One-stage Laparoscopic Nephrectomy and Ovariohysterectomy for Concurrent Dioctophymosis and Pyometra in a Bitch

Background: Dioctophyme renale, also known as “giant kidney worm”, is a cosmopolitan parasite, which usually affects domestic and wildlife canids in wetlands. Nephrotomy and nephrectomy are the only treatment options. Laparoscopic nephrectomy for dioctophymosis was first performed in veterinary patients in the late 90’s. Canine pyometra is one of themost frequent surgical disorder in the small animal setting. The purpose of this study was to report a case of successful one-stage laparoscopic approach for nephrectomy and ovariohysterectomy in a bitch.Case: A female stray dog, rescued from a riverside community, was presenting hematuria. Abdominal echography revealed presence of Dioctophyme renale worms within the right renal parenchyma. Moreover, the uterus was moderately filled by anechoic content. The patient was clinically stable and undergone laparoscopy. A 10-mm trocar was established at the middle third of the right flank, followed by 12-mmHg CO2 insufflation. The telescope was inserted and a giant worm wasseen free within the abdominal cavity. A second 10-mm port was inserted cranial and dorsally to the first one. The parasite was retrieved using a laparoscopic Kelly forceps. A third 5-mm trocar was inserted in a classic laparoscopic triangulation port positioning. Renal artery and vein were individually triple ligated using titanium clips and then transected. The rightovarian pedicle was sequentially coagulated and transected using laparoscopic bipolar forceps. The right kidney was then dissected and detached from the abdominal wall, followed by cauterization and transection of the left ovarian pedicle. The uterus was exposed out of the abdominal cavity through the 5-mm port access. Uterine body and vessels were double ligated using polyglactin 910, with transfixating ligatures, and then transected. The opening of the retrieval bag was exposed through the cranial port site incision. Eight dioctophyme worms and the kidney sections were withdrawn through the sacusing a Kelly hemostat. Abdominal wounds were closed in two layers using cross-mattress polyglactin 910 sutures. Skinwas closed using interrupted horizontal mattress nylon sutures. Patient was discharged on the early post-op, receiving tramadol chloride and sodium dipyrone for three days and enrofloxacin for seven days. The patient recovered uneventfully. Owner was contacted by phone eight months following surgery, which informed the bitch was clinically stable.Discussion: Riverside stray dogs present high incidence of dioctophymosis worldwide, due to irregular feeding and consequent intake of intermediate hosts. The reported patient met those features, without previous background regarding infestation episode. It presented hematuria, which usually results from renal parenchyma consumption by the worms. The patient was retrieved nine dioctophyme worms. Laparoscopic approach for nephrectomy has already been reported in veterinary patients, as well as three-port lap-assisted OVH have been performed. Innovative aspect of this case report concerns the one-stage laparoscopic approach for both nephrectomy and OVH. Moreover, the procedures required only three-port access, which was considered a suitable and safe minimally invasive approach in dogs affected by Dioctophyme renale and concurrent indication for OVH. The three-port access shown is adequate to perform one-stage nephrectomy and ovariohysterectomy in bitches, for reaching benefits of laparoscopic surgery in comparison to conventional approaches.Keywords: canine, endosurgery, kidney, laparoscopy, videosurgery

AGENESIA UNILATERAL DE CORNO UTERINO EM CADELA: CONSIDERAÇÕES REPRODUTIVAS, CIRÚRGICAS E HISTOPATOLOLÓGICAS

A agenesia unilateral de corno uterino é alteração incomum em cadelas e, embora algumas vezes relatada, as informações ainda são superficiais. É relatado o caso de uma fêmea canina primípara, sem raça definida, encaminhada para ovário-histerectomia eletiva. Durante a realização do procedimento verificou-se a ausência do corno uterino esquerdo. Por meio de avaliação anatomohistopatológica confirmou-se agenesia de corno uterino unilateral. O objetivo deste trabalho é relatar observações acerca dos aspectos reprodutivos de uma cadela portadora desta afecção, postuladas por autores, assim como a conduta cirúrgica e a avaliação histopatológica do caso em questão

Metamizol and Scopolamine for Conventional or Two-Port Laparoscopic-Assisted Ovariohysterectomy in Dogs

