Laparoscopic Ovariectomy In Dogs Research Articles

Comparison of two advanced bipolar tissue sealer/dividers for laparoscopic ovariectomy in dogs: articulating enseal G2 versus Ligasure Maryland device

BackgroundAdvanced bipolar tissue sealer/dividers provide the most reliable and efficient means of tissue dissection and blood vessel sealing in laparoscopic surgery and the techniques are continuously improved. In veterinary practice, cost-effectiveness is of major impact, leading to re-use of instruments designed and sold for single use. Two high-end devices were evaluated and compared in a highly standardized laparoscopic ovariectomy procedure in dogs: The new generation Ligasure Maryland Sealer/Divider (LMSD) with improved atraumatic curved jaw shape for delicate tissue handling and dissection and non-stick nanocoating, and the new-generation Articulating Enseal G2 (AENG2) with several proclaimed features improving surgical performance, including articulation of the forceps tip; improved tissue compression during sealing; unique offset electrode configuration; and specific nanoparticle coating minimizing thermal spread and tissue sticking. Twenty-one client-owned dogs admitted for elective laparoscopic ovariectomy were randomly assigned to one of two groups: ovariectomy using AENG2 on the left ovary and LMSD in the right ovary or vice-versa. Procedural video recordings were used to assess ovarian ligament fat score, smoke formation, occurrence of bleeding, and excision duration. Excised tissues were examined histopathologically and collateral thermal damage was scored in three anatomic zones: suspensory ligament, vascular pedicle, and uterine junction. Tissue sealers were used repeatedly following standardized cleaning protocol with instrument washing machine and ethylene oxide gas sterilization and the number of uses until device failure was recorded.ResultsExcision times were significantly increased for AENG2 (median 01:35 min) compared to LMSD (median 01:00 min). Minor hemorrhage from incomplete sealing occurred in 3 sites in 2 patients (2x AENG2, 1x LMSD) and was not significantly different between groups. Smoke production as scored on videos and thermal tissue damage scores on histopathology also did not differ between AENG2 and LMSD. Both vessel sealers could be re-used repeatedly.ConclusionAENG2 provides a good alternative to LMSD in laparoscopic ovariectomy, with only minor differences in measured variables. Subjectively, the articulating feature of AENG2 did not improve surgical performance in laparoscopic ovariectomy and the use of LMSD appeared more straight-forward for this specific procedure. However, differences in operating these devices may be subject to personal preference.

The impact of the transversus abdominis plane block (TAP) on stress response measured through the complete blood– derived inflammatory markers

This study aims to evaluate the effect of the transversus abdominis plane (TAP) block on the blood cells and the inflammatory markers neutrophil– to– lymphocyte ratio (NLR), platelet– to– lymphocyte ratio (PLR), and systemic immune– inflammation index (SII) after the laparoscopic ovariectomy (LapOV) in dogs. 72 healthy bitches undergoing LapOV were randomly allocated to the no– TAP group of dogs under inhaled anesthesia (IA), the TAP– S group (IA and TAP with saline), and the TAP– B group (IA and TAP with bupivacaine). The NLR, PLR, and SII were calculated 1 h before ovariectomy (T0) and at 2−3 h (T1), 6−8 h (T2), and 20−24 h (T3) post– surgery. The number of dogs requiring postoperative analgesic rescue with buprenorphine and the doses administered in each group were recorded. Significant changes were observed in all groups’ postoperative NLR, PLR, and SII over time. Between groups, no differences were observed in any of the ratios at any control point (NLR at T0−T3: p = 0.17, 0.36, 0.80, and 0.95; PLR at T0−T3: p = 0.70, 0.62, 0.21, 0.87; SII at T0−T3: p = 0.29, 0.65, 0.09, and 0.34). A significantly lower number of dogs required analgesic rescue in the TAP-B group (p = 0.0001) and a lower number of doses were administered (p = 0.001). There is no difference in the inflammatory response measured through the complete blood– derived inflammatory markers after the LapOV in dogs when the postoperative pain is managed entirely with opioids or with the TAP block with bupivacaine. The hydrodissection associated with the TAP block technique does not increase the inflammatory response.

Use of a Composed Simulator by Veterinarian Non-Experts in Minimally Invasive Surgery for Training and Acquisition of Surgical Skills for Laparoscopic Ovariectomy in Dogs.

