Veterinary Surgery最新文献

Objective: To evaluate the accuracy of ventral slot creation in canine cadavers with a three-dimensional (3D)-printed drill guide compared to the freehand technique.

Study design: Ex vivo study.

Sample population: Eight canine cadavers (23.4-39.8 kg).

Methods: Computed tomography (CT) data was used to create patient-specific 3D-printed surgical guides for ventral slot creation. Intervertebral sites were randomized to undergo either a guided (n = 12) or freehand (n = 12) ventral slot by a novice surgery resident. Postoperative CT images were used to compare ventral slot dimensions, shape, and position.

Results: Free-hand ventral slots were significantly shorter than the intended dimensions (p < .01). Dimensions of the guide-assisted ventral slots were not statistically different from the planned dimensions (p = .88, p = .72). Use of the guides resulted in improved accuracy for ventral slot positioning relative to midline and slot shape (difference in coefficient of variations, 32%, and 40%, respectively).

Conclusion: Ventral slot dimensions were more accurate when created with the patient-specific 3D-printed guide compared to the freehand technique.

Clinical significance: Use of a 3D-printed patient specific surgical guide improves accuracy of ventral slot creation in canine cadavers and improves surgical precision when used by a single novice surgical resident. The results of this study support evaluation of the guides in small breed cadavers and live patients.

Objective: To report the technique and outcomes of utilizing chest wall lift to perform thoracoscopic surgery in two cats.

Study design: Short case series.

Animals: Client-owned cats (n = 2).

Methods: A geriatric cat was referred for pleural effusion secondary to a left cranial lung lobe mass. A thoracoscopic exploration of the left hemithorax was planned with a lift device used for laparoscopy and attached to a ceiling mount. A young cat was referred for a foreign body lodged in the right caudal bronchus. Attempted bronchoscopic retrieval was unsuccessful. Thoracoscopic lung lobectomy was planned using a bent Steinmann pin as a lift device placed at the eighth intercostal space, along one of the cannula.

Results: Thoracic lift was achieved with the patient in right lateral recumbency for the first cat, leading to immediate improvement in the oxygenation and ventilation status of the patient while simultaneously allowing for continued thoracoscopic exploration of the hemithorax. With two additional ports, thoracoscopic dissection of the adhesions was performed prior to thoracoscopic assisted lung lobectomy at the fourth intercostal space. For the second cat, thoracic lift was performed with the patient in left lateral recumbency and allowed successful 3-port thoracoscopic lung lobectomy. No complication related to the use of either lift device was noted.

Conclusion: Chest wall lift improved anesthesia respiratory status in one cat and increased the working space to perform thoracoscopic procedures in both cats.

Clinical significance: This novel and simple technique could increase working space without anesthesia impairment, allowing thoracoscopic procedures in selected feline patients.

Objective: To determine if surgical skills instructors' experience and qualifications influence students' learning of small animal ovariohysterectomy on a model (mOVH).

Sample population: Second-year veterinary students (n = 105).

Methods: Students were randomized to three groups, taught by: (1) residency-trained surgeons with over 3 years' experience teaching mOVH, (2) general practitioners with over 3 years' experience teaching mOVH (GP >3), and (3) general practitioners with under 3 years' experience (GP <3). Students completed four 3-h laboratories where they performed mOVH under the supervision of one of the three types of instructors. Students were assessed performing mOVH using a validated 22-item rubric and completed a survey about their experience.

Results: GP <3 group students achieved lower total rubric scores than GP >3 group students (p = .021). Surgeon-taught students' scores did not differ from those taught by GP >3 (p = .685) or GP <3 (p = .052). GP <3 group students were more likely to require remediation than those taught by surgeons (p = .001); there were no differences between the other groups (surgeons vs. GP >3 p = .44; GP <3 vs. GP >3 p = .11). Students reported similar satisfaction with their instruction. Instructors with over 3 years' experience teaching mOVH had better student learning outcomes compared to instructors with under 3 years of experience. While mOVH teaching experience did influence learning, the instructor's completion of a surgical residency did not.

Conclusion: The results of the study indicate a need for more extensive training for new surgical skills instructors and demonstrates that GPs with experience teaching surgical skills are suitable instructors for teaching ovariohysterectomy on a model.

Clinical relevance: This study indicates a need for more extensive training for new surgical skills instructors and demonstrates that GPs with experience teaching surgical skills are suitable instructors for teaching ovariohysterectomy on a model.

Objective: The aim of the study was to evaluate time to closure, bursting pressures and luminal diameters of a single and double-layer end-to-end anastomoses in normal equine descending colon.

Study design: Experimental study.

Sample population: Eight adult horses.

Methods: Four segments of descending colon from each horse were randomly assigned to a control (n = 8, CON), one-layer (n = 12, group 1; continuous Lembert pattern), or two-layer group (n = 12, group 2; simple continuous oversewn with Cushing pattern). Anastomoses were performed, and time to closure and luminal diameter were measured. Bursting pressures were determined, and location of failure was recorded. Mixed analysis of variance (ANOVA) was employed.