Background: Ovariohysterectomy (OVH) is one of the most appliedtechniques in Veterinary Medicine. Although some analgesic protocols are used after this procedure in order to control post operatory pain, there is a lack of knowledge of the efficacy after conventional and two port laparoscopic-assisted techniques in dog female. Although the combined formulation of metamizol and scopolamine is used, there is no knowledge about the efficacy and collateral effects in a 6 h regimen after OVH. The aim of this research was to evaluate the efficacy of metamizol and scopolamine to analgesia after two techniques of OVH in dog female.Materials, Methods & Results: Fifteen adults and healthy dog female were submitted to OVH, being eight to the conventional procedure and seven to video assisted technic with two ports. The patients received a combination of metamizol and scopolamine, 6-6 h during 48 h and were evaluated before surgery, 60 min after extubation and on 1 h interval during the first 8 h, and at 12, 18, 24, 36, 48 and 72 h after surgery. For this, the University of Melbourne Pain Scale (UMPS) and the short-form of the Glasgow Composite Measure Pain Scale (CMPS-SF) were applied by three evaluators blinded to surgical technic. Glucoses measurement was realized at 1, 6, 12, 24, 48 and 72 h after surgery. Analgesic rescue was not necessary for any animal. Punctuation of UMPS in GC decreases at 8 h and at 5 h, and to GV at 12 and 24 h. Difference between groups happened at 3 h with larger average to GV; at 48 h the punctuation in GC was lager. Considering CMPS-SF to CG, higher average was observed at 1 h and decreased at 2, 3, 8 and 18. At GV highest average points was verified at 1, 2 and 3 h and decreased at 5, 8 and 18 h. Correlation was strong and positive between each two evaluators. Animals of both groups had increased average glucose concentrations from baseline to after surgery and the values reduced to baseline after 24 h; difference between groups were observed at 1 h after surgery, with bigger average to GC. Three animals from the GC had postoperative emesis and one patient vomited after 3 h; other at 6 h and another at 36 and 48 h and owners related no vomiting or changes following hospital discharge. The time to first spontaneous food intake was earlier to GV and time to first defecation was no different between groups. Discussion: For the evaluation it was used the UMPS and CMPS-SF since it is know that pain assessment is better performed when multidimensional or composite scales are used. Considering the UMPS, 27 points is considered the most painful condition. In our study it was observed bigger average to GC at 1 h (4,5) and to GV at 2 and 3 h (5,0). According to CMPS-SF, higher punctuation to GC (7.0) was observed than GV (6,0) in a maximum of 24 points. Considering both scales, it could be suggested that the combination of metamizol and scopolamine promote good analgesic effect. The glucoses measurements and the first spontaneous food intake suggested that laparoscopic approaches results in less stress than the traditional procedures, as observed in other studies. Three animals of GC had postoperative emesis, and it signal can be associated to abdominal pain, as well nausea, vomiting, diarrhea and abdominal distention, probably because it is accepted that video surgery promotes less pain and stress than open procedures. The protocol was efficient to control pain after elective conventional and laparoscopic assisted OHV technique in dog female.

Laparoscopic diaphragmatic hernioplasty in a dog

A hérnia diafragmática é caracterizada pela passagem das vísceras abdominais para a cavidade torácica, podendo ser de origem congênita ou adquirida, que exige o tratamento cirúrgico. Quando houver ausência de tecido ou em casos de herniação com evolução crônica, recomenda-se a utilização de implantes biológicos ou sintéticos. O objetivo deste trabalho é relatar a técnica de herniorrafia diafragmática laparoscópica com o uso de pericárdio bovino conservado em um canino, a partir do acesso laparoscópico com três portais. Devido ao grande defeito diafragmático, optou-se pela sua redução com o auxílio de implante de pericárdio bovino conservado em formaldeído a 4%, este fixado a musculatura diafragmática com sutura intracorpórea, utilizando para isso duas camadas de sutura ambas com náilon 0, a primeira contínua simples seguida de pontos isolados simples, em toda extensão da membrana conservada. Apesar do animal vir a óbito nas primeiras 24 horas do pós-operatório, a técnica adotada se mostrou viável.A diaphragmatic hernia is characterized by the passage of the abdominal viscera into the thoracic cavity, which may be congenital or acquired. Its treatment is achieved by surgical correction. When there is no tissue or in cases of herniation with a chronic disease, the use biological or synthetic implants is recommended. The objective of this study was to report a technique of laparoscopic diaphragmatic hernia repair using bovine pericardium preserved in a canine, using three portal accesses. Due to the large diaphragmatic defect, reduction with the aid of a network of preserved bovine pericardium in formaldehyde 4% was chosen. The mesh was sutured to the transversus abdominus muscle in two layers. The first layer was sutured using simple continuous pattern, and the second one using simple interrupted sutures. The patient collapsed and died 24hours postoperatively. However, the purposed technique was feasible.

