Comparison of conventional methods with commercially available topical hemostat surgical snow (oxidized cellulose) for achieving hemostasis in canine model of partial splenectomy.

Spleen is highly vascularized organ and bleeding control during partial splenectomy is a big challenge. In this study conventional methods of electrocautery, absorbable suturing and advance methods of topical hemostat Surgicel® were compared to control bleeding during partial splenec- tomy. Twelve healthy dogs (n=4) were divided in A, B and C groups. After partial splenectomy Surgicel®, electrocautery and absorbable horizontal mattress sutures were used to control hemor- rhages in group A, B and C respectively. Bleeding time and loss of blood volume was evaluated during surgery. In addition, blood samples were taken on day 0 pre-surgery and on days 3, 10 and 17 post-surgery to evaluate changes in biochemical parameters after the application of dif- ferent hemostatic techniques. Ultrasonography was also performed at alternative days to check any gross changes in the spleen. Dogs in group A showed minimum bleeding time and loss of blood volume as compared to group B and C. Drop in red blood cells count was compared be- tween group A, B and C showing significant change (p≤0.05) at day 3, 10 and 17, while a sig- nificant decline in hemoglobin was found in group C followed by groups B and A at 3rd and 10th day. There was no difference between platelet counts in various groups. Ultrasonography showed no significant changes in the spleen parenchyma. It was concluded that Surgicel® was an effective material for controlling hemorrhage in veterinary patients.

Ex vivo comparison of sliding knot ligatures vs. haemostatic clips for equine small intestinal mesenteric vessel occlusion.

BACKGROUND: In equine abdominal surgery, resection and anastomosis of strangulated intestine is a commonly performed procedure. To date, ligatures, vessel sealing devices and the ligate-divide stapler have been described for this use in horses. The objective of this study was to compare the application of haemostatic clips and ligatures to occlude equine mesenteric vessels. Portions of jejunum with ten associated mesenteric vessels were collected from 12 horses at a local abattoir and divided into two groups. Portions of intestine were divided into two sections comprising five vessels each and assigned to Group A or Group B. Each vessel was occluded with a triple ligature. In Group A, vessels were ligated with three circumferential ligatures tied with a sliding knot with two overthrows. In Group B, vessels were occluded with application of three haemoclips. The procedures were performed by the same experienced surgeon. Intestinal length, construction time and vessel leaking pressure were measured and compared between groups. RESULTS: The intestinal length (mean ± SD) was 3.78 ± 0.43 m in Group A and 3.04 ± 0.83 m in Group B. The difference was not significant (p = 0.297). The construction time (mean ± SD) was 7.03 ± 0.34 min in Group A and 2.40 ± 0.43 min in Group B. The difference was significant (p < 0.0001). The leaking pressure was 1000 (750-1050) mmHg (median, IQ range) in Group A and 1050 (800-1050) mmHg (median, IQ range) in Group B. The difference was not significant (p = 0.225). CONCLUSIONS: Haemoclip application is comparable in terms of leaking pressure but quicker than sliding knots to apply.

Technological Advances in Surgical Equipment in Exotic Pet Medicine.

Surgery can be challenging in exotic pets owing to their small size and blood volume, and their increased anesthetic risk compared with small animals. Various devices are available to facilitate suturing, cutting, and hemostasis in the human and veterinary fields. These surgical equipment improve the simplicity, rapidity, and effectiveness of surgery. Vessel-sealing devices, radiosurgery, lasers, and ultrasound devices are commonly used because of their ease of use and increase in surgical efficiency. Other surgical devices are available (eg, stapling devices) but are not discussed in this article.

Comparison of a 5-mm and 10-mm vessel sealing device in an open ovariectomy model in dogs.

