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Objective: To describe a minimally invasive approach to the parathyroid gland for the treatment of primary hyperparathyroidism., Study Design: Surgical technique description and clinical case report., Animals: Five canine cadavers and 5 client-owned dogs with primary hyperparathyroidism., Methods: A surgical technique for minimally invasive video-assisted parathyroidectomy (MIVAP), described for humans, was adapted for dogs. With the dog in dorsal recumbency, a 15 mm incision was made on the midline, 1 finger width caudal to the cricoid cartilage of the larynx. A 5 mm 30° rigid endoscope was inserted into the peritracheal space with the aid of a blunt suction dissector, and fine elevators. The parathyroid was subsequently removed using electrocautery and blunt and sharp dissection. The technique was refined in 5 cadaver dogs to assess feasibility, and was subsequently performed in 5 clinical cases., Results: A minimally invasive approach to the parathyroid gland was possible and allowed successful removal of a parathyroid mass in 5 dogs without complication. The use of fluid ingress was trialed in 1 cadaver and not found to be helpful. The use of a blunt suction dissector greatly facilitated dissection of the peritracheal space., Conclusion: Minimally invasive video-assisted parathyroidectomy is feasible in dogs and was not associated with complications in 5 clinical cases., Clinical Significance: Minimally invasive techniques tend to reduce morbidity and are popular with pet owners. This study demonstrates that a minimally invasive technique may be considered for parathyroidectomy in dogs., (© 2022 American College of Veterinary Surgeons.)

Objective: To compare the effect of three methods of subcutaneous tissue closure on postoperative incisional complications and pain in cats., Study Design: Single-center, randomized, blinded, controlled trial conducted in a veterinary teaching hospital., Animals: Two hundred ninety-seven cats undergoing midline celiotomy for ovariohysterectomy (n = 280) or other abdominal procedure (n = 17)., Methods: Cats (n = 297) were assigned to one of three subcutaneous closure methods: simple continuous apposition with tacking to the rectus fascia (n = 108, quilting [Q] group); simple continuous apposition (SC; n = 94); no subcutaneous closure (NC; n = 95). Primary outcomes were incidence of seroma formation, postoperative pain, and surgical site infection or dehiscence. Active follow-up was obtained at 10 and 30 days postoperatively., Results: Baseline characteristics did not differ between groups. Seroma was less common in the Q group (13.0%) than in the NC (27.3%) and SC (25.9%) groups (P = .03). Compared with the other two groups, the relative risk of seroma formation in the Q group was 0.49 (95% CI = 0.28-0.86, P = .01). Median mechanical pain thresholds were higher (indicating greater comfort) in cats with subcutaneous sutures (Q and SC = 1.23 [interquartile range (IQR), 0.2-2.6 N], NC = 0.83 [IQR, 0-1.87 N], P = .04) on the day after surgery., Conclusion: Closing subcutaneous tissues with a quilting closure pattern reduced seroma formation in cats undergoing celiotomy., Clinical Significance: Placing a quilting suture pattern in the subcutaneous tissues after celiotomy is a simple low-cost measure that reduces seromas in cats. Abstaining from subcutaneous closure cannot be recommended because of increased seroma formation and pain., (© 2019 The American College of Veterinary Surgeons.)

Objective: To report intraoperative and major postoperative complications in dogs treated surgically for epiglottic retroversion (ER), compare the incidence of major postoperative complications between procedures, and report survival of surgically treated dogs., Study Design: Multi-institutional retrospective study., Sample Population: Fifty dogs treated with 78 procedures., Methods: Medical records of dogs diagnosed and surgically treated for ER from 2003 to 2017 at 11 institutions were reviewed. Complications were divided into intraoperative and major postoperative complications., Results: Intraoperative complications occurred during 2 of 78 (2.6%) procedures. Thirty-six major postoperative complications were documented in 22 dogs after 36 of 74 (48.7%) procedures. Postoperative complications occurred after 7 of 12 (58.3%) nonincisional epiglottopexy, 23 of 43 (53.5%) incisional epiglottopexy, 2 of 4 (50%) partial epiglottectomy, 2 of 12 (16.7%) subtotal epiglottectomy, and 2 of 3 (66.7%) other surgical procedures. Epiglottopexy failure was the most common major postoperative complication. The incidence of major postoperative complications did not differ between procedures (P = .1239), although, when combined, epiglottopexy procedures (30/55) had a higher incidence of complications than epiglottectomy procedures (4/16; P = .048). Thirty (60%) dogs were alive at a median of 928 days (range, 114-2805), 8 (16%) were lost to follow-up after 411 days (range, 43-1158), and 12 (24%) were dead/euthanized after 301.5 days (range, 3-1212). Median survival time was not reached after a median of 716 days., Conclusion: Although intraoperative complications were uncommon, major postoperative complications were common, especially after epiglottopexy procedures., Clinical Significance: Although surgical treatment of ER is associated with a high rate of major postoperative complications, especially epiglottopexy procedures, long-term survival can be achieved., (© 2019 The American College of Veterinary Surgeons.)

