Comparison of 5 Surgical Techniques for Partial Liver Lobectomy in the Dog for Intraoperative Blood Loss and Surgical Time

Objective: To compare surgical time and intraoperative blood loss for 5 partial liver lobectomy techniques in the dog. Study Design: Experimental in vivo study. Animals: Dogs (n=10). Methods: Five surgical techniques (SurgiTie^?; LigaSure^?; Ultracision^® Harmonic Scalpel [UAS]; Suction+Clip; Suction+thoracoabdominal stapler [TA]) for partial liver lobectomy in dogs were evaluated and compared for total surgical time and intraoperative blood loss. Body weight, activated clotting time (ACT), heart rate, and intraoperative blood pressure (BP) were recorded. Blood loss was determined by adding the weight of the blood soaked sponges during surgery (1 g=1 mL) to the amount of suctioned blood (mL). Surgical time (in seconds) was determined from the start of the lobectomy until cessation of bleeding from the stump. Mean surgical time and mean blood loss for each technique were compared using a Tukey's multiple comparison test. Results: No significant differences were found between dogs for weight, ACT, heart rate, and intraoperative BP. No complications were seen with the SurgiTie^? technique in 9 of 10 cases. There was no significant difference in surgical time between techniques however there was a significant difference for blood loss; the Suction+Clip method had significantly more blood loss than the other techniques. Conclusions: Skeletonization of the lobar vessels before individually clipping them (Suction+Clip) resulted in a higher blood loss than using Suction+TA, UAS, SurgiTie^? or the LigaSure^? device. The SurgiTie^? appears to be an acceptable method for partial liver lobectomy. Clinical Relevance: Although skeletonization and individually clipping the vessels had the highest blood loss, it still was <7.5% of total blood volume. All 5 techniques should be safe for clinical use in small to medium sized dogs up to 26 kg.     

Thoracoscopic Lung Biopsies in Heaves‐Affected Horses Using a Bipolar Tissue Sealing System

Objective: To validate the use of the LigaSure? Vessel Sealing System (LVSS) to perform thoracoscopic lung tissue biopsies in heaves‐affected horses. Study design: Prospective clinical study. Animals: Heaves‐affected horses (n=12). Methods: Lung biopsies (n=34) were collected with the LVSS (2–4 biopsies/horse) in horses with and without clinical signs of heaves. Thoracoscope (13th intercostal space [ICS]) and 2 instruments (between the 12–15th ICS) portals were used. Selected clinical and arterial blood gas variables were monitored. Postoperative pneumothorax was evaluated. Depth of thermal injury to the surrounding tissue and representativeness of the biopsies were determined. Results: Mean surgical time was 22.9±8.0 minutes. The complication rate was 5.6%, and primarily related to a focal inadequate sealing of the biopsy margin. Five horses in exacerbation required intraoperative intranasal O₂. Mean PaO₂ was significantly lower in heaves‐affected horses with clinical signs compared with those without clinical signs. Postoperative pneumothorax was detected radiographically after 20 of the 34 procedures. One horse with clinical signs of heaves developed a fatal tension pneumothorax 5 days postoperatively despite close radiographic monitoring. Conclusion: Thoracoscopic lung biopsy using LVSS is a rapid and effective technique to harvest peripheral lung tissues from heaves‐affected horses. Although the complication rate was tolerable, tension pneumothorax was a potential life‐threatening complication because of incomplete lung sealing. Clinical Relevance: LVSS can be used with relative safety to perform thoracoscopic lung biopsy, but close postoperative monitoring is necessary to avoid tension pneumothorax.     

