Development of a technique for serial bilateral renal biopsy in steers

A biopsy procedure was developed to provide serial kidney samples from standing steers. Ten clinically normal steers were given intramuscular injections of gentamicin sulfate, 4 mg/kg body weight. Renal biopsy was performed at 5 separate times. After feed was withheld for 24 h, laparoscopic surgery was performed in standing stocks. Acepromazine, xylazine, and butorphanol were used for sedation and analgesia, and 2% lidocaine was used for local anesthesia. Two incisions approximately 2 cm long were made in the paralumbar fossa to allow for trocar introduction. The abdomen was insufflated with CO2 and, with endoscopic guidance, a biopsy forceps used to remove a kidney sample 2 to 3 mm in diameter, by either a left or a right abdominal approach. Each operation was recorded on videotape, and images were also captured with a digital medical device system. Respiration, heart rate, temperature, appetite, attitude, and postural positions were evaluated at 12, 24, 48, and 72 h after surgery. The 51 laparoscopic procedures provided 48 renal samples (approximately 100 mg each). The 1st and 2nd samples were from the right kidney, and the 3rd sample was from either the left or the right kidney; the 4th and 5th samples were from the left kidney. Adhesions made an approach from the right side difficult for the 3rd sample. No clinical changes were observed in 9 steers after the procedure. One steer died after the 3rd procedure owing to hemorrhage.     

One-port video assisted laparoscopic kidney biopsy in standing steers

The purpose of this study was to simplify the two-port laparoscopic renal biopsy technique used in support of pharmacokinetic studies through the application of a one-port system. Twelve Holstein steers were fasted for 24 h and sedated with acepromazine and xylaxine in preparation for laparoscopic surgery in standing stocks. Lidocaine 2% was injected to provide local anesthesia for introduction of the trocar-cannula assembly. The operating endoscope was inserted and the abdomen was insufflated with CO₂. A biopsy forceps was introduced into the channel of the operating endoscope to obtain a 100 mg kidney cortex sample. Eighteen laparoscopic procedures provided 18 kidney samples suitable for pharmacokinetic studies. No complications were encountered. The one-port laparoscopic kidney biopsy is feasible and safe, and advanced skill required for triangulation is not necessary for its performance.     

Laparoscopic Cryptorchid Castration in Standing Horses

Objective — This article describes a new technique for laparoscopic cryptorchid castration in standing horses. Study Design — Prospective study. Animals or Sample Population — Eight horses aged 11 months to 3 years and weighing between 300 and 643 kg. Methods — Food was withheld for 24 to 36 hours, and then horses were sedated with detomidine HC1 (0.02 to 0.03 mg/kg) and butorphanol tartrate (0.02 mg/kg). The paralumbar fossa region was desensitized with 2% mepivacaine in an inverted “L” pattern and caudal epidural anesthesia was administered with either xylazine (0.18 mg/kg diluted to 10 to 15 mL with 0.9% sodium chloride) or a combination of 2% mepivacaine and xylazine (0.18 mg/kg). Initial laparoscopic exploration was performed from the left flank; in three horses, right flank laparoscopy was needed to complete the procedure. The spermatic cord was ligated within the abdomen with one or two sutures of 0 polydioxanone suture, and the testis or testes removed through a flank incision. Results — In five horses with no palpably descended testes, standing laparoscopy was the only procedure performed, whereas in two horses, the abdominal testis was removed laparoscopically, and the descended testis was removed under short acting anesthesia. In one horse, with nonpalpable testes, it was determined by laparoscopic observation that the testes were in the inguinal canal, and castration was performed under general anesthesia. No surgical or postoperative complications were noted. The right side of the abdomen, and especially the right vaginal ring, could be easily observed from the left side by passing the laparoscope through a small perforation in the mesocolon of the descending colon or by elevating the descending colon with an instrument or by use of an arm in the rectum. Conclusions — The standing laparoscopic approach combined with or without short-acting anesthesia to remove the descended testis is easily performed. Clinical Relevance — This approach will provide surgeons with another option to castrate cryptorchid stallions.     

