To describe clinicopathologic features of dogs that underwent lung lobectomy for resection of primary lung tumors via video-assisted thoracoscopic surgery (VATS) or open thoracotomy (OT) and to compare short-term outcomes for dogs following these procedures.Retrospective cohort study.46 medium- to large-breed dogs with primary lung tumors.Medical records of dogs that underwent a lung lobectomy via VATS (n = 22) or OT (24) for resection of primary lung tumors between 2004 and 2012 were reviewed. Dogs were included if they weighed > 10 kg (22 lb) and resection of a primary lung tumor was confirmed histologically. Tumor volumes were calculated from preoperative CT scans where available. Surgical time, completeness of excision, time in the ICU, indwelling thoracic drain time, postoperative and total hospitalization time, incidence of major complications, and short-term survival rate were evaluated.VATS was performed with a 3-port (n = 12) or 4-port (10) technique and 1-lung ventilation (22). In 2 of 22 (9%) dogs, VATS was converted to OT. All dogs survived to discharge from the hospital. There were no significant differences between the VATS and OT groups with regard to most variables. Surgery time was significantly longer for VATS than for OT (median, 120 vs 95 minutes, respectively).In medium- to large-breed dogs, short-term outcomes for dogs that underwent VATS for lung lobectomy were comparable to those of dogs that underwent OT. Further studies are required to evaluate the effects of surgical approach on indices of postoperative pain and long-term outcomes.
Objective— To report the technique, complications, and effectiveness of thoracoscopic subphrenic pericardectomy (SPP) using double‐lumen endobronchial intubation for alternating 1‐lung (OLV) in healthy dogs. Study Design— Prospective cohort study. Animals— Mature purpose‐bred dogs (n=7). Methods— Bronchoscope‐assisted placement of a left‐sided double‐lumen endobronchial tube, immediately before surgery, allowed intraoperative alternation of ventilation between lung fields. A camera portal was established in a subxyphoid location. Two instrument portals were established at the 4th–6th intercostal spaces on the right and left sides. A vessel‐sealing device was used to create the subphrenic pericardectomy. After termination of the procedure, dogs were humanely euthanatized under anesthesia and necropsy performed. In each dog, the extent of pericardectomy and any complications were evaluated. Results— Technical difficulties with tube placement occurred in 4 dogs, but alternating OLV was achieved in all dogs and SPP completed successfully. Median surgical time was 87.5 minutes (range, 80–105 minutes). At necropsy, 0.5–2 cm of pericardial tissue remained ventral to the intact phrenic nerve in 6 dogs; in 1 dog, the phrenic nerve was transected on the left side only. Conclusions— Thoracoscopic subphrenic pericardectomy is a technically feasible procedure in healthy dogs. Double‐lumen endobronchial intubation allowed alternating OLV without intraoperative bronchoscopically guided tube manipulation in all but 1 dog. Clinical Relevance— Thoracoscopic subphrenic pericardectomy could potentially be used for management of conditions where relief of pericardial constriction or access to intrapericardial structures is desired.
Abstract Objective To describe a technique for treating pyometra in dogs using a 3‐portal laparoscopic‐assisted ovariohysterectomy (LAOVH) and evaluate outcome. Study Design Retrospective case series. Animals Dogs (n = 12). Methods Dogs with open or closed‐cervix pyometra with moderately sized (1–4 cm) uterine horn diameters based on preoperative ultrasonography and no evidence of perforation were included in the study. A 3‐portal technique for LAOVH was used. A wound retraction device was inserted into the caudal portal after enlargement of the incision to 3–4 cm to simplify removal of the uterus with minimal tension. Results Twelve dogs (median weight, 23.3 kg; range, 2.1–46.0 kg) met the inclusion criteria. Median uterine diameter was 3.0 cm (range, 1.2–4.0 cm). Median surgical time for LAOVH was 107 minutes (range, 82–120 minutes). Complications included mild hemorrhage from the uterine vessels in 1 dog during uterine removal through the wound retraction device and intra‐abdominal uterine rupture in 1 dog which necessitated conversion to an open approach. All dogs recovered from surgery and were discharged. Conclusions LAOVH can be used for treatment of select cases of canine pyometra. Careful case selection is mandatory to improve success and minimize conversion to an open approach. Gentle handling of the reproductive organs is imperative to avoid iatrogenic uterine rupture.
To describe surgical techniques for multiple port laparoscopic splenectomy (MLS) in dogs and report short-term outcome.Retrospective case series.Dogs (n = 10) with naturally occurring splenic disease.Medical records (March 2012-March 2013) of dogs that had MLS were reviewed. Data retrieved included signalment, weight, clinical signs, physical examination findings, preoperative laboratory and ultrasonographic findings, port number, size, and location, patient positioning, additional procedures performed, surgical duration, histopathologic diagnosis, duration of hospitalization, and perioperative complications.Ten dogs (median weight, 28.7 kg; range, 20.2-46.0 kg) had MLS using a 3 or 4 port technique and a vessel-sealing device for tissue dissection along the splenic hilus. Dog positioning varied because of additional laparoscopic or laparoscopic-assisted procedures including adrenalectomy (n = 2), ovariectomy (1), gastropexy (1), and intestinal resection and anastomosis (1). Conversion to an open approach was necessary in 1 dog because of inadequate visibility caused by omental adhesions. One dog had hemorrhage from an omental vessel, but open conversion was not required.MLS was associated with little perioperative morbidity and few complications in this cohort of dogs and may be a reasonable option for surgical management of dogs requiring elective splenectomy.
