Laparoscopic-assisted Ovariohysterectomy Research Articles

Advantages of laparoscopic-assisted ovariohysterectomy versus open ovariohysterectomy for dogs with pyometra not detected in randomized clinical trial.

To compare results for surgery time, perioperative pain, need for rescue analgesia, variables, serum C-reactive protein concentration, and postoperative complications for dogs with pyometra treated with laparoscopic-assisted ovariohysterectomy (LaOVH) versus open-surgery (OS) ovariohysterectomy. 12 client-owned dogs with pyometra between June 1, 2016, and December 31, 2019. Dogs enrolled in this prospective single-center randomized clinical trial had pyometra confirmed by history, physical examination, ultrasonography, and blood work and were randomly assigned to treatment group LaOVH or OS. Differences in results for variables of interest were compared between groups using the Mann-Whitney U test, except the number of dogs requiring rescue analgesia was analyzed using the Fisher exact test. Values of P ≤ .05 were considered significant. 6 dogs were recruited in each group; results for 1 dog in the LaOVH group were excluded from further analysis due to free abdominal fluid detected during surgery. Median surgery time was significantly shorter and median total incision length was longer for the OS group (23 minutes; 106 mm), compared to the LaOVH group (37 minutes; 38 mm). No other results differed significantly between groups. Although fewer patients in the LaOVH group required rescue analgesia, this was not statistically significant. Therefore, our results could not prove previously suggested advantages of LaOVH (eg, less perioperative pain or faster recovery) in dogs with pyometra. Additionally, for the LaOVH group, the median surgical time was approximately 50% longer, an assistant was needed, and specialized equipment was required.

Abstract 476: Negligible Impacts Of Anesthesia On The Morphodynamics Of Individual Red Blood Cells What Is Good News For Vessels: A Study Exploiting Holotomography

Rationale: The shape and membrane dynamics of individual red blood cells (RBCs) are known to play a significant role in their functionality. The morphodynamics of RBCs optimizes their flow properties in vessels and capillaries, which is important for the balance and optimal distribution of blood and nutrients to the tissues. It is also crucial in pathological contexts because changes can influence vascular and microvascular hemodynamics. It can dysregulate vascular function through the modulation of oxygen delivery and the scavenging and generation of nitric oxide. Therefore, the ideal conditions of RBCs are essential for healthy vascular function. Anesthetics, sedatives, analgesics, and fluids used during anesthesia can impact RBCs. The same applies to pneumoperitoneum performed in laparoscopic procedures. Objectives: Taking above we aimed to prospectively evaluate the influence of anesthesia on RBC volume (CV, fL), surface area (SA, μm2), sphericity (SI), dry mass (CH, pg), Hb concentration (CHC, g/dL) and membrane fluctuation (nm). Methods: We exanimated RBCs (n=760) from 5 female dogs undergoing laparoscopic-assisted ovariohysterectomy (OVH). The blood was collected 15 min after premedication with medetomidine and 1h after full anesthesia (isoflurane, fentanyl). Measurements of RBC parameters we performed using the non-invasive, label-free method of imaging with holotomography. Statistical significance was determined using Mann-Whitney test. Results: Morphodynamics parameter values during anesthesia were stable. We observe statistically no significant changes for RBC parameters after premedication vs. one hour of full anesthesia: CH 24.20 vs. 24,19, p=0.57; CV 59.17 vs. 59.04, p=0.89; CHC 42.33 vs. 41.53, p=0.60; SA 117.38 vs. 119.56, p=0.13; SI 0.63 vs. 0.62, p=0.31; fluctuation 68.18 vs. 65.18, p=0.95. Conclusions: Procedures related to OVH are not reflected in the parameters of RBCs and their well-being. This provides new insight into the impact and safety of the anesthetic protocol used in this study on blood cell function, which translates into the lack of risk of vascular damage.

Dipyrone, scopolamine, and meloxicam for conventional or two-port laparoscopic-assisted ovariohysterectomy in female dogs

For ethical and organic reasons, surgical and analgesic techniques that minimize and adequately control pain should be studied. Ovariohysterectomy is the most common surgical technique in veterinary medicine and is performed in female dogs for elective or therapeutic purposes. Both conventional and minimally invasive surgical techniques are used in veterinary medicine; however, the minimally invasive laparoscopic technique is considered superior to the conventional technique because it is associated with a less painful and faster post-operative recovery. However, for various reasons, the laparoscopic technique is not yet widely used in veterinary medicine, and the conventional ovariohysterectomy is still the most common. The aim of this study, therefore, was to validate the efficacy of the combination of dipyrone, scopolamine, and meloxicam after conventional or two-port laparoscopic-assisted ovariohysterectomies in female dogs. Additionally, this study sought to assess recovery after the two surgical modalities while receiving the same analgesic protocol. Fourteen healthy adult female dogs were spayed and then evaluated using the Visual Analogue Scale, the Melbourne Scale, and the short form of the Glasgow Composite Measure Pain Scale for 72 hours after surgery. The analgesic protocol was efficient for pain control after both techniques, with minimal differences between the groups.