The objectives of this study were to compare (1) the extent of thermal damage and (2) the time between the 5-mm LigaSure V (LS5) and 10-mm LigaSure Atlas (LS10) vessel sealing devices (VSD) when performing open ovariectomy in dogs. A prospective, randomised, clinical trial was performed in 40 client-owned sexually entire female dogs. In each dog, one ovary was randomly assigned to be surgically removed using LS5 and the contralateral using LS10. The depth of thermal spread, measured on histopathological preparations, was significantly larger for LS10 (LS10 1.35±0.23 mm v LS5 0.82±0.10 mm; P<0.001). Mean ovariectomy time was significantly faster when using LS10 (LS5 2.58±1.32 minutes v LS10 2.07±1.27 minutes; P=0.008). Bodyweight was positively correlated with the time required for ovariectomy using LS5 (P=0.004), but no such correlation was present for LS10 (P=0.611). In conclusion, during open ovariectomy using VSD, LS10 causes significantly more thermal spread but surgical time is shorter compared with LS5. When using LS5, the ovariectomy time increases with increasing bodyweight.

Update on Surgical Principles and Equipment.

The diversity implicit in exotic animal surgery requires a tailored approach to optimize successful outcomes. Outlined is information on patient preparation, instrumentation, hemostatic techniques, and magnification as it pertains to the exotic animal. Application of topical antiseptic solutions and judicious removal of pelage and feathers will decrease bacterial load during patient preparation. The use of specific barrier protection ensures proper aseptic technique and enables optimal patient monitoring. Magnification combined with a focal light source enhances visual acuity, allowing for better use of delicate instrumentation and identification of anatomic structures.

Facilitation of soft tissue surgery: surgical staplers and vessel sealing devices.

Recent advances and acceptance of various medical devices have clearly helped in the efficiency, simplicity, and effectiveness of veterinary surgery. The goals of surgery include efficient methods and minimal surgical times, delicate tissue handling techniques, confidence with tissue reconstruction, and minimizing contamination, leakage and complications. Mechanical means of suturing, cutting, and hemostasis assist with accomplishing these goals. Most recently, stapling instrumentation and vascular sealing devices have become common instruments on all levels of surgery because of their ease of use and increase in surgical efficiency.

Vessel sealing versus suture ligation for canine ovarian pedicle haemostasis: a randomised clinical trial.

Vessel sealing (VS) is well established in laparoscopic ovariectomy (OVE) in dogs. The objectives of this study were to evaluate the efficacy of ovarian pedicle haemostasis by VS using a commercially available VS tool in open OVE and compare it with suture ligation (SL). A prospective, randomised clinical trial including 20 female dogs was designed. Open OVE was performed via a standard mid-line celiotomy by a single surgeon using a standardised protocol. At random, the right ovarian pedicle was sealed (VS) or ligated (SL) whereas the left pedicle was treated by the alternative technique. Surgical times for procedural stages and intra-operative complications were recorded and statistically evaluated. Total surgical time was 29.28±11.13 minutes (range 12.50-62.13 minutes) and time from identification to removal of the ovary was significantly less when sealing (VS 2.22±0.58 minutes) than when ligating (SL 4.10±1.13 minutes P=0.0001). Intra-operative complications were rare for both techniques (failure of the electrode of the VS device (n=3); ovarian pedicle haemorrhage due to ligature slippage (n=1)). The results of the current study indicate that ovarian pedicle haemostasis achieved by VS is significantly faster than by placement of ligatures without appearing to compromise safety.

Hemostasia e incisão do pedículo ovariano de gatas submetidas à ovariossalpingo-histerectomia eletiva por meio da técnica das três pinças ou do eletrobisturi bipolaar. Estudo comparativo / Hemostasis and incision into the ovary pedicle of cats undergone elective ovariosalpingohysterectomy using the technique of the three bipolar forceps or eletrobisturi. Comparative study