This study aims to assess the acquisition of surgical skills for laparoscopic ovariectomy (LOE) in dogs by veterinary surgeons with no experience in minimally invasive surgery using the CALMA Veterinary Lap-trainer simulator (CVLTS) in an experimental and analytical setting. Veterinary surgeons with no experience in minimally invasive surgery (MIS) (experimental, n = 5), and MIS experts (experts, n = 3) were evaluated. Experimental and expert group participants watched an instructional video (initial time) before practicing the LOE on uterine tissues and ovaries freshly reconstituted after elective ovariohysterectomy (initial time evaluation). Then, the experimental group practiced five training sessions on the composite simulator with permanent feedback and then performed the LOE again (final time evaluation). Surgical performances in initial and final evaluations were video recorded and further evaluated by three external MIS experts using Global objective assessment of laparoscopic skills (GOALS) and LOE-specific rating scales (SRSs) in a double-blinded schedule. In addition, a hands movement assessment system (HMAS) attached to the back of the hands was used to quantitatively measure completion time, angularity, and movement smoothness. Data were analyzed with one-factor ANOVA and Tukey's contrast test. No statistically significant differences were found between the novice group's performance after training and the expert group's performance according to the GOALS (p < 0.01) and SRS (p < 0.05) scores. Moreover, the novices had significantly improved time, number of movements, and angularity in the final time compared with the initial time (p < 0.05), with no significant differences compared to the expert group (p > 0.05). LOE training using a composed simulator resulted in significantly improved laparoscopic skills and time, number, and angularity of movements data, providing evidence of the usefulness and reliability of CVLTS in training LOE.

A vessel sealing device and an ultrasonic dissector are equally effective and safe for single port laparoscopic ovariectomy in dogs.

To evaluate ovary removal surgery times and intraoperative complication rates between a 5-mm Sonicision cordless ultrasonic dissector (SCUD) and 5-mm vessel sealing device (VSD) for laparoscopic ovariectomy in dogs. Client-owned, intact female dogs (n = 10) presented for elective laparoscopic ovariectomy. In each dog, 1 ovarian pedicle was randomly assigned to the SCUD group and 1 to the VSD group. In the SCUD group (n = 10), the ovariectomy was performed using the SCUD device; the ovariectomy in the VSD group (10) was performed using a VSD. The number of applications of each device during ovariectomy, surgery time required for each ovary removal, total surgery duration, ovarian pedicle fat score, and intraoperative complications were recorded. Both left and right ovaries had median pedicle fat scores of 2 (range, 1 to 3). To complete an ovariectomy, the median number of SCUD applications was 9 (range, 7 to 13) times; the VSD had a median of 10 (range, 5 to 18) times (P = .98). Median surgery times for the removal of 1 ovary with the SCUD and VSD were 96 seconds (range, 45 to 417 seconds) and 110 seconds (range, 42 to 164 seconds), respectively (P = 1). No intraoperative complications were associated with either device. Therefore, the VSD was not required for rescue in the SCUD group, and no conversions to open ovariectomy were necessary. A standard approach laparoscopic ovariectomy performed with the SCUD was successful in our population of dogs, making the 5-mm SCUD safe for laparoscopic ovariectomy in healthy dogs, which provides a more affordable option for practitioners and clients.

Premedication with acetazolamide: Is its use for postoperative pain and stress control after laparoscopic ovariectomy in dogs ruled out?

Studies in human medicine have concluded that acetazolamide reduces pain associated with carbon dioxide insufflation during laparoscopic surgery. However, there are no published reports regarding the use of acetazolamide for this purpose in companion animals, despite the increasing popularity of laparoscopic techniques in veterinary medicine due to their advantages over open surgeries. Thirty mixed-breed female dogs were included in the study and randomly assigned to one of three groups: OVE (median celiotomy ovariectomy; n = 10), OVEL (laparoscopic ovariectomy, n = 10) and OVELA (laparoscopic ovariectomy with acetazolamide preoperative administration; n = 10). Experienced surgeons performed all procedures, and the anaesthetic and analgesic protocols were identical for all animals. Acetazolamide was administered orally (at a dose of 25 mg/kg) 2 h prior to induction in the OVELA group. Postoperative pain was evaluated using serum cortisol, salivary cortisol, and the University of Melbourne Pain Scale (UMPS) Score. Any statistical differences were observed in the UMPS scores when the OVELA group was compared to the OVEL group at 1 h after surgery (p = 0.515), 12 h (p = 0.375) and 24 h (p = 0.242). Animals undergoing open surgery (OVE group) had significantly higher pain scores at all times after surgery when compared with OVEL and OVELA groups. A high positive correlation (r = 0.792; p = 0.01) was found between serum and saliva cortisol concentrations. Mean saliva cortisol concentration was not significantly lower for the OVELA group compared to the other groups. This study found evidence that preoperative administration of acetazolamide may be beneficial in managing postoperative pain in dogs after laparoscopic surgeries. However, further research with a larger sample size is needed to confirm this and to determine if acetazolamide should be included in a multimodal postoperative analgesia protocol for laparoscopic ovariectomy in dogs.