Metamizol and Scopolamine for Conventional or Two-Port Laparoscopic-Assisted Ovariohysterectomy in Dogs

Background: Ovariohysterectomy (OVH) is one of the most appliedtechniques in Veterinary Medicine. Although some analgesic protocols are used after this procedure in order to control post operatory pain, there is a lack of knowledge of the efficacy after conventional and two port laparoscopic-assisted techniques in dog female. Although the combined formulation of metamizol and scopolamine is used, there is no knowledge about the efficacy and collateral effects in a 6 h regimen after OVH. The aim of this research was to evaluate the efficacy of metamizol and scopolamine to analgesia after two techniques of OVH in dog female.Materials, Methods & Results: Fifteen adults and healthy dog female were submitted to OVH, being eight to the conventional procedure and seven to video assisted technic with two ports. The patients received a combination of metamizol and scopolamine, 6-6 h during 48 h and were evaluated before surgery, 60 min after extubation and on 1 h interval during the first 8 h, and at 12, 18, 24, 36, 48 and 72 h after surgery. For this, the University of Melbourne Pain Scale (UMPS) and the short-form of the Glasgow Composite Measure Pain Scale (CMPS-SF) were applied by three evaluators blinded to surgical technic. Glucoses measurement was realized at 1, 6, 12, 24, 48 and 72 h after surgery. Analgesic rescue was not necessary for any animal. Punctuation of UMPS in GC decreases at 8 h and at 5 h, and to GV at 12 and 24 h. Difference between groups happened at 3 h with larger average to GV; at 48 h the punctuation in GC was lager. Considering CMPS-SF to CG, higher average was observed at 1 h and decreased at 2, 3, 8 and 18. At GV highest average points was verified at 1, 2 and 3 h and decreased at 5, 8 and 18 h. Correlation was strong and positive between each two evaluators. Animals of both groups had increased average glucose concentrations from baseline to after surgery and the values reduced to baseline after 24 h; difference between groups were observed at 1 h after surgery, with bigger average to GC. Three animals from the GC had postoperative emesis and one patient vomited after 3 h; other at 6 h and another at 36 and 48 h and owners related no vomiting or changes following hospital discharge. The time to first spontaneous food intake was earlier to GV and time to first defecation was no different between groups. Discussion: For the evaluation it was used the UMPS and CMPS-SF since it is know that pain assessment is better performed when multidimensional or composite scales are used. Considering the UMPS, 27 points is considered the most painful condition. In our study it was observed bigger average to GC at 1 h (4,5) and to GV at 2 and 3 h (5,0). According to CMPS-SF, higher punctuation to GC (7.0) was observed than GV (6,0) in a maximum of 24 points. Considering both scales, it could be suggested that the combination of metamizol and scopolamine promote good analgesic effect. The glucoses measurements and the first spontaneous food intake suggested that laparoscopic approaches results in less stress than the traditional procedures, as observed in other studies. Three animals of GC had postoperative emesis, and it signal can be associated to abdominal pain, as well nausea, vomiting, diarrhea and abdominal distention, probably because it is accepted that video surgery promotes less pain and stress than open procedures. The protocol was efficient to control pain after elective conventional and laparoscopic assisted OHV technique in dog female.

Outcome of laparoscopic ovariohysterectomy or ovariectomy in dogs with von Willebrand disease or factor VII deficiency: 20 cases (2012-2014).

