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Objective: To describe perioperative characteristics and outcomes of dogs surgically treated for intestinal intussusception., Study Design: Multi-institutional, retrospective study., Animals: One hundred fifty-three client-owned dogs with intestinal intussusception., Methods: Dogs were included when they had undergone surgical treatment of a confirmed intestinal intussusception. Medical records were reviewed for demographics and clinical data, including surgical complications (graded 1-4). Follow-up was obtained via telephone interview with owners and referring veterinarians., Results: Dogs had a median age of 10 months (range, 2-156), and the most common location for intussusception was ileocolic (66/153 [43%]). Most cases had no identifiable cause (104/155 [67%]). Intestinal resection and anastomosis (IRA) was performed in 129 of 153 (84%) dogs; enteroplication was performed in 28 of 153 (18%) dogs, including 13 with and 15 without IRA. Intraoperative complications occurred in 10 of 153 (7%) dogs, all involving intestinal damage during attempted manual reduction. The median duration of follow-up after discharge was 334 days (interquartile range, 15-990; range, 1-3302). Postoperative complications occurred in 53 of 153 (35%) dogs, including 22 of 153 (14%) with severe (grade 3 or 4) events. Diarrhea, regurgitation, and septic peritonitis were the most common postoperative complications; intussusception recurred in four of 153 (3%) dogs, all within 72 hours postoperatively. Fourteen-day postoperative mortality rate was 6%., Conclusion: Surgical treatment of intestinal intussusception was curative in most dogs, even when an underlying cause was not identified. Surgical complications were common, including a 14% risk of life-threatening short-term complications., Clinical Significance: Surgical treatment of intestinal intussusception offers an excellent prognosis, but the potential life-threatening complications should be considered., (© 2020 The American College of Veterinary Surgeons.)

Case Description: 4 cats (6 to 9 months old) were evaluated because of clinical signs consistent with a portosystemic shunt (PSS)., Clinical Findings: Among the 4 cats, 3 had neurologic abnormalities including ataxia, head pressing, disorientation, and obtundation. One cat was evaluated because of urethral obstruction; a retrieved urethral stone was determined to have urate composition. Clinicopathologic findings (hypoproteinemia, low BUN concentration, and high serum bile acids concentration) were consistent with a PSS in all cats. A diagnosis of intrahepatic PSS (IHPSS) was made for all cats on the basis of ultrasonographic and CT findings., Treatment and Outcome: All cats underwent percutaneous transvenous coil embolization (PTCE). No major intraprocedural complications were encountered, and all cats were discharged from the hospital. For the 3 cats that were presented with neurologic signs, an evaluation performed at 12, 14, or 48 months after the procedure revealed resolution of the neurologic signs, and owners reported that the behavior of each cat appeared normal. One cat that initially had neurologic and gastrointestinal signs had lower urinary tract signs after PTCE and developed an acquired extrahepatic PSS., Clinical Relevance: Although IHPSSs in cats are uncommon, the outcomes of PTCE for the 4 cats of the present report suggested that this treatment may benefit cats with an IHPSS. No short-term complications were encountered, and all cats had improvement in clinical signs following PTCE, although an acquired extrahepatic PSS was later identified in 1 cat. Further investigation of the use of endovascular techniques for the treatment of IHPSSs in cats and other species is warranted.

Objective: To identify prognostic factors for short-term survival of dogs that experience seizures within 7 days after surgical correction of single congenital extrahepatic portosystemic shunts (cEHPSS)., Study Design: Multi-institutional retrospective study., Sample Population: Ninety-three client-owned dogs., Methods: Medical records at 14 veterinary institutions were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 1, 2005 through February 28, 2018 and experienced postattenuation seizures (PAS) within 7 days postoperatively. Logistic regression analysis was performed to identify factors associated with 1-month survival. Factors investigated included participating institution, signalment, shunt morphology, concurrent/historical conditions, presence of preoperative neurologic signs, presence of preoperative seizures, aspects of preoperative medical management, surgical details including method and degree of shunt attenuation, type of PAS (focal only or generalized ± focal), drugs administered as part of the treatment of PAS, and development of complications during treatment of PAS., Results: Thirty (32.3%) dogs survived to 30 days. Seventy-six (81.7%) dogs experienced generalized PAS. Factors positively associated with short-term survival included having a history of preoperative seizures (P = .004) and development of focal PAS only (P = .0003). Most nonsurvivors were humanely euthanized because of uncontrolled or recurrent seizures., Conclusion: Dogs that experienced PAS that had a history of preoperative seizures and those that experienced focal PAS only had significantly improved short-term survival., Clinical Significance: The results of this study provide information that will help in the counseling of owners who seek treatment for PAS after surgical correction of cEHPSS. © 2020 The American College of Veterinary Surgeons., (© 2020 The American College of Veterinary Surgeons.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly emerged coronavirus that is responsible for the current pandemic of coronavirus disease 2019 (COVID-19), which has resulted in more than 3.7 million infections and 260,000 deaths as of 6 May 2020 1,2 . Vaccine and therapeutic discovery efforts are paramount to curb the pandemic spread of this zoonotic virus. The SARS-CoV-2 spike (S) glycoprotein promotes entry into host cells and is the main target of neutralizing antibodies. Here we describe several monoclonal antibodies that target the S glycoprotein of SARS-CoV-2, which we identified from memory B cells of an individual who was infected with severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003. One antibody (named S309) potently neutralizes SARS-CoV-2 and SARS-CoV pseudoviruses as well as authentic SARS-CoV-2, by engaging the receptor-binding domain of the S glycoprotein. Using cryo-electron microscopy and binding assays, we show that S309 recognizes an epitope containing a glycan that is conserved within the Sarbecovirus subgenus, without competing with receptor attachment. Antibody cocktails that include S309 in combination with other antibodies that we identified further enhanced SARS-CoV-2 neutralization, and may limit the emergence of neutralization-escape mutants. These results pave the way for using S309 and antibody cocktails containing S309 for prophylaxis in individuals at a high risk of exposure or as a post-exposure therapy to limit or treat severe disease.

At present, veterinary laparoscopic surgery training is lacking in experiences that provide a controlled and safe environment where surgeons can practice specific techniques while receiving experts' feedback. Surgical skills acquired using simulators must be certified and transferable to the operating room. Most models for practicing laparoscopic skills in veterinary minimally invasive surgery are general task trainers and consist of boxes (simulators) designed for training human surgery. These simulators exhibit several limitations, including anatomic species and procedural differences, as well as general psychomotor training rather than in vivo skill recreation. In this paper, we review the existing methods of training, evaluation, and validation of technical skills in veterinary laparoscopic surgery. Content includes global and specific scales, and the conditions a structured curriculum should meet for improving the performance of novice surgeons during and after training. A focus on trainee-specific assessment and tailored-technical instruction should influence training programs. We provide a comprehensive analysis of current theories and concepts related to the evaluation and validation of simulators for training laparoscopic surgery in small animal surgery. We also highlight the need to develop new training models and complementary evaluation scales for the validation of training and acquisition of basic and advanced skills in veterinary laparoscopic surgery., (Copyright © 2020 Oviedo-Peñata, Tapia-Araya, Lemos, Riaño-Benavides, Case and Maldonado-Estrada.)

Objective: To evaluate the feasibility of fluoroscopy-assisted placement of one-lung ventilation (OLV) devices in dogs., Study Design: Experimental study., Sample Population: Canine cadavers (n = 8) weighing between 20.2 and 37.4 kg., Methods: Thoracoscopic access with a two-port approach was established to evaluate bilateral lung ventilation patterns. Advancement of a left-sided Robertshaw double-lumen endobronchial tube (DLT) and the EZ-blocker (EZ) were evaluated under direct fluoroscopic guidance. Each dog also underwent bronchoscopy-assisted placement of an Arndt endobronchial blocker (EBB). Time to initial placement, success of creating complete OLV (after initial placement attempt and after up to two repositionings), and ease of placement score were recorded. Device position was evaluated bronchoscopically after each fluoroscopy-assisted placement attempt., Results: Time to initial placement was significantly shorter for EZ than for DLT and EBB. The rate of successful placement after up to two repositioning attempts was 87.5%, 87.5%, and 100.0% on the right and 87.5%, 100.0%, 100.0% on the left for DLT, EZ, and EBB, respectively, and was not different between devices. Ease of placement scores were significantly higher for DLT compared with EZ and EBB on both the left and the right sides., Conclusion: Fluoroscopy-assisted placement of DLT and EZ appears feasible in canine cadavers. EZ-blocker placement was efficient and technically easier than DLT, but positioning must be adapted for dogs. Bronchoscopy-assisted placement of EBB remains highly successful., Clinical Significance: Fluoroscopy-assisted placement of EZ and DLT is a useful alternative to bronchoscopy-assisted placement of these OLV devices., (© 2019 The American College of Veterinary Surgeons.)

