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Comparison between single and three portal laparoscopic splenectomy in dogs.

Khalaj A, Bakhtiari J, Niasari-Naslaji A - BMC Vet. Res. (2012)

Bottom Line: All dogs recovered uneventfully.There were no post-operative wound complication including inflammation, infection, hernia formation and dehiscence up to one month after surgery.Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches.

View Article: PubMed Central - HTML - PubMed

Affiliation: Minimally Invasive Surgery Research Centre, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Single incision laparoscopic surgery (SILS) is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs. Mongrel dogs (n = 18), weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional). The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO₂ using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments.

Results: All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min) and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P < 0.001). There were no post-operative wound complication including inflammation, infection, hernia formation and dehiscence up to one month after surgery. Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches.

Conclusion: This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional) for splenectomy in dog.

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Single incision laparoscopic surgery (SILS).
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Figure 1: Single incision laparoscopic surgery (SILS).

Mentions: The area from xiphoid to pubis was prepared under aseptic condition. Dog was placed in dorsal recumbency, head down and tilted 30 degree in the right lateral position. The surgeon and cameraman both stood on the right side of the dog and monitor was placed on the opposite side. For dogs operated by SILS method (n = 12), 3 cm midline skin incision starting from umbilicus to the caudal was made and the subcutis was reflected until revealing the linea alba. The linea alba was incised and the umbilical single portal was inserted using 5 mm TriPort trocar (Advanced Surgical Concepts, Wicklow, Ireland; Figure1). For dogs operated by conventional method (n = 6), 3 portals including umbilical, cranial and caudal were inserted, 3 cm apart in a straight line, using 5 mm trocars. In both methods, the length of umbilical incision was enlarged, with routine surgical technique, according to the size of spleen (Figure2). Pneumoperitoneum was established by CO2 using an automatic high flow pressure until the pressure of 12 mm Hg was achieved. A 5 mm in diameter 30 degree rigid telescope (29 cm length, Wolf, Germany) connected to a light source was inserted into the peritoneal cavity from the umbilical portal. The orientation of the spleen and the location of its proximal and distal poles were located initially. The 5 mm curved flexible-tip Maryland forceps (Carl Storz, Germany) was introduced from the cranial port and inserted through the splenic vessels at the hilum to lift the spleen up from its middle part or the more accessible portion. The ultracision harmonic scalpel (lotus hand piece, SRA Developments LTD, Devon, UK), was inserted from the caudal portal to seal and cut the splenic, left gasteroepiploic and short gastric arteries, veins and gastrosplenic ligament. The location of camera and forceps were changed during the operation to maintain ergonomy for better visualization and maneuver. The direction of sealing of the splenic vessels was highly depended on the size of spleen and its orientation. Thus sealing of vessels was started either from the center of spleen and continued cranially and caudally or from the distal pole and continued toward the splenic hilus to proximal pole. Following transection of the splenic attachments, the pedicles were checked to ensure hemostasis. With the help of camera from the enlarged umbilical portal, cranial pole of the spleen was oriented and removed. Then it was grasped by Doyen forceps and exposed through the incision. It was pulled out of the abdomen very firmly to avoid fracture of the splenic parenchyma (Figure3). The abdominal incision was closed in a three layer routine manner. All surgeries were video recorded and the operative time, total length of the scar, weight of the spleen and its dimensions were estimated. Post operative complications were evaluated on Days 1, 3, 5, 7 and 30 after surgery.


Comparison between single and three portal laparoscopic splenectomy in dogs.

Khalaj A, Bakhtiari J, Niasari-Naslaji A - BMC Vet. Res. (2012)

Single incision laparoscopic surgery (SILS).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3585911&req=5

Figure 1: Single incision laparoscopic surgery (SILS).
Mentions: The area from xiphoid to pubis was prepared under aseptic condition. Dog was placed in dorsal recumbency, head down and tilted 30 degree in the right lateral position. The surgeon and cameraman both stood on the right side of the dog and monitor was placed on the opposite side. For dogs operated by SILS method (n = 12), 3 cm midline skin incision starting from umbilicus to the caudal was made and the subcutis was reflected until revealing the linea alba. The linea alba was incised and the umbilical single portal was inserted using 5 mm TriPort trocar (Advanced Surgical Concepts, Wicklow, Ireland; Figure1). For dogs operated by conventional method (n = 6), 3 portals including umbilical, cranial and caudal were inserted, 3 cm apart in a straight line, using 5 mm trocars. In both methods, the length of umbilical incision was enlarged, with routine surgical technique, according to the size of spleen (Figure2). Pneumoperitoneum was established by CO2 using an automatic high flow pressure until the pressure of 12 mm Hg was achieved. A 5 mm in diameter 30 degree rigid telescope (29 cm length, Wolf, Germany) connected to a light source was inserted into the peritoneal cavity from the umbilical portal. The orientation of the spleen and the location of its proximal and distal poles were located initially. The 5 mm curved flexible-tip Maryland forceps (Carl Storz, Germany) was introduced from the cranial port and inserted through the splenic vessels at the hilum to lift the spleen up from its middle part or the more accessible portion. The ultracision harmonic scalpel (lotus hand piece, SRA Developments LTD, Devon, UK), was inserted from the caudal portal to seal and cut the splenic, left gasteroepiploic and short gastric arteries, veins and gastrosplenic ligament. The location of camera and forceps were changed during the operation to maintain ergonomy for better visualization and maneuver. The direction of sealing of the splenic vessels was highly depended on the size of spleen and its orientation. Thus sealing of vessels was started either from the center of spleen and continued cranially and caudally or from the distal pole and continued toward the splenic hilus to proximal pole. Following transection of the splenic attachments, the pedicles were checked to ensure hemostasis. With the help of camera from the enlarged umbilical portal, cranial pole of the spleen was oriented and removed. Then it was grasped by Doyen forceps and exposed through the incision. It was pulled out of the abdomen very firmly to avoid fracture of the splenic parenchyma (Figure3). The abdominal incision was closed in a three layer routine manner. All surgeries were video recorded and the operative time, total length of the scar, weight of the spleen and its dimensions were estimated. Post operative complications were evaluated on Days 1, 3, 5, 7 and 30 after surgery.

Bottom Line: All dogs recovered uneventfully.There were no post-operative wound complication including inflammation, infection, hernia formation and dehiscence up to one month after surgery.Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches.

View Article: PubMed Central - HTML - PubMed

Affiliation: Minimally Invasive Surgery Research Centre, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Single incision laparoscopic surgery (SILS) is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs. Mongrel dogs (n = 18), weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional). The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO₂ using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments.

Results: All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min) and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P < 0.001). There were no post-operative wound complication including inflammation, infection, hernia formation and dehiscence up to one month after surgery. Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches.

Conclusion: This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional) for splenectomy in dog.

Show MeSH
Related in: MedlinePlus