Laparoscopic Splenectomy for Treatment of Splenic Hemangiosarcoma in a Dog

Objective: To report laparoscopic splenectomy in a dog. Study Design: Clinical report. Animals: Mixed breed dog (n=1). Methods: Hemangiosarcoma was diagnosed by ultrasound‐guided fine‐needle aspiration of a splenic mass in an 11‐year‐old, 30 kg, mixed breed dog. No metastatic disease was identified during complete staging (chest radiographs, echocardiogram, and abdominal ultrasonography); however, cystic calculi were identified. Laparoscopic splenectomy using Ligasure V was performed through 3 portals and the calculi were removed by laparoscopic‐assisted cystoscopy. Results: Total surgical time was 2 hours and for laparoscopic splenectomy, 65 minutes. The celiotomy incision for splenic removal was 7 cm. The dog recovered uneventfully and was ambulatory 2 hours postoperatively. Conclusion: Laparoscopy with Ligasure V facilitated successful removal of a spleen with a 3 cm mass. Clinical Relevance: Laparoscopic splenectomy in dogs is feasible for removal of a normal‐sized spleen with a moderate‐sized mass.     

Right Dorsal Colon Resection and Bypass for Treatment of Right Dorsal Colitis in a Horse

Objective: To describe a novel surgical technique for management of right dorsal colitis in the horse. Study Design: Clinical report. Animals: 14‐year‐old Warmblood gelding. Methods: The horse was referred for treatment of a stromal abscess and signs of right dorsal colitis. Plasma chemistry revealed marked hypoproteinemia. Abdominal ultrasonographic examination showed a thickened right dorsal colon (RDC). Medical treatment was unsuccessful. With the horse in left lateral recumbency under general anesthesia, an approach to the right side of the abdomen through a 16th rib resection was made. The thoracic cavity was entered during the approach. Surgical resection of the RDC and side‐to‐side anastomosis of the diaphragmatic flexure to the small colon (bypass) was performed. The thoracic cavity was closed by attaching the diaphragm to the body wall and air was removed at the completion of surgery. Results: Resection of the RDC and bypass of the resected area was successfully performed. The colic signs and hypoproteinemia resolved. Complications of surgery included a deep surgical site infection with development of a large intrathoracic abscess. The abscess was managed with drainage and long‐term antimicrobial treatment. Conclusion: Right dorsal colitis can be treated successfully with resection and bypass of the RDC. In cases where the thoracic cavity is penetrated during the abdominal approach, the diaphragm should be sutured to the body wall at the beginning of surgery to avoid development of an infection within the thoracic cavity. Clinical Relevance: RDC resection and bypass may be an alternative approach for management of horses with right dorsal colitis.     

Micro Total Hip Replacement for Dogs and Cats: Surgical Technique and Outcomes

Objective: To describe the surgical technique for the micro total hip replacement (Micro THR) system and report clinical outcomes. Study Design: Prospective study. Animals: Dogs (n=49) and cats (n=8) with coxofemoral arthropathy. Methods: Small breed dogs and cats with coxofemoral arthritis were enrolled for Micro THR. Patient data were recorded. Implant positioning and cement mantle quality were evaluated radiographically. Orthopedic examinations and client interviews were used to assess outcome. Results: Micro THR was performed unilaterally (40 dogs, 8 cats) and staged bilaterally (9 dogs) to resolve pain associated with osteoarthritis or trauma. Mean body weight was 7.2 kg. Postoperative complications included prosthesis luxation (9), cup aseptic loosening (1), and sciatic neurapraxia (1). Mean radiographic follow up was 96.1 weeks; 10 joints were followed for ≥3.0 years. Sixty of the 66 (91%) Micro THRs had excellent outcomes. Two dogs (<2.75 kg) were too small for the prosthesis and 4 dogs with unmanageable luxation had explantation. Conclusions: Micro THR is considered a satisfactory procedure for management of small breed dogs and cats with coxofemoral disease unresponsive to medical management. Clinical Relevance: Micro THR is a viable option to treat disabling disorders of the hip. More than 170 cat and small dog breeds, and many mixed breeds, could benefit from Micro THR surgery.     

