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Gibson EA, Brust K, Steffey MA. Evaluation of mediastinoscopy for cranial mediastinal and tracheobronchial lymphadenectomy in canine cadavers. Vet Surg 2024; 53:834-843. [PMID: 38686899 DOI: 10.1111/vsu.14095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/17/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To report technical feasibility and describe procedural details of a novel single incision minimally invasive approach to the mediastinum in cadaver dogs. STUDY DESIGN Cadaveric study. ANIMALS Large breed (25-40 kg) cadaver dogs (n = 10). METHODS Three of 10 cadavers were used for preliminary technique development without data recording. Cadaver specimens underwent pre- and postoperative thoracic computed tomographic scans. Seven dogs were placed in dorsal recumbency and mediastinoscopy was performed via a SILS port placed cranial to the thoracic inlet with CO2 insufflation of the mediastinum at 2-4 mmHg. Retrieval of all CT and visually identified mediastinal lymph nodes (LN) was attempted; endoscopic compartmental and individual LN dissection times and subjective operative challenges were recorded. Procedural success scores for visualization and dissection as well as NASA-task force index scores were recorded per lymph node, per cadaver. RESULTS Median time required for initial approach including SILS placement was 5 min (range 5-10 min). Individual LN retrieval times ranged from 2 to 32 min. Mediastinoscopic retrieval of LNs was most commonly successful for the left tracheobronchial LN (7/7), followed by the right tracheobronchial LN (4/7), the left and right sternal LNs (3/7 each), and the cranial mediastinal LNs (1/7). Post-procedure pleural gas was identified on CT in 4/7 cadavers. CONCLUSIONS Mediastinoscopy as reported was feasible in large breed canine cadavers and retrieval or cup biopsy of a variety of lymph nodes is possible from the described approach. Application in living animals and its associated challenges should be further investigated. CLINICAL SIGNIFICANCE Mediastinoscopy may provide a novel minimally invasive approach to the evaluation and oncologic staging of the cranial mediastinum in dogs.
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Affiliation(s)
- Erin A Gibson
- William R. Prichard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Kelsey Brust
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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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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Nonselective Lymph Node Dissection and Sentinel Lymph Node Mapping and Biopsy. Vet Clin North Am Small Anim Pract 2019; 49:793-807. [PMID: 31147188 DOI: 10.1016/j.cvsm.2019.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Clinical staging is important for determining the extent of disease in animals with malignant cancers. The status of the lymph node will help determine whether adjuvant treatment is indicated. Historically, the regional anatomic lymph node has been sampled to determine the presence or absence of metastatic disease, but there is increasing evidence that the regional anatomic lymph node is often different to the sentinel lymph node. As a result, several sentinel lymph node mapping techniques have been described for more accurate clinical staging of oncologic patients.
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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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Singh A, Scott J, Case JB, Mayhew PD, Runge JJ. Optimization of surgical approach for thoracoscopic-assisted pulmonary surgery in dogs. Vet Surg 2018; 48:O99-O104. [PMID: 30387502 DOI: 10.1111/vsu.13128] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/16/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the optimal intercostal space (ICS) to perform thoracoscopic-assisted lung lobectomy. STUDY DESIGN Cadaveric study. ANIMALS Six mature, medium-sized canine cadavers. METHODS Cadavers were placed in right or left lateral recumbency. A 15-mm thoracoscopic cannula was inserted in the middle third of the 9th or 10th ICS. A wound retraction device was placed into a 7-cm minithoracotomy incision created in the middle third of the 4th-7th ICS on the left side and the 4th-8th ICS on the right side. The pulmonary ligaments were sectioned by using a combined intracorporeal and extracorporeal technique. Each lung lobe was sequentially withdrawn from the wound retraction device at the respective ICS and side. A thoracoabdominal stapler was positioned to simulate lung lobectomy, and the distance from the stapler anvil to the hilus was measured. RESULTS Simulated thoracoscopic-assisted lung lobectomy performed at left or right ICS 4 and 5, compared with other ICS evaluated, resulted in a significantly shorter median distance from the stapler anvil to the pulmonary hilus of the left cranial and caudal lung lobes and right cranial and middle lung lobes, respectively (all P < .05). Lobectomy at right ICS 5 or 6 resulted in a significantly shorter median distance from the stapler anvil to the pulmonary hilus of the right caudal and accessory lung lobes, respectively (both P < .05). CONCLUSION These data may inform minithoracotomy positioning to optimize tumor margin excision during thoracoscopic-assisted lung lobectomy for treatment of pulmonary neoplasia in dogs. CLINICAL SIGNIFICANCE Complete lung lobectomy is possible by using the described thoracoscopic-assisted technique in normal, cadaveric lungs.