Use of a T'LIFT transabdominal organ retraction device in two-portal laparoscopic ovariectomy in dogs.

To describe the use of the T'LIFT transabdominal organ retraction device to suspend ovaries during canine laparoscopic ovariectomy (LapOVE) and compare its use to a transabdominal suspension suture (TSS). Randomized clinical trial. Client-owned intact bitches (n=30). Dogs were randomly assigned either to group T, in which LapOVE was performed with the T'LIFT, or to group S, in which a TSS was used. Laparoscopic ovariectomy was performed by using a standard two-portal protocol. Signalment (age, weight, body condition score [BCS], fat score of the ovarian pedicle [FSOP]), overall operative time, ovarian resection time, and perioperative complications were compared between groups. No significant differences were found between groups regarding age, weight, BCS, or FSOP. Surgical times were not significantly different between groups. No significant differences in major or minor complications were recorded. Overall operative time was significantly shorter for the last half of the cases compared with the first half, for the overall population, and within each group. Ovarian resection time for the last cases was significantly shorter compared with that for the first ones only in group T. The T'LIFT was used to suspend ovaries for two-portal LapOVE, with no major complications noted. There was no significant difference in surgical times or complications compared with transabdominal suturing. The T'LIFT can be considered as an alternative to transabdominal suture for ovarian suspension in dogs undergoing LapOVE.

Laparoscopic ovariectomy in dogs in late gestation

BackgroundSurgical sterilization of stray dogs is the most widely used technique to control stray dog population. Although ovariectomy is an effective technique for elective sterilization of female dogs, most stray dog population control programs generally utilize ovariohysterectomy for spaying female dogs. In the context of stray dog sterilization, laparoscopic ovariectomy has been utilized and reported to be cost-effective compared to programs utilizing open surgical approaches. However, when pregnant stray dogs are encountered either conventional ovariohysterectomy is performed or surgery is deferred altogether. It is reported that ovariectomy at any stage during canine pregnancy results in fetal resorption or abortion, however, clinical outcomes following laparoscopic ovariectomy in dogs in late gestation have not been previously reported. The purpose of this study was to investigate the outcome of laparoscopic ovariectomy with intra-gestational sac injection (IGSI) of potassium chloride (KCl) in dogs in late gestation.ResultsEight client owned dogs in the gestational age range of 40–50 days underwent laparoscopic ovariectomy with IGSI of KCl. Laparoscopic ovariectomy resulted in decreased serum progesterone from 11.6 ± 2.6 ng/ml on day 0 to 1.3 ± 0.4 ng/ml 24 h’ post-surgery. IGSI of KCl did not result in immediate fetal death and fetal death temporally closely followed the drop in serum progesterone noted 24 h post-ovariectomy. Viscous brown vulvar discharge preceded fetal expulsion by 12 h and all the fetuses were dead when expelled. Uterine evacuation was documented within 45 ± 20 h (1–3.5 days) in all dogs without any clinically significant complications.ConclusionLaparoscopic ovariectomy enables elective termination of pregnancy and simultaneous neutering of dogs in late gestation and has potential applications in high volume stray dog sterilization programs which utilize laparoscopy. Utility of IGSI of KCl in this regard is unclear.

Rates of intraoperative complications and conversion to laparotomy during laparoscopic ovariectomy performed by veterinary students: 161 cases (2010-2014).