Objective: To determine the influence of a quilting suture pattern tacking the subcutaneous tissues to the deep fascia on complications after midline celiotomy in dogs., Study Design: Single-center, randomized, blinded, controlled trial conducted in a veterinary teaching hospital., Animals: Four hundred thirty-two dogs undergoing midline celiotomy for ovariohysterectomy (n = 249) or other abdominal procedures (n = 183)., Methods: Dogs were randomly assigned to (1) a quilting group, subcutaneous tissue with apposition plus tacking to the rectus fascia or (2) a nonquilting group, with apposition of subcutaneous tissue without tacking. Randomization was stratified on hospital admitting service. Primary outcome was the incidence of incisional seroma. Secondary outcomes included postoperative pain the day after surgery and surgical site infection (SSI). Outcomes were assessed during the first 30 postoperative days., Results: No differences were detected between the quilting group (n = 183) and the nonquilting group (n = 175) in terms of illness severity, surgical procedure performed, surgeon's experience, duration of surgery, intraoperative complications, or methods of surgical closure other than the intervention under study. In an intent-to-treat analysis, the incidence of incisional seroma was lower in the quilting group (odds ratio = 0.30, 95% CI = 0.13-0.67, P = .004). Pain assessed 24 hours postoperatively was lower in the quilting group (P = .03). The incidence of SSI did not differ between groups., Conclusion: Tacking the subcutaneous tissues to the deep fascia is indicated to reduce seroma during celiotomy closure., (© 2017 The American College of Veterinary Surgeons.)

Objective: To report the outcome of a modified total ear canal ablation (TECA) technique to maintain normal ear carriage in cats., Study Design: Case series., Animals: Six cats with external ear canal disease., Methods: Medical records were reviewed to identify cats in which a modified TECA using a single pedicle advancement flap was used to maintain normal ear carriage. Signalment, histopathologic diagnosis, complications, and outcome were retrieved. Owners were contacted to document long-term outcome., Results: Modified TECA procedures (7) were performed in 6 cats. Normal ear carriage was present immediately after surgery and was preserved at follow-up interview. Owners were satisfied with cosmetic appearance. Histopathologic diagnosis of excised ear masses included ceruminous gland adenocarcinoma (2 cats), ceruminous gland adenoma (2 cats, 3 ears), and inflammatory polyp (2 cats)., Conclusions: Modification of the TECA skin incision preserved normal ear carriage in all cats. Owners were satisfied with overall outcome and with cosmetic result. Rate and nature of complications were similar to previously published data., Clinical Relevance: A simple modification of the TECA skin incision to create a single pedicle advancement flap maintains normal ear carriage in cats.

Five modifications of a cricoarytenoid lateralization and two modifications of a thyroarytenoid lateralization laryngoplasty technique were evaluated for their effect on rima glottidis area. All procedures and evaluations were performed on canine cadaver larynges. Cricoarytenoid lateralization (CAL) techniques provided a greater increase of the size of the glottic opening than did any of the thyroarytenoid lateralization techniques. Cricoarytenoid and interarytenoid disarticulation associated with CAL did not significantly increase glottic size compared with normal. After disarticulation of the cricoarytenoid joint, there was no difference in glottic enlargement whether the suture was placed through the muscular process or through the articular facet of the arytenoid cartilage. Transection of the sesamoid band combined with cricoarytenoid diarticulation distorted the dorsal margin of the rima glottidis.

The biochemical holding strength and histological characteristics of a laparoscopic stapled gastropexy (LG) adhesion were compared with that of an incisional gastropexy (IG) adhesion. An LG was performed in 14 dogs and an IG was performed in six dogs. During the LG procedure, the abdomen was insufflated with carbon dioxide and three cannulae were placed in the caudal aspect of the right side of the abdomen. A 35 mm laparoscopic stapler was used to staple the gastric antrum to the adjacent right lateral abdominal wall. The IG procedure was performed through ventral midline celiotomy. A 35 mm IG was made by apposing the gastric antrum to the adjacent right lateral abdominal wall with two continuous rows of suture. Half of each group of dogs was euthanatized at 7 and 30 days after surgery. The mean tensile load to failure at 7 days was 44.86 +/- 18.54 N for the LG group and 85.33 +/- 23.59 N for the IG group (P < .05). At 30 days the values were 72.39 +/- 18.01 N for the LG group and 71.17 +/-12.11 N for the IG group (P = .41). The gastropexy adhesions in the 7-day postoperative group contained variable amounts of fibrin, hemorrhage, mononuclear cell inflammation, loose fibrovascular tissue, and mature collagenous connective tissue. Adhesions in the 7-day postoperative group were divided subjectively into three histological subgroups based on the relative amounts of mature connective tissue within the adhesion. The LG and IG adhesions were randomly distributed among these subgroups (P = 1.0). Adhesions in the 30-day postoperative group contained well-organized fibrous connective tissue. No difference in the amount of connective tissue could be detected histologically in the LG or IG adhesions. Complications with the LG procedure included stomach perforation (2 cases), splenic puncture (2 cases), and subcutaneous emphysema (4 cases).