Relationships of Body Weight,Body Size,Subject Velocity,and Vertical Ground Reaction Forces in Trotting Dogs

Objective: To evaluate the relationship of body weight (BW) and size, dog velocity, and vertical ground reaction forces (GRF) from a large number of dogs of various sizes. Study Design: Clinical research. Animals: Orthopedically healthy dogs (n=129) Methods: BW and dog size, represented as height at the withers (WH), were obtained. Stance times (ST), vertical impulses (VI), and peak vertical forces (PVF) of thoracic and pelvic limbs were measured on a force plate at controlled trotting speed. They were evaluated against BW and WH using linear regression analysis in absolute (nonnormalized) values, and when normalized to BW and/or body size according to the theory of dynamic similarity. Relative velocities were calculated for each dog. Results: Absolute ST, VI, and PVF showed strong positive correlations with BW and/or body size. When GRFs were normalized to BW, correlations with body size were markedly reduced, but remained positive for VI, and turned negative for PVF. Normalizing the time‐dependent variables (ST and VI) also to WH eliminated most size influence. A small dependency of fully normalized GRF on body size remained that was because of differences in relative velocity between dogs of different sizes. Reference values for the fully normalized data are given. Conclusions: The inherent relationship between BW, body size, dog velocity, and vertical GRF was demonstrated. Clinical Relevance: BW, body size, and relative dog velocity must be accounted for when wanting to obtain GRF variables that are comparable between different dogs.     

Saline Volume Necessary to Achieve Predetermined Intraluminal Pressures during Leak Testing of Small Intestinal Biopsy Sites in the Dog

Objective: To determine the volume of saline needed to achieve targeted intraluminal pressures during leak testing of closed jejunal biopsy sites in the dog. Study Design: Experimental. Animals: Dogs (n=38). Methods: Jejunal biopsies in dogs were performed and closed using 3–4 full thickness simple interrupted sutures. Saline volumes needed to achieve 2 predetermined intraluminal pressures (20 and 34 cm water [15 and 25 mmHg]) in a 10 cm canine jejunal segment containing a closed biopsy site using 2 methods of luminal occlusion were recorded. Results: The 95% confidence intervals for the volume of saline needed to achieve 20 and 34 cm water intraluminal pressure were 10.9–13.6 and 16.3–19.0 mL, respectively with digital occlusion and 8.5–11.1 and 12.1–14.8 mL, respectively with Doyen occlusion. Correlation between volume of saline instilled and the pressure achieved was 0.76 for digital occlusion and 0.86 for Doyen occlusion. Conclusion: Correlation between volume of saline instilled and pressure achieved was greater with Doyen than digital occlusion. Clinical Relevance: For canine jejunum, saline volumes of 16.3–19 mL (digital occlusion) and 12.1–14.8 mL (Doyen occlusion) can be used to achieve intraluminal pressures of 34 cm water during leak testing of a 10 cm segment containing a closed biopsy site.     

Ex Vivo Comparison of Three Surgical Techniques to Stabilize Canine Cranial Cruciate Ligament Deficient Stifles

Objective— To quantify and compare canine stifle stability after 3 stabilization techniques. Study Design— Randomized controlled study. Sample Population— Adult canine cadaveric pelvic limbs. Methods— Total craniocaudal (CrCa) tibial translation quantified in stifles with the cranial cruciate ligament (CrCL) intact, transected, and stabilized with 1 of 3 techniques: (1) hamstring graft (HG); (2) modified retinacular imbrication (MRIT); (3) anatometric fascia lata translocation (AFLT). Tibial translation was quantified from radiographs generated during application of cranial and caudal forces to the tibia. After removal of all soft tissues except periarticular ligaments and fixation, CrCa tibial translation, as before, and medial–lateral rotation, via torsional loading, was quantified with an active motion analysis system. Total tibial translation was evaluated for effect of technique and cruciate status using mixed effect linear model with significance considered at P‐value <.05. Results— CrCa translation was not significantly different across stabilization techniques with CrCLs intact, transected, or after stabilization. Poststabilization translation was significantly less than posttransection for all techniques. Compared with the intact CrCL, CrCa translation poststabilization after HG was significantly greater whereas poststabilization after MRIT and AFLT was not significantly different. Tibial rotation exceeded instrumentation limits in 62.5% HG limbs, 20% MRIT limbs, and 60% AFLT limbs. Conclusions— All 3 stifle stabilization techniques confer comparable CrCa translational stability after CrCL disruption with that provided by the MRIT and AFLT techniques comparable to the intact CrCL. Clinical Relevance— The extra‐ and intracapsular techniques evaluated in this study reduced CrCa tibial translation in CrCL deficient stifles to varying amounts.     

