One-lung versus two-lung ventilation in the closed-chest anesthetized dog: a comparison of cardiopulmonary parameters

OBJECTIVE: To evaluate cardiopulmonary effects of one-lung ventilation (OLV) versus two-lung ventilation (TLV) in closed-chest anesthetized dogs. STUDY DESIGN: Controlled, randomized experiment. ANIMALS: Fourteen, 2- to 7-year-old adult dogs, weighing 23 +/- 6 kg. METHODS: The dogs were anesthetized with acepromazine, morphine, thiopental, and halothane in oxygen, ventilated, and paralyzed with vecuronium. Tidal volume was 10 mL/kg. Respiratory rate was set to maintain end-tidal CO2 (ETCO2) at 40 +/- 2 mm Hg before instrumentation then not changed. The left bronchus of 7 dogs was obstructed with a Univent bronchial blocker (Fuji Systems Corp, Tokyo, Japan). Blood gas analysis and hemodynamic measurements were taken at predetermined intervals for 1 hour in the TLV group and at baseline and following bronchial obstruction in the OLV group. RESULTS: Shunt fraction was not significantly different between groups, but in OLV shunt increased from baseline at 5 minutes. Arterial oxygen (PaO2) decreased after baseline in OLV compared with TLV. Arterial carbon dioxide (PaCO2) increased with OLV and decreased with TLV. In OLV, systemic vascular resistance was variable and decreased compared with TLV. Cardiac index increased over time in both groups but was not affected by treatment. Heart rate, mean arterial pressure, and diastolic arterial pressure increased with OLV compared with TLV but did not change over time. CONCLUSION: This study shows that OLV statistically decreases oxygen tension and transiently increases shunt fraction, but with 100% O2 it appears to be a feasible procedure with minimal cardiopulmonary side effects in healthy dogs. CLINICAL RELEVANCE: OLV is a feasible procedure in anesthetized dogs to better facilitate thoracic procedures such as bronchopleural fistula repair and thoracoscopy.     

Successful ventilatory management of post‐anesthetic airway collapse and hypoxemia in a dog

Abstract Objective: To report a life‐threatening complication (airway collapse) associated with a common procedure (anesthesia) and to describe its successful management. Case Summary: A dog without pre‐existing signs of respiratory disease developed hypoxemia and severe atelectasis in the post‐anesthetic recovery period and was demonstrated, by bronchoscopic examination, to have severe airway collapse. Mechanical ventilation was used to re‐expand collapsed lung units and to prevent re‐collapse. A ventilation strategy designed to minimize airway and alveolar trauma was used. The dog was successfully weaned from the ventilator and made a full recovery. Unique Information Provided: Acute, severe hypoxemia due to airway collapse occurred in the post‐operative period in a dog with no signs of pre‐existing respiratory disease. The dog was successfully managed with short‐term mechanical ventilation. High frequency jet ventilation was used for a diagnostic bronchoscopy.     

Alternating one lung ventilation using a double lumen endobronchial tube and providing CPAP to the non-ventilated lung in a dog

Introduction This case report describes the anaesthetic management of exploratory thoracoscopy and alternating one lung ventilation (OLV) in a dog with a pulmonary bulla, and the application of continuous positive airway pressure (CPAP) to the non‐ventilated lung for preventing and treating hypoxia. Case history A 6‐year‐old, male castrated Border collie was scheduled for exploratory thoracoscopy to investigate spontaneous pnemothorax that had not resolved with repeated suction. Specific requirements for the thoracoscopy were alternating OLV to allow the surgical access to the right middle lobe and its removal, and the examination of the left hemithorax to rule out the presence of other lesions. Diagnosis and management Selective lung ventilation was performed with a double lumen endobronchial tube (DLT), inserted under endoscopic guidance. After a short period of two lung ventilation during preparation of the surgical field, alternating OLV was performed, combining CPAP, provided to the non‐ventilated lung via a Mapleson D breathing system, and positive end‐expiratory pressure (PEEP) applied to the ventilated lung. Left OLV occurred first and resection of the right middle pulmonary lobe was successfully performed; right OLV followed to allow the examination of the left hemithorax. Discussion and conclusions The combination of CPAP and PEEP resulted in a satisfactory intra‐operative management of hypoxemia. Alternating OLV can be performed successfully by using a DLT. CPAP, commonly employed in human medicine, should be considered an important tool in the anaesthetic management of OLV in small animals.     