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Affiliation(s)
- Ameet Singh
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Jacqueline Scott
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - J Brad Case
- College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Philipp D Mayhew
- School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jeffrey J Runge
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Kneifel W, Borak D, Bockstahler B, Schnabl-Feichter E. Use of a custom-made limb-press model to assess intra- and extracapsular techniques for treating cranial cruciate ligament rupture in cats. J Feline Med Surg 2018; 20:271-279. [PMID: 28434280 PMCID: PMC11129221 DOI: 10.1177/1098612x17704562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives This study aimed to compare the under-and-over technique, a type of intracapsular treatment, and the standard fabella-tibial suture, a method for extracapsular treatment, in achieving immediate, postoperative stifle stability after cranial cruciate ligament (CrCL) rupture by using a feline, custom-made limb-press model. Methods Cadaveric feline hindlimb specimens (n = 14) were positioned in the limb press at predefined joint angles (stifle joint: 120°; hock joint: 120°), and vertical loads of 5%, 10%, 20% and 30% body weight were applied statically. Mediolateral radiographic views were obtained of the stifles under each load before and after CrCL transection, as well as after treatment with either of the two surgical techniques, and differences in distance between two predefined radiographic points for each radiograph were analysed. Results The general linear model showed a significant effect of load ( P <0.01) and technique ( P = 0.004) and a significant interaction between load and technique ( P = 0.006) regarding craniocaudal stifle stability. Distances between predefined tibial and femoral reference points were consistently higher in transected CrCLs than in intact stifles. All standard fabella-tibial suture-treated stifles (n = 7) were stable at all loads tested. Of the seven under-and-over technique-treated stifles, one was unstable at 20% body weight load and three at 30% body weight load. Conclusions and relevance Our model, which appropriately reproduced certain aspects of domestic shorthair cat stifle mechanics, indicated that a 40 lb monofilament nylon prosthesis, tightened at 20 N, produces more favourable biomechanical stabilisation of craniocaudal cruciate-related stifle instability than a 0.5 cm wide strip of fascia lata applied intracapsularly.
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Affiliation(s)
- Wolfgang Kneifel
- Department for Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, University of Veterinary Medicine, Vienna, Austria
| | - Danilo Borak
- Department for Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, University of Veterinary Medicine, Vienna, Austria
| | - Barbara Bockstahler
- Department for Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, University of Veterinary Medicine, Vienna, Austria
| | - Eva Schnabl-Feichter
- Department for Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, University of Veterinary Medicine, Vienna, Austria
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Guedes RL, Höglund OV, Brum JS, Borg N, Dornbusch PT. Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application. Surg Innov 2018; 25:158-164. [DOI: 10.1177/1553350617751293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rogério Luizari Guedes
- Federal University of Paraná, Curitiba, Paraná, Brazil
- Tuiuti University of Paraná, Curitiba, Paraná, Brazil
| | - Odd Viking Höglund
- Swedish University of Agricultural Sciences, Uppsala, Sweden
- Resorbable Devices AB, Uppsala, Sweden
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Lim H, Kim J, Li L, Lee A, Jeong J, Ko J, Lee S, Kweon OK, Kim WH. Bilateral medial iliac lymph node excision by a ventral laparoscopic approach: technique description. J Vet Med Sci 2017; 79:1603-1610. [PMID: 28781294 PMCID: PMC5627336 DOI: 10.1292/jvms.16-0627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to describe a ventral laparoscopic technique for bilateral medial iliac lymphadenectomy in dogs. Twelve intact male purpose-bred research dogs, weighing less than 15 kg, were positioned in dorsal
recumbency, and a 3-portal technique was used. Bilateral dissection was performed with vessel-sealing devices while tilting the surgical table by up to 30° towards the contralateral side of the target medial iliac lymph node
(MILN) without changing the surgeon’s position. Using a ventral laparoscopic approach, bilateral MILNs were identified and excised in all dogs. The mean times for unilateral and bilateral MILN dissections were 9.7 ± 3.8 and 21.0 ±
6.0 min, respectively. The mean times for the right and left MILN dissections were 10.8 ± 4.3 and 9.8 ± 2.5 min, respectively. The mean total surgery time was 43.7 ± 7.7 min. In total, 26 MILNs were dissected. Several
complications, including mild to moderate capillary hemorrhage from perinodal fat and vessels (controlled laparoscopically), mild spleen trauma caused by the first trocar insertion and capsular damage of MILNs, were observed.
