Implementation of a Canine Ergonomic Abdominal Simulator for Training Basic Laparoscopic Skills in Veterinarians

The validity of the CALMA Veterinary Lap-trainer simulator (CVLTS) for training basic veterinary laparoscopic skills was assessed and compared to a simple collapsible mobile box trainer. Ten veterinarian surgeons with no experience in laparoscopic surgery and four experts with at least two years of experience in minimally invasive surgery (MIS) were included. The training curriculum included object transfer, non-woven gauze cutting with curved scissors, and interrupted and continuous intracorporeal sutures, which were practiced on the CVLTS. The initial and final assessments were carried out in both the CVLTS and in a collapsible mobile simulator. These were video-recorded and evaluated by external experts using the Objective Structured Assessment of Technical Skills (OSATS) and a specific scale evaluation in a double-blinded schedule. The time, angular displacement, number, and movement smoothness were recorded using a hands movement assessment system (HMAS). Through a survey, the face validity and content were evaluated. The data were analyzed by a Pearson's proportions comparison or Mann Whitney U test and a bilateral Student's t-test. The experimental group OSATS, specific scores, and HMAS values, with the exception of the smoothness of movements, significantly improved after training, with no statistically significant differences compared to the expert group. No differences were found between the two simulators. The experts' and experimental participants' CVLTS mean score was 4.8. Our data support the CVLTS validations for laparoscopic surgery basic skills training.

Development and validation of a composed canine simulator for advanced veterinary laparoscopic training

The development of innovative simulation models for veterinary laparoscopic surgery training is a priority today. This study aimed to describe a didactic simulation tool for the training of total laparoscopic gastropexy (TLG) with intracorporeal sutures in dogs. CALMA Veterinary Lap-trainer composite simulator (CLVTS) was developed from a plaster cast of 2 Great Dane canines mimicking the space and the correct position to carry out a TLG. After video instruction, 16 veterinarians with different degrees of experience in minimally invasive surgery (Experts, n = 6 and intermediates, n = 10) evaluated four sequential simulating TLG with intracorporeal suturing in the CLVTS. Subsequently, they completed an anonymous questionnaire analyzing the realism, usefulness, and educational quality of the simulator. The CLVTS showed a good preliminary acceptance (4.7/5) in terms of the usefulness and adequacy of the exercises that, in the participants' opinion, are appropriate and are related to the difficulty of the TLG. In addition, both experienced and intermediate surgeons gave high marks (4.5/5) to the feeling of realism, design, and practicality. There were no significant differences between the responses of the two groups. The results suggest that the CVLTS has both face and content validity. Where it can be practiced in a structured environment for the development of a total laparoscopic gastropexy with intracorporeal suture and without compromising patient safety, but still has some limitations of the scope of the study. Further studies are needed to establish the ability to assess or measure technical skills, including the degree of transferability to the actual surgical environment.

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.

Concomitant Presence of Ovarian Tumors (Teratoma and Granulosa Cell Tumor), and Pyometra in an English Bulldog Female Dog: A Case Report

Background: The diagnosis of ovarian tumors in dogs is usually complicated because the clinical signs can be very discrete and can be easily confused with other diseases. There are few reports of ovarian tumors with different cellular characteristics in the same dog. Our objective was to describe an unusual case of the concomitant presence of ovarian teratoma and granulosa cell tumors in a female dog presenting symptoms compatible with pyometra at clinical consultation.

Clinical history: A non-spayed 6-years-old female English Bulldog was attended at the consultation, with no history of previous steroid hormonal treatment. The dog had presented regular estrus every 6 months; 3 months elapsed between the last estrus and consultation. The dog had presented vulvar discharge for more than 2 weeks.

Clinical and laboratory findings: the patient presented a slightly pale oral mucosa, decay, vulvar edema, and mucous-purulent uterine discharge. The ultrasound examination revealed the presence of neoformations in the ovaries, and evidence of cystic endometrial hyperplasia-pyometra in the uterus.

Treatment: We performed a ventral ovariohysterectomy. During the surgical procedure, it was found several masses in the left and right ovaries, exhibiting characteristics of other tissues different from ovarian tissue. All samples were sent for histopathological examination. The diagnosis was a granulosa cell tumor in the left ovary and a well-differentiated teratoma in the right ovary.

Conclusion: Practitioners must improve the use of diagnostic tools when attending non-spayed dogs at advanced ages (more than 6 years old), which would probably be at high risk of suffering from undetected ovarian tumors, some of them with malignancy behavior.