Na cirurgia de ovariossalpingo-histerectomia (OSH), há várias técnicas para realização da hemostasia e da secção do pedículo ovariano, sendo mais comum a técnica das três pinças. O eletrobisturi bipolar pode ser utilizado com eficácia para hemostasia e corte de tecidos. Objetivou-se nesta pesquisa comparar, em gatas, a hemostasia e a secção do pedículo ovariano mediante o uso do eletrobisturi bipolar com a técnica das três pinças, ambas via celiotomia mediana, em relação ao tempo cirúrgico e à eficiência hemostática (hematócrito). Quarenta gatas, com idade de seis meses a sete anos, peso entre 1,68 e 4,14kg, foram submetidas à hemostasia e à secção desse pedículo, sendo 20 pela técnica convencional e 20 por meio do eletrobisturi bipolar. Na análise estatística, observou-se que o uso do eletrobisturi bipolar gera uma diminuição média significativa na duração da cirurgia, quando comparado com o outro método, sem diferenças quanto à comparação de hematócritos pré e pós-cirúrgicos. Por meio do modelo de regressão múltiplo, verificou-se que as variáveis: idade, peso, número de gestações, número de partos e número de cios não influenciaram significativamente no tempo. Concluiu-se, portanto, que o eletrobisturi bipolar oferece eficiência e maior rapidez na realização da hemostasia e da diérese do pedículo ovariano de gatas submetidas à OSH eletiva...

In ovariosalpingohisterectomy (OSH) surgery, there are several techniques for hemostasis and resection of ovarian pedicle, the most common being the three tweezers technique. The bipolar eletrobisturi can be used effectively for hemostasis and cutting tissue. The aim of this research was to compare, in cats, hemostasis and resection of ovarian pedicle eletrobisturi with bipolar forceps and the three techniques, both via median celiotomy, in relation to time and surgical hemostatic efficiency (hematocrit). Forty cats aged six months to seven years, weighing between 1.68 and 4.14kg, underwent hemostasis and pedicle of this section, 20 with the conventional technique and 20 with eletrobisturi bipolar. Statistical analysis showed that the use of bipolar eletrobisturi generates a significant decrease in the mean duration of surgery when compared with a method without differences in hematocrit comparing pre-and post-surgery. Through the multiple regression model we found that the variables age, weight, number of pregnancies, number of births and number of cycles did not significantly influence the time. We conclude, therefore, that the bipolar eletrobisturi is efficient and fast for hemostasis and dieresis ovarian pedicle of cats undergoing elective ovariohysterectomy...

Decreased surgical time with a vessel sealing device versus a surgical stapler in performance of canine splenectomy.

The purpose of this retrospective study of 72 dogs was to compare a vessel sealing device with a surgical stapling device for performance of splenectomy. The results of this study demonstrate a statistically significant shorter surgical time for splenectomy, without an adverse effect on outcomes, performed in dogs with the vessel sealing device (mean time, 58.4 min ± 3.3 min; median time, 60 min; range, 22-131 min) compared with a traditional stapling device (mean time, 66.9 min ± 2.4 min; median time, 66 min; range, 40-100 min). No other significant differences were found between the two groups of patients.

Ligation of the ovarian pedicles in dogs with a resorbable self-locking device--a long-term follow-up study.

A prospective clinical trial was performed to evaluate applicability, hemostatic efficiency, and long-term tissue reactions of a novel medical device. The device was made of polydioxanone and designed in principle as a cable-tie with a flexible band running through a locking case. It was tested for ligation of the ovarian pedicles during ovariohysterectomy in nine intact female dogs. The dogs were followed-up monthly by physical examination and ultrasonography of the abdomen for 5-12 months after surgery. Macroscopic and histological post mortem examinations were performed in two dogs 7 and 18 months after surgery. Hemostasis was achieved with the devices although 1 of the 18 devices needed further tightening during a reoperation. Ultrasonography revealed a hyperechoic device that caused acoustic shadowing, which decreased over time indicating gradual resorption. Post mortem examinations demonstrated adhesions and a local transient tissue reaction at site of the device. The results show that the device may be a future alternative for ligation of ovarian pedicles in dogs.

Intra and postoperative assessment of re-sterilised Ligasure Atlas for orchidectomies in horses: clinical study.