However, there were no other major complications. All MILN samples were evaluated and deemed suitable for histopathologic diagnosis. Laparoscopic excision of MILNs is a useful method of excisional biopsy for histopathologic
diagnosis. Using this ventral laparoscopic approach with the 3-portal technique, bilateral MILN dissection suitable for obtaining histopathologic samples could be achieved in a short time in dogs weighing less than 15 kg.
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Affiliation(s)
- Hyunjoo Lim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Jina Kim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Li Li
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Aeri Lee
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Junemoe Jeong
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Jonghyeok Ko
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Sungin Lee
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Oh-Kyeong Kweon
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Wan Hee Kim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
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Liu HF, Gao L, Liu T, Yan-Jiang, Wang HB. Comparison of acute phase reaction and postoperative stress in pigs undergoing video-assisted thoracoscopic versus thoracotomy pneumonectomy. Acta Vet Scand 2016; 58:75. [PMID: 27829432 PMCID: PMC5101706 DOI: 10.1186/s13028-016-0256-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/24/2016] [Indexed: 11/18/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has been used for many thoracic diseases as an alternate approach to thoracotomy. The aim of this study was to compare the surgical outcome of pneumonectomy using VATS with that using thoracotomy pneumonectomy in pigs. Fourteen pigs were equally divided into two groups; one group underwent VATS and the other group underwent transthoracic pneumonectomy. We monitored pre-, intra-, and post-operative physiologic parameters, along with blood cell count, serum C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and cortisol. The differences between the two approaches were analyzed. Results Mean surgical time in the VATS group (160.6 ± 16.2 min) was significantly longer than that in the thoracotomy group (123.7 ± 13.2 min). In both groups, CRP and IL-6 concentrations were significantly increased at postoperative 4 h, and then gradually decreased to preoperative levels. CRP and IL-6 at postoperative day 1 were significant lower in the VATS group compared with the thoracotomy group. SAA was significantly increased at postoperative days 1 and 3 in both groups compared with preoperative levels. Cortisol was significantly increased immediately after surgery in both groups compared with preoperative levels, and was significantly higher in the thoracotomy group than the VATS group at postoperative 4 h and 1 day. Conclusions There was no difference between the two groups in physiologic parameters and blood cell count. However, the results indicate that VATS resulted in a smaller incision, less acute-phase reaction, less stress and less pain compared with thoracotomy pneumonectomy.
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Case JB. Advances in Video-Assisted Thoracic Surgery, Thoracoscopy. Vet Clin North Am Small Anim Pract 2016; 46:147-69. [DOI: 10.1016/j.cvsm.2015.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bleakley S, Duncan CG, Monnet E. Thoracoscopic Lung Lobectomy for Primary Lung Tumors in 13 Dogs. Vet Surg 2015; 44:1029-35. [DOI: 10.1111/vsu.12411] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Seth Bleakley
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins Colorado
| | - Colleen G. Duncan
- 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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Radlinsky MG. Complications and Conversion from Endoscopic to Open Surgery. Vet Clin North Am Small Anim Pract 2015; 46:137-45. [PMID: 26410561 DOI: 10.1016/j.cvsm.2015.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Endoscopic surgery is a rapidly expanding modality of diagnosis and treatment of small animal patients. The development of skills, equipment, and minimally invasive means of correcting complications may be of great importance in decreasing the incidence of conversion from endoscopic to open surgery; however, conversion to an open approach should never be seen as a failure. Conversion should be considered at any time that it is of the greatest benefit for the patient. This concept is important enough to warrant discussion with the owner before surgery and acceptance of the need to convert without further consultation during the procedure.
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Affiliation(s)
- MaryAnn G Radlinsky
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, The University of Georgia, 2200 College Station Road, Athens, GA 30602, USA.
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Radlinsky M. Current concepts in minimally invasive surgery of the thorax. Vet Clin North Am Small Anim Pract 2015; 45:523-35. [PMID: 25735217 DOI: 10.1016/j.cvsm.2015.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Thoracoscopy is a technique that has been shown to decrease patient morbidity and is rapidly becoming more diversely applied for diagnostic and therapeutic interventions in veterinary medicine. This article describes the basic equipment and application of thoracoscopy in small animal surgery. The diagnostic and therapeutic applications are introduced and briefly described.
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Affiliation(s)
- MaryAnn Radlinsky
- Small Animal Medicine and Surgery, College of Veterinary Medicine, The University of Georgia, DW Brooks Drive, Athens, GA 30602-7390, USA.
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