The objectives of this retrospective, observational study were to characterize the anatomical features of the cisterna chyli (CC) in a cohort of dogs diagnosed with idiopathic chylothorax that underwent CT lymphangiography (CTLa), and to evaluate the feasibility of computer-assisted design (CAD) software to quantify volumetric measurements of the CC. Twenty-three client-owned dogs with idiopathic chylothorax were included. Additionally, CTLa was performed in three canine cadavers to assess the ability of CAD software to accurately acquire volumetric measurements. Injection sites, attenuation values, anatomic location, dimensions, and aortic diameter to CC ratio (Ao:CC) were recorded. Video records of video-assisted thoracic surgery (VATS) thoracic duct ligation (TDL) were reviewed in eight out of 23 dogs to compare operative and CTLa findings. The CC was dorsal and right-sided in 18 out of 23 dogs, located between L1 and L4 in 21 dogs, and extended as far cranially as T11 in two dogs. The median measurements for length, height, and width were 150.0, 5.5, and 13.3 mm, respectively. Median total volume was 1.82 mL. Median volumes to the right and left of the aorta were 1.46 and 0.49 mL, respectively (P = .014). Median total CC volume to body weight ratio (CC:bw) was 0.07 mL/kg. The presence of an intrathoracic CC was observed intraoperatively in six out of eight cases that underwent VATS TDL. Findings supported the use of CTLa and CAD as feasible methods for characterizing the CC in dogs diagnosed with chylothorax. These methods may facilitate interventional planning involving the CC such as embolization., (© 2020 American College of Veterinary Radiology.)

Ovarian remnant syndrome (ORS) is a condition resulting from incomplete removal of ovarian tissue during ovariectomy and/or ovariohysterectomy. Single-port laparoscopy (SPL) is an alternative to ventral midline laparotomy for treatment of ORS. Medical records of 13 client-owned female dogs who underwent SPL for the treatment of ORS were retrospectively reviewed to evaluate surgical technique and outcome. Dogs who had undergone a previous attempt at open ovariectomy or ovariohysterectomy were included. Major intraoperative complications did not occur and conversion to open laparotomy was not required. In 1 dog, an SPL + 1 technique was used, in which an additional port was placed cranial to the single-port device to aid in dissection and tissue manipulation. Median surgical time was 45 min (range, 30-90 min). Clinical signs related to estrus had resolved in 11 of 13 dogs with a median follow-up time of 18 mo. Two of 13 dogs were lost to follow-up at 3 mo postoperatively; however, signs of estrus had resolved at time of last follow-up. SPL treatment for ORS was feasible and successful in this cohort of dogs. Reduced surgical time was found in this study compared with previous reports investigating multiple-port laparoscopic treatment of ORS.

Communication skills are paramount for a successful veterinary curriculum. Technological advances have improved communication processes, and the way instruction is delivered. Yet, with these advances come challenges such as email overload, increased interruptions, and miscommunications. Time is a valuable commodity at any high caseload veterinary teaching hospital. When increasingly more time is spent sending and receiving emails, text messages, pages, and calls in lieu of more focused clinical teaching, then the modes of communication and traditional learning theories need to be evaluated. An effective mode of communication is needed to reduce information overload and miscommunication. This article describes lessons learned from a pilot study to determine if a team-based messaging application could improve a surgical team's communication by having all forms of transmitted media directly related to their scope of work accessible to everyone on the team in one real-time digital platform (Slack). Fifteen members of a university-based surgical team were enrolled into the study and provided with surveys at specific time points to evaluate the efficacy of an internet-based team communication tool during a 3-month period. Results of our study showed an overall perception of improved communication among team members when using a team-based communication platform. Recommendations are provided to address team member's underutilization of the platform, which resulted in duplicate messages and miscommunication. We conclude an initial adoption by staff members is essential when implementing significant shifts in communication platforms.

Objective: To report the clinical characteristics, types of vascular ring anomalies (VRA), operative findings, complications, and survival after surgical treatment of cats with VRA., Study Design: Retrospective, multi-institutional case series., Animals: Client- or shelter-owned cats presenting to academic, referral veterinary institutions., Methods: Medical records of cats with VRA that underwent surgical treatment were reviewed. Signalment, relevant medical history, clinical signs, diagnostic imaging, surgical findings, complications, and survival were recorded., Results: Twenty cats with VRA were included. Vascular ring anomalies were most commonly (75% [15/20]) diagnosed in cats less than 1 year old, with no breed or sex predilection. Regurgitation was the most common clinical sign, present in 18 of 20 (90%) cats. A persistent right aortic arch was diagnosed in 17 of 20 (85%) cats, with concurrent aberrant left subclavian artery in four of the cats. Surgical treatment was associated with survival to discharge in 18 of 20 (90%) cats. Persistent clinical signs were reported in nine of 13 (69%) cats, and radiographic evidence of megaesophagus persisted in four of 13 (31%) cats, with a median follow-up of 275 days after discharge., Conclusion: Persistent right aortic arch was the most commonly diagnosed VRA in cats in this series, although multiple anomalies were observed. Surgical treatment of VRA in cats was associated with a high survival to discharge, although persistence of clinical signs and megaesophagus was noted in 69% and 31% of the cats, respectively., Clinical Significance: Surgical treatment of VRA in cats is associated with a high survival rate; however, persistence of clinical signs is an expected outcome., (© 2019 The American College of Veterinary Surgeons.)

Objective: To compare demographics and disease characteristics in dogs in which peritoneopericardial diaphragmatic hernia (PPDH) had been diagnosed and report outcomes after surgical treatment (ST) or conservative treatment (CT)., Study Design: Retrospective study., Sample Population: One hundred twenty-eight dogs (91 ST, 37 CT) in which PPDH had been diagnosed., Methods: Medical records were reviewed for demographics, perioperative findings, and outcomes. Follow-up was obtained via telephone interview and email correspondence with owners and referring veterinarians. Baseline variables were compared between treatment groups., Results: Dogs treated surgically were younger (P < .001), more likely to be sexually intact (P = .002), more likely to have clinical signs from PPDH vs an incidental diagnosis (P < .001), and more likely to have other congenital abnormalities (P = .003) compared with dogs treated conservatively. Ninety-seven percent of ST dogs were discharged from hospitals. Intraoperative and postoperative complications were reported in 22% and 41% of dogs, respectively, although most complications were classified as low grade (75% and 83%, respectively). Follow-up was available in 87 dogs, at a median of 1062 days. Hernia recurrence was not reported in any surgically treated dog. The deaths of nine dogs (five ST, four CT) could be attributed to PPDH, and long median survival times were observed in both the ST and CT groups (8.2 and 5 years, respectively)., Conclusion: Preoperative characteristics differed between dogs treated conservatively vs surgically. Surgical treatment was associated with low operative mortality, and both ST and CT dogs had good long-term survival., Clinical Significance: A diagnosis of PPDH can confer a good long-term prognosis for both ST and CT dogs., (© 2019 The American College of Veterinary Surgeons.)