OBJECTIVE To describe surgical techniques and perioperative management of dogs with von Willebrand disease (VWD) or factor VII (FVII) deficiency undergoing laparoscopic ovariohysterectomy or ovariectomy and evaluate outcomes. DESIGN Retrospective case series. ANIMALS 20 client-owned dogs with VWD (n = 16) or FVII deficiency (4). PROCEDURES Dogs with VWD or FVII deficiency that underwent laparoscopic ovariohysterectomy or ovariectomy between 2012 and 2014 were retrospectively identified via a multi-institutional review of medical records. RESULTS Median expression of von Willebrand factor was 19% (interquartile range, 18% to 30%). All 16 dogs with VWD were Doberman Pinschers, and all were pretreated with desmopressin; 4 also received cryoprecipitate. One of 4 dogs with FVII deficiency received plasma preoperatively, and 1 was treated with desmopressin; 2 dogs received no preoperative treatment. Laparoscopic ovariectomy was performed in 9 dogs with VWD and 2 dogs with FVII deficiency, laparoscopic ovariectomy with gastropexy was performed in 6 dogs with VWD and 1 dog with FVII deficiency, and laparoscopic-assisted ovariohysterectomy was performed in 1 dog with VWD and 1 dog with FVII deficiency. Iatrogenic splenic laceration requiring conversion to laparotomy occurred during trocar insertion in 1 dog with VWD. No postoperative complications, including signs of hemorrhage, were reported for any dogs. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopic ovariohysterectomy or ovariectomy in dogs with VWD or FVII deficiency pretreated with desmopressin, cryoprecipitate, or plasma transfusions were not associated with clinical signs of hemorrhage, suggesting that minimally invasive ovariohysterectomy or ovariectomy may be considered in female dogs affected with these coagulopathies.

SINGLE PORT LAPAROSCOPIC-ASSISTED OVARIOHYSTERECTOMY IN 3 RABBITS

Single incision laparoscopic surgery (SILS) involves only a single 2-3cm incision in the ventral midline of the patient with entry of the port, particularly the foam SILS Port multiple access port. This type of minimally invasive surgery using only 1 port and a controlled Hasson approach provides decreased risk of iatrogenic abdominal viscera penetration. This SILS Port (Covidien, Medtronic, Minneapolis, MN) also allows easy transition of instruments, telescope, and bipolar electrocautery devices amongst the 3 built-in cannulae for ideal triangulation for each side of the patient. In these 3 cases, the body wall incision length was reduced as compared to an open technique, involved fewer incisions as compared to a multiple port access technique, and subjectively proposed less risk to the cecum with the foam port. The median surgery time was 50 minutes (45-55 minutes), and no intraoperative or immediate postoperative complications were encountered in this series. The purpose of this clinical technique article is to describe and illustrate the laparoscopic-assisted ovariohysterectomy procedure via SILS for the domestic rabbit.

Outcome of laparoscopic ovariectomy and laparoscopic-assisted ovariohysterectomy in dogs: 278 cases (2003-2013).

OBJECTIVE To compare outcomes for laparoscopic ovariectomy (LapOVE) and laparoscopic-assisted ovariohysterectomy (LapOVH) in dogs. DESIGN Retrospective case series. ANIMALS 278 female dogs. PROCEDURES Medical records of female dogs that underwent laparoscopic sterilization between 2003 and 2013 were reviewed. History, signalment, results of physical examination, results of preoperative diagnostic testing, details of the surgical procedure, durations of anesthesia and surgery, intraoperative and immediate postoperative (ie, during hospitalization) complications, and short- (≤ 14 days after surgery) and long-term (> 14 days after surgery) outcomes were recorded. Data for patients undergoing LapOVE versus LapOVH were compared. RESULTS Intraoperative and immediate postoperative complications were infrequent, and incidence did not differ between groups. Duration of surgery for LapOVE was significantly less than that for LapOVH; however, potential confounders were not assessed. Surgical site infection was identified in 3 of 224 (1.3%) dogs. At the time of long-term follow-up, postoperative urinary incontinence was reported in 7 of 125 (5.6%) dogs that underwent LapOVE and 12 of 82 (14.6%) dogs that underwent LapOVH. None of the dogs had reportedly developed estrus or pyometra by the time of final follow-up. Overall, 205 of 207 (99%) owners were satisfied with the surgery, and 196 of 207 (95%) would consider laparoscopic sterilization for their dogs in the future. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that short- and long-term outcomes were similar for female dogs undergoing sterilization by means of LapOVE or LapOVH; however, surgery time may have been shorter for dogs that underwent LapOVE. Most owners were satisfied with the outcome of laparoscopic sterilization.