Horses (n=35) underwent orchidectomy in a single institution with a re-sterilised LSA as sole means of haemostasis. During the surgery, the gross quality of the seal, the stickiness of the forceps to the tissues, bleeding/oozing from the stump and the need for a subsequent application in already severed spermatic cord were assessed for haemostasis quality. After surgery, physical parameters (appearance of the mucous membranes, quality of the peripheral pulse, heart rate, respiratory rate, rectal temperature and blood dripping from the incisions), haematology or packed cell volume and total protein were monitored to assess signs of bleeding or any other condition. For cleanliness and asepsis assessment, signs of surgical infection were recorded. Complications during surgery were mild degree of sticking of the LSA forceps to the tissues and dulling of the blade. There was no need to reapply LSA a second time except in one horse. This means a haemostasis complication rate of 2.85 per cent of the horses. No postoperative bleeding was detected. Only two horses with fever had associated signs of surgical site infection. This means an infection rate of 5.71 per cent of the horses.

Evaluation of EnSeal®, an adaptive bipolar electrosurgical tissue-sealing device.

Relatively few, and inconsistent, data are available in the literature about the properties of EnSeal®, an electrosurgical tissue-sealing device. For this reason, we conducted control safety tests on experimental pigs. The mean burst pressure of sealed vessels (2-7 mm in diameter) proved to be 873.89 ± 120.57 mmHg (n = 60). Surface temperature increased to 69.25 ± 0.98 °C in average (n = 22). The mean diameter of the collateral microscopic thermal injury zone was found to be 0.28 ± 0.04 mm, and it did not show significant differences among the groups of tissues studied (n = 183). During our studies, the device worked reliably and met the relevant requirements in all cases. It can be established that EnSeal® enables high-safety clinical interventions at high blood pressure values, in different tissues and even at sites adjacent to heat-sensitive tissues, and thus it paves the way for new operative solutions in both human and veterinary surgery. In our opinion, the discrepancies between data reported in the literature arise from differences in the design of studies and in the designated limit values. To ensure standardisation, we recommend the use of the nitroblue-tetrazolium chloride/lactate dehydrogenase (NBTC/LDH) enzyme histochemical technique for studying thermal injury induced by the different performance levels and application times of devices operating with electromagnetic energy.

The use of haemostatic gelatin sponges in veterinary surgery.

OBJECTIVES: To describe the use of absorbable gelatin sponges as haemostatic implants in clinical veterinary surgical cases and to document any related postoperative complications. METHODS: Practice databases were searched for the product names "Gelfoam" and "Spongostan". Patient records were retrieved and data regarding patient signalment, surgical procedure, National Resource Council (NRC) wound classification, source of haemorrhage, pre- and postoperative body temperature, postoperative complications, time to discharge and details of any postoperative imaging were recorded and reviewed. Follow-up information was obtained by repeat clinical examination or telephone interview with either the owner or referring veterinary surgeon. Cases with incomplete surgical records or those which were not recovered from anaesthesia were excluded from the analysis. RESULTS: Fifty cases (44 dogs and 6 cats) satisfied the inclusion criteria. Satisfactory haemostasis was achieved in 49 cases with one case requiring reoperation during which a second gelatin sponge was used. There were no detected hypersensitivity responses or confirmed postoperative complications relating to the use of gelatin sponges during the follow-up period (median 13 months). CLINICAL SIGNIFICANCE: This is the first review of the use of gelatin sponges in clinical veterinary surgery and suggests that gelatin sponges are safe to use in cats and dogs.

A new resorbable device for ligation of blood vessels - A pilot study.

