Recent advances in soft tissue minimally invasive surgery

Video-Assisted Ventral Bulla Osteotomy to Remove a Bullet Foreign Body in a Cat

A 7 yr old castrated male domestic shorthair presented for assessment of a chronic left head tilt, losses of balance, and positional nystagmus. A computed tomographic scan of the head revealed several fragments of a metallic foreign body in the left tympanic cavity. The foreign material was removed under endoscopic assistance through a minimally invasive ventral bulla osteotomy. No complications were noted during the immediate postoperative period. Follow-up 5 mo after surgery revealed complete resolution of the neurological signs with no evidence of recurrence. Foreign bodies associated with middle ear infection have not been previously reported in the cat. They should now be included in the differential diagnosis of vestibular disease. Endoscopic-assisted foreign body removal in the middle ear seems to be a safe and efficient way to retrieve small foreign bodies in bullae in cats.

Use of a Composed Simulator by Veterinarian Non-Experts in Minimally Invasive Surgery for Training and Acquisition of Surgical Skills for Laparoscopic Ovariectomy in Dogs

This study aims to assess the acquisition of surgical skills for laparoscopic ovariectomy (LOE) in dogs by veterinary surgeons with no experience in minimally invasive surgery using the CALMA Veterinary Lap-trainer simulator (CVLTS) in an experimental and analytical setting. Veterinary surgeons with no experience in minimally invasive surgery (MIS) (experimental, n = 5), and MIS experts (experts, n = 3) were evaluated. Experimental and expert group participants watched an instructional video (initial time) before practicing the LOE on uterine tissues and ovaries freshly reconstituted after elective ovariohysterectomy (initial time evaluation). Then, the experimental group practiced five training sessions on the composite simulator with permanent feedback and then performed the LOE again (final time evaluation). Surgical performances in initial and final evaluations were video recorded and further evaluated by three external MIS experts using Global objective assessment of laparoscopic skills (GOALS) and LOE-specific rating scales (SRSs) in a double-blinded schedule. In addition, a hands movement assessment system (HMAS) attached to the back of the hands was used to quantitatively measure completion time, angularity, and movement smoothness. Data were analyzed with one-factor ANOVA and Tukey's contrast test. No statistically significant differences were found between the novice group's performance after training and the expert group's performance according to the GOALS (p < 0.01) and SRS (p < 0.05) scores. Moreover, the novices had significantly improved time, number of movements, and angularity in the final time compared with the initial time (p < 0.05), with no significant differences compared to the expert group (p > 0.05). LOE training using a composed simulator resulted in significantly improved laparoscopic skills and time, number, and angularity of movements data, providing evidence of the usefulness and reliability of CVLTS in training LOE.

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.

Long-Term Outcome after Cholecystectomy without Common Bile Duct Catheterization and Flushing in Dogs

The aim of this study is to report outcomes of dogs undergoing cholecystectomy for gall bladder mucocele (GBM) without flushing and catheterization of the common bile duct (CBD). This is a retrospective multicentric study from three veterinary referral hospitals and included 82 dogs diagnosed with GBM. Medical records were reviewed for clinical and histopathological findings. Long-term outcome was assessed with an owner questionnaire. The common bile duct was considered normal (<4 mm), mildly dilated (5−6 mm) and moderately dilated (>7 mm) in 88%, 10% and 2.4% of dogs, respectively. Surgery was uncomplicated in 83% of dogs. Intraoperative complications were recorded in 21% of dogs, with hypotension being the most common, whereas postoperative complications were documented in 20% of dogs, with vomiting/regurgitation being the most common. Ninety-six percent of dogs that underwent cholecystectomy in this study survived to discharge. Follow-up ranged from 142 to 3930 days (median: 549 days). Eighty-five percent of dogs were alive at the time of follow-up. Dogs undergoing cholecystectomy for GBM without catheterization and flushing of the CBD have a favourable prognosis for recovery and quality of life.

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.