OBJECTIVE To assess rates of intraoperative complications and conversion to laparotomy associated with supervised veterinary students performing laparoscopic ovariectomy in dogs. DESIGN Retrospective case series. ANIMALS 161 female shelter dogs for which elective laparoscopic ovariectomy had been performed by supervised senior (fourth-year) veterinary students from 2010 through 2014. PROCEDURES Medical records of all dogs were reviewed and data collected regarding duration of surgery, surgical complications and other characteristics, and whether conversion to laparotomy was required. RESULTS Laparoscopic ovariectomy was performed with a 2-cannula technique and a 10-mm vessel-sealing device for hemostasis in all dogs. A Veress needle was used for initial insufflation in 144 (89.4%) dogs; method of insufflation was not reported for the remaining 17 (10.6%) dogs. Mean ± SD duration of surgery was 114.90 ± 33.40 minutes. Surgical complications, all classified as minor blood loss, occurred in 24 (14.9%) dogs. These included splenic puncture during insertion of the Veress needle (n = 20 [12.4%]) and minor bleeding from the ovarian pedicle (4 [2.5%]). Splenic puncture required no intervention, and ovarian pedicle bleeding required application of the vessel-sealing device an additional time to control the bleeding. Two ovaries were dropped in the abdominal cavity at the time of removal. Both were retrieved without complication. Conversion to laparotomy was not required for any dog. All dogs were discharged from the hospital within 24 hours after surgery. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopic ovariectomy in dogs was performed safely by closely supervised novice surgeons, with only minor intraoperative complications encountered and no need for conversion to laparotomy.

Cordless ultrasonic dissector versus advanced bipolar vessel sealing device for laparoscopic ovariectomy in dogs.

To compare Sonicision cordless ultrasonic dissector (SCUD) to LigaSure vessel sealing device (LVSD) for laparoscopic ovariectomy (Lap OVE) in dogs. Randomized, paired prospective clinical trial. Client-owned dogs (n = 22) presented for elective Lap OVE. Dogs were randomly assigned to one of two protocols: protocol 1 required the left ovary resected using SCUD and the right ovary using LVSD; protocol 2 required the left ovary resected using LVSD and the right ovary using SCUD. Duration of ovary excision, complications, surgical smoke production, and collateral thermal damage were compared between SCUD and LVSD. Total surgery duration, postoperative convalescence, obesity, mesovarial fat score, and technique-associated costs were also recorded. Ovary excision was significantly faster with LVSD than SCUD. Surgical smoke production was significantly greater for SCUD than LVSD. Minor pedicle hemorrhage occurred 3 times with SCUD and one time with LVSD (not significantly different) and was easily corrected intraoperative. Presence of hemorrhage significantly increased ovary excision time. Technique-associated costs were lower for SCUD than LVSD. No significant differences were found in collateral thermal damage between SCUD and LVSD. Total surgery duration and convalescence time were similar to previous reports of Lap OVE in dogs at the authors' institution. SCUD is a cost-effective alternative for Lap OVE, taking into account differences in technique and user preference.

Retrospective analysis of the learning curve associated with laparoscopic ovariectomy in dogs and associated perioperative complication rates.

To assess the learning curve associated with laparoscopic ovariectomy (LOE) in 618 dogs and to report perioperative complication rates. Case series. Dogs (n = 618). Data retrieved from the medical records of bitches admitted for LOE over 42 months included date of surgery, breed, weight (kg), age (months), surgeon, suture material used, intraoperative complications and postoperative complications. Each LOE was defined as "successful" or "unsuccessful" by the absence or presence of an intraoperative complication and "failure" rate described using a CUSUM technique. Follow-up time ranged from 152 to 1,435 days (median, 737 days). Intraoperative complications occurred in 10 dogs (1.6%) and included: splenic laceration (6 dogs; 1%), urinary bladder perforation (3 dogs; 0.5%), and subcutaneous emphysema (1 dog; 0.2%). Postoperative complications occurred in 99 dogs (16%) and included: incisional inflammation treated with antibiotics (87 dogs [14%]; 96/1,854 incisions; 5.1%), incisional seroma (5 dogs [0.8%]; 5/1,854 incisions, 0.3%), incisional hernia (4 dogs [0.6%]; 4/1,854 incisions, 0.2%), and ovarian remnant syndrome (3 dogs; 0.5%). CUSUM charts indicated an initial "learning curve" of ∼80 LOE. LOE is a technique with an initial learning curve but once surgical proficiency is reached after ∼80 procedures then intraoperative complication rates associated with the procedure can be low.

