Comparison of clinical and physiologic parameters, complications, and techniques, between laparoscopic ovariectomy and ovariohysterectomy in dogs

Dissertação de Mestrado Integrado em Medicina VeterináriaGonadectomy is one of the most frequently performed surgical procedures in veterinary medicine, this can be achieved by several techniques, for example ovariohysterectomy (OVH) or laparoscopic ovariectomy (LapOVE). Given that these procedures are performed routinely, the objective of this work is to compare the parameters temperature and glucose, complications (intraoperative and post-operative), the time it takes to execute the surgical techniques and pain to evaluate if one is superior to the other. This study was done throughout the six months of traineeship at Kingston Veterinary Group at Park Street Hospital. To accomplish it, two groups were used, - the LapOVE with 14 animals and the OVH with 10 animals, in which the parameters above mention, were recorded and compared. We can conclude from the results obtained, that the time to prepare the patient, perform the surgical procedure and the total procedure is longer for the LapOVE group as opposed to the OVH group. To evaluate if there was a significant effect of the procedure over temperature and glucose a linear mixed model analysis was performed. There was a significant effect of the procedures over time on temperature levels (P <0.0003) with OVH having a less impact on the patient, given that the temperature before and after the surgery varied less. The procedure chosen had a significant effect on glucose P (<0.016). Which can mean less operative pain in the LapOVE procedure. Regarding post-operative pain, although a very slight difference existed in the first three hours after the patients were extubated, there were no major differences between the two procedures, even when the pain score in the OVH group was higher than the LapOVE. In the LapOVE group there were more intraoperative and postoperative complications. Even though the laparoscopic technique presented several advantages, for this specific procedure, gonadectomy, they were not substantial or important enough to choose performing a LapOVE over a conventional OVH.RESUMO - Comparação de parâmetros clínicos e fisiológicos, complicações e técnicas entre ovariectomia por laparoscopia e ovariohisterectomia em cães - A gonadectomia é um dos procedimentos cirúrgicos realizados com maior frequência na medicina veterinária, podendo ser realizado por várias técnicas como por exemplo, a ovariohisterectomia (OVH) ou ovariectomia por laparoscopia (LapOVE). Uma vez que estes procedimentos são realizados por rotina na prática clínica, este trabalho tem por objetivo comparar os parâmetros temperatura e glucose, as complicações (intraoperatórias e pósoperatórias), os tempos de execução das técnicas cirúrgicas e dor para avaliar se alguma delas poderá ser superior à outra.. Este estudo decorreu ao longo de seis meses do estágio intracurricular no “Kingston Veterinary Group”, no Hospital de Park Street. Para o realizar utilizaram-se dois grupos, - o da LapOVE com 14 animais e o da OVH com 10 animais, nos quais se registaram e de seguida compararam os parâmetros já mencionados. Os resultados obtidos permitem verificar que o tempo necessário para preparar o paciente e para realizar a cirurgia, bem como o tempo total do procedimento foram superiores no grupo LapOVE do que no grupo OVH. Para se avaliar se houve um efeito significativo do procedimento sobre a temperatura e a glucose realizou-se uma análise com modelos lineares mistos, tendo-se verificado um efeito significativo do procedimento ao longo do tempo na temperatura (P <0.0003) tendo a OVH um menor impacto sobre o paciente pois a temperatura antes e depois da cirurgia variou menos. O procedimento escolhido teve um efeito significativo na glucose (P<0.016), o que poderá ser indicativo de menor dor cirúrgica no procedimento da LapOVE. Em relação à dor pós-cirúrgica, apesar de existir uma pequena diferença nas primeiras três horas após os pacientes serem extubados, não houve diferença pronunciada entre os dois procedimentos, mesmo quando a pontuação da dor no grupo OVH foi superior ao grupo LapOVE. No grupo LapOVE houve mais complicações intraoperatórias e pós-operatórias. Assim e apesar da técnica laparoscópica, apresentar algumas vantagens para este procedimento específico, a gonadectomia, as mesmas não são suficientemente fortes ou importantes para que se prefira a realização da LapOVE em vez de OVH convencional.N/

Ultrasound-guided transvaginal radiofrequency ablation of uterine fibroids assisted by virtual needle tracking system : a preliminary study

Purpose: The purpose of this study was to assess the feasibility and outcome of transvaginal ultrasound (US)-guided radiofrequency ablation of uterine fibroids assisted by a real-time virtual needle tracking (VT) system. Methods: Between January 2017 and February 2018, 19 patients (age 45 \ub1 8 y, range 36\u201353 y) with 25 symptomatic uterine fibroids underwent transvaginal radiofrequency ablation (RFA) at a single center. Mean number of fibroids for patient was 1.7 (min, max: 1\u20133). Patients with more than one fibroid were 10 (52.6%). Uterine fibroids (mean volume: 13.6 mL; range: 5.3\u201341.9 mL) were treated with a dedicated internally cooled 17 G 35 cm RF needle with 1 cm or variable active tip and the moving shot technique. An electromagnetic system was used for showing a virtual needle during the procedure. Contrast-enhanced ultrasound evaluation was performed before and immediately at the end of procedure. Feasibility of the procedure, technical success rate, volume percentage reduction at 1, 3 and 6 months, clinical outcome (QOL score) and complications were analyzed. Results: Procedure was feasible in 19/19 patients (100%). Technical success was achieved in 100% of 25 treated fibroids. Mean fibroids volume decreased from 13.6 ml at baseline to 5.9 ml at 6 month (reduction rate 62.7%, range 48.5\u201376.9; p &lt;.05). No major immediate or late complications occurred. Minor complications occurred in two patients. QOL score significantly improved from 68 \ub1 36 at baseline to 97 \ub1 16 at six-months follow-up (p &lt;.05). Conclusion: Transvaginal US-guided RFA assisted by a real-time VT system is a feasible, safe and effective technique for the treatment of uterine fibroids