Cardiopulmonary changes induced during one-lung ventilation in anesthetized dogs with a closed thoracic cavity

OBJECTIVE: To evaluate the effects of one-lung ventilation (OLV) on oxygen delivery (DO2) in anesthetized dogs with a closed thoracic cavity. ANIMALS: 7 clinically normal adult Walker Hound dogs. PROCEDURE: Dogs were anesthetized. Catheters were inserted in a dorsal pedal artery and the pulmonary artery. Dogs were positioned in right lateral recumbency. Data were collected at baseline (Paco2 of 35 to 45 mm Hg), during two-lung ventilation, and 15 minutes after creating OLV. Hemodynamic and respiratory variables were analyzed and calculations performed to obtain DO2, and values were compared among the various time points by use of an ANOVA for repeated measures. RESULTS: OLV induced a significant augmentation of shunt fraction that resulted in a significant reduction in Pao2, arterial oxygen saturation, and arterial oxygen content. Cardiac index was not significantly changed. The net result was that DO2 was not significantly affected by OLV. CONCLUSIONS AND CLINICAL RELEVANCE: Use of OLV in healthy dogs does not induce significant changes in DO2, which is the ultimate variable to use when evaluating tissue oxygenation. One-lung ventilation can be initiated safely in dogs before entering the thoracic cavity during surgery. Additional studies are necessary to evaluate OLV in clinically affected patients and variations in age, body position, and type of anesthetic protocol.     

Bronchoscopic findings in 48 cats with spontaneous lower respiratory tract disease (2002-2009)

Background: Diagnosis of lower respiratory disease requires collection of airway samples to confirm the etiology of disease. Bronchoscopic evaluation is commonly performed in dogs but less information is available in cats. Hypothesis: The presence and number of bronchoscopic abnormalities visualized during bronchoscopic evaluation of cats with lower respiratory disease will correlate with the type of disease and total and differential cell counts in bronchoalveolar lavage (BAL) fluid. Animals: Forty‐eight cats prospectively evaluated by a single bronchoscopist. Methods: Bronchoscopy was performed during clinical evaluation of cats presenting with cough, respiratory distress, or both. Cats were evaluated for airway hyperemia, stenosis, or collapse, mucus accumulation, bronchiectasis, and epithelial irregularities. Cats were placed into groups of bronchitis/“asthma,” pneumonia, or neoplasia based on BAL findings, histopathology, and response to appropriate medical therapy. Summation of bronchial abnormalities and total and differential cell counts were compared among groups. Results: Endobronchial abnormalities were common in cats with feline bronchitis/asthma, pneumonia, and neoplasia and no differentiating features were found. Excessive mucus accumulation was common (83%), followed by stenosis of bronchial openings and nodular epithelial irregularities (56%), airway hyperemia (54%), airway collapse (48%), and bronchiectasis (27%). Total bronchoscopic score and total cell count did not differ among groups, although differential cell counts were significantly different. A weak correlation (R²= 0.16, P= .006) between age and total bronchoscopic score was noted. Conclusions and Clinical Relevance: Bronchoscopic abnormalities are common in cats with lower respiratory tract disease, and visualization of the airways provides additional nonspecific clinical information in cats.     