A surgical glove port technique for laparoscopic-assisted ovariohysterectomy for pyometra in the bitch

The objective of the study was to describe the feasibility of a glove port technique for laparoscopic-assisted surgical treatment of canine pyometra. In this retrospective case series, a total of 10 female dogs (median age 7 years, range 5.5–10.5 years; median weight 37.0 kg, range 12.9–64.0 kg) with pyometra were included. A multiaccess port was created from a surgical glove attached to an Alexis wound retractor and placed in the ventral midline between the middle and caudal third of the distance between umbilicus and pubic rim. A vessel sealing device was used for transection of the ovarian pedicle. The port size was selected on the basis of maximum uterine diameter determined by ultrasound. Median incision length was 5.0 cm (range 3.1–7.7 cm) for a maximum uterine diameter of 4.0 cm (range 2.0–7.0 cm). Median surgical time was 57 minutes (range 48–65 minutes). No case had to be converted to open celiotomy. Complications included one case of minor, self-limiting splenic trauma by the endoscope. In eight dogs, the distended uterine horns endangered safe access to the ovarian pedicle, and the vessel sealing device was inserted through a second cannula placed periumbilically. Extension of the original incision was necessary to exteriorize organs in two dogs. All dogs recovered quickly and were discharged either on the day of surgery or 1 day thereafter. In conclusion, a surgical glove port technique in combination with an Alexis wound retractor is feasible for surgical laparoscopic treatment of canine pyometra up to a diameter of 7 cm.

Meloxicam associado ou não ao tramadol no controle da dor após ovário-histerectomia videoassistida em cadelas

O objetivo deste estudo foi avaliar a eficácia do meloxicam associado ou não ao tramadol, no controle da dor após ovário-histerectomia (OVH) laparoscópica com dois portais. Foram selecionadas 14 cadelas hígidas. Os animais foram separados de forma aleatória, em dois grupos. O grupo M (GM) recebeu meloxicam (0,2mg kg-1, s.i.d.), enquanto os animais do grupo MT (GMT) receberam a associação de meloxicam (0,2mg kg-1, s.i.d.) e tramadol (4mg kg-1, t.i.d.), ambos durante dois dias de pós-operatório. Para avaliação da dor pós-cirúrgica, foram utilizadas as escalas de Melbourne e escala visual analógica (EVA), além de mensurações de glicemia e cortisol sérico. Não houve diferença ao se avaliarem os grupos GM e GMT pela escala de Melbourne nem pela EVA. As mensurações de cortisol não atingiram valores superiores aos de referência para a espécie, enquanto os valores de glicemia não apresentaram variação significativa ao longo do tempo de avaliação nem entre grupos. Com os resultados deste estudo, foi possível concluir que a utilização de meloxicam associado ou não ao tramadol, nas doses e posologias propostas, é eficaz para controlar a dor pós-operatória de cadelas submetidas à OVH laparoscópica com dois portais.

Single Incision, Laparoscopic-Assisted Ovariohysterectomy for Mucometra and Pyometra in Dogs.

To describe a single-incision, laparoscopic-assisted technique for ovariohysterectomy and its application for treatment of mucometra and pyometra in dogs. Prospective case series. Seven dogs. Dogs were included if they had an open or closed pyometra or mucometra and an approximate uterine body diameter of less than 5 cm based on ultrasound or abdominal radiographs. Each dog underwent a laparoscopic-assisted ovariohysterectomy through a single-incision laparoscopic port. The procedure was performed in 6 dogs with pyometra and 1 dog with mucometra. Conversion to an open procedure was necessary in 1 dog with uterine rupture. A 2nd port was necessary in 1 dog to exteriorize the uterine body. Median uterine body diameter was 2.2 cm (range 2-3.9). The median surgical time was 85 minutes (range 40-110). Six of 7 dogs were released from the hospital at 1 day postoperative. Follow up ranged from 7 to 421 days and no complications were reported. A single-incision, laparoscopic-assisted technique for pyometra was feasible in dogs, given restricted case selection and experience with single-incision laparoscopy.

Comparison of surgical variables and pain in cats undergoing ovariohysterectomy, laparoscopic-assisted ovariohysterectomy, and laparoscopic ovariectomy.

Laparoscopy is an established modality in veterinary medicine. To date, laparoscopy in feline surgery is rarely reported. The objectives of this study were to compare surgical time, complications, and postoperative pain in a group of cats undergoing laparoscopic ovariectomy (LOVE), laparoscopic-assisted ovariohysterectomy (LAOVH), and ovariohysterectomy via celiotomy (COVH). Eighteen healthy cats were randomly assigned to undergo LOVE, LAOVH, or COVH. Severity of pain was monitored 1, 2, 3, and 4 hr after surgery. Surgical time was significantly longer for LAOVH (mean ± standard deviation [SD], 51.6 ± 7.7 min) compared to COVH (mean ± SD, 21.0 ± 7.1 min) and LOVE (mean ± SD, 34.2 ± 11.2 min). There were no major intraoperative complications, although minor complications were more common in both laparoscopic groups. Cats sterilized via laparoscopy (LOVE and LAOVH) were statistically less painful than cats spayed via celiotomy (COVH) 4 hr following surgery. Results suggested that LOVE in cats is safe, can be performed in a comparable amount of time as COVH, and may result in less postoperative discomfort.

