Laparoscopic Cholecystectomy with Single Port Access System in 15 Dogs

Three-dimensional versus two-dimensional laparoscopy for cholecystectomy in a canine cadaveric study

OBJECTIVE

To compare the effect of three-dimensional (3D) and two-dimensional (2D) laparoscopy on surgical time and intraoperative complications during cholecystectomies in canine cadavers.

STUDY DESIGN

Experimental prospective study.

ANIMALS

Twelve canine cadavers.

METHODS

The laparoscopic cholecystectomies were performed in canine cadavers with four cannulas and with either 2D or 3D cameras by a single surgeon. The following surgical times were recorded: time from insertion of laparoscopic instruments to first endoclip placement, time from first endoclip placement to second endoclip placement, time from second endoclip placement to complete gall bladder dissection, and total surgical time. The cystic duct length distal to the first endoclip, intraoperative complications, and the amount of liver attached to the gall bladder were also recorded.

RESULTS

Time from the insertion of the instruments to the application of the first endoclip was shorter for the 3D group than for the 2D group (p = .016). Other surgical times were not different between groups. There was no difference in the cystic duct length distal to the first endoclip, intraoperative complications, or the amount of liver attachment.

CONCLUSION

Three-dimensional laparoscopy shortened the time from insertion of the laparoscopic instruments to placement of the first endoclip. However, total surgical time was not affected by the type of camera in laparoscopic cholecystectomy.

CLINICAL SIGNIFICANCE

Three-dimensional laparoscopy may be beneficial when performing procedures requiring enhanced spatial orientation. However, this technique did not shorten the total surgical time in this cadaveric study. Further studies in a clinical setting are necessary for the optimization of the future use of 3D laparoscopy.

Clinical Outcomes in Dogs Undergoing Cholecystectomy via a Transverse Incision: A Meta-Analysis of 121 Animals Treated between 2011 and 2021

Although many studies have been conducted on the use of median and transverse incisions in various surgeries in the field of human medicine, related studies in veterinary medicine are lacking. This study aimed to present treatment options for dogs requiring cholecystectomy by reporting the pros and cons of 121 cholecystectomies performed via transverse incision at our hospital over 10 years. In most included cases, nonelective cholecystectomy was performed in an unstable emergency situation. The perioperative mortality rate was 23.14%, which was not significantly different from that of cholecystectomy performed via the conventional midline approach. However, the overall operation time (46.24 ± 6.13 min; range 35-65 min) was shortened by securing an adequate surgical field of view. The transverse incision approach facilitates fast and accurate surgery without increasing the fatality rate in small-breed dogs, in whom securing an adequate surgical field of view is difficult. Thus, transverse incision should be actively considered in dogs undergoing cholecystectomy due to emergency conditions, such as bile leakage or biliary tract obstruction, since prolonged anesthesia can be burdensome. This study may improve cholecystectomy outcomes in small-breed dogs with difficult-to-secure surgical fields.

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.

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.

Intraoperative cholangiography and bile duct flushing in 47 dogs receiving laparoscopic cholecystectomy for benign gallbladder disease: A retrospective analysis

OBJECTIVE

To describe a laparoscopic approach for performing intraoperative cholangiography (IOC) and bile duct flushing (BDF) during laparoscopic cholecystectomy (LC) in dogs. To investigate the clinical outcomes of dogs undergoing these procedures for the treatment of benign gallbladder disease, ie gallbladder mucocele (GM) or cholecystitis.

STUDY DESIGN

Retrospective study.

ANIMALS

Forty-seven client-owned dogs.

METHODS

Medical records of client-owned dogs with benign gallbladder diseases that underwent IOC and BDF during LC between September 2016 and December 2019 were reviewed. Of these dogs, only dogs with GM or cholecystitis were included in the study. The fundus dissection first method was used for LC. Intraoperative cholangiography and BDF procedures were performed laparoscopically using a catheter inserted into the cystic duct following dissection within the subserosal layer of the gallbladder. Videos recorded during each procedure were reviewed, and data on procedure duration, completion, outcome, and technical approach were recorded.

RESULTS

Forty-seven dogs were included in the study. The median procedure time for BDF and IOC was 4 min (range, 2-48 min), and no intraoperative or postoperative complications occurred.

CONCLUSION

During LC, BDF and IOC were performed safely and successfully. Intraoperative cholangiography identified obstructions and strictures in the common bile duct that were not detected using BDF alone.

CLINICAL SIGNIFICANCE

Our findings suggest that BDF and IOC are both safe and time effective and should be considered for routine use by surgeons during LC.

Evaluation of coagulation parameters in dogs with gallbladder mucoceles

BACKGROUND

Gallbladder mucocele (GBM) is a common biliary disorder in dogs. Limited information is available on the coagulation status of dogs with GBM.

HYPOTHESIS/OBJECTIVES

To determine patterns of coagulation alterations in dogs with GBM and correlate them with clinicopathologic abnormalities and ultrasonographic findings of disease severity.

ANIMALS

Twenty-three dogs with GBM identified on ultrasound examination were prospectively enrolled.

METHODS

At the time of GBM identification, blood and urine were collected for CBC, serum biochemical panel, urinalysis, prothrombin time, activated partial thromboplastin time (aPTT), factor VIII, protein C (PC), von Willebrand's factor (vWF), antithrombin activity, fibrinogen, D-dimers, and thromboelastrography (TEG). Gallbladder mucoceles were classified into ultrasound types 1 to 5. Medical records were reviewed for clinical presentation, underlying conditions and to determine if systemic inflammatory response syndrome (SIRS) was present.

RESULTS

Based on TEG parameters, maximal amplitude, and G, 19/23 (83%) of dogs with GBM had evaluations consistent with hypercoagulability. On plasma-based coagulation testing, dogs with GBM had increased total PC activity (20/23, 87%), fibrinogen (9/23, 39%), platelet count (9/23, 39%), and D-dimers (6/15, 40%) as well as prolongations in aPTT (9/22, 41%) and low vWF activity (5/21, 24%). No correlation was found between TEG G value and any coagulation or clinical pathology variables, ultrasound stage of GBM or disease severity as assessed by the presence of SIRS.

CONCLUSIONS AND CLINICAL IMPORTANCE

Dogs with ultrasonographically identified GBM have changes in whole blood kaolin-activated TEG supporting a hypercoagulable state although traditional plasma-based coagulation testing suggests that a complex state of hemostasis exists.

Case Report: Surgical Correction of a Cystic Duct Stump Leakage Following Cholecystectomy Using an Autologous Rectus Sheath Graft in a Dog

A 2.7 kg, 13-year-old, castrated male Yorkshire Terrier was presented with bile peritonitis after cholecystectomy. Exploratory coeliotomy to identify and correct bile leakage revealed that the transected end of the cystic duct was open with no in-situ ligatures or vascular clips. The residual cystic duct stump was too short to ligate or seal directly. An autologous rectus sheath graft, harvested from the internal leaf of the rectus sheath, was used to patch the cystic duct stump. The graft was secured over the open duct using several simple interrupted sutures and covered with an omentalization. The clinical signs resolved after surgery, except for a transient increase in hepatobiliary enzyme levels and intrahepatic bile duct dilatation. The enzyme levels returned to near normal on day 25 after surgery. No intrahepatic bile duct dilatation was detected on day 55 after surgery. The owner was contacted for 3 years post-operatively and reported that the dog remained healthy without any long-term complications. Grafting using autologous rectus sheath can be used to treat cystic duct stump leakage that cannot be managed with direct closure using traditional modalities due to spatial constraints.