Upper airway obstruction caused by a nasopharyngeal polyp and brachycephalic airway syndrome in a Chinese Shar-Pei puppy

Objective: To describe the case management for a dog diagnosed with a nasopharyngeal polyp.
Case summary: A 9-week-old Shar-Pei puppy presented for progressive dyspnea and collapse. Clinical signs were consistent with an upper airway obstruction (UAO) and a temporary tracheostomy was performed. The puppy was at first diagnosed with and treated for brachycephalic airway syndrome but continued to exhibit signs of an UAO after soft palate resection. Nasopharyngoscopy revealed a nasopharyngeal polyp causing the UAO, which was surgically removed. The puppy has been free of clinical signs for 1 year after removal of the polyp.
New or unique information provided: This is the first report of a nasopharyngeal polyp causing a life-threatening UAO in a puppy. It emphasizes the importance of examining the nasopharyngeal space in neonates presenting with UAO.     

Custom total knee replacement in a dog with femoral condylar bone loss

Objective— To report surgical planning, technique, and outcome of custom total knee replacement (TKR) performed to manage a medial femoral condylar nonunion in a dog.
Study Design— Clinical case report.
Animal— A 3-year-old, 20 kg Karelian Bear Hound.
Methods— Computed tomographic scan of the left pelvic limb was used to build a stereolithography model of the distal portion of the femur. The model was used to create a custom augment to replace the missing medial femoral condyle and a custom stem for intramedullary condylar cemented fixation. The augment and stem were adapted to femoral and tibial components already available. The model was used to rehearse the surgery and then the custom prosthesis was implanted.
Results— Weight bearing returned 8 hours after surgery and improved thereafter. Joint alignment was normal and prosthetic joint motion was 60–165° postoperatively. The dog resumed moose hunting 3 months after surgery. Peak vertical force and impulse of the operated limb measured 17 months after surgery were 65% and 47% of the normal, contralateral limb.
Conclusion— Based on short-term follow-up, cemented canine TKR was successfully achieved for management of a severely abnormal stifle joint.
Clinical Relevance— With further refinement and development of commercially available prostheses, TKR should be possible for canine patients.     

Congenital branchial apparatus malformation in a Haflinger colt

Objective— To report the diagnosis and treatment of a branchial apparatus anomaly (BAA) associated with a mandibular malformation in a foal.
Design— Clinical report.
Animal— Haflinger foal.
Methods— A 6-day-old foal had a fluctuating cystic mass in the pharyngeal (throatlatch) region, which changed in appearance after ingestion of milk. Upper airway endoscopy and diagnostic imaging (ultrasonography, radiography, computed tomography) permitted identification of the anatomic location of a communicating tract between the lumen of the cystic mass and the pharynx. The mass was surgically removed and communication with the pharynx ligated. Histologic appearance of this mass was consistent with a branchial cyst or sinus. The mandibular malformation was managed conservatively.
Results— Surgical resection of a third branchial sinus resulted in an excellent functional and cosmetic outcome. There was no evidence of any mandibular deformity 2 years later.
Conclusion— BAA may induce secondary mandibular deformation in utero and may cause respiratory compromise postpartum. Careful surgical dissection and removal of BAA resulted in an excellent outcome.
Clinical Relevance— BAAs should be included in the differential diagnosis of a throatlatch region mass in equine neonates. Complete surgical excision is recommended and full recovery of any associated mandibular deformity may be anticipated without additional treatment in very young patients.     

Thoracoscopic Subphrenic Pericardectomy Using Double‐Lumen Endobronchial Intubation for Alternating One‐Lung Ventilation