Amd3100 Administration For The Treatment Of Asherman’s Syndrome In A Murine Model

Statement of Purpose 1. Optimize a murine model of Asherman’s Syndrome.2. Assess fertility outcomes in mild Asherman’s Syndrome model mice treated with AMD3100. 3. Determine timing of peak serum and uterine levels of CXCL12 after AS induction. 4. Identify an optimal time point for AMD3100 administration in AS

Experimental foundation for natural orifice transluminal endoscopic surgery and hybrid natural orifice transluminal endoscopic surgery

Natural orifice transluminal endoscopic surgery (NOTES) is one of the most exciting concepts that has emerged recently in the surgical field. All accesses to the abdominal cavity in the porcine model using natural orifices, e.g. transgastric, transvesical, transcolonic and transvaginal, have been described and explored. The experimental feasibility of all procedures by NOTES was successfully demonstrated in the porcine model using different types of natural orifices. However, few translations to the human have been made. NOTES is in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. This paper is an update on the experimental foundation for NOTES and hybrid NOTES and examines the opportunities presented by this new surgical vision

Recent Advances in Laparoscopic Surgery

The implementation of laparoscopy has revolutionized surgery over the past few years, incorporating significant benefits for the patient. However, this evolution has also entailed many technical obstacles for surgeons. This book is for readers wanting to learn more about recent surgical techniques and technologies. Topics cover novel sophisticated approaches for single-site surgery, natural orifice transluminal endoscopic surgery, and transanal surgery, among others. Also included are reviews of new innovative surgical devices, robotic platforms, and methodological guidelines for improving surgical performance and surgeon ergonomics

Evaluation of optical tracking and augmented reality for needle navigation in sacral nerve stimulation

Background and objective: Sacral nerve stimulation (SNS) is a minimally invasive procedure where an electrode lead is implanted through the sacral foramina to stimulate the nerve modulating colonic and urinary functions. One of the most crucial steps in SNS procedures is the placement of the tined lead close to the sacral nerve. However, needle insertion is very challenging for surgeons. Several x-ray projections are required to interpret the needle position correctly. In many cases, multiple punctures are needed, causing an increase in surgical time and patient's discomfort and pain. In this work we propose and evaluate two different navigation systems to guide electrode placement in SNS surgeries designed to reduce surgical time, minimize patient discomfort and improve surgical outcomes. Methods: We developed, for the first alternative, an open-source navigation software to guide electrode placement by real-time needle tracking with an optical tracking system (OTS). In the second method, we present a smartphone-based AR application that displays virtual guidance elements directly on the affected area, using a 3D printed reference marker placed on the patient. This guidance facilitates needle insertion with a predefined trajectory. Both techniques were evaluated to determine which one obtained better results than the current surgical procedure. To compare the proposals with the clinical method, we developed an x-ray software tool that calculates a digitally reconstructed radiograph, simulating the fluoroscopy acquisitions during the procedure. Twelve physicians (inexperienced and experienced users) performed needle insertions through several specific targets to evaluate the alternative SNS guidance methods on a realistic patient-based phantom. Results: With each navigation solution, we observed that users took less average time to complete each insertion (36.83 s and 44.43 s for the OTS and AR methods, respectively) and needed fewer average punctures to reach the target (1.23 and 1.96 for the OTS and AR methods respectively) than following the standard clinical method (189.28 s and 3.65 punctures). Conclusions: To conclude, we have shown two navigation alternatives that could improve surgical outcome by significantly reducing needle insertions, surgical time and patient's pain in SNS procedures. We believe that these solutions are feasible to train surgeons and even replace current SNS clinical procedures.Research supported by projects PI18/01625 and AC20/00102 (Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, Asociación Española Contra el Cáncer and European Regional Development Fund "Una manera de hacer Europa"), IND2018/TIC-9753 (Comunidad de Madrid) and project PerPlanRT (ERA Permed). Funding for APC: Universidad Carlos III de Madrid (Read & Publish Agreement CRUE-CSIC 2022)

Transvesical endoscopic peritoneoscopy: intra-abdominal scarless surgery for urologic applications

For many abdominal procedures, advantages such as minimal scarring, reduced pain, and faster recovery have made laparoscopy the favored approach over traditional open surgery. The most recent minimally invasive approach is natural orifice transluminal endoscopic surgery (NOTES), which limits morbidity because this surgery does not require incision. This article reviews the history, development, and current and future applications of NOTES in the field of urology

Transanal total mesorectal excision: a pure NOTES approach for selected patients

Background: The concept of natural orifice transluminal endoscopic surgery (NOTES) has stimulated the development of various “incisionless” procedures. One of the most popular is the transanal approach for rectal lesions. The aims of this study were to report how we standardized NOTES technique for transanal mesorectal excision without abdominal assistance, discuss the difficulties and surgical outcomes of this technique and report its feasibility in a small group of selected patients. Methods: Three consecutive female patients underwent transanal NOTES rectal resection without transabdominal laparoscopic assistance for rectal lesions. Functional results were assessed with the Fecal Incontinence Quality of Life scale and the Wexner score. Results: The technical steps are described in details and complemented with a video. All procedures were completed without transabdominal laparoscopic help. The mesorectal plane was entirely dissected without any disruption, and distal and circumferential margins were tumor-free. No major complications were observed. Functional results show a significant impairment after surgery with improvement at 6 months to levels near those of the preoperative period. Conclusions: The performance and publication of NOTES procedures are subject to much discussion. Despite the small number of patients, this procedure appears feasible and can be accomplished maintaining fecal continence and respecting oncologic principles