BACKGROUND: During surgery, controlled haemostasis to prevent blood loss is vital for a successful outcome. It can be difficult to ligate vessels located deep in the abdomen. A device that is easy to use and enables secure ligatures could be beneficial. Cable ties made of nylon have been used for ligation but the non-resorbable material caused tissue reactions. The objective of this study was to use a resorbable material to construct a device with a self-locking mechanism and to test its mechanical strength and ligation efficiency. METHODS: The device was manufactured by injection moulding of polydioxanone, a resorbable polymer used for suture materials. Polydioxanone with inherent viscosities of 1.9 dL/g and 1.3 dL/g were tested. The device consisted of a perforated flexible band which could be pulled through a case with a locking mechanism. After a first version of the device had been tested, some improvements were made. The locking case was downsized, corners were rounded off, the band was made thicker and the mould was redesigned to produce longer devices. Tensile tests were performed with the second version.The first version of the device was used to ligate the ovarian pedicle in a euthanized dog and to test echogenicity of the device with ultrasound. Compression of vessels of the ovarian pedicle was examined by histology. Both versions of the device were tested for haemostasis of and tissue grip on renal arteries in six anaesthetised pigs. RESULTS: The tensile strength of the flexible band of the devices with inherent viscosity of 1.9 dL/g was 50.1 ± 5.5 N (range 35.2-62.9 N, n = 11) and the devices with inherent viscosity of 1.3 dL/g had a tensile strength of 39.8 ± 8.1 N (range 18.6-54.2 N, n = 11). Injection moulding of the polymer with lower inherent viscosity resulted in a longer flow distance.Both versions of the device had an effective tissue grip and complete haemostasis of renal arteries was verified. The device attached to the ovarian pedicle could be seen with ultrasound, and vessel compression and occlusion were verified by histology. CONCLUSIONS: Tests of functionality of the device showed complete haemostasis and good tissue grip. Devices with a band of sufficient length were easily applied and tightened in tissue.

Use of a vessel sealant device for splenectomy in dogs.

OBJECTIVE: To (1) describe a technique for splenic vessel hemostasis and (2) report complications and outcome after use of bipolar sealant device during splenectomy in dogs. STUDY DESIGN: Case series. ANIMALS: Dogs (n=27) with naturally occurring splenic disease. METHODS: Between January 2006 and March 2008, splenectomy was performed using a vessel sealant device in 27 dogs with naturally occurring splenic disease. Number of sutures needed for splenectomy and complications were recorded. Splenic artery diameter was measured using a caliper. Intraoperative hemostasis, device ease of use, postoperative hemorrhage, and short-term survival were evaluated. RESULTS: Splenectomy was performed successfully in 27 dogs with the vessel sealant device; none of the dogs required vessel ligation with suture. The splenic artery was dissected and adequately sealed in each dog. One dog was readmitted 4 days after surgery with hemoabdomen. Abdominal exploration revealed splenic pedicle hemorrhage and pancreatitis, the vessel sealant device was used to coagulate splenic pedicle bleeding. The dog was alive at suture removal. CONCLUSION: In dogs, a vessel sealant device may be used to achieve efficient and safe hemostasis of the splenic vascular pedicle without sutures.

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.

Repair of a canine forelimb skin deficit by microvascular transfer of a caudal superficial epigastric flap.

Extensive skin loss from the forelimb of a Border collie was repaired by a microvascular caudal superficial epigastric flap, with secondary meshing of the flap to increase coverage. The caudal superficial epigastric artery and vein were anastomosed to the brachial artery and vein. End-to-end anastomosis to the brachial artery and vein did not compromise peripheral blood flow, and no flap necrosis was observed after subsequent limited meshing of the flap.

Comparison of three techniques for ovarian pedicle hemostasis during laparoscopic-assisted ovariohysterectomy.