Results: Mean time to completion was decreased (p = .003) in group 1 (18.6 min ± 22.8 s) compared with group 2 (21.35 min ± 22.8 s). Luminal diameter was reduced (p < .0001) in group 2 (47 ± 2.46 mm) compared to group 1 (65 ± 2.77 mm). Location of failure was remote to the anastomosis in all but one segment; therefore, differences in anastomotic bursting pressures could not be determined.

Conclusion: Two-layer closures resulted in significant luminal reduction and took longer to complete than one-layer anastomoses.

Clinical significance: Use of one-layer closures may be advantageous primarily with respect to luminal diameter.

Objective: To compare the practicability and tissue sample quality between different intestinal biopsy techniques.

Study design: Experimental, randomized ex vivo study.

Sample population: Small intestine of nine horses.

Methods: Four different biopsy techniques were evaluated in the aboral jejunum and the ileum within 1 h after euthanasia. One segment was used as control (C), and the applied techniques included an 8 mm biopsy punch (BP), transverse wedge resection (TW), longitudinal wedge resection with transverse closure (LW) and a longitudinal sample using Eppendorfer biopsy forceps (EF). Defects were closed using a single-layer continuous Lembert pattern. Duration of the procedure, intestinal diameter, contamination, and bursting pressure were determined. The quality of the obtained tissue samples for histological assessment was evaluated using a semiquantitative score. The jejunal and ileal samples were analyzed separately.

Results: All biopsy procedures including defect closure were completed within 5 min, with shorter closure times for BP (p = .03). Minimal contamination could be noted in 1/8 TW and 2/8 LW cases, without significant differences between the groups. Longitudinal closure techniques (BP, EF) showed more constriction than transverse closures (TW, LW) (p < .05). Bursting pressure was >75 mmHg in all cases. Technique BP showed significantly lower biopsy quality scores (p = .009).

Conclusion: The tested biopsy techniques could all be applied effectively within a reasonable time frame, yet the biopsy punch was associated with significant artifacts and risk of missing mucosa.

Clinical significance: The findings provide insights into the possible advantages and limitations of the different techniques and alert the surgeon to potential issues with the quality of the tissue sample.

Objective: To describe a combined transdiaphragmatic and caudal median sternotomy (TDCM) approach to the accessory lung lobe and to compare its accessibility with intercostal thoracotomy (ICT) and median sternotomy (MS).

Study design: Cadaveric study.

Animals: Twelve canine cadavers.

Methods: Cadavers underwent an accessory lung lobectomy using an articulating EndoGIA stapler via randomly assigned approach: ICT (n = 4), MS (n = 4) or TDCM (n = 4). The percentage of accessory lung tissue removed was measured in surface area and weight. Exposure was measured as area of cavitary or bicavitary exposure at maximal retraction, by tracing a line around the circumference of the exposed cavity using an imaging software. Staple line leak pressures were evaluated to 40 cmH₂O.

Results: The average area of exposure was larger in the TDCM approach (TDCM = 193.5 cm², MS = 106.5 cm², ICT = 73.5 cm²); (p = .01). Two of four ICT staple lines leaked at 40 cmH₂O or lower, and 1/4 MS resulted in iatrogenic damage to an adjacent lobe. There was no difference in the percentage of the lobe excised by weight or surface area between groups.

Conclusion: The transdiaphragmatic and caudal median sternotomy approach provided greater exposure, although the percentage of the lobe excised and the surgical time did not differ between approaches.

Clinical significance: All three approaches allowed for adequate excision of the accessory lung lobe (ALL) with similar surgical times; however, the TDCM approach provided a greater area of exposure, which could increase accessibility to the ALL.

Objective: To describe the surgical technique and outcomes of arthroscopic treatment for talar osteochondritis dissecans (OCD) in dogs, using scope and instrument portals placed on the same side of the joint as the lesion.

Study design: Retrospective case series.

Animals: Fifteen client-owned dogs (19 tarsi).

Methods: The records of dogs with talar OCD lesions managed by arthroscopy using this modified approach to portal placement were reviewed. Signalment, owner-completed questionnaires-the Canine Brief Pain Inventory (CBPI) and a visual analog scale (VAS)-together with clinical and imaging data, surgical techniques, and postoperative complications were recorded. Mid- to long-term outcomes (over 6 months) were assessed using orthopedic examinations, osteoarthritis radiographic scores, and owner-completed questionnaires.

Results: Visualization of the affected articular structures was adequate in all cases. The multiple OCD fragments identified on CT scans were removed without intraoperative complication in 17 tarsi. Mini-arthrotomy was performed in one dog and mini-tenotomy of the deep digital flexor sheath was performed in another. Minor postoperative complications (synovial cysts) were reported in four cases. Mid- to long-term outcomes were good to excellent in 11 of the 14 dogs with substantial improvement in lameness, CBPI, and VAS scores compared with preoperative results. Degenerative joint disease progression was observed in 10 of the 14 cases.