Bending Characteristics of Polymethylmethacrylate Columns,Connecting Bars of Carbon Fiber,Titanium, and Stainless Steel Used in External Skeletal Fixation and an Acrylic Interface

Objective: To (1) mechanically evaluate polymethylmethacrylate (PMMA) columns of various sizes and compare them to connecting bar materials (carbon fiber composite, titanium, stainless steel) and (2) compare the properties of an intact PMMA column to those of an acrylic interface. Study Design: Experimental mechanical study. Sample Population: Experiment 1: 6 groups of 6 specimens each; experiment 2: 2 groups of 12 specimens each. Methods: All specimens were tested in 3‐point bending. Stiffness, yield strength, and ultimate strength values were calculated for each specimen. Results: PMMA 1 columns (23.25 mm) compared favorably to titanium or stainless‐steel bars. PMMA 3 columns (30.15 mm) and carbon fiber bars had similar yield strength but PMMA 3 columns were less stiff than carbon fiber bars. PMMA 3 columns had lower bending modulus and a higher variability in their mechanical properties than PMMA 1 or PMMA 2 (25.64 mm) columns. Acrylic interface specimens were less strong but as stiff as intact specimens. Conclusion: An acrylic interface was easily created and had acceptable biomechanical characteristics. Clinical Relevance: PMMA 2 and PMMA 3 columns are not recommended for clinical use at this time. Further tests are needed to analyze an acrylic patch in a more clinically relevant loading model.     

Juvenile Pubic Symphysiodesis and Juvenile Pubic Symphysiodesis Associated with Pectineus Myotomy: Short‐Term Outcome in 56 Dysplastic Puppies

Objectives— (1) To compare short‐term outcome of juvenile pubic symphysiodesis (JPS) in puppies aged 12–17 weeks with lax hips (group JPS1), in puppies aged 18–22 weeks (group JPS2), and control (group C) puppies; and (2) to document outcome of bilateral pectineus myotomy (PM) associated with JPS in 18–22‐week‐old puppies (group JPS–PM). Study Design— Prospective study. Methods— Puppies (12–22 weeks) from large and giant breed dogs with a combination of a positive Ortolani sign, poor acetabular coverage (Norberg angle [NA]≤100°), and a subluxation index (SI) >0.5 for one or both hips were selected. Puppies aged <18 weeks were randomly assigned to group JPS1 or C. Puppies aged 18–22 weeks were randomly assigned to group JPS2, JPS–PM, or C. Three to 4 months later, surgery was considered successful in pain‐free dogs with negative Ortolani sign, normalized acetabular coverage (NA≥105°), and SI>0.5. Success rates were compared using Fisher's exact tests: JPS1 versus JPS2 versus C; JPS2 versus JPS–PM. Significance was set at P<.05. Results— All dysplastic hips from nonoperated (C) groups were dysplastic at follow‐up, meaning that our criteria for case selection were accurate. JPS1 had significantly better success rate than JPS2 (85 versus 17.8%, respectively). JPS–PM dysplastic hips failed to demonstrate a better outcome than JPS2 hips. Clinical Relevance— This study confirms, on a large series of dysplastic hips, the age‐dependent effects of JPS, with better results if performed before 18 weeks of age. There is no benefit of adding PM to the procedure in candidates >18 weeks at surgery.