Minimally invasive video-assisted parathyroidectomy in dogs: Technique description and feasibility study

OBJECTIVE

To describe a minimally invasive approach to the parathyroid gland for the treatment of primary hyperparathyroidism.

STUDY DESIGN

Surgical technique description and clinical case report.

ANIMALS

Five canine cadavers and 5 client-owned dogs with primary hyperparathyroidism.

METHODS

A surgical technique for minimally invasive video-assisted parathyroidectomy (MIVAP), described for humans, was adapted for dogs. With the dog in dorsal recumbency, a 15 mm incision was made on the midline, 1 finger width caudal to the cricoid cartilage of the larynx. A 5 mm 30° rigid endoscope was inserted into the peritracheal space with the aid of a blunt suction dissector, and fine elevators. The parathyroid was subsequently removed using electrocautery and blunt and sharp dissection. The technique was refined in 5 cadaver dogs to assess feasibility, and was subsequently performed in 5 clinical cases.

RESULTS

A minimally invasive approach to the parathyroid gland was possible and allowed successful removal of a parathyroid mass in 5 dogs without complication. The use of fluid ingress was trialed in 1 cadaver and not found to be helpful. The use of a blunt suction dissector greatly facilitated dissection of the peritracheal space.

CONCLUSION

Minimally invasive video-assisted parathyroidectomy is feasible in dogs and was not associated with complications in 5 clinical cases.

CLINICAL SIGNIFICANCE

Minimally invasive techniques tend to reduce morbidity and are popular with pet owners. This study demonstrates that a minimally invasive technique may be considered for parathyroidectomy in dogs.

Pet-owner perceptions of laparoscopy in an urban hybrid veterinary practice

OBJECTIVE

To investigate owner perceptions of laparoscopic surgery, including attitudes towards paying more for minimally invasive surgery (MIS).

STUDY DESIGN

Randomized cross-sectional prospective survey.

SAMPLE POPULATION

One hundred owners presenting at a combined general and specialty practice.

METHODS

Participants were interviewed using a survey tool to assess prior knowledge of laparoscopic procedures, attitude for or against these procedures, reasons for this attitude, and whether they would pay more for these procedures. Demographic data were collected.

RESULTS

Fifty-five percent of owners had previous knowledge of laparoscopy. Ninety-two percent of owners would choose laparoscopy over an open procedure for their pet. Reasons given for preferring laparoscopy: less postoperative pain (66.3%), shorter length of hospitalization (26.1%), better cosmesis (20.1%), perception of lower cost (15.2%), faster return to function (14.1%), length of anesthesia (5.4%), and other reasons (26.1%). Ninety-one percent of owners were willing to pay more for MIS. Among owners who indicated they would be willing to pay more, owners presenting with dogs were 2.5 times more likely to be willing to pay at least $1000 more than owners presenting with cats.

CONCLUSION

The majority of owners surveyed at a large hybrid hospital in an urban setting choose laparoscopic over open procedures and are willing to pay more for them.

CLINICAL SIGNIFICANCE

The results highlight the importance of client and veterinarian education regarding the options of MIS for pets, as owners who are informed may prefer referral for these procedures. The financial investment to build a MIS practice may be justified.

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.

Validation of Training and Acquisition of Surgical Skills in Veterinary Laparoscopic Surgery: A Review

At present, veterinary laparoscopic surgery training is lacking in experiences that provide a controlled and safe environment where surgeons can practice specific techniques while receiving experts' feedback. Surgical skills acquired using simulators must be certified and transferable to the operating room. Most models for practicing laparoscopic skills in veterinary minimally invasive surgery are general task trainers and consist of boxes (simulators) designed for training human surgery. These simulators exhibit several limitations, including anatomic species and procedural differences, as well as general psychomotor training rather than in vivo skill recreation. In this paper, we review the existing methods of training, evaluation, and validation of technical skills in veterinary laparoscopic surgery. Content includes global and specific scales, and the conditions a structured curriculum should meet for improving the performance of novice surgeons during and after training. A focus on trainee-specific assessment and tailored-technical instruction should influence training programs. We provide a comprehensive analysis of current theories and concepts related to the evaluation and validation of simulators for training laparoscopic surgery in small animal surgery. We also highlight the need to develop new training models and complementary evaluation scales for the validation of training and acquisition of basic and advanced skills in veterinary laparoscopic surgery.