Laparoscopic intestinal exploration and full-thickness intestinal biopsy in standing horses: a pilot study

OBJECTIVE: To assess a laparoscopic technique for equine intestinal biopsy. STUDY DESIGN: Experimental study. ANIMALS: Seven adult horses. METHODS: Food but not water was withheld for 36 hours before laparoscopy. In 3 horses (group A) standing, right laparoscopic access to different small intestinal segments was compared with ventral median celiotomy access. Inaccessible segments were identified at necropsy. In 4 horses (group B), the feasibility of obtaining full-thickness duodenal and cecal biopsies and any associated morbidity were evaluated. Biopsy specimens were collected during standing right laparoscopy using a 2-step procedure and intracorporeal suturing technique, and abdominal lavage was performed. Horses were monitored clinically and by abdominal fluid cytology and microbial culture, and repeat laparoscopy was performed on day 6. RESULTS: Standing right flank laparoscopy provided good observation of small intestinal segments and enabled manipulation of all but 15-20 cm of the duodenum and approximately 40 cm more ileum compared with ventral median celiotomy. Group B horses had no complications, no adhesions, and no bacterial growth from peritoneal fluid samples. None of the horses had signs of abdominal pain. CONCLUSION: A 2-stage intestinal biopsy technique performed during standing, right flank laparoscopy may be a safe alternative to exploratory celiotomy and biopsy in normal horses. CLINICAL RELEVANCE: Right flank laparoscopy allows biopsy of intestinal segments including duodenum and 50% more of the ileum than is accessible by ventral median celiotomy. This technique should be evaluated in clinical patients.     

Evaluation of an endoscopic liver biopsy technique in green iguanas

OBJECTIVE: To establish a safe and effective endoscopic technique for collection of liver biopsy specimens from lizards by use of a 2.7-mm rigid endoscope system that is commonly available in zoologic veterinary practice. DESIGN: Prospective study. ANIMALS: 11 subadult male green iguanas (Iguana iguana). PROCEDURES: Each lizard was anesthetized, and right-sided coelioscopic examination of the right liver lobe and gallbladder was performed. Three liver biopsy specimens were collected from each lizard by use of a 2.7-mm rigid endoscope and 1.7-mm (5-F) biopsy forceps. Biopsy samples were evaluated histologically for quality and crush artifact. Ten days following surgery, all iguanas were euthanatized and underwent full necropsy examination. RESULTS: For all 11 iguanas, the right liver lobe and gallbladder were successfully examined endoscopically, and 3 biopsy specimens of the liver were collected without complications. Mean +/- SD durations of anesthesia and surgery were 24 +/- 7 minutes and 6.8 +/- 1.0 minutes, respectively. At necropsy, there was no evidence of trauma or disease associated with the skin or muscle entry sites, liver, or any visceral structures in any iguana. All 33 biopsy specimens were considered acceptable for histologic interpretation; in most samples, the extent of crush artifact was considered minimal. CONCLUSIONS AND CLINICAL RELEVANCE: By use of a 2.7-mm rigid endoscope, liver biopsy procedures can be performed safely, swiftly, and easily in green iguanas. Biopsy specimens obtained by this technique are suitable for histologic examination. For evaluation of the liver and biopsy specimen collection in lizards, endoscopy is recommended.     

Hand-assisted laparoscopic left nephrectomy in standing horses

OBJECTIVE: To describe a hand-assisted, laparoscopic technique to remove the left kidney in standing horses. STUDY DESIGN: Prospective evaluation. ANIMALS: Eight horses. METHODS: Food was withheld for a minimum of 12 hours. Horses were sedated with detomidine hydrochloride (0.01-0.02 mg/kg, intravenously) and restrained in standing stocks. The left paralumbar fossa was prepared for surgery, and the surgical site was infiltrated with 2% mepivacaine. Hand-assisted, laparoscopic removal of the left kidney was performed through an incision in the center of the paralumbar fossa; the surgeon's hand was used to isolate the left kidney and associated vasculature. The renal artery and vein were isolated and individually ligated. After vessel transection distal to the ligatures, the left kidney was exteriorized, the ureter ligated and transected, and the incision closed. RESULTS: Laparoscopic removal of the left kidney was successfully performed in all horses. Retroperitoneal infiltration of local anesthesia provided adequate anesthesia. Intraoperative hemorrhage occurred in 3 horses. Surgical duration (initial skin incision to transection of the left kidney) ranged from 20 to 90 minutes. In 2 horses, no signs of pain were noted for 48 hours postoperatively. CONCLUSION: Hand-assisted laparoscopic surgery can be used for removal of the left kidney in horses. Clinical Relevance-Hand-assisted laparoscopic nephrectomy can be safely performed in standing horses; however, care should be taken to identify accessory branches of the renal artery to limit potential complications with hemorrhage.     