Objective: To determine the optimal intercostal space (ICS) for thoracoscopic-assisted pulmonary surgery for lung lobectomy in cats., Sample: 8 cat cadavers., Procedures: Cadavers were placed in lateral recumbency. A 5-cm minithoracotomy incision was made in the middle third of ICS 4 through 7 on the left side and 4 through 8 on the right side, and a wound retractor device was placed. A camera port was made in the middle third of ICS 9. Each lung lobe was sequentially exteriorized at each respective ICS. A thoracoabdominal stapler was placed to simulate a lung lobectomy, and distance from the stapler anvil to the hilus was measured., Results: For the left cranial lung lobe, there was no significant difference in median distance from the stapler anvil to the pulmonary hilus for ICS 4 through 6. Simulated lobectomy of the left caudal lung lobe performed at ICS 5 and 6 resulted in a significantly shorter distance, compared with lobectomy performed at ICS 4 and 7. Simulated lobectomy of the right cranial and right middle lung lobes performed at ICS 4 and 5 resulted in a significantly shorter distance, compared with lobectomy performed at ICS 7. Simulated lobectomy of the accessory and right caudal lung lobes at ICS 5 and 6 resulted in a significantly shorter distance than for lobectomy performed at ICS 8., Conclusions and Clinical Relevance: An optimal ICS for a minithoracotomy incision was determined for thoracoscopic-assisted lung lobectomy in cats.

Objective: To evaluate the feasibility of ultrasound-guided, temporary, percutaneous T-fastener gastropexy (TG) and gastrostomy catheter (GC) placement for providing sustained gastric decompression in dogs with acute gastric dilatation-volvulus (GDV) and to compare findings with those of trocarization., Animals: 16 dogs with GDV., Procedures: Dogs were randomly assigned to undergo gastric decompression by means of percutaneous trocarization (trocar group; n = 8) or temporary TG and GC placement (TTG+GC group; 8) with ultrasound guidance. The gastric volvulus was then surgically corrected, and the decompression sites were examined. Outcomes were compared between groups., Results: The proportion of dogs with successful decompression did not differ significantly between the TTG+GC (6/8) and trocar (7/8) groups; median procedure duration was 3.3 and 3.7 minutes, respectively. After the failed attempts in the TTG+GC group, the procedure was modified to include ultrasound guidance during T-fastener placement. The decrease in intragastric pressure by 5 minutes after trocar or GC insertion was similar between groups. For dogs in the TTG+GC group, no significant difference in intragastric pressure was identified between 5 and 60 minutes after GC insertion. Complications included inadvertent splenic or jejunal placement in 2 dogs (TTG+GC group) and malpositioned and ineffective trocar placement in 1 dog (trocar group). All dogs survived for at least 2 weeks., Conclusions and Clinical Relevance: Ultrasound-guided, temporary, percutaneous TG and GC placement was safe and effective at providing sustained gastric decompression in dogs with GDV, suggesting that this technique would be ideal for dogs in which surgical delays are anticipated or unavoidable.

Intestinal wounds require precise closure after intestinal biopsy, enterotomy, or enterectomy in small animals. Preexisting factors such as intra-abdominal sepsis and hypoalbuminemia as well as poor surgical technique increase the risk of intestinal dehiscence, with considerable negative impact on patient morbidity and mortality. Live dog studies have demonstrated the dangers of mucosal eversion especially in the septic abdomen. Approximating patterns preserve luminal diameter, heal optimally, and have equal bursting strength compared with inverting patterns after 24 hours. Simple interrupted and simple continuous suture patterns and disposable skin staples are established alternatives for manual wound closure. Knotless quilled suture currently used in laparoscopic gastropexy techniques shows bursting strength equal to monofilament sutures in dog cadaveric intestine. Dehiscence rates with hand sewn vs titanium automated stapling anastomosis are similar in uncomplicated cases; however, auto stapling devices may be the preferred method of anastomosis when preexisting abdominal sepsis is present and when patient size allows it. Regardless of the technique, current standard of care involves leak testing and omental wrapping, followed by early postoperative feeding. The past decade has ushered in an exciting new era of laparoscopic assisted techniques that have the potential to reduce postoperative pain and patient morbidity. An understanding of these applications will establish the future of minimally invasive small animal intestinal surgery for veterinary specialists. In summary, surgeons have a variety of methods at their disposal for optimal clinical outcome in small animal intestinal surgery., (© 2019 The American College of Veterinary Surgeons.)

Objective: To determine the influence of oversewing a transverse staple line in functional end-to-end stapled intestinal anastomoses (FEESA) in dogs., Study Design: Retrospective observational study., Sample Population: Seventy-seven client-owned dogs that underwent 78 FEESA reinforced (n = 30) or not reinforced (n = 48) with suture at the transverse staple line., Methods: The medical records database was searched and reviewed for dogs that had undergone a FEESA between January 2008 and September 2018. Data were collected regarding signalment, body weight, clinical presentation, indication for surgery, serum albumin, presence of septic peritonitis, previous surgeries, surgical techniques (ie, oversew, crotch suture, omental wrap, omental patch, serosal patch), histopathology results, and postoperative outcome., Results: The only differences identified between groups consisted of higher preoperative albumin (2.89 ± 0.56 vs 2.34 ± 0.62 g/dL; P = .006) and lower postoperative dehiscence rate (0/30 vs 7/48; P = .028) in dogs with an oversewn FEESA. Oversewing the FEESA was identified as the significant factor in a model with oversewing and preoperative albumin fit to the outcome of dehiscence (oversew P = .010, albumin P = .761). The location of the dehiscence was specified in four of seven dogs, all along the transverse staple line. Patterns used for oversew were unspecified (n = 11), simple continuous (8), Cushing (4), simple interrupted (2), cruciate (1), interrupted horizontal mattress (1), and Lembert (1)., Conclusion: Oversewing the transverse staple line in FEESA was associated with a reduced occurrence of postoperative dehiscence., Clinical Significance: Our results provide evidence to support additional investigation of suture reinforcement (oversewing) at the transverse staple line of FEESA to reduce postoperative dehiscence., (© 2019 The American College of Veterinary Surgeons.)

Objective: To evaluate the usefulness of a high-fidelity model for teaching ovariohysterectomy (OHE) to veterinary students., Study Design: Longitudinal survey., Sample Population: Clinicians with ≥2 years postgraduate experience in small animal surgery and a sophomore veterinary student population at 1 institution., Methods: Twelve clinicians evaluated the high-fidelity model for realism. Questionnaires were distributed to sophomore veterinary students prior to and after OHE training on the high-fidelity model (SynDaver Surgical Canine) and after performing OHE as primary surgeon with a live dog. Time for students to perform OHE (identify the first ovarian pedicle to transecting the uterine body) and number of technical errors (visceral injury, hemorrhage, loose ligatures) were compared between the model and live dog groups., Results: Evaluators rated the high-fidelity model as moderate-to-highly realistic. Students' confidence improved after practicing on the model in all critical steps and additionally improved after performing an OHE on a live dog. Time to complete the OHE on the model (mean ± SD,73.4 ± 27.1 minutes) and live dogs (83.0 ± 24.7 minutes) did not differ (P = .20). Frequency of hemorrhagic events (P = .77) and accidental visceral injury (P = .30) did not differ between the model and live dogs. However, fewer loose ligatures were placed in live dogs (23/64) compared with the model (22/37; P = .02)., Conclusion: The high-fidelity model improved the confidence of sophomore students. The duration of OHE did not differ between the model and live dogs., Clinical Impact: The high-fidelity model is valuable for improving confidence in veterinary students prior to live-dog OHE., (© 2019 The American College of Veterinary Surgeons.)

Objective: To describe surgical technique, biopsy sample quality, and short-term outcome of minimally invasive small intestinal exploration and targeted abdominal organ biopsy (MISIETB) with use of a wound retraction device (WRD) in dogs., Animals: 27 client-owned dogs that underwent MISIETB with a WRD at 1 of 4 academic veterinary hospitals between January 1, 2010, and May 1, 2017., Procedures: Medical records were retrospectively reviewed, and data collected included signalment; medical history; findings from physical, ultrasonographic, laparoscopic, cytologic, and histologic evaluations; surgical indications, procedures, duration, and complications; and short-term (14-day) outcomes. The Shapiro-Wilk test was used to evaluate the normality of continuous variables, and descriptive statistics were calculated for numeric variables., Results: Laparoscopic exploration was performed through a multicannulated single port (n = 18), multiple ports (5), or a single 6-mm cannula (4). Median length of the incision for WRD placement was 4 cm (interquartile [25th to 75th percentile] range, 3 to 6 cm). All biopsy samples obtained had sufficient diagnostic quality. The 2 most common histologic diagnoses were lymphoplasmacytic enteritis (n = 14) and intestinal lymphoma (5). Twenty-five of 27 (93%) dogs survived to hospital discharge, and 3 (12%) dogs had postsurgical abnormalities unrelated to surgical technique., Conclusions and Clinical Relevance: Results indicated that MISIETB with WRD was an effective method for obtaining diagnostic biopsy samples of the stomach, small intestine, pancreas, liver, and mesenteric lymph nodes in dogs. Prospective comparison between MISIETB with WRD and traditional laparotomy for abdominal organ biopsy in dogs is warranted.