To evaluate the exposure obtained for minimally invasive abdominal organ biopsy (MIOB) from 3 access incisions in cats.Prospective experimental study and clinical case series.6 purpose-bred research cats and 6 feline clinical patients with indications for abdominal organ biopsy.Three 3-cm incisions into the peritoneal cavity were created at different locations along the linea alba in research cats in randomized order. A wound retraction device was inserted in each incision. Ability to exteriorize various abdominal organs to the extent required to reasonably perform a surgical biopsy was recorded, and results were compared among incision sites. On the basis of results obtained, the access incision that provided exposure of the most frequently biopsied abdominal organs was used to perform MIOB in 6 feline clinical patients with various underlying pathological conditions.On the basis of experiments with research cats, a 3-cm access incision centered midway between the caudal margin of the xiphoid cartilage and the umbilicus was found to provide access for MIOB for most organs. In 5 of 6 clinical patients, all of the organs of interest were biopsied successfully via this incision location, although access to all hepatic lobes and all parts of the pancreas was inconsistent. In 1 cat, conversion to an open approach was performed because a palpable mass was detected in the area of the duodenocolic ligament.Optimization of access incision location for MIOB allowed biopsy specimen collection from organs of interest to be performed in a minimally invasive manner in cats.
Abstract Objective —To describe a technique and evaluate the outcome of thoracoscopic thoracic duct ligation (TDL) and subphrenic pericardiectomy (SPP) for treatment of idiopathic chylothorax (IC) in dogs. Design —Retrospective case series. Animals —6 client-owned dogs. Procedures —Medical records of dogs with a diagnosis of IC that were subsequently treated by thoracoscopic TDL and SPP and that had not undergone previous surgical treatment were reviewed. Thoracoscopic TDL was performed via a 3-portal technique with the patient in lateral recumbency. Subphrenic pericardiectomy was subsequently performed via a 3-portal technique with the patient in dorsal recumbency. If visualization during SPP was suboptimal, 1-lung ventilation was used to ensure that pericardial resection was close to the phrenic nerves bilaterally but without risk of iatrogenic nerve injury. Results —All TDL and SPP procedures were completed successfully in a median surgical time of 177 minutes (range, 135 to 210 minutes). All 6 dogs showed resolution of clinical signs of chylothorax with no recurrence during a median follow-up period of 39 months (range, 19 to 60 months). Final postoperative thoracic radiographic evaluation was performed at a median of 14.5 months (range, 7 to 25 months). Complete resolution of pleural effusion occurred in all but 1 dog. In 1 dog, a small volume of pleural effusion was persistent at a 7-month postoperative radiographic follow-up but was not associated with clinical signs and did not require thoracocentesis at any time during the dog's 25-month follow-up period. Conclusions and Clinical Relevance —From this limited series of patients, results suggested that a minimally invasive TDL-SPP combined surgical technique for management of IC in dogs may be associated with a similarly successful outcome as has been reported for open surgical TDL-SPP.
Clinical summary: The clinical findings, treatment and outcome for three cats that underwent laparoscopic splenectomy using bipolar vessel-sealing devices for resection of diffuse splenic disease are described. In each case, a three-portal laparoscopic technique was used. The spleen was manipulated and its mesentery and associated vessels sequentially cauterized and ligated to enable removal through a portal incision with minimal hemorrhage. Each of the three patients recovered from anesthesia without incident and was able to be discharged to the owner the next day. Practical significance: Laparoscopic splenectomy may be a safe and effective alternative to celiotomy in a select group of cats requiring splenectomy.
To determine the frequency and severity of complications after corrective surgery in dogs with lateral patellar luxation (LPL) and identify risk factors for reluxation.Retrospective case series.36 client-owned dogs with 47 affected stifle joints.Medical records of dogs that underwent surgical correction of LPL at 1 of 2 veterinary teaching hospitals between 2000 and 2011 were reviewed. Data analyzed included signalment, grade of luxation, orthopedic comorbidities, surgical procedures performed, frequency and type of complications, and whether a second surgery was performed.A total of 36 dogs with 47 affected stifle joints met the inclusion criteria. Complications were recorded for 24 of 47 (51.1%) stifle joints; there were major complications for 18 of 47 (38.3%) stifle joints. All complications were confirmed through examination by a veterinarian. The most frequent complication was reluxation, which was detected in 10 of 47 (21.3%) stifle joints. Dogs that underwent bilateral surgical repair during a single anesthetic episode had odds of reluxation that were 12.5 times the odds of reluxation for dogs that underwent unilateral surgical repair.Complication rate after corrective surgery for LPL was high, with reluxation being the most common complication in this population of dogs. Performing staged bilateral surgeries may decrease the risk of reluxation.
Objective To correlate changes in hepatic volume, hepatic perfusion, and vascular anatomy of dogs with congenital extrahepatic portosystemic shunts, before and after attenuation with an ameroid constrictor. Study Design Prospective study. Animals Dogs (n = 22) with congenital extrahepatic portosystemic shunts. Methods CT angiography and perfusion scans were performed before and after attenuation of a portosystemic shunt with an ameroid constrictor. Changes in hepatic volume, hepatic perfusion, and vascular anatomy were measured. Portal scintigraphy was performed in 8 dogs preoperatively and 22 dogs postoperatively. Results Dogs with smaller preoperative liver volumes had greater increases in liver volume postoperatively compared with those with larger preoperative liver volumes. Hepatic arterial fraction was increased in dogs preoperatively and returned to normal range after shunt attenuation, and was correlated with increase in liver size and decreased shunt fraction. Three dogs with no visible portal vasculature preoperatively developed portal branches postoperatively. Conclusions Dogs with smaller preoperative liver volumes had the largest postoperative increase in liver volume. Hepatic arterial perfusion and portal scintigraphy correlate with liver volume and are indicators of successful shunt attenuation. Dogs without visible vasculature on CT angiography had visible portal vasculature postoperatively.
