case study. SAMPLE POPULATION Thirty cadaveric canine lung lobes and 5 client-owned dogs. METHODS Thirty canine lung lobes from dogs weighing 22.5-35 kg were randomized to lobectomy with stapler, PLL, or suture ligation. After lobectomy, each bronchial stump was submerged in water, and the mainstem airway pressure was increased to 80 mm Hg. Leakage was compared between techniques. The PLL was subsequently used in 5 dogs (17-25 kg) with neoplastic disease requiring total lung lobectomy. RESULTS Two stapled and 4 sutured bronchial stumps leaked at supraphysiological pressures >15 mm Hg. One stapled bronchial stump failed at a physiological airway pressure (5 mm Hg). None of the PLL lobectomies leaked. The incidence of bronchial stump failures did not differ among techniques (P = .15). Lung lobectomy was performed successfully with the PLL in 5 clinical cases with no intraoperative or postoperative complications; median follow-up time was 6 months. CONCLUSION Bronchial ligation with the PLL reliably resisted physiological airway pressures and performed comparably to current standard techniques in cadavers. The PLL provided an adequate air and vascular seal in 5 clinical cases undergoing total lung lobectomy. CLINICAL RELEVANCE Pre-tied ligature loops provide an alternative method for total lung lobectomy in dogs.
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Affiliation(s)
- Anna M Cronin
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Sasja B Pustelnik
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Laura Owen
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Jon L Hall
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Eater Bush Campus, Midlothian, UK
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Brückner M, Heblinski N, Henrich M. Use of a novel vessel-sealing device for peripheral lung biopsy and lung lobectomy in a cadaveric model. J Small Anim Pract 2019; 60:411-416. [PMID: 30790298 DOI: 10.1111/jsap.12985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/09/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the Caiman vessel-sealing device for peripheral lung biopsy and total lung lobectomy in cadaveric canine lung lobes. MATERIAL AND METHODS Twelve lung lobes were randomly assigned to peripheral lung biopsy (n=6) or total lung lobectomy (n=6) with the 12-mm Caiman vessel-sealing device. Lungs were connected to a ventilator set at 10 breaths per minute with an initial pressure of 5 cm H2 O during the procedure. The lungs were submerged in water for leak testing and the pressure increased until leakage occurred. RESULTS Mean airway pressure at which leakage occurred was 39.17 ±13.20 cm H2 O for peripheral lung biopsies and 38.33 ±13.67 cm H2 O for total lung lobectomies. None of the samples leaked below 25 cm H2 O, which is well above the physiologic airway pressure. Histologically, the largest bronchial diameter at the sealed area was 8.84 mm and the extent of collateral damage was approximately 2.7 mm in all specimens. CLINICAL SIGNIFICANCE The Caiman vessel-sealing device was successfully used for peripheral lung biopsy and total lung lobectomy in cadaveric canine lung lobes. All sealed lung lobes tolerated supra-physiologic airway pressure, displayed minimal collateral damage, and were of good diagnostic quality. Further experimental studies are needed to evaluate the clinical safety of the device for peripheral lung biopsy or total lung lobectomy.
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Affiliation(s)
- M Brückner
- Blå Stjärnans Djursjukhus, Göteborg, 41707, Sweden
| | - N Heblinski
- Specialist Djursjukhus Strömsholm, Strömsholm, 73494, Sweden
| | - M Henrich
- Institut fuer Veterinärpathologie, Justus-Liebig-University of Gießen, Gießen, 35392, Germany
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Nylund AM, Chen C, Höglund OV, Campbell BG, Fransson BA. Evaluation of a resorbable self‐locking ligation device for performing peripheral lung biopsies in a caprine cadaveric model. Vet Surg 2019; 48:845-849. [DOI: 10.1111/vsu.13171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Adam M. Nylund
- College of Veterinary MedicineWashington State University Pullman Washington
| | - Chi‐Ya Chen
- College of Veterinary MedicineWashington State University Pullman Washington
| | - Odd V. Höglund
- Department of Clinical SciencesSwedish University of Agricultural Sciences Uppsala Sweden
| | - Bonnie G. Campbell
- College of Veterinary MedicineWashington State University Pullman Washington
| | - Boel A. Fransson
- College of Veterinary MedicineWashington State University Pullman Washington
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Nylund AM, Höglund OV, Fransson BA. Thoracoscopic‐assisted lung lobectomy in cat cadavers using a resorbable self‐locking ligation device. Vet Surg 2018; 48:563-569. [DOI: 10.1111/vsu.13109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/23/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Adam M. Nylund
- College of Veterinary MedicineWashington State University Pullman Washington
| | - Odd V. Höglund
- Department of Clinical SciencesSwedish University of Agricultural Sciences Uppsala Sweden
| | - Boel A. Fransson
- College of Veterinary MedicineWashington State University Pullman Washington
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Imhoff DJ, Monnet E. Inflation Pressures for Ex Vivo Lung Biopsies After Application of Graduated Compression Staples. Vet Surg 2015; 45:79-82. [DOI: 10.1111/vsu.12420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Darren J. Imhoff
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins Colorado
| | - Eric Monnet
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins Colorado
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Hazenfield KM, Smeak DD. In vitro holding security of six friction knots used as a first throw in the creation of a vascular ligation. J Am Vet Med Assoc 2014; 245:571-7. [DOI: 10.2460/javma.245.5.571] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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