Laparoscopic Nephrotomy to Removal of Staghorn Calculus in a Canine

Background: Renal urolithiasis is the third most common disease of the urinary tract of dogs. In humans, staghorn lithiasis affects 1 to 1.5% of the population, often women over 50 years old. In veterinary medicine, this type of lithiasis has been little reported, and there are few descriptions of treatment, both in small and large animals. The objective of this work is to report a rare case of renal staghorn stones treated by laparoscopic nephrotomy.Case: A six-year-old female schnauzer with 6 kg body weight was evaluated clinically in order to spay. According to the owner, the animal showed polydipsia. Additional tests such as blood count, serum biochemistry, radiography and abdominal ultrasound were done, showing hematological examinations within the standards for the species. After the ultrasound we noticed an asymmetric kidneys with the right kidney with preserved cortical layer and hyperechoic line corticomedullary interface, with posterior acoustic shadow and left kidney with relative/corticomedullary differentiation and pelvis preserved without alteration; this evocative image of kidney stones in kidney right. In abdominal radiographs was possible to visualize radiopaque mass in the right kidney compatible with renal staghorn stones. Excretory urography was done, which demonstrated evident excretion of contrast material in the left kidney and the right kidney doubtful. Based on these findings, we opted for exploratory laparoscopy followed by laparoscopic nephrectomy or nephrotomy for removal of urolithiasis, depending of the lesions visualized during the procedure. All procedure were performed using a minimally invasive approach without the need for conversion to open or videoassisted procedures. The most complex and delicate step was the nephrorrafy, due the little time for suturing to avoid renal ischemia. Eight months after the surgery, the owner is contacted, and it said that the animal was well, without clinical signs of kidney disease. After returning and performing ultrasound and excretory urography revealed that the right kidney had atrophied, but there was still draining contrast shown by excretory urography.Discussion: Although the use of laparoscopy is increasing worldwide is still considered an underexplored approach to renal calculi in veterinary medicine. Our choice in this case was due the numerous potential advantages that have minimally invasive compared to open technique, as demonstrated in medicine and veterinary medicine studies. At the beginning of laparoscopy was possible to elect the procedure (nephrectomy or nephrotomy) to be performed; the anatomic changes presente as renal artery patency /coloring kidney and wrist, observed by laparoscopic visualization, with amplification, showed the possibly of renal preservation. This is an advantage associated with videosurgical access. Laparoscopic view allowed to discard residual gallstones as well as to promote the correct synthesis of renal tissue. All steps of the nephrotomy were performed by minimally invasive access. It was not possible to directly correlate with the histological analysis technique renal disorder before and after the surgery, because the kidney was already reduced in size in the first operation and biopsy was not done in that occasion. The present report demonstrates that laparoscopic surgery can be considered viable for the management of renal staghorn stones in dogs.Keywords: surgery, nephrolity, canine

Laparoscopic Nephrotomy to Removal of Staghorn Calculus in a Canine

Background: Renal urolithiasis is the third most common disease of the urinary tract of dogs. In humans, staghorn lithiasis affects 1 to 1.5% of the population, often women over 50 years old. In veterinary medicine, this type of lithiasis has been little reported, and there are few descriptions of treatment, both in small and large animals. The objective of this work is to report a rare case of renal staghorn stones treated by laparoscopic nephrotomy.Case: A six-year-old female schnauzer with 6 kg body weight was evaluated clinically in order to spay. According to the owner, the animal showed polydipsia. Additional tests such as blood count, serum biochemistry, radiography and abdominal ultrasound were done, showing hematological examinations within the standards for the species. After the ultrasound we noticed an asymmetric kidneys with the right kidney with preserved cortical layer and hyperechoic line corticomedullary interface, with posterior acoustic shadow and left kidney with relative/corticomedullary differentiation and pelvis preserved without alteration; this evocative image of kidney stones in kidney right. In abdominal radiographs was possible to visualize radiopaque mass in the right kidney compatible with renal staghorn stones. Excretory urography was done, which demonstrated evident excretion of contrast material in the left kidney and the right kidney doubtful. Based on these findings, we opted for exploratory laparoscopy followed by laparoscopic nephrectomy or nephrotomy for removal of urolithiasis, depending of the lesions visualized during the procedure. All procedure were performed using a minimally invasive approach without the need for conversion to open or videoassisted procedures. The most complex and delicate step was the nephrorrafy, due the little time for suturing to avoid renal ischemia. Eight months after the surgery, the owner is contacted, and it said that the animal was well, without clinical signs of kidney disease. After returning and performing ultrasound and excretory urography revealed that the right kidney had atrophied, but there was still draining contrast shown by excretory urography.Discussion: Although the use of laparoscopy is increasing worldwide is still considered an underexplored approach to renal calculi in veterinary medicine. Our choice in this case was due the numerous potential advantages that have minimally invasive compared to open technique, as demonstrated in medicine and veterinary medicine studies. At the beginning of laparoscopy was possible to elect the procedure (nephrectomy or nephrotomy) to be performed; the anatomic changes presente as renal artery patency /coloring kidney and wrist, observed by laparoscopic visualization, with amplification, showed the possibly of renal preservation. This is an advantage associated with videosurgical access. Laparoscopic view allowed to discard residual gallstones as well as to promote the correct synthesis of renal tissue. All steps of the nephrotomy were performed by minimally invasive access. It was not possible to directly correlate with the histological analysis technique renal disorder before and after the surgery, because the kidney was already reduced in size in the first operation and biopsy was not done in that occasion. The present report demonstrates that laparoscopic surgery can be considered viable for the management of renal staghorn stones in dogs.Keywords: surgery, nephrolity, canine