Effects of intra-abdominal pressure on laparoscopic working space in domestic rabbits (Oryctolagus cuniculus)

OBJECTIVE

To assess the effects of 3 intra-abdominal pressures (IAPs) on pneumoperitoneal (laparoscopic working space) volume in domestic rabbits (Oryctolagus cuniculus).

ANIMALS

6 female New Zealand White rabbits.

PROCEDURES

A Latin-square design was used to randomly allocate sequences of 3 IAPs (4, 8, and 12 mm Hg) to each rabbit in a crossover study. Rabbits were anesthetized, subumbilical cannulae were placed, and CT scans were performed to obtain baseline measurements. Each IAP was achieved with CO₂ insufflation and maintained for ≥ 15 minutes; CT scans were performed with rabbits in dorsal, left lateral oblique, and right lateral oblique recumbency. The abdomen was desufflated for 5 minutes between treatments (the 3 IAPs). Pneumoperitoneal volumes were calculated from CT measurements with 3-D medical imaging software. Mixed linear regression models evaluated effects of IAP, rabbit position, and treatment order on working space volume.

RESULTS

Mean working space volume at an IAP of 8 mm Hg was significantly greater (a 19% increase) than that at 4 mm Hg, and was significantly greater (a 6.9% increase) at 12 mm Hg than that at 8 mm Hg. Treatment order, but not rabbit position, also had a significant effect on working space. Minor adverse effects reported in other species were observed in some rabbits.

CONCLUSIONS AND CLINICAL RELEVANCE

A nonlinear increase in abdominal working space was observed with increasing IAP. Depending on the type of procedure and visual access requirements, IAPs > 8 mm Hg may not provide a clinically important benefit for laparoscopy in rabbits.

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.

Efficacy of en bloc thoracic duct ligation in combination with pericardiectomy by video-assisted thoracoscopic surgery for canine idiopathic chylothorax

OBJECTIVE

To compare the outcomes of pericardiectomy performed with conventional clipping thoracic duct ligation (C-TDL) to those with en bloc thoracic duct ligation (EB-TDL) using video-assisted thoracoscopic surgery (VATS) for canine idiopathic chylothorax.

STUDY DESIGN

Retrospective consecutive case series.

ANIMALS

Thirteen client-owned dogs with idiopathic chylothorax.

METHODS

Medical records of dogs treated with pericardiectomy in combination with TDL by VATS without intraoperative contrast were reviewed. Five and seven dogs underwent C-TDL and EB-TDL, respectively, and 11 dogs were evaluated by preoperative and 7- to 10-days-postoperative computed tomography-lymphography (CTLG). No clinical symptoms with absent or minimal pleural effusion was defined as clinical improvement. Long-term remission (LTR) was defined as rapid resolution of pleural effusion and no recurrence for more than 1 year. Anesthesia time, operation time, the duration of hospitalization, and time until pleural effusion resolution were compared.

RESULTS

Clinical improvement was achieved in 91.7% of the cases (C-TDL, 4/5; EB-TDL, 7/7), excluding one case of intraoperative death. The LTR rate was significantly higher with EB-TDL (6/7 [85.7%]) than with C-TDL (1/5 [20%]). Anesthesia time, operation time, and time until pleural effusion resolution were significantly better with EB-TDL than with C-TDL. The rates of thoracic ducts visualization by postoperative CTLG were 100% (5/5) with C-TDL and 42.9% (3/7) with EB-TDL.

CONCLUSION

En bloc TDL was an effective treatment for canine idiopathic chylothorax in this patient population. It compared favorably to C-TDL, although missed branches at the time of surgery may explain the difference between C-TDL and EB-TDL in this small population of cases.