Progress towards less invasive veterinary surgery

ONE of the most remarkable areas of advance in medical science over the past two or three decades has been the development of methodologies for surgical and diagnostic procedures that...

Laparoscopic ovariectomy in dogs using a single-port multiple-access device

The aim of this case series was to describe a novel technique of single-incision laparoscopic ovariectomy in dogs using the SILS Port (Covidien), a single-port multiple-access device, in 40 client-owned...

The Effect of Neuromuscular Blockade on Canine Laparoscopic Ovariectomy: A Double‐Blinded, Prospective Clinical Trial

To evaluate the effect of neuromuscular blockade (NMB) on surgical time and various anesthetic variables during laparoscopic ovariectomy in dogs. Prospective, double-blinded, randomized clinical trial. Female dogs (n = 40). Laparoscopic ovariectomy by bipolar electrocoagulation was performed by 1 surgeon using a standardized protocol, where 1 ovary was removed under NMB, and the other without NMB. Surgical and anesthetic (respiratory and circulatory) variables were recorded for predetermined procedural stages and were statistically evaluated. Mean total surgical time was 25.1 ± 6.3 minutes (range, 16-47 minutes). With NMB, mean duration of surgical excision of the ovary (5.7 ± 2.3 minutes) was not significantly changed compared to ovariectomy without NMB (5.9 ± 1.9 minutes). Arterial blood pressure was the only recorded anesthetic variable that significantly changed under NMB (5% decrease). Occurrence of intraoperative complications did not differ. In obese dogs, total surgical time was increased by 22%. Other variables, including occurrence of intraoperative mesovarial bleeding did not influence surgical duration. NMB did not significantly improve laparoscopic ovariectomy times and except for a 5% decrease in arterial blood pressure did not change any of the evaluated anesthetic and surgical variables.

Laparoscopic ovariectomy in dogs: a comparison of the LigaSure™ and the SonoSurg™ systems

The objective of this study was to evaluate the surgical times for removal of ovaries, and the frequency of intra-operative complications with two different instruments used for canine laparoscopic ovariectomy. A randomised prospective clinical study. Laparoscopic ovariectomy was performed under general anaesthesia on 10 healthy female dogs admitted for elective ovariectomy. Each ovary was randomly assigned to removal by use of either a SonoSurg™ ultrasonic surgical device (Olympus), or a LigaSure™ vessel-sealing system (Valleylab/Covidien). Surgical time for removal of each ovary was measured and the frequency of intra-operative complications was recorded. A follow-up was made by interview with the owners, 2·5 years after surgery. The two techniques did not statistically differ with regard to surgical time, or frequency of complications. All owners were very satisfied with the procedure. Both the SonoSurg™ and the LigaSure™ devices appear to be effective, safe and easy to use when performing laparoscopic ovariectomy in dogs.

COMPARISON BETWEEN LAPAROSCOPIC VERSUS OPEN OVARIECTOMY IN DOGS

The present study aimed to describe a technique for laparoscopic ovariectomy in dogs, and compare the blood biochemical changes, the surgical time, complications, and postoperative activity of dogs undergoing laparoscopic ovariectomy to those undergoing traditional open ovariectomy. Intact breed female dogs (n=17) were randomized. Ventral median celiotomy was performed for traditional open ovariectomy. A 2-midline portal technique using a laparoscope port and an instrument portal was used for laparoscopic ovariectomy. Blood samples were collected before and at the 1th, 2th, 3th days after laparoscopic ovariectomy and traditional open ovariectomy. White blood cells count and biochemical analysis as blood Suger and Creatine Phosphokinase (CpK) were performed. There is a significant different in the value of Creatine Phosphokinase (CpK) between before (324 ± 62) and after (1576 ± 107) in the traditional open ovariectomy but no significant different in the laparoscopic ovariectomy. No major complications occurred and surgical time for laparoscopic ovariectomy was significantly longer than for traditional open ovariectomy (P < 0.05). Dogs regeurate activity in the laparoscopic ovariectomy after two hours but in traditional open ovariectomy regeurate after two days. Both procedures were performed with reasonable surgical times and without major complication. Blood biochemical changes and postoperative activity was better in laparoscopic ovariectomy