Laparoscopic-assisted treatment of pyometra associated with mammary fibroadenomatous hyperplasia in a cat

This paper describes a case of laparoscopic-assisted ovariohysterectomy in a female cat presenting pyometra and mammary fibroadenomatous hyperplasia. Using four portals, mesovarium were ligated by titanium ligature clips whereas the uterine vessels were occluded by video-assisted conventional ligatures. There were no postoperative complications. Video-assisted technique can be an alternative method for treatment of pyometra and cystic endometrial hyperplasia in female cats.

Evaluation of Laparoscopic‐Assisted Ovariohysterectomy for Treatment of Canine Pyometra

To describe a technique for treating pyometra in dogs using a 3-portal laparoscopic-assisted ovariohysterectomy (LAOVH) and evaluate outcome. Retrospective case series. Dogs (n = 12). 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. 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. 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.

Comparison of Three Techniques for Ovarian Pedicle Hemostasis During Laparoscopic‐Assisted Ovariohysterectomy

To describe the safety, surgical time, and complications associated with 3 techniques for achieving hemostasis during laparoscopic-assisted ovariohysterectomy (LAOVH). Prospective, randomized clinical trial. Female dogs (n=30). Dogs were randomly assigned to 1 of 3 methods for achieving ovarian pedicle hemostasis during LAOVH: extracorporeal modified Roeder knot application (suture group), metal clip application using a multifire 10 mm laparoscopic clip applier (clip group), or use of a novel 5 mm bipolar vessel-sealing device (vessel-sealing group). In all dogs a 3 median portal technique was used. Controlling for the dogs' bodyweights, there was a significant association between surgical time and which method for hemostasis was used. This association was different when comparing the first 5 procedures using each method to the second 5. For a 20 kg dog, the surgical time (95% CI) for the first 5 procedures was 80 (69-91), 68 (57-79), and 33 (21-45) minutes for the suture, clip, and vessel-sealing groups, respectively. For the second 5 procedures surgical time was 71 (60-81), 50 (39-60), and 40 (29-51) minutes. Pedicle hemorrhage occurred in all dogs in the clip group, 3 dogs in the suture group, and none of the dogs in the vessel-sealing group although in all cases was considered hemodynamically inconsequential. All dogs recovered uneventfully. All methods of hemostasis were safe for pedicle sectioning. A learning curve exists for clip and suture methods. Use of a vessel-sealing device significantly shortens surgical time and provides excellent hemostasis during LAOVH.

Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs

To describe a simple method of laparoscopic-assisted ovariohysterectomy (LAOHE) and compare duration of surgery, complications, measures of surgical stress, and postoperative pain with open ovariohysterectomy (OHE) in dogs. Randomized, prospective clinical trial. 20 healthy sexually intact female dogs weighing >10 kg (22 lb). Dogs were randomly allocated to receive conventional OHE or LAOHE. Intraoperative complications, anesthetic complications, total anesthesia time, and total surgery time were recorded. Serum cortisol and glucose concentrations, temperature, heart rate, and respiratory rate were measured preoperatively and 1, 2, 4, 6, 12, and 24 hours postoperatively. Pain scores were assigned by a nonblinded observer at 1, 2, 4, 6, 12, and 24 hours postoperatively. Duration of surgery, pain scores, objective measures of surgical stress, anesthetic complications, and surgical complications were compared between OHE and LAOHE. Age, weight, PCV, and duration of surgery did not differ between treatment groups. Nine of 10 dogs in the OHE group required additional pain medication on the basis of pain scores, whereas none of the dogs in the LAOHE group did. Blood glucose concentrations were significantly increased from preoperative concentrations in the OHE group at 1, 2, 4, and 6 hours postoperatively and at 1 hour postoperatively in the LAOHE group. Cortisol concentrations were significantly increased at 1 and 2 hours postoperatively in the OHE group. LAOHE caused less pain and surgical stress than OHE and may be more appropriate for an outpatient setting.