Use of a Composed Simulator by Veterinarian Non-Experts in Minimally Invasive Surgery for Training and Acquisition of Surgical Skills for Laparoscopic Ovariectomy in Dogs.

This study aims to assess the acquisition of surgical skills for laparoscopic ovariectomy (LOE) in dogs by veterinary surgeons with no experience in minimally invasive surgery using the CALMA Veterinary Lap-trainer simulator (CVLTS) in an experimental and analytical setting. Veterinary surgeons with no experience in minimally invasive surgery (MIS) (experimental, n = 5), and MIS experts (experts, n = 3) were evaluated. Experimental and expert group participants watched an instructional video (initial time) before practicing the LOE on uterine tissues and ovaries freshly reconstituted after elective ovariohysterectomy (initial time evaluation). Then, the experimental group practiced five training sessions on the composite simulator with permanent feedback and then performed the LOE again (final time evaluation). Surgical performances in initial and final evaluations were video recorded and further evaluated by three external MIS experts using Global objective assessment of laparoscopic skills (GOALS) and LOE-specific rating scales (SRSs) in a double-blinded schedule. In addition, a hands movement assessment system (HMAS) attached to the back of the hands was used to quantitatively measure completion time, angularity, and movement smoothness. Data were analyzed with one-factor ANOVA and Tukey's contrast test. No statistically significant differences were found between the novice group's performance after training and the expert group's performance according to the GOALS (p < 0.01) and SRS (p < 0.05) scores. Moreover, the novices had significantly improved time, number of movements, and angularity in the final time compared with the initial time (p < 0.05), with no significant differences compared to the expert group (p > 0.05). LOE training using a composed simulator resulted in significantly improved laparoscopic skills and time, number, and angularity of movements data, providing evidence of the usefulness and reliability of CVLTS in training LOE.

Implementation of a Canine Ergonomic Abdominal Simulator for Training Basic Laparoscopic Skills in Veterinarians.

The validity of the CALMA Veterinary Lap-trainer simulator (CVLTS) for training basic veterinary laparoscopic skills was assessed and compared to a simple collapsible mobile box trainer. Ten veterinarian surgeons with no experience in laparoscopic surgery and four experts with at least two years of experience in minimally invasive surgery (MIS) were included. The training curriculum included object transfer, non-woven gauze cutting with curved scissors, and interrupted and continuous intracorporeal sutures, which were practiced on the CVLTS. The initial and final assessments were carried out in both the CVLTS and in a collapsible mobile simulator. These were video-recorded and evaluated by external experts using the Objective Structured Assessment of Technical Skills (OSATS) and a specific scale evaluation in a double-blinded schedule. The time, angular displacement, number, and movement smoothness were recorded using a hands movement assessment system (HMAS). Through a survey, the face validity and content were evaluated. The data were analyzed by a Pearson's proportions comparison or Mann Whitney U test and a bilateral Student's t-test. The experimental group OSATS, specific scores, and HMAS values, with the exception of the smoothness of movements, significantly improved after training, with no statistically significant differences compared to the expert group. No differences were found between the two simulators. The experts' and experimental participants' CVLTS mean score was 4.8. Our data support the CVLTS validations for laparoscopic surgery basic skills training.

Development and validation of a composed canine simulator for advanced veterinary laparoscopic training.

The development of innovative simulation models for veterinary laparoscopic surgery training is a priority today. This study aimed to describe a didactic simulation tool for the training of total laparoscopic gastropexy (TLG) with intracorporeal sutures in dogs. CALMA Veterinary Lap-trainer composite simulator (CLVTS) was developed from a plaster cast of 2 Great Dane canines mimicking the space and the correct position to carry out a TLG. After video instruction, 16 veterinarians with different degrees of experience in minimally invasive surgery (Experts, n = 6 and intermediates, n = 10) evaluated four sequential simulating TLG with intracorporeal suturing in the CLVTS. Subsequently, they completed an anonymous questionnaire analyzing the realism, usefulness, and educational quality of the simulator. The CLVTS showed a good preliminary acceptance (4.7/5) in terms of the usefulness and adequacy of the exercises that, in the participants' opinion, are appropriate and are related to the difficulty of the TLG. In addition, both experienced and intermediate surgeons gave high marks (4.5/5) to the feeling of realism, design, and practicality. There were no significant differences between the responses of the two groups. The results suggest that the CVLTS has both face and content validity. Where it can be practiced in a structured environment for the development of a total laparoscopic gastropexy with intracorporeal suture and without compromising patient safety, but still has some limitations of the scope of the study. Further studies are needed to establish the ability to assess or measure technical skills, including the degree of transferability to the actual surgical environment.

Validation of Training and Acquisition of Surgical Skills in Veterinary Laparoscopic Surgery: A Review.

