Amanda Bianchi, Francesco Collivignarelli, Massimo Vignoli, Lorenzo Scaletta, Amedeo Cuomo, Ilaria Falerno, Andrea Paolini, Roberto Tamburro
Simple summary:
Laparoscopy is routinely used in veterinary medicine for both diagnostic and operative procedures. Laparoscopy requires the creation of a pneumoperitoneum to increase the working space, and the placement of portals to allow the insertion of instruments into the abdominal cavity. Instrument insertion is associated with most of the intraoperative complications described in the literature and can also prolong the operation time. Different techniques for reducing the complication rate and time taken for the first portal placement have been described, but there are no clear guidelines in either medical (human) or veterinary literature. In the present study, a total of 30 female dogs underwent laparoscopic ovariectomy. The times required for the first portal placement and the complication rates when using the Veress needle (10 patients) or the modified Hasson technique (20 patients) were recorded and compared. The results of this study suggest that the modified Hasson technique is faster and safer.
Abstract:
Minimally invasive surgery is increasingly being used in veterinary medicine. Laparoscopic
procedures have several advantages compared with open surgery. These include the magnification of
the field of surgery, reduced post-surgical pain and associated stress, reduced post-operative infection
rates, and decreased hospitalization time. The establishment of a pneumoperitoneum is a critical step;
however, this procedure can prolong the operation time, and most of the complications associated
with laparoscopic surgery have been attributed to the insertion of devices into the abdominal
cavity. Two main techniques have been employed to create pneumoperitoneum: the closed-entry
method using the Veress needle and the open Hasson technique. The first portal is necessary
to start insufflation and, subsequently, to realize the operative channel to insert the laparoscopic
instruments into the abdomen. Many authors have compared the time necessary to create the
first portal using different techniques in human medicine, but studies on this topic in veterinary
medicine are lacking. In the veterinary medicine literature, complications associated with the creation
of a pneumoperitoneum and the placement of ports include spleen, bowel, or bladder injuries;
pneumothorax; and subcutaneous emphysema. The aim of the present study was to compare
the times required for the placement of the first portal and the creation of pneumoperitoneum,
and the rates of intraoperative complications using the Veress needle technique (VNT) and the
open modified Hasson technique (MHT). The sample population comprised 30 female dogs who
underwent laparoscopic ovariectomies. The dogs were randomly organized into two groups and
two different entry techniques were used: Veress needle (VNT = group A) and the modified Hasson
technique (MHT = group B). Complications related to abdominal entry were classified as major, in
cases of organ perforation, and minor, in cases of subcutaneous emphysema and gas leakage. The
VNT and MHT required 374.0 s and 242.9 s, respectively, for the placement of the first portal and
for establishing pneumoperitoneum (p < 0.05). Their major complications rates were 20% and 0%,
respectively (p < 0.05). Their minor complications rates were 20% and 35%, respectively (p < 0.05). No
surgical procedures required laparotomy. The MHT was associated with a lower major complication
rate and required less time to create the first portal, compared with the Veress needle technique.