Iliac Lymphadenectomy following Intrauterine Mapping in a Female Dog with Breast Neoplasm

Background: The lymphatic system plays an important role in the local control of neoplasms as well as in the transportation of tumor cells, which represents the most common pathway of metastasis. From the tumorigenesis, there is a remarkable enlargement of the tumor drainage network towards the regional and target lymph nodes. Since the mammary lymphatic system of animals with neoplasms as well as the demarcation of the pelvic and abdominal caudal chain are poorly studied, the aim of the present study is to report a case of iliac lymphadenectomy after intrauterine lymphatic dyeing in a dog with breast neoplasm, which allowed the identification of metastasis in the medial iliac lymph node.Case: A 7-year-old, 13.4 kg, non neutered, mixed breed, female dog was diagnosed with ulcerative neoplasm in the left caudal abdominal breast, which presented evolution of approximately 90 days, presenting ulceration for 10 days, according to the tutor. After a clinical evaluation, thoracic radiography and abdominal ultrasonography were requested, whichdid not present metastasis suggestive images. Therefore, left unilateral total mastectomy was indicated. Retro-umbilical celiotomy was performed for the administration of 0.5 mL of 1% intrauterine methylene blue (body of the uterus), which allowed lymphatic mapping and medial iliac lymphadenectomy. Subsequently, ovariohysterectomy was performed andafter celiorrhaphy, axillary lymphadenectomy was performed, followed by left unilateral mastectomy and concomitant removal of the superficial inguinal lymph node. The patient had a prompt recovery and was discharged from hospital in six hours postoperatively. The excised material was referred for histopathological examination, which revealed the presence of metastasis of simple tubulopapillary carcinoma of the mammary gland in the left medial and superficial inguinal lymph nodes, while the axillary lymph node had no metastases. At the end of 10 days, the patient was clinically stable, with good healing of the surgical wound. After a 120-day postoperative period, the patient had a good clinical status, with no respiratory alterations, and there was no evidence of metastasis on the chest X-ray as well as abdominal ultrasound.Discussion: Considering the great occurrence of breast neoplasms, it is important to develop studies on new approaches in the therapeutic management of this condition and sharing of reports as described. The objective of the lymphadenectomy was to evaluate the possible involvement of regional lymph nodes, since, according to the condition of the lymph nodes in the histopathological examination, it appears as an important prognostic factor, seeing that the survival time is less thantwo years for 85.7% in dogs with regional lymph node metastases. In animals, there are no studies based on the therapeutic alternative of lymphadenectomy, which is believed to be palliative in the reported patient, due to the fact that it is a tubulopapillary carcinoma with different foci of lymph node metastases. Otherwise, lymphadenectomy enabled a better definition of the prognosis and proved to be an important tool for staging. The use of methylene blue was chosen because it was reportedly used in dogs, with excellent results in sentinel lymph nodes mapping, and due to its ease of obtaining and low cost of application. It is concluded that in canines with breast neoplasms, it is important to perform lymphatic mapping to identify possible metastases in cellular tissues and to delimit regional lymph vessels and lymph nodes, thus facilitating the surgical removal of these structures with safety margins. In addition, it is important to perform lymphadenectomy even to lymph nodes that are not infarcted or present macroscopic changes, given that in this case, it already existed metastasis, even in a lymph node of 4 mm.Keywords: metastasis, sentinel lymph node, lymphatic mapping, mastectomy, canine