Conclusion: The modified arthroscopic technique resulted in few complications, rapid clinical improvement, and full or acceptable function in most cases.

Clinical significance: This modified approach to portal placement is an appealing and suitable alternative to the approach described previously for managing tarsal OCD lesions.

Objective: The aim of the present study was to investigate the long-term survival and postoperative complications in horses that had undergone small intestinal resection and a modified anastomosis technique using a partially stapled, functional end-to-end anastomosis.

Study design: Observational retrospective case series.

Animals: A total of 25 horses underwent small intestinal resection and a partially stapled, functional end-to-end anastomosis.

Methods: A modified technique to create a partially stapled, functional end-to-end anastomosis is described. The clinical case records of all horses that fulfilled the criteria between January 1, 2010 and January 1, 2020 were reviewed. Data on short-term survival and postoperative complications were collated. A telephone questionnaire of owners was undertaken to evaluate long-term survival.

Results: Duration of follow up was from one to 4232 days (median 785 days). A total of 21/25 (84%) of horses survived to discharge, 19/25 (76%) horses were alive at 6 and 12 months and 64% survived to 2 years. A total of 64% of horses developed at least one postoperative complication. Two horses developed a small intestinal volvulus necessitating repeat laparotomy. One horse had kinking at the anastomosis site diagnosed at post-mortem examination.

Conclusion: Partially stapled functional end-to-end anastomosis technique in this study had similar short- and long-term survival to those reported in previous studies using handsewn techniques, but severe complications at the anastomosis site occurred in >10% of cases.

Clinical relevance: The anastomosis technique described appears to have similar short- and long-term survival and complication rates, compared to more commonly used anastomosis techniques. However, there is potential for severe complications at the anastomosis site.

Objective: To provide an overview of available research about effects of horseshoes on equine kinetics and kinematics.

Methods: The terms, "horse/equine," "hoof," "shoes/horseshoes," "kinetics," and "kinematics" were searched in PubMed, Web of Science, Center for Agriculture and Bioscience International, and United States Department of Agriculture National Agricultural Library for manuscripts from first availability to 2024. Independent reviewers used preferred reporting items for systematic reviews and meta-analyses guidelines to map and extract evidence-based data from sources. Metrics included participant demographics, research methods, major findings, and study limitations. Knowledge gaps were also identified.

Results: A total of 46 studies were included. Most utilized non-lame horses to compare original shoe designs or modifications to unshod or a standard open-heel shoe. Horse demographics and gait, study design and outcome measures varied widely. Prevalent data collection equipment included force platforms and pressure plates, wearable force measuring technology, and videography. Many studies reported shoeing effects on limb forces and motion, but there was little consensus among unrelated studies. Common limitations included insufficient data resolution, no randomization, small sample size, single breed, and outcome measures specific or unique to the study. Knowledge gaps included data collection from all limbs and the impact of conformation and limb and hoof morphology and health condition on outcomes.

Conclusion: Information from manuscripts that met inclusion criteria confirmed distinct, variable effects of shoe characteristics on equine gait parameters.

Clinical significance: Details from published work can serve as resource for clinical decisions and to guide standardization among investigations on shoe configuration effects on equine motion.

Objective: To report the use of intraoperative sentinel lymph node (SLN) mapping with indocyanine green (ICG) and near-infrared (NIR) imaging in a dog with a primary pulmonary carcinoma that underwent lung lobectomy via a video-assisted thoracoscopic approach.

Study design: Case report.

Animals: A 9-year-old female spayed Labrador retriever.

Methods: A solitary, 6.5 cm diameter, right caudal pulmonary mass was identified on contrast-enhanced thoracic and abdominal computed tomography, with no overt metastatic disease or other primary neoplastic diseases. The dog underwent video-assisted thoracoscopic surgery. A right-sided thoracoscopic approach was initially performed for right caudal pulmonary ligament transection and image-guided peritumoral (intrapulmonary) ICG injection. Due to the large size of the mass, a wound retractor was then placed in the right 6th intercostal space for right caudal lung lobectomy. Sentinel lymph node mapping was performed via NIR imaging, and the SLN was extirpated for histologic assessment.

Results: The right tracheobronchial lymph node was identified as sentinel via NIR fluorescence following peritumoral ICG injection. Right caudal lung lobectomy and right tracheobronchial lymph node extirpation were performed without complication, and histologic evaluation revealed a grade 1 pulmonary adenocarcinoma with pneumonia and a reactive lymph node.

Conclusion: Peritumoral ICG administration with NIR imaging appears to be an effective method for intraoperative SLN mapping in dogs with primary pulmonary tumors. The technique utilized in this report can be applied to open or minimally invasive procedures. Large-scale studies with SLN mapping are needed to determine an accurate incidence of nodal metastatic disease and any effect of extirpation of early metastatic disease via SLN mapping techniques on oncologic outcomes in dogs with primary pulmonary carcinoma.