Objective: To report the morbidity and mortality associated with adrenalectomy with cavotomy for resection of invasive adrenal neoplasms in dogs and evaluate risk factors for perioperative outcomes., Study Design: Retrospective study., Animals: Forty-five client-owned dogs., Methods: Dogs that underwent open adrenalectomy with cavotomy for resection of adrenal masses with tumor thrombus extending into the vena cava were included. Clinicopathologic data were harvested from medical records. Selected clinical, imaging, and operative variables were statistically evaluated as risk factors for packed red blood cell transfusion, nephrectomy, perioperative death, and overall survival., Results: Thirty-six of 45 masses were pheochromocytomas, 7 were adrenocortical carcinomas, and 2 were unknown type. Caval thrombus terminated prehepatically in 21 of 45 dogs and extended beyond the porta hepatis but terminated prediaphragmatically (intrahepatic prediaphragmatic location) in 15 dogs and thrombi extended postdiaphragmatically in 5 dogs. Thirty-four (76%) dogs were discharged from the hospital, and 11 (24%) dogs died or were euthanized prior to discharge. Median overall survival time for all 45 dogs was 547 days (95%CI 146-710). Bodyweight, tumor type, and size and extent of caval thrombus did not affect survival to discharge, but postdiaphragmatic (rather than prediaphragmatic) thrombus termination was associated with a greater risk of death., Conclusion: Long-term survival was common in dogs that survived the perioperative period. Postdiaphragmatic thrombus extension affected the prognosis for overall survival., Clinical Significance: Findings of this study help to stratify operative risk in dogs with adrenal neoplasia and caval invasion., (© 2019 The American College of Veterinary Surgeons.)

Objective: To determine the optimal intercostal space (ICS) to perform thoracoscopic-assisted lung lobectomy., Study Design: Cadaveric study., Animals: Six mature, medium-sized canine cadavers., Methods: Cadavers were placed in right or left lateral recumbency. A 15-mm thoracoscopic cannula was inserted in the middle third of the 9th or 10th ICS. A wound retraction device was placed into a 7-cm minithoracotomy incision created in the middle third of the 4th-7th ICS on the left side and the 4th-8th ICS on the right side. The pulmonary ligaments were sectioned by using a combined intracorporeal and extracorporeal technique. Each lung lobe was sequentially withdrawn from the wound retraction device at the respective ICS and side. A thoracoabdominal stapler was positioned to simulate lung lobectomy, and the distance from the stapler anvil to the hilus was measured., Results: Simulated thoracoscopic-assisted lung lobectomy performed at left or right ICS 4 and 5, compared with other ICS evaluated, resulted in a significantly shorter median distance from the stapler anvil to the pulmonary hilus of the left cranial and caudal lung lobes and right cranial and middle lung lobes, respectively (all P < .05). Lobectomy at right ICS 5 or 6 resulted in a significantly shorter median distance from the stapler anvil to the pulmonary hilus of the right caudal and accessory lung lobes, respectively (both P < .05)., Conclusion: These data may inform minithoracotomy positioning to optimize tumor margin excision during thoracoscopic-assisted lung lobectomy for treatment of pulmonary neoplasia in dogs., Clinical Significance: Complete lung lobectomy is possible by using the described thoracoscopic-assisted technique in normal, cadaveric lungs., (© 2018 The American College of Veterinary Surgeons.)

Objective: To determine laparoscopic accessibility of liver lobes and access to the hilus and describe laparoscopic microwave ablation (LMWA) in 2 dogs with hepatic neoplasia., Study Design: Experimental/descriptive case series., Sample Population: Six canine cadavers and 2 clinical dogs., Methods: Cadavers in dorsal recumbency underwent laparoscopic assessment of the liver. A 17 gauge MWA probe was inserted to create an ablation zone at the most proximal aspect of the hilus. The distance from the center of each ablation zone to the most proximal aspect of the corresponding hilus was determined. Two dogs with hepatic neoplasia underwent LMWA., Results: All lobes of the canine liver were accessible via laparoscopy. The median (interquartile range) distances from the ablation zones to the hilus for the caudate process, left lateral, left middle, quadrate, right lateral, and right middle lobes were 2.2 (1.2-2.6), 2.1 (1-4.4), 1.5 (1.4-3.7), 2, 1, 2.5 (1-4.1) cm, respectively. Histopathologic diagnoses treated by LMWA included metastatic hemangiosarcoma and primary hepatocellular carcinoma. Laparoscopic microwave ablation was technically feasible, and no complications from the procedure resulted., Conclusion: Laparoscopic access to the hilus of each liver lobe is possible via a ventrodorsal approach provided reverse Trendelenburg and lateral rotation is used, especially for the right lateral lobe. Laparoscopic microwave ablation is feasible in some dogs with hepatic neoplasia. The indications for and efficacy of LMWA for hepatic neoplasia in dogs requires additional investigation., Clinical Significance: Laparoscopic access to all liver lobes and MWA of some neoplastic lesions is feasible in a canine pilot study., (© 2019 The American College of Veterinary Surgeons.)

Objective: To report the outcome of dogs with presumptive echocardiographic idiopathic pericardial effusion treated with thoracoscopic pericardectomy and pericardioscopy., Study Design: Multi-institutional retrospective study (2011-2017)., Animals: Eighteen dogs., Methods: Records were searched for dogs with pericardial effusion and no identified cause by preoperative echocardiography and subsequent thoracoscopic pericardectomy and pericardioscopy. Collected data included presenting complaint, physical examination, laboratory results, imaging, and operative findings. Follow-up was obtained via telephone interview and/or recheck examination., Results: No evidence of mass lesions or cause for the effusion was identified in any of the dogs by preoperative echocardiography. Nine dogs had unremarkable pericardioscopic examination results. Nine dogs had pericardioscopic abnormalities consistent with masses, nodules, or adhesions. Median survival time (MST) for the 9 dogs with abnormalities identified by pericardioscopy was 66 days, whereas MST for the 9 dogs with unremarkable pericardioscopic examination results was not reached (P = .0067). Median survival time for dogs based on histopathologic diagnosis alone was not different between dogs with a diagnosis of neoplasia and dogs with a diagnosis of pericarditis (P = .1056). Among dogs with lesions identified during pericardioscopy, MST did not differ between those with a diagnosis of malignancy and those with a diagnosis of pericarditis (P = .78)., Conclusion: Dogs with presumptive idiopathic pericardial effusion without evidence of masses, nodules, and/or adhesions during thoracoscopic pericardectomy and pericardioscopy lived longer than dogs in which abnormalities were identified during pericardioscopy., Clinical Significance: Thoracoscopic pericardectomy/pericardioscopy and targeted biopsy of the pericardium and pleura are recommended in dogs with echocardiographic idiopathic pericardial effusion., (© 2018 The American College of Veterinary Surgeons.)

