Ch 24 Laparoscopy and Thoracoscopy Flashcards

Question

Comparison between intracorporeal and extracorporeal ligations in a laparoscopic ovariectomy model in dogs Martin 2021

Answer 1

Study design: Prospective randomized experimental study. Animals: Healthy intact female dogs (n = 18). No difference was identified between extracorporeal and intracorporeal ligations of ovarian pedicles.

Answer 2

Study design: Systematic review. Animals: Client-owned or healthy research dogs most commonly reported intraoperative and postoperative complications were related to abdominal entry and portal incisions, respectively. In 53 of 54 non-randomized studies, high risk of bias was found The overall quality of evidence was low, limiting direct comparison of complication rates between studies The most common intraoperative complication was splenic laceration, was most commonly related to abdominal entry technique The conversion rate across all studies ranged from 0% to 30%. highest conversion rate was described in a case series of 20 dogs undergoing cholecystectomy postoperative complications, recorded 192 times in 20 (31.3%) studies and across all organ systems, were wound related and included emphysema, inflammation, infection, swelling, seroma, discharge, and incisional authors of a recent study evaluated the prevalence of and risk factors for complications related to three different entry techniques, the modified Hasson, Veress needle, and Ternamian visual entry techniques.81 In that study, complications were five and 28 times higher with modified Hasson (26%) and Veress needle entry (60%) techniques, respectively, compared with Ternamian visual entry (9%) technique. more experienced laparoscopist, proficient and comfortable with complex laparoscopic procedures, would tolerate more adverse situations for a longer time before converting to an open procedure. Other factors such as careful case selection are also very likely to influence intraoperative conversion rates.

Answer 3

Multi-institutional retrospective study. Animals: Client-owned dogs (N = 411). LAG > In either case, a laparoscope is used to identify the stomach, the stomach is grasped and exteriorized through a right-sided paramedian incision, and the gastropexy is performed extracorporeally at that location Paramedian incisional complications were observed in 78 of 411 (19%) dogs. The most common complication was seroma formation, which occurred in 51 (12.4%) dogs. Surgical site infections were observed in 16 (3.9%) dogs, and dehiscence or development of excessive scar tissue at the incision site were each observed in nine (2.2%) dogs The odds of complications were approximately twice as high in dogs undergoing single port than in dogs undergoing multiport The high complication rate associated with paramedian LAG incisions may be a rationale for intracorporeal gastropexy.

Answer 4

retroperitoneal access for adrenalectomy – space limitations and anatomy - indocyanine green – bound to proteins in plasma/lymph – absorbs light in near-IF ~806nm - once protein-bound → fluorescence at 830nm - imaging devices provided NI light → absorption → excitation - resulting fluorescence transferred to monitor - visual colour from microbubbles during reconstitution rather than chemical - applications: tumour/metastasis detection (pulmonary, wound beds, SLN-mapping) chylothorax – lymphangiography, TD/CC colourisation extrahepatic biliary tract surgery – biliary excretion 15-20min peak at 30min-2hr

Answer 5

retrospectively reviewed Major intraoperative complications did not occur and conversion to open laparotomy was not required. In 1 dog, an SPL 1 1 technique was used, in which an additional port was placed cranial Clinical signs related to estrus had resolved in 11 of 13 dog

Answer 6

Retrospective study. Animals: Twenty-eight client-owned dogs After laparoscopic evaluation, a wound retraction device (WRD) was inserted. The small intestine was extracorporeally explored, and foreign body removal was performed. The surgeon's hand was inserted through the WRD to palpate portions of the gastrointestinal tract not able to be extracorporeally evaluated Conversion from SILAIS to OL occurred in 3/13 cases was not significantly different from OL in a variety of outcome measures in this cohort of dogs. Diagnostic imaging including ultrasonography or computed tomography may improve appropriate case selection for SILAIS for simple foreign body removal.

Answer 7

A retrospective study 46 of 106 (44%) dogs undergoing open ovariectomy developed a complication Thirty-one (20%) of 154 dogs undergoing laparoscopic ovariectomy developed a complication herniation occurred in none of the laparoscopic cases. rates of overall and wound healing complications were lower for the laparascopic group than the open surgical group in this non-randomised study. Laparoscopy might be considered preferable for ovariectomy in dogs but confirmation requires a randomised trial

Answer 8

Cadaveric and retrospective study. Animals: Six canine cadavers and 14 client-owned dogs wound retractor device (WRD) and a single-port device were placed in the abdominal flank 2–3 cm caudal to the 13th rib. Successful ML was completed by using ICG in all 6 canine cadavers. A right- or left-sided single-port laparoscopic CCA was successfully performed in 14 dogs No intraoperative complications were reported. Three dogs developed severe chyloabdomen postoperatively, with 1 dog requiring multiple abdominocenteses. sternal recumbency allows both a CCA and an intraoperative ML through the same incision. This procedure may be combined with thoracoscopic thoracic duct ligation and pericardectomy for the treatment of idiopathic chylothorax in dogs.

Answer 9

Clinical randomized prospective study. Animals: Nine client-owned dogs Portal pressure increased by 38% at 6 mmHg, 95% at 10 mmHg, and 175% at 14 mmHg compared to baseline No systemic hemodynamic adverse events were observed. supports the use of the minimum insufflation pressure necessary feasible in the laparoscopic setting and insufflation is unlikely to affect portal pressure interpretation before or after laparoscopic shunt attenuations, following desufflation of the abdomen.

Answer 10

- chylothorax – NIRF, TDL and pericardectomy - pulmonary lobectomy – thoracoscopic-assisted lobectomy - pericardectomy – window, subtotal, window+fillets - pyothorax – conversion 14% - pneumothorax – careful bilateral evaluation to detect blebs/bullae - PRAA – thoracoscopic LA transection +/- aberrant left subclavian

Ch 24 Laparoscopy and Thoracoscopy Flashcards

(34 cards)