Two calves and two foals presented with episodic clinical signs of diffuse central nervous system disease. Portosystemic anomalies were tentatively diagnosed based on the history, clinical signs and increased serum concentrations of blood ammonia and total serum bile acids with normal concentrations of liver derived enzymes. one calf died before intraoperative contrast portography, whereas the other calf and both foals had marked clinical improvement after intensive medical therapy. Surgical correction was attempted in these three animals and was successful in one foal. A right paracostal celiotomy was superior to a ventral median approach for exposure to the portal vascular system and shunt access.

Articular cartilage exposure and immediate postoperative stability provided by three medial surgical approaches in canine cadaver elbows were compared. The approaches evaluated were a desmotomy of the medial collateral ligament (DMCL) that included a tenotomy of the pronator teres muscle, a longitudinal myotomy of the flexor carpi radialis (MFCR), and an osteotomy of the medial epicondyle (OME). Nondestructive biomechanical testing was performed before the surgical approach and repeated after surgery. The stiffness at 13 degrees valgus deviation of the elbow and energy absorption up to 13 degrees valgus deviation of the elbow were determined from the preoperative and postoperative torque-rotation curves. The perimeters of the ulnar and humeral articular cartilage that were visualized through the approach were scored with a dental pick. Latex casts were made of articular surfaces of the elbow. The humeral and ulnar articular exposures were determined by computerized planimetric analysis of latex cast photocopies. The humeral cartilage exposure of the OME approach was significantly greater than either the MFCR or DMCL approaches. The DMCL approach provided a significantly greater humeral cartilage exposure than the MFCR approach. All three approaches provided statistically similar percentages of ulnar cartilage exposure. The stiffness and energy absorption of the OME and MFCR approaches were similar and significantly greater than the DMCL approach. The OME approach provided the best combination of exposure and immediate postoperative stability.

This study was divided into two phases. In the in vitro phase, a stainless steel bone plate was applied to the cranial surface of the radius in 14 canine limbs. The effect of the presence of a bone plate on bone density analysis using radiographic photodensitometry (RP) was evaluated by comparing the density measurement of the unplated limb to the density measurement of the plated limb. The optical density of the plated bones was 12% greater than that of the unplated bones. This information was used as a correction factor for the in vivo study. In the in vivo phase, 23 dogs with radial and ulnar fractures were examined for complications associated with the long-term application of a stainless steel plate applied to the cranial surface of the radius. In 14 dogs, RP analysis was used to compare the plated limb with the normal, contralateral limb. No significant differences in radial cortical bone density existed between the plated limb and the contralateral limb after taking into account the effect a bone plate had on photodensitometry readings. There was no significant correlation between the change in radial cortical density and the duration of bone plate application, suggesting that a steady state between bone loss and bone production occurs after long-term plate fixation of the fractured canine radius. The majority (87%) of the dogs with a plate applied to the radius greater than 1 year had normal limb usage when standing, walking, or running.

Cecal-colic volvulus was confirmed by surgery in two dogs. Both dogs were intact, male Great Danes. The clinical and diagnostic findings were not specific for large bowel volvulus. Clinical signs included peracute to acute onset of vomiting, mild abdominal distention and pain, lack of feces, and tenesmus. Abdominal radiographs demonstrated severe dilatation of bowel loops in both dogs. One dog survived.

Nuclear medical bone imaging was used in combination with targeted radiography to detect metastatic or multicentric lesions in 23 dogs with skeletal neoplasms. Each dog with a radiographically diagnosed skeletal neoplasm was injected with Technetium-99m labeled methylene diphosphonate (99mTc-MDP) (15.0 mCi intravenously) for whole body imaging. All areas with increased uptake of 99mTc-MDP were radiographed. In 19 dogs, the amount of bone shaft involvement in primary sites indicated by bone imaging was larger than the amount indicated by radiography. Eighteen dogs had secondary areas of increased 99mTc-MDP uptake, six of which had secondary areas that were suspected radiographically to be neoplastic. Four dogs had lesions characterized histologically as neoplasia, one as bone infarction and one as normal cortical bone. Positive predictive value for this strategy was 66.7%. Results of this study suggest that nuclear medical bone imaging with targeted radiography is a quick, noninvasive technique with a good positive predictive value for evaluation of the skeleton for metastatic or multicentric sites of neoplasia.

Three bilateral thyroidectomy techniques used in 41 hyperthyroid cats over a 7 year period were compared for rates of postoperative hypocalcemia. Extracapsular dissection of the thyroid glands resulted in an 82% rate of postoperative hypocalcemia. An intracapsular dissection technique produced a 36% rate of postoperative hypocalcemia. The incidence of postoperative hypocalcemia was reduced to 11% when bilateral thyroidectomies were done asynchronously (staged), 3 to 4 weeks apart. Immediate postoperative treatment with dihydrotachysterol did not reduce the incidence of postoperative hypocalcemia. Because the incidence of hypocalcemia did not differ significantly between intracapsular and staged intracapsular dissection, the authors concluded that staged bilateral thyroidectomy in hyperthyroid cats had limited benefit over simultaneous bilateral thyroidectomy.