Objective: To evaluate the perceived efficacy of a high-fidelity synthetic canine model for simulating common gastrointestinal surgical procedures., Study Design: Survey of students and experienced clinicians., Sample Population: Twelve clinicians with >2 years of postgraduate experience in the field of small animal surgery and 102 senior year veterinary students., Methods: The model was subjectively evaluated by 12 clinicians with >2 years of postgraduate experience in the field of small animal surgery. Senior year veterinary students (n = 102) were asked to complete questionnaires before and after a laboratory on common gastrointestinal surgical procedures that included rating of perceived proficiency, anatomical knowledge, and the use of synthetic models compared with live animals., Results: Clinicians assessed most aspects of the model as moderately realistic and unanimously agreed that it would be helpful for students to train on this model prior to live surgery. Student survey response rates were 91% and 99% before and after the laboratory, respectively. The proportion of students that felt moderately-to-highly proficient with the procedures increased from 8% prior to the laboratories to 59% after the laboratories (P < .001). The proportion of students that felt that they had superior-to-excellent knowledge of abdominal surgical anatomy increased from 16% prior to the laboratories to 44% after the laboratories (P < .001). The proportion of students that were satisfied with synthetic models instead of live animals increased from 52% prior to the laboratories to 74% after the laboratories (P = .014)., Conclusion: Experienced clinicians considered the model to have moderate realism. A positive shift in the students' self-perceived proficiency with gastrointestinal surgery was evident after the use of the model., Clinical Impact: This synthetic model should be considered for training of veterinary gastrointestinal surgery. However, comparison studies are recommended to ascertain the relative educational value of this model., (© 2019 The American College of Veterinary Surgeons.)

Objective: To determine the ability of a polyacrylic acid-silicone radiolucent self-retaining gradual occlusion device (PAS-OD) to attenuate congenital extrahepatic portosystemic shunts (EHPSS) in dogs., Study Design: Prospective clinical trial., Animals: Six client-owned dogs with single, congenital EHPSS., Methods: Serum bile acids (SBA), abdominal ultrasonography, and computed tomographic angiography (CTA) were performed preoperatively and at 4 and 8 weeks postoperatively. Each dog was treated for EHPSS by placement of a PAS-OD., Results: PAS-OD were placed without complication an average of 4.3 seconds (range, 3-7) after isolation of the shunt. Median surgical time was 38.5 minutes (range, 28-84) including concurrent procedures. All dogs recovered from surgery without complications. SBA were normal in 5 of 6 dogs at 4 and 8 weeks after surgery. The shunt was completely attenuated in 2 of 6 dogs at 4 weeks and in 4 of 6 dogs at 8 weeks, without evidence of acquired shunt formation in any dog. The size and velocity of the portal vasculature were improved in 5 of 6 dogs according to 8-week postoperative CTA and ultrasonography results, respectively. The remaining dog had a persistently decreased portal vasculature size but a normal velocity according to 8-week postoperative CTA and ultrasound results, respectively., Conclusion: The PAS-OD led to complete attenuation in 4 of 6 dogs and partial attenuation with mild residual flow of 2 EHPSS over an 8-week period in dogs., Clinical Significance: The PAS-OD is a new option for gradual occlusion of congenital EHPSS over 8 weeks., (© 2018 The American College of Veterinary Surgeons.)

Objective: To describe pet owner preferences within the veterinary community when choosing operative techniques for canine spay., Study Design: Prospective survey., Sample Population: 1234 respondents from 5 veterinary university teaching hospitals in North America., Methods: An electronic survey was distributed to faculty, students, and staff that currently are or previously were dog owners. Responses were analyzed to determine what spay technique respondents would choose for their own dogs. Surgical options offered included open celiotomy, 2-port (TP) laparoscopy, single-port (SP) laparoscopy, and natural orifice transluminal endoscopic surgery (NOTES)., Results: TP laparoscopic ovariectomy (OVE) was the most popular choice, followed by SP laparoscopic OVE; NOTES was the least popular technique when all surgical options were available. If only minimally invasive surgeries were offered, 0.3% of respondents would refuse surgery. Nearly half (48%) of respondents were willing to spend between $100 and $200 more for a minimally invasive OVE than for an open celiotomy., Conclusion: Minimally invasive OVE is an acceptable operative approach to those in the veterinary community. Additional study is required to correlate these findings with the general veterinary client population., (© 2018 The American College of Veterinary Surgeons.)

Objective: To describe a technique and report complications and outcome for single-port laparoscopic splenectomy in dogs., Study Design: Retrospective study., Animals: Twenty-two client-owned dogs., Methods: Medical records of dogs that underwent single-port laparoscopic splenectomy at 4 veterinary teaching hospitals were evaluated. Commercially available single-port devices were used in all dogs. In all cases, a vessel-sealing device was used to perform a hilar splenectomy. After the procedure was completed, the spleen was exteriorized through the single-port device incision or placed into a specimen retrieval device; enlargement of the incision was required in some cases., Results: Median weight of dogs was 9.9 kg (interquartile range [IQR], 7.0-26.0). Splenectomy was performed because of splenic mass (n = 14), diffuse splenic disease (n = 4), or as adjunctive treatment for management of immune-mediated disease (n = 4). In cases with splenic masses, median maximal diameter of the largest splenic mass was 2.0 cm (IQR, 1.3-2.5). In 6 of 22 cases, mild splenic capsular bleeding occurred during the procedure. Conversion occurred in 6 of 22 cases to either a laparoscopic-assisted approach (n = 5) or an open celiotomy (n = 1). Reasons for conversion included large splenic dimensions (n = 3), adhesion formation (n = 1) or poor visualization resulting from abundant intra-abdominal fat (n = 1) or hemorrhage (n = 1). Heavier body weight was significantly associated with conversion (odds ratio, 1.62; 95% confidence interval, 1.05-2.51), but body condition score, having a splenic mass, splenic mass size, and surgical time were not., Conclusion: Single-port laparoscopic splenectomy is an effective approach for elective splenectomy in dogs. The technique may be well suited to smaller dogs with modestly sized splenic masses or diffuse splenic disease., (© 2017 The American College of Veterinary Surgeons.)

Objective: To compare clinical outcomes of dogs with congenital intrahepatic portosystemic shunts (CIHPSS) treated with cellophane banding (CB) or percutaneous transvenous coil embolization (PTCE)., Study Design: Dual-institutional retrospective study., Animals: Fifty-eight dogs with CIHPSS (2001-2016)., Methods: Medical records of dogs undergoing CB or PTCE for CIHPSS were reviewed for signalment, body weight, hematologic values, shunt location, attenuation technique, procedure time, duration of hospitalization, complications, date of follow-up, and cause of death if applicable., Results: Thirty-one dogs underwent CB, and 27 dogs underwent PTCE. No differences were detected between groups for gender, preoperative packed cell volume, albumin, cholesterol, or bile acids. Body weight was greater in dogs treated via PTCE. Shunts differed in location because dogs undergoing CB were diagnosed with more left divisional shunts compared with PTCE dogs. Procedural duration of CB and PTCE did not differ. Dogs treated with CB sustained more minor postoperative complications and were hospitalized longer than dogs treated with PTCE. The 1-year and 2-year survival rates were 89% for the CB group and 87% and 80% for the PTCE group, respectively. The proportion surviving at 5 years was 75% and 80% for CB dogs and PTCE dogs, respectively., Conclusion: CB and PTCE are associated with similar short-term and intermediate-term survival. PTCE is a minimally invasive alternative to CB via celiotomy. However, CB allows concurrent abdominal procedures requiring the same approach., (© 2017 The American College of Veterinary Surgeons.)

Emerging coronaviruses (CoVs) cause severe disease in humans, but no approved therapeutics are available. The CoV nsp14 exoribonuclease (ExoN) has complicated development of antiviral nucleosides due to its proofreading activity. We recently reported that the nucleoside analogue GS-5734 (remdesivir) potently inhibits human and zoonotic CoVs in vitro and in a severe acute respiratory syndrome coronavirus (SARS-CoV) mouse model. However, studies with GS-5734 have not reported resistance associated with GS-5734, nor do we understand the action of GS-5734 in wild-type (WT) proofreading CoVs. Here, we show that GS-5734 inhibits murine hepatitis virus (MHV) with similar 50% effective concentration values (EC 50 ) as SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). Passage of WT MHV in the presence of the GS-5734 parent nucleoside selected two mutations in the nsp12 polymerase at residues conserved across all CoVs that conferred up to 5.6-fold resistance to GS-5734, as determined by EC 50 The resistant viruses were unable to compete with WT in direct coinfection passage in the absence of GS-5734. Introduction of the MHV resistance mutations into SARS-CoV resulted in the same in vitro resistance phenotype and attenuated SARS-CoV pathogenesis in a mouse model. Finally, we demonstrate that an MHV mutant lacking ExoN proofreading was significantly more sensitive to GS-5734. Combined, the results indicate that GS-5734 interferes with the nsp12 polymerase even in the setting of intact ExoN proofreading activity and that resistance can be overcome with increased, nontoxic concentrations of GS-5734, further supporting the development of GS-5734 as a broad-spectrum therapeutic to protect against contemporary and emerging CoVs. IMPORTANCE Coronaviruses (CoVs) cause severe human infections, but there are no approved antivirals to treat these infections. Development of nucleoside-based therapeutics for CoV infections has been hampered by the presence of a proofreading exoribonuclease. Here, we expand the known efficacy of the nucleotide prodrug remdesivir (GS-5734) to include a group β-2a CoV. Further, GS-5734 potently inhibits CoVs with intact proofreading. Following selection with the GS-5734 parent nucleoside, 2 amino acid substitutions in the nsp12 polymerase at residues that are identical across CoVs provide low-level resistance to GS-5734. The resistance mutations decrease viral fitness of MHV in vitro and attenuate pathogenesis in a SARS-CoV animal model of infection. Together, these studies define the target of GS-5734 activity and demonstrate that resistance is difficult to select, only partial, and impairs fitness and virulence of MHV and SARS-CoV, supporting further development of GS-5734 as a potential effective pan-CoV antiviral., (Copyright © 2018 Agostini et al.)