Objective— To report the technique, complications, and effectiveness of thoracoscopic subphrenic pericardectomy (SPP) using double‐lumen endobronchial intubation for alternating 1‐lung (OLV) in healthy dogs. Study Design— Prospective cohort study. Animals— Mature purpose‐bred dogs (n=7). Methods— Bronchoscope‐assisted placement of a left‐sided double‐lumen endobronchial tube, immediately before surgery, allowed intraoperative alternation of ventilation between lung fields. A camera portal was established in a subxyphoid location. Two instrument portals were established at the 4th–6th intercostal spaces on the right and left sides. A vessel‐sealing device was used to create the subphrenic pericardectomy. After termination of the procedure, dogs were humanely euthanatized under anesthesia and necropsy performed. In each dog, the extent of pericardectomy and any complications were evaluated. Results— Technical difficulties with tube placement occurred in 4 dogs, but alternating OLV was achieved in all dogs and SPP completed successfully. Median surgical time was 87.5 minutes (range, 80–105 minutes). At necropsy, 0.5–2 cm of pericardial tissue remained ventral to the intact phrenic nerve in 6 dogs; in 1 dog, the phrenic nerve was transected on the left side only. Conclusions— Thoracoscopic subphrenic pericardectomy is a technically feasible procedure in healthy dogs. Double‐lumen endobronchial intubation allowed alternating OLV without intraoperative bronchoscopically guided tube manipulation in all but 1 dog. Clinical Relevance— Thoracoscopic subphrenic pericardectomy could potentially be used for management of conditions where relief of pericardial constriction or access to intrapericardial structures is desired.     

Exercise-induced pulmonary haemorrhage in the horses: results of a detailed clinical, post mortem and imaging study. VII. Ventilation/perfusion scintigraphy in horses with EIPH

Detailed post mortem examination of the lungs of horses with exercise-induced pulmonary haemorrhage (EIPH) has demonstrated significant small airway disease and intense bronchial arterial proliferation in the dorsocaudal lungfields. The purpose of this study was to investigate ventilation and perfusion distribution in the lungs of a similar group of horses to compare changes in the live animal with the previously reported post mortem findings. Thoracic radiography and ventilation/perfusion (V/Q) scintigraphy were performed on five racing Thoroughbreds with recent histories of EIPH. Parametric images of V/Q ratios for left and right lungfields were also generated from the scan images. In all horses, ventilation and perfusion deficits were demonstrated in the dorsocaudal areas of the lung corresponding closely to the observed radiographic lesions. In particular, the perfusion images and V/Q ratio displays indicated that, in affected areas of lung, pulmonary arterial perfusion was the more seriously impaired. This finding appears to confirm the post mortem evidence of reduced pulmonary arterial perfusion and bronchial arterial dominance in these areas. Ventilation deficits in the same areas also confirmed the likelihood of partial airway obstruction consistent with the small airway disease noted in previous post mortem observations. These results suggest that the vascular and airway lesions demonstrated in detailed post mortems of horses with EIPH are also functionally important in affected horses, even at rest. As a consequence of the apparent persistent, insidious and progressive nature of the lesions associated with EIPH there are serious long term implications for management of the condition.     

Endoscopic evaluation of bronchial morphology in rabbits

OBJECTIVE: To evaluate bronchial morphology endoscopically in rabbits and develop a valid nomenclature for the endobronchial branching pattern. ANIMALS: 10 mature New Zealand White rabbits. PROCEDURES: Flexible bronchoscopy was performed in rabbits anesthetized with isoflurane via nasal mask. Airways were systematically evaluated from the larynx to the terminal branches accessible with a 2.5-mm-outer diameter flexible endoscope. Airway branching patterns were identified and assessed for variation among subjects. RESULTS: Airways of all rabbits were readily examined with the 2.5-mm flexible endoscope. Laryngeal structure and function were normal in each rabbit, and airway branching patterns in all rabbits evaluated were identical. At the carina, branching into left and right principal bronchi was evident. The left principal bronchus divided immediately into the left cranial and left caudal lobar bronchi. The left cranial lobe bronchus further divided into dorsal and ventral segmental bronchi. The left caudal lobe bronchus gave rise to branches originating dorsally, ventrally, and medially before continuing caudally. The right principal bronchus divided into the right cranial, right middle, and accessory lobar bronchi and continued distally as the right caudal lobar bronchus. The right cranial lobe bronchus also divided into dorsal and ventral segmental bronchi, and the right caudal lobe bronchus had branches that originated dorsally, ventrally, and medially. CONCLUSIONS AND CLINICAL RELEVANCE: Definition of a standard nomenclature for airway branching in rabbits will allow precise localization of disease in clinical cases and accurate collection of airway samples in clinical and scientific evaluations.     