CLINICAL SIGNIFICANCE

En bloc TDL by VATS was an effective minimally invasive treatment for canine idiopathic chylothorax. Computed tomography-lymphography can be used for surgical planning and postoperative evaluation.

Influence of Hydrogen-rich Saline on Hepatocyte Autophagy During Laparoscopic Liver Ischaemia-reperfusion Combined Resection Injury in Miniature Pigs

Introduction

The purpose of this study was to investigate the protective effect of hydrogen-rich saline (HRS) against liver ischaemia-reperfusion combined resection injury.

Material and Methods

Eighteen miniature pigs were randomly divided into three groups: a sham operated group (sham group, laparoscopic liver ischaemia-reperfusion combined resection injury group (IRI group), and a hydrogen-rich saline intervention group (IRI + HRS group). Samples of hepatic tissue and serum were collected at the time of reperfusion and then 3 h, 1 d, and 3 d post reperfusion. Liver function, oxidative stress, autophagy-related mRNA genes, and protein expression were evaluated. Changes in cell and tissue ultrastructure were examined by transmission electron microscopy.

Results

Compared with the sham group, the level of autophagy of hepatocytes increased in the IRI and IRI + HRS groups, corresponding to high oxidative stress and severe liver function injury. Liver function, antioxidant content, autophagy levels, and liver injury were improved after intervention with HRS in the IRI + HRS group compared with the IRI group.

Conclusion

Intervention with hydrogen-rich saline could exert a protective effect against liver ischaemia-reperfusion combined resection injury through the reduction of oxidative stress and hepatocyte autophagy.

CT cholangiography in dogs with gallbladder mucocoele

OBJECTIVES

To summarise CT cholangiography findings in dogs with gallbladder mucocoele.

MATERIALS AND METHODS

Each of 10 dogs with gallbladder mucocoele underwent CT cholangiography using meglumine iotroxate before cholecystectomy. The following structures of the biliary system were evaluated: the right and left hepatic ducts, common hepatic duct, cystic duct, common bile duct and gallbladder.

RESULTS

The hepatic duct, cystic duct, common bile duct and gallbladder were imaged by contrast-enhanced CT cholangiography. The passage of the contrast medium through the bile duct into the duodenum was visible in nine dogs. The curved planar reformation images of two dogs showed they had filling defects in the bile duct system. In one dog with hyperbilirubinaemia due to chronic hepatitis, the bile duct system was not completely contrast-enhanced. Surgical exploration revealed no evidence of common bile duct obstruction in any dog.

CLINICAL SIGNIFICANCE

CT cholangiography delineates the structural characteristics of the biliary system and partially estimates its patency in dogs with gallbladder mucocoele. Therefore this procedure may be useful as a preoperative screen of the bile duct system in dogs with gallbladder mucocoele.

Evaluation of pet owner preferences for operative sterilization techniques in female dogs within the veterinary community

OBJECTIVE

To describe pet owner preferences within the veterinary community when choosing operative techniques for canine spay.

STUDY DESIGN

Prospective survey.

SAMPLE POPULATION

1234 respondents from 5 veterinary university teaching hospitals in North America.

METHODS

An electronic survey was distributed to faculty, students, and staff that currently are or previously were dog owners. Responses were analyzed to determine what spay technique respondents would choose for their own dogs. Surgical options offered included open celiotomy, 2-port (TP) laparoscopy, single-port (SP) laparoscopy, and natural orifice transluminal endoscopic surgery (NOTES).

RESULTS

TP laparoscopic ovariectomy (OVE) was the most popular choice, followed by SP laparoscopic OVE; NOTES was the least popular technique when all surgical options were available. If only minimally invasive surgeries were offered, 0.3% of respondents would refuse surgery. Nearly half (48%) of respondents were willing to spend between $100 and $200 more for a minimally invasive OVE than for an open celiotomy.

CONCLUSION

Minimally invasive OVE is an acceptable operative approach to those in the veterinary community. Additional study is required to correlate these findings with the general veterinary client population.