Coronaviruses (CoVs) are positive-sense RNA viruses that infect numerous mammalian and avian species and are capable of causing severe and lethal disease in humans. CoVs encode several innate immune antagonists that counteract the host innate immune response to facilitate efficient viral replication. CoV nonstructural protein 14 (nsp14) encodes 3'-to-5' exoribonuclease activity (ExoN), which performs a proofreading function and is required for high-fidelity replication. Outside of the order Nidovirales , arenaviruses are the only RNA viruses that encode an ExoN, which functions to degrade double-stranded RNA (dsRNA) replication intermediates. In this study, we tested the hypothesis that CoV ExoN also functions to antagonize the innate immune response. We demonstrate that viruses lacking ExoN activity [ExoN(-)] are sensitive to cellular pretreatment with interferon beta (IFN-β) in a dose-dependent manner. In addition, ExoN(-) virus replication was attenuated in wild-type bone marrow-derived macrophages (BMMs) and partially restored in interferon alpha/beta receptor-deficient (IFNAR -/- ) BMMs. ExoN(-) virus replication did not result in IFN-β gene expression, and in the presence of an IFN-β-mediated antiviral state, ExoN(-) viral RNA levels were not substantially reduced relative to those of untreated samples. However, ExoN(-) virus generated from IFN-β-pretreated cells had reduced specific infectivity and decreased relative fitness, suggesting that ExoN(-) virus generated during an antiviral state is less viable to establish a subsequent infection. Overall, our data suggest murine hepatitis virus (MHV) ExoN activity is required for resistance to the innate immune response, and antiviral mechanisms affecting the viral RNA sequence and/or an RNA modification act on viruses lacking ExoN activity. IMPORTANCE CoVs encode multiple antagonists that prevent or disrupt an efficient innate immune response. Additionally, no specific antiviral therapies or vaccines currently exist for human CoV infections. Therefore, the study of CoV innate immune antagonists is essential for understanding how CoVs overcome host defenses and to maximize potential therapeutic interventions. Here, we sought to determine the contributions of nsp14 ExoN activity in the induction of and resistance to the innate immune response. We show that viruses lacking nsp14 ExoN activity are more sensitive than wild-type MHV to restriction by exogenous IFN-β and that viruses produced in the presence of an antiviral state are less capable of establishing a subsequent viral infection. Our results support the hypothesis that murine hepatitis virus ExoN activity is required for resistance to the innate immune response., (Copyright © 2017 American Society for Microbiology.)

The coronavirus (CoV) RNA genome is the largest among the single-stranded positive-sense RNA viruses. CoVs encode a proofreading 3'-to-5' exoribonuclease within nonstructural protein 14 (nsp14-ExoN) that is responsible for CoV high-fidelity replication. Alanine substitution of ExoN catalytic residues [ExoN(-)] in severe acute respiratory syndrome-associated coronavirus (SARS-CoV) and murine hepatitis virus (MHV) disrupts ExoN activity, yielding viable mutant viruses with defective replication, up to 20-fold-decreased fidelity, and increased susceptibility to nucleoside analogues. To test the stability of the ExoN(-) genotype and phenotype, we passaged MHV-ExoN(-) 250 times in cultured cells (P250), in parallel with wild-type MHV (WT-MHV). Compared to MHV-ExoN(-) P3, MHV-ExoN(-) P250 demonstrated enhanced replication and increased competitive fitness without reversion at the ExoN(-) active site. Furthermore, MHV-ExoN(-) P250 was less susceptible than MHV-ExoN(-) P3 to multiple nucleoside analogues, suggesting that MHV-ExoN(-) was under selection for increased replication fidelity. We subsequently identified novel amino acid changes within the RNA-dependent RNA polymerase and nsp14 of MHV-ExoN(-) P250 that partially accounted for the reduced susceptibility to nucleoside analogues. Our results suggest that increased replication fidelity is selected in ExoN(-) CoVs and that there may be a significant barrier to ExoN(-) reversion. These results also support the hypothesis that high-fidelity replication is linked to CoV fitness and indicate that multiple replicase proteins could compensate for ExoN functions during replication. IMPORTANCE Uniquely among RNA viruses, CoVs encode a proofreading exoribonuclease (ExoN) in nsp14 that mediates high-fidelity RNA genome replication. Proofreading-deficient CoVs with disrupted ExoN activity [ExoN(-)] either are nonviable or have significant defects in replication, RNA synthesis, fidelity, fitness, and virulence. In this study, we showed that ExoN(-) murine hepatitis virus can adapt during long-term passage for increased replication and fitness without reverting the ExoN-inactivating mutations. Passage-adapted ExoN(-) mutants also demonstrate increasing resistance to nucleoside analogues that is explained only partially by secondary mutations in nsp12 and nsp14. These data suggest that enhanced resistance to nucleoside analogues is mediated by the interplay of multiple replicase proteins and support the proposed link between CoV fidelity and fitness., (Copyright © 2017 Graepel et al.)

OBJECTIVE To describe surgical techniques and perioperative management of dogs with von Willebrand disease (VWD) or factor VII (FVII) deficiency undergoing laparoscopic ovariohysterectomy or ovariectomy and evaluate outcomes. DESIGN Retrospective case series. ANIMALS 20 client-owned dogs with VWD (n = 16) or FVII deficiency (4). PROCEDURES Dogs with VWD or FVII deficiency that underwent laparoscopic ovariohysterectomy or ovariectomy between 2012 and 2014 were retrospectively identified via a multi-institutional review of medical records. RESULTS Median expression of von Willebrand factor was 19% (interquartile range, 18% to 30%). All 16 dogs with VWD were Doberman Pinschers, and all were pretreated with desmopressin; 4 also received cryoprecipitate. One of 4 dogs with FVII deficiency received plasma preoperatively, and 1 was treated with desmopressin; 2 dogs received no preoperative treatment. Laparoscopic ovariectomy was performed in 9 dogs with VWD and 2 dogs with FVII deficiency, laparoscopic ovariectomy with gastropexy was performed in 6 dogs with VWD and 1 dog with FVII deficiency, and laparoscopic-assisted ovariohysterectomy was performed in 1 dog with VWD and 1 dog with FVII deficiency. Iatrogenic splenic laceration requiring conversion to laparotomy occurred during trocar insertion in 1 dog with VWD. No postoperative complications, including signs of hemorrhage, were reported for any dogs. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopic ovariohysterectomy or ovariectomy in dogs with VWD or FVII deficiency pretreated with desmopressin, cryoprecipitate, or plasma transfusions were not associated with clinical signs of hemorrhage, suggesting that minimally invasive ovariohysterectomy or ovariectomy may be considered in female dogs affected with these coagulopathies.