Left- and right-sided laparoscopic-assisted nephrectomy in standing horses with unilateral renal disease

Objective— To describe a technique for, and outcome after, left‐ or right‐sided laparoscopic‐assisted nephrectomy in standing horses with unilateral renal disease. Study Design— Clinical report. Animals— Horses (n=3) with unilateral renal disease. Methods— Horses were sedated with detomidine (0.01 mg/kg intravenously [IV]) and levomethadone (0.05 mg/kg IV). Paravertebral anesthesia and infiltration‐anesthesia with 2% lidocaine were used to create a surgical field incorporating the 17th intercostal space and paralumbar fossa. Two separate, ipsilateral portals and a mini‐laparotomy were used. The perirenal peritoneum was horizontally incised (10–15 cm) using endoscissors and the incision digitally enlarged for manual dissection of the perirenal fat and kidney mobilization. The renal vessels and ureter were individually dissected, ligated, and transected under laparoscopic observation and the kidney removed. The perirenal and laparotomy peritoneal defects were not closed; and the laparotomy was closed in a multilayered fashion. The transverse abdominal muscle was apposed in a continuous pattern using 1 polyglactin 910, the subcutaneous tissue (simple continuous pattern) and skin (simple interrupted pattern) with 2–0 polyglactin 910. Results— Left (2) and right (1) sided laparoscopic‐assisted nephrectomy (1 nephrolithiasis, 2 hydronephrosis) was performed successfully. Sedation and local anesthesia was adequate for intraoperative immobilization and analgesia. No intraoperative complications occurred. Incisional seroma formation and fever occurred on days 3 and 4 in 1 horse and resolved with medical management. Conclusion— Laparoscopic‐assisted nephrectomy can be used for removal of the left or right kidney in standing horses with unilateral kidney disease. Clinical Relevance— To avoid risks associated with general anesthesia and to reduce surgical trauma, laparoscopic‐assisted nephrectomy can be performed in the standing sedated horse using a 2 portal technique and a mini‐laparotomy.     

Complications associated with cannula insertion techniques used for laparoscopy in standing horses

OBJECTIVE: To report our experience and complications associated with different cannula insertion techniques for laparoscopy in standing horses. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Forty horses that had laparoscopy for diagnostic or surgical purposes. METHODS: After a physical examination, including rectal palpation, standing laparoscopy was performed in 40 sedated horses. Local anesthetic was injected at each site of cannula insertion in the left flank. Horses were divided into 5 groups: Pneumoperitoneum was induced before cannula insertion using a Verres needle (group 1, n = 3) or a 12-g catheter (group 2, n = 14); the cannula was inserted before inducing a pneumoperitoneum (group 3, n = 9); the cannula was inserted under visual control, using an operating laparoscope (group 4, n = 2) or a Visiport Optical Trocar (group 5, n = 12). Horses were observed for 7 days. RESULTS: Problems with insufflation or cannula insertion occurred in 12 horses: 6 had peritoneal detachment, 4 had a splenic puncture, and 2 had descending colon puncture. Eleven of these complications occurred in groups 1 to 3 and only 1 in groups 4 and 5. CONCLUSIONS: The Visiport optical device allows controlled insertion of the initial trocar, and thus avoided potential problems associated with "blind" cannula insertion techniques and was used effectively in horses that had feed withheld for 12 hours. This technique enables direct insertion of a cannula directly into the right flank. CLINICAL RELEVANCE: Complications associated with initial cannula insertion in the paralumbar fossa, for laparoscopy, in standing horses can be minimized with the use of an optical cannula.     