OBJECTIVE: To describe the safety, surgical time, and complications associated with 3 techniques for achieving hemostasis during laparoscopic-assisted ovariohysterectomy (LAOVH). STUDY DESIGN: Prospective, randomized clinical trial. ANIMALS: Female dogs (n=30). METHODS: Dogs were randomly assigned to 1 of 3 methods for achieving ovarian pedicle hemostasis during LAOVH: extracorporeal modified Roeder knot application (suture group), metal clip application using a multifire 10 mm laparoscopic clip applier (clip group), or use of a novel 5 mm bipolar vessel-sealing device (vessel-sealing group). In all dogs a 3 median portal technique was used. RESULTS: Controlling for the dogs' bodyweights, there was a significant association between surgical time and which method for hemostasis was used. This association was different when comparing the first 5 procedures using each method to the second 5. For a 20 kg dog, the surgical time (95% CI) for the first 5 procedures was 80 (69-91), 68 (57-79), and 33 (21-45) minutes for the suture, clip, and vessel-sealing groups, respectively. For the second 5 procedures surgical time was 71 (60-81), 50 (39-60), and 40 (29-51) minutes. Pedicle hemorrhage occurred in all dogs in the clip group, 3 dogs in the suture group, and none of the dogs in the vessel-sealing group although in all cases was considered hemodynamically inconsequential. All dogs recovered uneventfully. CONCLUSIONS: All methods of hemostasis were safe for pedicle sectioning. A learning curve exists for clip and suture methods. CLINICAL RELEVANCE: Use of a vessel-sealing device significantly shortens surgical time and provides excellent hemostasis during LAOVH.

Acute normovolaemic haemodilution--is it a solution to reduce perioperative blood transfusions?

Haemodilution is a technique used to reduce perioperative homologous blood transfusions. Haemodilution is a poorly investigated technique in veterinary medicine. This article reviews haemodilution as a potential technique to reduce perioperative homologous blood transfusions. The history of haemodilution is briefly reviewed followed by the mathematical basis to haemodilution. The issue of critical oxygen delivery and its implications for haemodilution are discussed. The effects of haemodilution on the patient, including the effects on oxygen transport, blood flow and coagulation are discussed as well as the use of colloids, fluids and blood components in haemodilution. The success and failure of haemodilution in human clinical trials and experimental evidence is discussed. Some guidelines are given for the use of haemodilution in small animal patients in the perioperative setting. It appears in all likelihood that haemodilution has a limited application in cats and other small patients. Haemodilution is most beneficial when the initial haematocrit is high, a low haemodiluted haematocrit is achieved, the patients circulating volume is large and a large amount of blood was lost. It is important to avoid haemoconcentration during surgery as this increases red blood cell loss. Haemodilution is not a substitute for poor surgical technique and inadequate haemostasis intra-operatively. Intravascular volume should be maintained throughout the procedure.

Quantification of surgical blood loss.

OBJECTIVE: To compare gravimetric and colorimetric methods of quantifying surgical blood loss, and to determine if there is a correlation between preoperative hemostatic tests (buccal mucosa bleeding time [BMBT] and intraoperative blood loss). STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=15) admitted for cutaneous tumor excision, orthopedic procedure, or exploratory laparotomy. METHODS: Intraoperative blood loss was quantified by measuring irrigation fluid and weighing surgical sponges used for blood and fluid collection during surgery. Results of gravimetric measurements were then correlated to blood loss quantified using spectrophotometric analysis of hemoglobin (Hb) content. Hemostatic variables including BMBT were measured before surgery and compared with the calculated amount of blood loss. RESULTS: Blood loss quantified by gravimetric measurement showed a significant correlation with colorimetric determination of Hb content in surgical sponges and collected irrigation fluid (r=0.93, P<.0001). BMBT correlated weakly but significantly with intraoperative blood loss (r=0.56, P<.05). CONCLUSIONS: Quantifying intraoperative blood loss using spectrophotometric Hb analysis accurately assessed the amount of blood loss; however, it is a time-consuming procedure, primarily applicable as a research tool. Gravimetric evaluation of intraoperative blood loss was found to be an accurate method, which can be recommended for use in a clinical setting. CLINICAL RELEVANCE: Estimation of blood loss using a gravimetric method is accurate and applicable in the clinical setting and provides surgeons with a simple and objective tool to evaluate intraoperative blood loss.