Effect of changes in intra-abdominal pressure on diameter, cross-sectional area, and distensibility of the lower esophageal sphincter of healthy dogs as determined by use of an endoscopic functional luminal imaging probe

OBJECTIVE To evaluate the effect of intra-abdominal pressure (IAP) on morphology and compliance of the lower esophageal sphincter (LES) by use of impedance planimetry in healthy dogs and to quantify the effect of changes in IAP. ANIMALS 7 healthy, purpose-bred sexually intact male hound-cross dogs. PROCEDURES Dogs were anesthetized, and cross-sectional area (CSA), minimal diameter (MD), LES length, LES volume, and distensibility index (DI) of the LES were evaluated by use of an endoscopic functional luminal imaging probe. For each dog, measurements were obtained before (baseline) and after creation of a pneumoperitoneum at an IAP of 4, 8, and 15 mm Hg. Order of the IAPs was determined by use of a randomization software program. RESULTS CSA and MD at 4 and 8 mm Hg were not significantly different from baseline measurements; however, CSA and MD at 15 mm Hg were both significantly greater than baseline measurements. The LES length and LES volume did not differ significantly from baseline measurements at any IAP. The DI differed inconsistently from the baseline measurement but was not substantially affected by IAP. CONCLUSIONS AND CLINICAL RELEVANCE Pneumoperitoneum created with an IAP of 4 or 8 mm Hg did not significantly alter LES morphology in healthy dogs. Pneumoperitoneum at an IAP of 15 mm Hg caused a significant increase in CSA and MD of the LES. Compliance of the LES as measured by the DI was not greatly altered by pneumoperitoneum at an IAP of up to 15 mm Hg.

Comparison between Training Models to Teach Veterinary Medical Students Basic Laparoscopic Surgery Skills

The objective of this study was to compare the effectiveness of two different laparoscopic training models in preparing veterinary students to perform basic laparoscopic skills. Sixteen first- and second-year veterinary students were randomly assigned to a box trainer (Group B) or tablet trainer (Group T). Training and assessment for both groups included two tasks, "peg transfer" and "pattern cutting," derived from the well-validated McGill University Inanimate System for Training and Evaluation of Laparoscopic Skills. Confidence levels were compared by evaluating pre- and post-training questionnaires. Performance of laparoscopic tasks was scored pre- and post-training using a rubric for precision and speed. Results revealed a significant improvement in student confidence for basic laparoscopic skills (p<.05) and significantly higher scores for both groups in both laparoscopic tasks (p<.05). No significant differences were found between the groups regarding their assessment of the video quality, lighting, and simplicity of setup (p=.34, p=.15, and p=.43, respectively). In conclusion, the low-cost tablet trainer and the more expensive box trainer were similarly effective in preparing pre-clinical veterinary students to perform basic laparoscopic skills on a model.

Preliminary application of a single-port access technique for laparoscopic ovariohysterectomy in dogs

Laparoscopic ovariohysterectomy using single-portal access was performed in nine selected owned dogs admitted for elective ovariohysterectomy and the surgical technique and outcomes were detailed. A multiport device (SILS Port, Covidien, USA) was placed at the umbilical area through a single 3 cm incision. Three cannulae were introduced in the multiport device through the access channels and laparoscopic ovariohysterectomy was performed using a 5-mm sealing device, a 5-mm articulating grasper and a 5-mm 30° laparoscope. The mean total operative time was 52.66±15.20 minutes and the mean skin incision during surgery was 3.09±0.20 cm. Of the nine cases examined, in the one with an ovarian tumour, the technique was converted to multiport laparoscopy introducing an additional 5-mm trocar. No surgical complications were encountered and intraoperative blood loss was minimum in all animals. Clashing of the instruments and reduced triangulation were the main limitations of this technique. The combination of articulated and straight instruments facilitated triangulation towards the surgical field and dissection capability. One month after surgery a complete wound healing was observed in all animals. The present data showed that ovariohysterectomy performed with a single-port access is technically feasible in dogs. The unique abdominal incision minimises the abdominal trauma with good cosmetic results.