Laparoscopic Anatomy of the Llama Abdomen

Paralumbar laparoscopy was performed, caudal to the last rib, in seven llamas. All animals were anesthetized, instrumented, and placed in sternal recumbency. Systematic exploration was performed in six donated llamas dividing the abdomen into right and left, cranial and caudal quadrants. The main structures of diagnostic significance that could be observed from the right side were the parietal and visceral surface of the liver, diaphragm, first compartment of the stomach (CI), caudal aspect of the third compartment of the stomach (C3), pancreas, kidney duodenum, jejunum, and ascending colon. From the left side CI, varying lengths of jejunum, ileum, ascending colon, and spiral colon were identified. From both approaches the bladder, and in females the uterus and ovaries could be observed. All animals were necropsied immediately following the procedure. Gross examination of the abdominal viscera in the did not yield any abnormalities that had been missed by laparoscopic evaluation. Using a left paralumbar approach, one clinical case presenting with signs of acute abdominal discomfort was evaluated. A diagnosis was made of diffuse enteritis that was confirmed at necropsy. Because of the distensible nature of the South American camelid (SAC) abdominal wall, the small size of the abdominal viscera, and the freely mobile nature of most portions of the gastrointestinal tract a thorough examination was possible in all animals.     

Laparoscopic nephron-sparing surgery for the treatment of canine dioctophymosis

This paper reports on two cases of laparoscopic nephrotomy employed in the treatment of canine dioctophymosis, which is considered a unusual procedure and a new treatment proposal heretofore not performed in veterinary medicine. Two patients were treated, one with a history of hematuria and the other with incidental finding of the parasite in the abdominal cavity during elective ovariohysterectomy. Both dogs were subjected to abdominal ultrasound, which produced images indicating the presence of the parasite in the right side kidney, but with partial parenchymal preservation. The patients were therefore subjected to laparoscopic nephrotomy. The surgical procedure was effective in treating dioctophymosis and enabled minimum tissue invasion during surgery, in addition to preservation of the kidney.     

Laparoscopic-assisted enterostomy tube placement and full-thickness biopsy of the jejunum with serosal patching in dogs

OBJECTIVE: To develop laparoscopic-assisted techniques for enterostomy feeding tube placement and full-thickness biopsy of the jejunum in dogs. ANIMALS: 15 healthy dogs. PROCEDURE Dogs were anesthetized, and positive pressure ventilation was provided. A trocar cannula for the laparoscope was inserted on the ventral midline caudal to the umbilicus. For enterostomy tube placement, a second trocar cannula was placed lateral to the right rectus abdominis muscle, and a Babcock forceps was used to grasp the duodenum and elevate it to the incision made for the cannula. The duodenum was sutured to the abdominal wall, and a feeding tube was inserted. For jejunal biopsy, a third trocar cannula was placed lateral to the left rectus abdominis muscle. A portion of jejunum was elevated to the incision for the second or third cannula, and a full-thickness biopsy specimen was obtained. A second specimen was obtained from another portion of jejunum, and retention sutures for the 2 biopsy sites were tied so that serosal surfaces of the biopsy sites were apposed to each other. Dogs were euthanatized 30 days after surgery. RESULTS: The enterostomy tube was properly positioned and functional in all 8 dogs that underwent laparoscopic-assisted enterostomy tube placement, and sufficient samples for histologic examination were obtained from all 7 dogs that underwent laparoscopic-assisted jejunal biopsy. None of the dogs had any identifiable problems after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in dogs, laparoscopic-assisted procedures for enterostomy tube placement and jejunal biopsy are an acceptable alternative to procedures performed during a laparotomy.     

Percutaneous lung biopsy in cattle.