The Role of Bronchoscopy in Foreign Body Removal in Dogs and Cats: 37 Cases (2000–2008)

Background: Foreign body aspiration is a differential diagnosis for acute or chronic cough that requires medical or surgical management in animals. Hypothesis: Success of bronchoscopy in airway foreign body removal is dependent on the size of the animal, duration of clinical signs, and location of the foreign body. Animals: Thirty‐two dogs and 5 cats with airway foreign bodies identified at the UC Davis Veterinary Medical Teaching Hospital. Methods: Retrospective case study evaluating the role of duration of clinical signs and body size in successful bronchoscopic removal of foreign bodies. In addition, radiographic localization of disease was compared with bronchoscopic identification. Bronchoalveolar lavage (BAL) culture and cytologic findings are reported. Results: Bronchoscopy was successful for removal of airway foreign bodies in 76% of animals (24/28 dogs and 2/5 cats), and in dogs was independent of duration of clinical signs or body size. One‐third of thoracic radiographs lacked distinctive features of an airway foreign body, and therefore radiography was unable to predict the affected site. BAL fluid at the site of the foreign body contained more neutrophils and more often had intracellular bacteria than lavage fluid from a separate site. Conclusions and Clinical Importance: Bronchoscopy was successful in removing airway foreign bodies regardless of animal size or long duration of clinical signs. Results of this study confirm the utility of bronchoscopy with lavage in management of suspected foreign bodies, even in the absence of localizing radiographic findings.     

Transpalpebral eye enucleation in 40 standing horses

Objective— To report a technique for eye enucleation in standing sedated horses and to report outcome in 40 horses.
Study Design— Retrospective study.
Animals— Horses (n=40) requiring eye enucleation.
Methods— The eye was enucleated using a transpalpebral technique in 40 horses restrained in stocks and sedated. Anesthesia of orbital structures was provided by local nerve blocks and infiltration of the surgical site with local anesthetic solution.
Results— Affected eyes were successfully enucleated with the horse standing. Short-term complications included moderate swelling (5 horses) and wound discharge (1). Long-term complications were not observed.
Conclusions— A diseased eye can be safely enucleated with a horse standing.
Clinical Relevance— Enucleating an equine eye in the standing position eliminates the risks and costs of general anesthesia.     

Surgical correction of wry nose in four horses

Objective— To describe surgical techniques used for correction of congenital nasal deviation (wry nose) in horses (wry nose) and to report outcome.
Study Design— Retrospective study.
Animals— Horses (n=4), 5–17 months old with wry nose.
Methods— Nasal deviation was corrected by transecting the premaxillae/maxillae and nasal bones at their site of maximum curvature and realigning and stabilizing the bones in a more normal alignment using internal fixation. The nasal septum was removed during the same anesthetic period.
Results— For each horse, physical appearance was improved and respiratory stridor eliminated.
Conclusions— Wry nose can be corrected by transecting the premaxillae/maxillae and nasal bones and stabilizing the transected bones in a more normal alignment; the nasal septum can be removed concurrently.
Clinical Relevance— Surgical correction of wry nose may provide a good functional and cosmetic outcome.     