At present, veterinary laparoscopic surgery training is lacking in experiences that provide a controlled and safe environment where surgeons can practice specific techniques while receiving experts' feedback. Surgical skills acquired using simulators must be certified and transferable to the operating room. Most models for practicing laparoscopic skills in veterinary minimally invasive surgery are general task trainers and consist of boxes (simulators) designed for training human surgery. These simulators exhibit several limitations, including anatomic species and procedural differences, as well as general psychomotor training rather than in vivo skill recreation. In this paper, we review the existing methods of training, evaluation, and validation of technical skills in veterinary laparoscopic surgery. Content includes global and specific scales, and the conditions a structured curriculum should meet for improving the performance of novice surgeons during and after training. A focus on trainee-specific assessment and tailored-technical instruction should influence training programs. We provide a comprehensive analysis of current theories and concepts related to the evaluation and validation of simulators for training laparoscopic surgery in small animal surgery. We also highlight the need to develop new training models and complementary evaluation scales for the validation of training and acquisition of basic and advanced skills in veterinary laparoscopic surgery.

Concomitant Presence of Ovarian Tumors (Teratoma and Granulosa Cell Tumor), and Pyometra in an English Bulldog Female Dog: A Case Report.

Background: The diagnosis of ovarian tumors in dogs is usually complicated because the clinical signs can be very discrete and can be easily confused with other diseases. There are few reports of ovarian tumors with different cellular characteristics in the same dog. Our objective was to describe an unusual case of the concomitant presence of ovarian teratoma and granulosa cell tumors in a female dog presenting symptoms compatible with pyometra at clinical consultation. Clinical history: A non-spayed 6-years-old female English Bulldog was attended at the consultation, with no history of previous steroid hormonal treatment. The dog had presented regular estrus every 6 months; 3 months elapsed between the last estrus and consultation. The dog had presented vulvar discharge for more than 2 weeks. Clinical and laboratory findings: the patient presented a slightly pale oral mucosa, decay, vulvar edema, and mucous-purulent uterine discharge. The ultrasound examination revealed the presence of neoformations in the ovaries, and evidence of cystic endometrial hyperplasia-pyometra in the uterus. Treatment: We performed a ventral ovariohysterectomy. During the surgical procedure, it was found several masses in the left and right ovaries, exhibiting characteristics of other tissues different from ovarian tissue. All samples were sent for histopathological examination. The diagnosis was a granulosa cell tumor in the left ovary and a well-differentiated teratoma in the right ovary. Conclusion: Practitioners must improve the use of diagnostic tools when attending non-spayed dogs at advanced ages (more than 6 years old), which would probably be at high risk of suffering from undetected ovarian tumors, some of them with malignancy behavior.

Histiocitoma de Células de Langerhans en canino: reporte de caso en Colombia / Langerhans Cell Histiocytoma in canine: a case report in Colombia / Histiocitoma das células de Langerhans em caninos: relato de caso na Colômbia

Resumen Se reporta el caso clínico de un paciente canino de 10 años de edad, macho, mestizo y esterilizado, que llega a la Clínica veterinaria de Antioquia, Medellín Colombia, con una masa de 5 cms de diámetro en la región lateral del prepucio. La masa de forma circular y de consistencia firme, a la evaluación histopatológica correspondió a un histiocitoma de las células de Langerhans. El paciente fue sometido a resección quirúrgica de la masa y tratado posteriormente con cefalexina 25 mg/kg cada 12 horas oral por 1 semana, prednisolona por 20 días y desinfección de la zona con clorhexidina cada 12 horas, además se aplica en la zona dimetilsulfóxido tópico cada 12 horas por 3 semanas. Debido a lo poco descrito este tipo de histiocitoma en dermatología, se considera de valor científico su reporte.

Abstract A 10–year-old crossbred neutered dog was submitted to Clínica Veterinaria de Antioquia (Medellín, Colombia) presenting a firm and circular mass of 5 cm in diameter in the lateral region of the foreskin. After histopathological evaluation, the mass corresponded to a Langerhans cell histiocytoma. The patient underwent surgical resection of the mass and was then treated with cephalexin (25 mg/kg every 12 hours, orally, for 1 week), prednisolone (20 days), disinfection of the area (every 12 hours using chlorhexidine), and applying dimethyl sulfoxide on the area (every 12 hours for 3 weeks). We consider this report has a scientific value because this type of histiocytoma is rarely described in dermatology.

Resumo Relatar o caso clínico de um paciente canino de 10 anos de idade, macho, mestiço e esterilizado, que chegou a Clínica Veterinária de Antioquia, Medellín, Colômbia, com uma massa de 5 cm de diâmetro na região lateral do prepúcio, a massa era de forma circular e de consistência firme, na avaliação histopatológica revelou-se um histiocitoma das células de Langerhans, o paciente foi submetido a resseção cirúrgica da massa e tratado posteriormente com cefalexina 25 mg/kg a cada 12 horas oral durante uma semana, prednisolona por 20 dias e desinfecção da região com clorexidina a cada 12 horas, além disto, se aplicou na região afetada dimetilsulfóxido tópico a cada 12 horas durante três semanas. Devido as poucas referencias escritas deste tipo de histiocitoma em dermatologia, considera-se de valor cientifico seu relato.