OBJECTIVE: To determine safety of lung biopsy in healthy cattle and compare 3 biopsy instruments for suitability of use. DESIGN: Prospective study. ANIMALS: 60 healthy cows. PROCEDURE: Bilateral lung biopsy through the ninth intercostal space was attempted in all cows. The procedure was performed with cows standing and restrained by an assistant. To study the short-term effects of lung biopsy, 50 cows were slaughtered 1 day after the procedure and examined. To study the long-term effects of lung biopsy, the remaining 10 cows were examined daily for 10 days and then slaughtered. Three biopsy instruments--the Autovac biopsy cannula, the Tru-Cut needle, and the Bard Biopty-System--were evaluated. RESULTS: 2 cows collapsed momentarily during the procedure but recovered quickly. The remaining cows did not develop adverse effects, and general attitude and condition were not affected. Postmortem examination of the 50 cows slaughtered 1 day after the procedure revealed lesions < or = 5.0 mm long and with a surface area < or = 4.0 mm2 at 108 of 154 (71%) biopsy sites involving the pulmonary pleura. Biopsy specimens were obtained during 48 of 50 (96%) procedures in which the Tru-Cut needle was used, during 38 of 39 (97%) procedures in which the Bard Biopty-System was used, and during only 1 of 11 biopsy procedures in which the Autovac cannula was used. At postmortem examination of the 10 cows slaughtered 10 days after the procedure, lesions were seen as small scars; adhesions were not observed. CONCLUSIONS AND CLINICAL RELEVANCE: Percutaneous lung biopsy is a safe procedure in healthy cows.     

Topographic laparoscopy for buffaloes in the quadruped position

This study aimed to describe the anatomical topography of the abdominal cavity of buffaloes in the quadruped position to establish the best endosurgical access and vantage points and identify possible limitations. Laparoscopies were performed on 10 healthy female buffaloes obtained from the Universidade Federal Rural da Amazônia to explore possible access points to the abdomen. Techniques for assessing and possibly observing certain organs and structures through the left and right flanks of 10 animals have been described. In five animals, access was created through the right side of the last intercostal space to allow more cranial access to the abdominal cavity. Despite the presence of the rumen, access through the left flank allowed the visualization of the structures of the gastrointestinal tract and the genitourinary system. With access through the right flank, however, imaging was hampered by the presence of the greater omentum and its deep and superficial walls, which prevented the progression of the endoscope. Access through the last right intercostal space allowed the visualization of the cranial structures of the abdominal cavity, such as the caudate process, right lobe of the liver, right kidney, and pancreas. Laparoscopic access through the left flank and the last intercostal space in healthy buffaloes in the quadruped position is feasible, and it is promising for the exploration, diagnosis, and treatment of various disorders in buffaloes.     

The development of a novel percutaneous lung biopsy procedure for use on feedlot steers

The purpose of this study was to develop a percutaneous lung biopsy technique to be used on steers in a commercial feedlot setting. Thirty-four crossbred steer and heifer calves from a commercial feedlot in southern Alberta were used in this study. The calves originated from the auction market and all were chronically affected with bovine respiratory disease (BRD). A technique was developed to obtain a lung sample from the right cranioventral lung lobe, intercostal space (ICS) 2, using a manual or an automatic biopsy instrument with a 14- or 12-gauge (ga) biopsy needle. Overall, lung parenchyma was successfully harvested in 55.9% of experimental animals and in 55.0% of lung biopsy trials. Compared with postmortem diagnosis, the biopsy resulted in the same pathologic diagnosis for 75% of biopsy samples when evaluated using standardized criteria by the same veterinary pathologist. The success rate was 61.5% and 42.9% in a hospital or field setting, respectively. With an automatic instrument, lung was recovered from 57.9% and 37.5% of samples obtained using a 12- or 14-ga biopsy needle, respectively. One experimental animal or 2.9% of the total had fatal complications from the procedure. In a commercial feedlot setting, the procedure took 20 min for each animal. Percutaneous lung biopsy of the right cranioventral lung lobe may be a viable technique when used on feedlot steers affected with chronic pneumonia. These findings suggest that using an automatic instrument with either a 14- or 12-ga biopsy needle may yield lung samples that are suitable for histopathological evaluation. However, this technique needs to be further evaluated in a field setting.     