Radiography, computed tomography and virtual bronchoscopy in four dogs and two cats with lung lobe torsion

This report describes the imaging features of radiography, computed tomography and virtual bronchoscopy in dogs and cats with lung lobe torsions. The medical records, thoracic radiographs and computed tomography images of four dogs and two cats with confirmed lung lobe torsions were retrospectively reviewed. Computed tomography with virtual bronchoscopy showed bronchial narrowing, collapse or occlusion in all six animals, while this was only appreciated on one radiographic examination. A tapering terminating angle of the air-filled bronchus proximal or distal to the collapsed region was seen only on computed tomography and virtual bronchoscopy in all six animals. The vesicular emphysema pattern typical of lung lobe torsion was seen on three computed tomographies but only on one radiographic examination. The lung lobe torsion-specific findings of vesicular emphysema and a proximally narrowed or occluded bronchus were more easily recognised on computed tomography and virtual bronchoscopy than with radiographs. Computed tomography slices acquired through the bronchus and lung lobe of interest in a cat or dog with possible lung lobe torsion can be reformatted into virtual bronchoscopic images that can be utilised along with computed tomography to help make a more definitive preoperative diagnosis.     

Respiratory reflexes in response to upper-airway administration of sevoflurane and isoflurane in anesthetized, spontaneously breathing dogs

OBJECTIVE: To evaluate the respiratory effects occurring during administration of sevoflurane or isoflurane to the upper airway in dogs. STUDY DESIGN: A prospective, randomized study. ANIMALS: Twelve healthy adult beagles (6 males, 6 females). METHODS: At least 2 weeks after undergoing permanent tracheostomy, dogs were premedicated with acepromazine-buprenorphine, and anesthesia was induced with thiopental and maintained with alpha-chloralose. The upper airway was functionally isolated so that the inhalant could be administered to the upper airway while dogs were breathing 100% O2 via the tracheostomy. Respiratory reflexes in response to the administration of sevoflurane or isoflurane at concentrations of 1.2, 1.8, and 2.4 times the minimal alveolar concentration (MAC) (administered in 100% O2 at a flow rate of 5 L/min) were recorded. Reflexes in response to administration of each anesthetic were also recorded following upper-airway administration of lidocaine. RESULTS: Respiratory reflexes elicited by upper-airway administration of each anesthetic were characterized by a dose-dependent increase in expiration time, with a resultant decrease in respiratory minute ventilation and increase in end-tidal PCO2. The magnitude of these responses was greater with isoflurane than with sevoflurane at 1.8 and 2.4 MAC. These reflexes were abolished after lidocaine nebulization into the upper airway. CONCLUSION: Isoflurane induces greater reflex inhibition of breathing than does sevoflurane when the anesthetic is inhaled into the upper airway at concentrations used for mask induction.     

Anesthesia for patients with head trauma.

Patients undergoing anesthesia soon after head trauma are at great risk for further neural damage during the anesthetic, especially if the head injury is severe or the anesthetic technique is suboptimal. Secondary complications of the anesthetic that are often lethal include hypoventilation, increases in ICP, airway obstruction, and brain-stem herniation. Anesthetic management of patients with head injury must include intravenous induction with barbiturates or narcotics, smooth endotracheal intubation, controlled ventilation with oxygen, and minimal amounts of inhalational agents. It is important to position the patient so that jugular veins are not occluded, in about 10 degrees head up position, and to avoid inducing patient coughing and straining. Recovery from anesthesia should be quiet and rapid, with the maintenance of a clear airway and the use of as little depressant medication post-operatively as possible. Oxygen should be provided.     

Intra-articular Anesthesia of the Distal Interphalangeal Joint Alleviates Lameness Associated With the Navicular Bursa in Horses