Objective: To describe video-assisted microwave ablation (VAMA) for the treatment of a metastatic lung lesion secondary to right forelimb osteosarcoma in a dog., Study Design: Case report., Animals: A 10-year-old female spayed mixed breed dog with a metastatic lung lesion secondary to appendicular osteosarcoma., Methods: An osteosarcoma of the right distal scapula and proximal humerus that was suspected to be a radiation-induced osteosarcoma was treated with limb amputation and carboplatin chemotherapy. The patient developed pulmonary metastatic lesions and hypertrophic osteopathy (HO). VAMA of a metastatic lesion in the right caudal lung lobe was performed 227 days after amputation. The procedure was performed without complication., Results: Follow-up information with the referring veterinarian 40 days after VAMA indicated that the patient was stable and that the clinical signs of HO had resolved. Thoracic radiographs taken by the referring veterinarian (RDVM) at monthly intervals showed that the previously treated metastatic lesion was stable. At 134 days from VAMA, the patient presented to the RDVM for lethargy and dyspnea and was transferred to an emergency clinic. The patient arrested and died 136 days from the VAMA procedure while hospitalized. A postmortem was not performed., Conclusion: VAMA for pulmonary metastatic lesions is technically feasible and allows for the treatment of symptoms associated with HO and minimally invasive management of pulmonary metastases in the case reported., (© 2017 The American College of Veterinary Surgeons.)

Objective: To describe the surgical technique and evaluate short-term outcome after minimally invasive small intestinal exploration and targeted organ biopsy with a wound retractor device (WRD) in cats., Study Design: Multi-institutional retrospective study., Animals: Forty-two cats., Methods: A wound retractor was inserted into the abdomen on the ventral midline through a 2-4 cm incision at the level of the umbilicus. Short segments (6-10 cm long) of intestinal tract were sequentially exteriorized and explored through the WRD. Full thickness, small intestinal biopsies were obtained extracorporeally via the WRD. A commercially available single-port device was inserted through the WRD for laparoscopic exploration of the abdomen., Results: The majority of the small intestine could be exteriorized and explored through the WRD. In all cases, full thickness biopsies of the small intestine of diagnostic quality were obtained. The most common histological findings were inflammatory bowel disease (n = 16), intestinal lymphoma (n = 14), and eosinophilic enteritis (n = 7). Two cases required conversion to a traditional open laparotomy due to abdominal pathology diagnosed after placement of the WRD (abdominal adhesions and need for a splenectomy). Postoperative complications occurred in 4 of 39 cats (10.3%), leading to 2 deaths after discharge from the hospital., Conclusions and Clinical Relevance: MISIETB with a WRD alone or combined with laparoscopy is a safe technique for small intestinal exploration and targeted abdominal organ biopsy in cats. Single-port laparoscopy can effectively be performed through the WRD for complete abdominal exploration and biopsy of abdominal organs., (© 2017 The American College of Veterinary Surgeons.)

CASE DESCRIPTION A 17-month-old neutered female Labrador Retriever with a 3- to 4-month history of abdominal distention was referred for evaluation and treatment. CLINICAL FINDINGS Evaluation of a peritoneal fluid specimen collected by the referring veterinarian indicated a pure transudate. At admission, transabdominal ultrasonography revealed microhepatica, dilation of the intrahepatic and mesenteric vasculature, peritoneal effusion, and multiple aberrant blood vessels. A large, high-flow hepatic arteriovenous malformation (HAVM) with secondary portal hypertension, peritoneal effusion, multiple acquired portosystemic shunts, and microhepatica was evident on CT angiography. TREATMENT AND OUTCOME Transfemoral hepatic arteriography and staged coil and glue (n-butyl cyanoacrylate) embolization of the complex arteriovenous malformation nidus and central main left hepatic artery resulted in ablation of the lesion, restoration of arterial blood flow to the contralateral hepatic lobes, and resolution of the peritoneal effusion. The dog remained without clinical signs of hepatic disease until it was euthanized 5 months after treatment for an unrelated condition. CLINICAL RELEVANCE Successful endovascular management of a HAVM was accomplished by means of coil and glue embolization in the patient of this report. Dogs with comparable HAVMs may benefit from similar minimally invasive treatment.

Objective: To evaluate the use of sonication to improve recovery of bacteria from metal discs infected with bacteria commonly associated with implant infections in veterinary medicine., Methods: In vitro study in which sterile titanium (Ti6Al4V) and stainless steel (AIS1316-L) discs were incubated with either Staphylococcus pseudintermedius or Pseudomonas aeruginosa for 24 hours. The following three groups were compared: 1) the sonication group involved immersing the discs in sterile saline and sonicating for five minutes; 2) the sham group was considered a negative control in which the discs were immersed in saline for five minutes without sonication; and 3) the swab group involved systematically swabbing the implant with a sterile culturette. All samples were plated on blood agar and incubated for 24 hours. Colonies were then counted and compared., Results: For both species of bacteria, there was a significant increase in bacterial colonies isolated using sonication compared to the other two study groups (p = 0.0001). No differences in bacterial growth were found between the two types of metal implants. There was a significant increase in bacterial colony counts for S. pseudintermedius when comparing the swab group versus the sham group, but this was not significant for P. aeruginosa., Clinical Significance: Sonication significantly improves recovery of bacteria commonly associated with veterinary implant-associated surgical site infections compared to swabbing of implants in vitro. A prospective clinical evaluation is indicated to determine the in vivo efficacy of sonication in veterinary patients.

OBJECTIVE To evaluate the feasibility of laparoscopy versus exploratory laparotomy for the diagnosis of specific lesions in dogs with suspected gastrointestinal obstruction. DESIGN Controlled trial. ANIMALS 16 client-owned dogs with physical and radiographic findings consistent with gastrointestinal obstruction. PROCEDURES Single-incision laparoscopy with intracorporeal and extracorporeal examination of the gastrointestinal tract was performed by 1 surgeon. Immediately afterward, exploratory laparotomy was performed by a second surgeon. Accessibility and gross appearance of organs, surgical diagnoses, incision lengths, procedure duration, and complications were compared between diagnostic techniques. RESULTS Mean (95% confidence interval) incision length was 4.9 cm (3.9 to 5.9 cm) for laparoscopy and 16.4 cm (14.0 to 18.7 cm) for exploratory laparotomy. Mean (95% confidence interval) procedure duration was 36.8 minutes (31.6 to 41.2 minutes) and 12.8 minutes (11.4 to 14.3 minutes), respectively. Diagnoses of the cause of obstruction were the same with both methods. In 13 dogs, the laparoscopic examination was successfully completed, and in the other 3, it was incomplete. In 4 dogs in which laparoscopy was successful, conversion to exploratory laparotomy or considerable extension of the laparoscopic incision would have been required to allow subsequent surgical treatment of identified lesions. No dogs developed major complications, and minor complication rates were similar between procedures. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopy was feasible and clinically applicable in dogs with suspected gastrointestinal obstruction. Careful patient selection and liberal criteria for conversion to an open surgical approach are recommended when laparoscopy is considered for the diagnosis of gastrointestinal lesions in dogs.

OBJECTIVE To evaluate the usefulness of noncontrast abdominal CT and abdominal ultrasonography for the detection of mechanical gastrointestinal obstruction in dogs and compare intestinal diameter ratios between dogs with and without obstruction. DESIGN Controlled trial. ANIMALS 16 client-owned dogs with physical and radiographic findings consistent with mechanical gastrointestinal obstruction. PROCEDURES Abdominal ultrasonography and CT were performed for all dogs, followed by laparoscopy and exploratory laparotomy. Time required for image acquisition and presence and location of gastrointestinal obstruction were assessed with both imaging modalities. Findings were compared with those of exploratory surgery. Maximum and minimum intestinal diameters were recorded on CT scans; values were converted to a ratio and compared between dogs with and without obstruction. RESULTS Results of abdominal CT and exploratory surgery for the diagnosis of mechanical obstruction agreed for all 16 dogs; 10 dogs had complete obstruction, 3 had partial obstruction, and 3 had no obstruction. In 1 dog with functional ileus, abdominal ultrasonography resulted in an incorrect diagnosis of mechanical obstruction. Median (interquartile range) image acquisition time for abdominal CT (2.5 minutes [2.0 to 3.8 minutes]) was markedly and significantly shorter than that for ultrasonography (26.0 minutes [22.0 to 35.8 minutes]). In both dorsal and transverse CT planes, dogs with gastrointestinal obstruction (partial or complete) had significantly larger intestinal diameter ratios than dogs without obstruction. CONCLUSIONS AND CLINICAL RELEVANCE Abdominal CT was feasible, rapid, and accurate for the diagnosis of mechanical obstruction in dogs with clinical signs and physical examination findings consistent with partial or complete gastrointestinal obstruction.