Laparoscopia versus laparotomía paraprepucial en el tratamiento de criptorquidismo abdominal en caninos / Laparoscopy versus parapreputial laparotomy for the treatment of abdominal cryptorchidism in dogs / Laparoscopia versus laparotomía paraprepucial no tratamento de criptorquidismo abdominal em caninos

Resumen Objetivo: determinar diferencias en tiempo de cirugía, dolor y complicaciones entre criptorquidectomía por laparoscopia (CL) y criptorquidectomía por laparotomía medio ventral (CLMV) en caninos con criptorquidismo unilateral abdominal. Materiales y métodos: se utilizaron 11 pacientes, con peso promedio de 20 ± 9.6 kg y edad promedio de 21 ± 12.8 meses, distribuidos en grupos de 6 y 5 animales para realizarles CL y CLMV respectivamente. Se midió el tiempo quirúrgico total, el tiempo de extracción del testículo abdominal y el escrotal. La evaluación del dolor se realizó a las 0, 1, 2, 4, 6, 12 y 24 horas poscirugía, usando la escala de la Universidad de Melbourne (UMPS). Las complicaciones se monitorearon hasta 24 horas mediante valoración clínica y ultrasonografía. Resultados: la criptorquidia fue más común en razas puras y afectó principalmente el testículo derecho. El tiempo de cirugía fue significativamente menor usando CLMV para extraer el testículo abdominal. En la evaluación cualitativa del dolor, todos los pacientes presentaron nivel leve, excepto un paciente del grupo CLMV que presentó mayor dolor. Se encontró una diferencia estadística significativa a favor del grupo CL en la valoración del dolor a las 2 horas posquirúrgicas. Se detectó una complicación en un paciente del grupo CL a las 4 horas y tuvo que ser reintervenido. Conclusiones: ambos procedimientos produjeron dolor leve con diferencias estadísticamente significativas solo a las 2 horas. Se requirió menor tiempo de cirugía para la extracción del testículo abdominal realizando CLMV. La hemorragia posquirúrgica es una complicación a tener en cuenta al realizar CL.

Abstract Objective: to determine differences in the length of time of surgery, pain, and complications between laparoscopic cryptorchidectomy (CL) and cryptorchidectomy through mid-ventral laparotomy (CLMV) in dogs suffering from unilateral abdominal cryptorchidism. Materials and methods: 11 patients were used. The average weight of the dogs was 20 ± 9.6 kg, and the average age was 21 ± 12.8 months. Six and five dogs were assigned to CL and CLMV, respectively. Total surgery time and extraction time of abdominal and scrotal testis were measured. Pain evaluation was performed at 0, 1, 2, 4, 6, 12, and 24 hours after surgery using the pain scale developed by the University of Melbourne (UMPS). Complications were monitored during 24 hours by clinical assessment and ultrasonography. Results: cryptorchidism was more common in pure breeds and it affected mainly the right testicle. The operating time to remove the abdominal testis was significantly less using CLMV. Qualitative assessment of pain showed that all patients had mild pain, except for a patient in the CLMV group that showed higher pain. A statistically significant difference was found favoring the CL group in the assessment of pain at 2 h after surgery. A complication was detected in one patient of group CL four hours after surgery and was re-intervened. Conclusions: both procedures resulted in mild pain, with statistically significant differences only at 2 hours. CLMV took less time for removal of the testis. Post-surgery bleeding is a complication to consider when performing CL.

Resumo Objetivo: determinar diferenças no tempo de cirurgia, dor e complicações entre criptorquidectomia por laparoscopia (CL) e criptorquidectomia por laparotomía média ventral (CLMV) em caninos com criptorquidismo unilateral abdominal. Materiais e métodos: utilizaram-se 11 pacientes, com peso médio de 20 ± 9,6 kg e idade promedio de 21 ± 12,8 meses, distribuídos em grupos de seis e cinco animais para realizar lhes CL e CLMV respectivamente. Mediou-se o tempo quirurgico total, o tempo de extração do testículo abdominal e o escrotal. A avaliação da dor realizou-se as 0, 1, 2, 4, 6, 12 e 24 horas após cirurgia, utilizando uma escada de referencia da Universidade de Melbourne (UMPS). As complicações foram monitoradas ate às 24 horas mediante valoração clinica e ultrassonografia. Resultados: a criptorquidia foi mais comum em raças puras e afetou principalmente o testículo esquerdo. O tempo de cirurgia foi significativamente menor usando CLMV para extrair o testículo abdominal. Na avaliação qualitativa da dor, todos os pacientes apresentaram nível leve, exceto um paciente do grupo CLMV que apresentou muita dor. Encontrou-se uma diferença significativa (P<0,05) sendo menor a dor no grupo CL às 2 horas após cirurgia. Detectou-se uma complicação num paciente do grupo CL às 4 horas e teve que ser reintervenido. Conclusões: os dois procedimentos produziram dor leve com diferenças significativas só às 2 horas. Requereu-se menor tempo de cirurgia para a extração do testículo abdominal realizando CLMV. A hemorragia pós-operatória é uma complicação que deve ser tida em conta para realizar CL.