Laparoscopic techniques for investigating the equine oviduct

Reasons for performing study: The diagnostic and therapeutic options for oviduct disorders in the mare are limited. The current best techniques require exploratory surgery under general anaesthesia or flank laparotomy. Hypothesis: The orthograde flushing of the oviduct for diagnostic or therapeutic options is possible using laparoscopic techniques in the standing sedated mare. Methods: Development of a laparoscopic technique for catheterisation of the infundibulum and flushing of the oviduct (sterile methylene blue solution) in the standing sedated mare was examined in 2 experiments. The first involved a transvaginal laparoscopic approach, the second a laparoscopic flank approach. Passage of fluid into the uterus was assessed by post operative hysteroscopy. Results: In Experiment I, visualisation of the infundibulum was possible (left side 7/8 cases, right side in 6/8 cases). The beginning of the oviductal ampulla could be seen in 3 of 8 cases on the left side. An adequate opening of the infundibulum and visualisation or catheterisation of the abdominal ostium were not possible. In Experiment II, catheterisation of the ampulla was successful in 7 of 11 cases, and in 5 of these 7 cases the injected fluid could be identified in the uterus by post operative hysteroscopy. Conclusion: A transvaginal laparoscopic approach to the oviduct is not appropriate for oviductal flushing in the mare. However, a laparoscopic flank‐approach permits investigation and flushing of the oviduct. Potential relevance: Laparoscopic flushing could become a practical method for diagnosis and therapy of oviduct disorders and a minimally invasive technique for collection of young embryos or the transfer of gametes (GIFT).     

Evaluation of transcutaneous pulmonoscopy for examination and biopsy of the lungs of ball pythons and determination of preferred biopsy specimen handling and fixation procedures

OBJECTIVE: To establish a safe and effective technique for the endoscopic examination and biopsy of snake lungs by use of a 2.7-mm rigid endoscope system. DESIGN: Clinical trial. ANIMALS: 17 adult ball pythons (Python regius). PROCEDURES: The right lung of each anesthetized snake was transcutaneously penetrated at a predetermined site. Endoscopic lung examination was objectively scored, and 3 lung biopsies were performed. Tissue samples were evaluated histologically for diagnostic quality. One year later, 11 of the 17 snakes again underwent pulmonoscopy and biopsy; specimens were placed in various fixatives to compare preservation quality. All 17 snakes were euthanatized and necropsied. RESULTS: No major anesthetic, surgical, or biopsy-associated complications were detected in any snake. In 16 of 17 pythons, ease of right lung entry was satisfactory to excellent, and views of the distal portion of the trachea; primary bronchus; intrapulmonary bronchus; cranial lung lobe; and faveolar, semisaccular, and saccular lung regions were considered excellent. In 1 snake, mild hemorrhage caused minor procedural difficulties. After 1 year, pulmonoscopy revealed healing of the previous transcutaneous lung entry and biopsy sites. Important procedure-induced abnormalities were not detected at necropsy. Diagnostic quality of specimens that were shaken from biopsy forceps into physiologic saline (0.9% NaCl) solution before fixation in 2% glutaraldehyde or neutral-buffered 10% formalin was considered good to excellent. CONCLUSIONS AND CLINICAL RELEVANCE: By use of a 2.7-mm rigid endoscope, lung examination and biopsy can be performed safely, swiftly, and with ease in ball pythons. Biopsy specimens obtained during this procedure are suitable for histologic examination.     

Tissue/fluid correlation study for the depletion of sulfadimethoxine in bovine kidney, liver, plasma, urine, and oral fluid

Sulfonamides are among the oldest, but still effective, antimicrobial veterinary medicines. In steers and dairy cows, the sulfonamides are effective in the treatment of respiratory disease and general infections. Sulfadimethoxine (SDM) has been approved by US Food and Drug Administration (FDA) for use in steers and dairy cows with a tolerance of 100 ng/g (ppb) in edible tissues and 10 ppb in milk. The detection of SDM residue above tolerance in the animal slaughtered for food process will result in the whole carcass being discarded. This report describes a comprehensive depletion study of SDM (and its main metabolite) in plasma, urine, oral fluid, kidney, and liver. In this study, nine steers were injected intravenously with the approved dose of SDM; the loading dose was 55 mg/kg, followed by 27.5 mg/kg dose at 24 h and again at 48 h. Fluids (blood, urine, and saliva) and tissue (liver and kidney) samples were collected at intervals after the last dose of SMD. The combination of laparoscopic serial sampling technique with the liquid chromatography/mass spectrometry method provided the data to establish the tissue/fluid correlation in the depletion of SMD. A strong correlation and linearity of the log-scale concentration over time in the depletion stage has been confirmed for kidney, liver, and plasma.