Objective — To determine if intra-articular anesthesia of the distal interphalangeal joint could alleviate lameness associated with the navicular bursa in horses.
Study Design — Experimental investigation.
Animals — Six clinically normal horses.
Methods — Lameness was induced in each horse by injecting either the left or right front navicular bursa with 5 mg of amphotericin-B. Forty-eight hours later each horse was videotaped walking and trotting before, and 5, 30, and 60 minutes after injecting the distal interphalangeal joint of the treated limb with 5 mL of 2% mepivacaine hydrochloride. All video recordings were then rerecorded onto master tapes in a random sequence. Four clinicians, unaware of the animal identity related to observation time or limb treated, independently viewed these tapes and graded the lamenesses.
Results — There was a significant reduction in lameness 5 and 30 minutes after anesthetic was injected into the distal interphalangeal joint. Lameness scores 60 minutes after anesthetic administration were not significantly different than baseline values. Gross pathological examination confirmed marked inflammation of the treated navicular bursae and normal appearance of the distal interphalangeal joints.
Conclusions — Intra-articular anesthesia of the distal interphalangeal joint can alleviate lameness associated with the navicular bursa.
Clinical Relevance — Intra-articular anesthesia of the distal interphalangeal joint is not specific only for lameness originating in the distal interphalangeal joint.     

Cardiopulmonary effects of positive end-expiratory pressure during one-lung ventilation in anesthetized dogs with a closed thoracic cavity

OBJECTIVE: To evaluate the effects on oxygen delivery (DO2) of 2.5 and 5 cm H2O of positive end-expiratory pressure (PEEP) applied to the dependent lung during one-lung ventilation (OLV) in anesthetized dogs with a closed thoracic cavity. ANIMALS: 7 clinically normal adult Walker Hound dogs. PROCEDURE: Dogs were anesthetized, and catheters were inserted in a dorsal pedal artery and the pulmonary artery. Dogs were positioned in right lateral recumbency, and data were collected during OLV (baseline), after application of 2.5 cm H2O of PEEP for 15 minutes during OLV, and after application of 5 cm H2O of PEEP for 15 minutes during OLV. Hemodynamic and respiratory variables were analyzed and calculations performed to obtain DO2, and values were compared among the various time points by use of an ANOVA for repeated measures. RESULTS: PEEP induced a significant decrease in shunt fraction that resulted in a significant increase in arterial oxygen saturation. However, it failed to significantly affect arterial oxygen content (CaO2) or cardiac output. Thus, DO2 was not affected in healthy normoxemic dogs as a net result of the application of PEEP. CONCLUSIONS AND CLINICAL RELEVANCE: The use of PEEP during OLV in anesthetized dogs with a closed thoracic cavity did not affect DO2. Use of PEEP during OLV in dogs with a closed thoracic cavity is recommended because it does not affect cardiac output and any gain in CaO2 will be beneficial for DO2 in critically ill patients.     

Laparoscopic Splenectomy in Goats

Objective— To report laparoscopic splenectomy in goats.
Study Design— Experimental study.
Animals— Healthy female goats (n=9); aged, 10–18 months; weighing, 22–30 kg.
Methods— Food was withheld for 24 hours and water for 10 hours. Anesthetized right laterally recumbent goats had a laparoscopic portal and 3 instrumental portals created in the left flank. Splenic attachments were dissected with monopolar electrocautery and blunt dissection through 2 instrument portals. Exposure and isolation of splenic vessels was performed with laparoscopic "right-angle" preparation forceps. Vessels were ligated with a medium-titanium clip and 2 silk sutures and then transected between the silk sutures. The detached spleen was manipulated into a specimen retrieval bag, morcellated, and the bag retrieved through an enlarged portal. Repeat laparoscopic examination was performed at 1 month.
Results— Laparoscopic splenectomy required 70 minutes (range, 52–88 minutes) and was successful without major intraoperative and postoperative complications. Postoperatively, all goats had signs of mild abdominal discomfort. On repeat laparoscopy, with the exception of 1 goat that had a focal omental adhesion to the enlarged portal site, no other abnormalities were identified.
Conclusions— Laparoscopic splenectomy can be accomplished in goats using 4 portals in the left flank and a combination of monopolar cautery dissection of splenic attachments, ligation of vessels using metal clips and intracorporeal ligatures, and intra-abdominal morcellation of the detached spleen in a specimen retrieval bag.
Clinical Relevance— Laparoscopic splenectomy is an effective and safe technique in goats.