Objective: To report the perioperative findings and outcome of dogs undergoing video-assisted thoracic surgery (VATS) for the management of pyothorax., Design: Multi-institutional, retrospective study., Animals: Client-owned dogs (n = 14)., Methods: Medical records of dogs with pyothorax managed via VATS were reviewed for signalment, history, clinical signs, clinicopathological findings, diagnostic imaging results, surgical variables, bacterial culture and sensitivity results, post-operative management and outcome. VATS was performed after placing a paraxyphoid endoscopic portal and 2-3 intercostal instrument portals. VATS exploration was followed by one or more of the following: mediastinal debridement, tissue sampling, pleural lavage, and placement of a thoracostomy tube., Results: Two dogs (14%) required conversion from VATS to an open thoracotomy to completely resect proliferative mediastinal tissue. These dogs had severe pleural effusion on preoperative thoracic radiographs and one had severely thickened contrast-enhancing mediastinum on preoperative computed tomography (CT). The cause of pyothorax was identified as a penetrating gastric foreign body (n = 2), migrating plant material (n = 2), and idiopathic (n = 10). The median follow-up time was 143 days (range, 14-2402 days). All dogs were discharged from the hospital and their clinical signs resolved. One patient had recurrence of a pyothorax requiring revision surgery 17 months postoperatively., Conclusion: VATS allows minimally invasive treatment of uncomplicated canine pyothorax. Preoperative thoracic CT may help identify candidates for VATS among dogs with pyothorax., (© 2017 The American College of Veterinary Surgeons.)

Emerging viral infections are difficult to control because heterogeneous members periodically cycle in and out of humans and zoonotic hosts, complicating the development of specific antiviral therapies and vaccines. Coronaviruses (CoVs) have a proclivity to spread rapidly into new host species causing severe disease. Severe acute respiratory syndrome CoV (SARS-CoV) and Middle East respiratory syndrome CoV (MERS-CoV) successively emerged, causing severe epidemic respiratory disease in immunologically naïve human populations throughout the globe. Broad-spectrum therapies capable of inhibiting CoV infections would address an immediate unmet medical need and could be invaluable in the treatment of emerging and endemic CoV infections. We show that a nucleotide prodrug, GS-5734, currently in clinical development for treatment of Ebola virus disease, can inhibit SARS-CoV and MERS-CoV replication in multiple in vitro systems, including primary human airway epithelial cell cultures with submicromolar IC 50 values. GS-5734 was also effective against bat CoVs, prepandemic bat CoVs, and circulating contemporary human CoV in primary human lung cells, thus demonstrating broad-spectrum anti-CoV activity. In a mouse model of SARS-CoV pathogenesis, prophylactic and early therapeutic administration of GS-5734 significantly reduced lung viral load and improved clinical signs of disease as well as respiratory function. These data provide substantive evidence that GS-5734 may prove effective against endemic MERS-CoV in the Middle East, circulating human CoV, and, possibly most importantly, emerging CoV of the future., (Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

OBJECTIVE To characterize clinical findings, surgical procedures, complications, and outcomes in dogs undergoing extirpation of masses from the cranial mediastinum via video-assisted thoracic surgery (VATS) and establish preliminary guidelines for case selection when considering VATS for thymectomy in dogs. DESIGN Retrospective case series. ANIMALS 18 client-owned dogs that underwent extirpation of a cranial mediastinal mass by means of VATS at 5 academic referral hospitals from 2009 through 2014. PROCEDURES Medical records were reviewed and data extracted regarding signalment, clinical signs, physical examination findings, diagnostic imaging results, surgical approach and duration, cytologic and histologic examination results, complications, outcome, and cause of death, when applicable. RESULTS 16 dogs had a thymoma, 1 had thymic anaplastic carcinoma, and 1 had hemangiosarcoma. Seven had both megaesophagus and myasthenia gravis. Median approximate tumor volume was 113.1 cm 3 (interquartile range, 33.5 to 313.3 cm 3 ). Median duration of VATS was 117.5 minutes (interquartile range, 91.5 to 136.3 minutes). Conversion to an open thoracic surgical procedure was required for 2 dogs, 1 of which died during surgery. Median survival time following VATS for dogs with thymoma and concurrent myasthenia gravis and megaesophagus was 20 days. Dogs with thymoma without paraneoplastic syndrome survived for ≥ 60 days, and none of these dogs died of disease-related causes. CONCLUSIONS AND CLINICAL RELEVANCE VATS appeared to be an acceptable approach for extirpation of masses from the cranial mediastinum in dogs under certain conditions. Dogs with myasthenia gravis and megaesophagus had a poor postoperative outcome.

OBJECTIVE To evaluate the economic and clinical feasibility of introducing rigid endoscopy and laparoscopy to a small animal general practice. DESIGN Prospective study. SAMPLE A single 2-veterinarian small animal practice in southern California. PROCEDURES In early 2012, endoscopic equipment was purchased, and both veterinarians in the practice undertook training in rigid endoscopic and laparoscopic procedures. Subsequently, information for client-owned animals that underwent endoscopic and laparoscopic procedures during a 12-month period (2012 to 2013) was collected. Cost of equipment and training, revenue generated, specific procedures performed, surgery time, complications, and client satisfaction were evaluated. RESULTS 78 endoscopic procedures were performed in 73 patients, including 71 dogs, 1 cat, and 1 rabbit. Cost of endoscopic and laparoscopic equipment and training in the first year was $14,809.71; most equipment was financed through a 5-year lease at a total cost of $57,507.70 ($ 10,675.20/y). Total revenue generated in the first year was $50,423.63. The most common procedures performed were ovariectomy (OVE; n = 49), prophylactic gastropexy (6), and video otoscopy (12). Mean ± SD surgery times for OVE (n = 44) and for OVE with gastropexy (5) were 63.7 ± 19.7 minutes and 73.0 ± 33.5 minutes; respectively. Twelve of 54 patients undergoing laparoscopic procedures experienced minor intraoperative complications. Conversion to laparotomy was not required in any patient. There were no major complications. All 49 clients available for follow-up were satisfied. CONCLUSIONS AND CLINICAL RELEVANCE With appropriate training and equipment, incorporation of basic rigid endoscopy and laparoscopy may be feasible in small animal general practice. However, results of the present study are not applicable to all veterinarians and practice settings, and patient safety considerations should always be paramount.

Objective: To describe the use and outcome of a single, simple continuous, barbed suture line for prophylactic, total laparoscopic gastropexy in dogs., Study Design: Multi-center, retrospective case series., Animals: Sixty-three client-owned dogs., Methods: Medical records of dogs undergoing total laparoscopic gastropexy using a barbed suture at 4 academic veterinary hospitals from 2011-2015 were reviewed. Data collected included signalment, procedure time, procedure-associated complications, short-term complications, and long-term outcome. All procedures were performed under general anesthesia in dorsal to dorsal-left oblique recumbency. Laparoscopic ports were placed on ventral midline in 1 of 3 port configurations, and 5 mm laparoscopic needle drivers were used for intracorporeal sutured gastropexy with unidirectional barbed suture. The gastropexy was positioned just caudal to the 13th rib, 2-4 cm lateral to the rectus abdominis muscle., Results: Sixty-three dogs underwent total laparoscopic gastropexy with a single, simple continuous, barbed suture line. Median gastropexy surgery time was 70 minutes (interquartile range [IQR] 60-90 minutes). One dog sustained splenic laceration from Veress needle penetration during initial abdominal insufflation. Short term (>24 hours to 6 months postoperative) complications included incisional seroma formation (n = 2) and suture reaction (n = 1). Long term (>6 months postoperative) complications included intermittent regurgitation and chronic diarrhea in 1 dog. Fifteen dogs had postoperative ultrasound and all had intact gastropexy sites., Conclusion: Total laparoscopic barbed gastropexy using a single, simple continuous, barbed suture line in dogs is safe and results in an intact gastropexy long term., (© 2016 The American College of Veterinary Surgeons.)