Para se escolher uma técnica cirúrgica em relação a outra, é necessário avaliar A cistotomia com hidropulsão uretral bidirecional apresenta sucesso em sete. Esse paciente foi novamente submetido à cistotomia laparoscópica similar sem a ocorrência de complicações. A técnica proposta foi adequada e pode ser. Después de más de 30 años de experiencia, en nuestras manos la técnica de neoimplante ureteral extravesical de Lich-Gregoir presenta.
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Laparoscopic cystotomy for urolith removal in dogs: Brun I ; S. Oliveira II ; S. Messina I ; R. Stedile II ; R. The use of laparoscopic surgery for the removal of cystic calculi in three dogs was reported.
Three trocars were used, one in the ventral midline 10mm and the others in the right 10mm and left 5mm flanks. The calculi were removed and the bladder was sutured with intracorporeal technique in two layers, a simple continuous pattern and interrupted or continuous Lembert pattern.
No postoperative complications were observed. One patient had a recurrence of urolithiasis, attributed to inadequate conservative treatment and to the lack of an appropriate diet. It was submitted to another similar videolaparoscopic cystotomy without complication. The proposed technique is appropriate and an alternative to conventional cystotomy for treatment of canine vesical urolithiasis. This surgical removal is indicated for obstructive lithiasis, except for those constituted of magnesium ammonium phosphate Waldron,permitting uroliths analysis Fossum, Endoscopic surgery was initially used in urinary tract of dogs for diagnostics purposes Grauer et al.
Latter, laparoscopic surgery was used for treatments of different diseases such as dioctophimosis Brun et al. Despite the existence of different endoscopic cystotomy techniques Rawlings et al. In that study, the dogs were positioned in Trendelenburg position and one mm trocar was introduced in the ventral midline. Similar trocar was introduced in the peritoneal cavity, in the ventral midline or paramedially, depending on the sex of the patients. The bladder was grasped by Babcock forceps and externalized from the cavity, allowing the introduction of the cystoscope through the organ wall with removal of the lithiasis.
Laparoscopic cystotomy for urolith removal in dogs: three case reports
The suitability of laparoscopic surgery in the management of cystic calculi in a cat was also reported Brun et al. Given that laparoscopic surgery has been more advantageous to humans than conventional surgery in terms of recovery and postoperative pain, esthetics and early return to normal activities Monson et al. Three female dogs diagnosed with bladder uroliths were submitted to laparoscopic cystotomy, with the consent of their owners.
The first patient was a four-year-old Poodle Standard, not spayed, weighting 12kg. This dog had presented dysuria and hematuria for four months clstotomia abdominal pain during the physical exam, but it was afebrile.
In the radiographic exam, three triangular calculi were visualized within the bladder. Ultrasonography confirmed the presence of the calculi. Urine was collected by cystocentesis technique and confirmed hematuria, proteinuria, pyuria, bacteriuria, and bilirubinuria were confirmed.
The urine pH and specific gravity were 7. Considering the size of the calculi, yecnica 3. Subsequent chemical analysis showed that they were constituted of carbonate, oxalate, calcium phosphate, and of magnesium ammonium phosphate. The animal did not demonstrate signs of further urolithiasis six months after surgery. But, eighteen months later, the patient returned with hematuria.
The owner said that the animal had not been fed the special diet. Radiography showed two vesical calculi. At the request of the owner, repeat videolaparoscopic cystotomy was performed, using the same technique that will be cistoto,ia furtherexcept for an interrupted Lembert pattern in the second bladder layer.
In this surgery, the adhered omentum was seen in the ventral bladder wall and in the transverse abdominal muscle, where the 10mm lateral trocar tecncia positioned. The surgery lasted 60 minutes and there were no complications. In the post-operative period, the patient showed a primary cicatrisation and no signs of urolithiasis for 12 months. The second patient was an adult mongrel bitch, weighing 8kg, with a small ventral abdominal hernia and no absorbable sutures in the ventral cistktomia line.
Hematuria and pollakiuria were detected in this dog. Ultrasonographically, similar images as in the first animal were obtained; but, the bitch had a single round-shaped calculus 3. The values of hematology were unremarkable. The alanine amino-transferase Calculi analysis revealed carbonate, oxalate, calcium, magnesium, and ammonia. Sixteen months after surgery, the animal did not demonstrate signs or new urolithiasis. The third patient was an 8kg adult mongrel bitch, with incontinence and hematuria of unknown duration.
Physical exam revealed a solid mass in the urinary bladder. In the radiographic exam, two rounded-shaped calculi were observed 3 x 2cm. Bladder wall thickening was also evident. Values of hematocrit Hematology demonstrated macrocytic anemia 4, Leukocytosis was observed 24, Urine was collected by catheter.
Urinary pH and specific gravity were 7.
Severe hematuria, proteinuria, pyuria, bacteriuria, and bilirubinuria were observed. The chemical analysis of the calculi demonstrated that they were constituted of carbonate, oxalate, calcium, magnesium, and ammonia. Ten months after surgery the dog had no recurrence. In all surgeries, the animals were positioned in horizontal recumbency. An incision was made in the ventral medium line 2cm distal to the umbilical scar.
In the first patient, pneumoperitoneum with CO 2 was created through a Veress needle inserted in the operative wound. In the other two animals, a 10mm trocar was employed.
One bitch had been previously undergone a celiotomy and presented small ventral abdominal hernia. The intracavitary pressure was stabilized at 12mmHg through the trocar positioned in the ventral medium line.
Two more trocars were introduced via the flanks, one in the right lateral 10mm and the other in the left lateral 5mmcreating a triangular disposition Fig. A longitudinal incision in the ventral surface of the organ was made after grasping the bladder with Babcock forceps, in the first patient using a harmonic scalpel, and in the others by Metzenbaum scissors. The calculi were removed with Kelly or grasping forceps and placed in a specimen retrieval bag.
After inspection of the interior of the bladder, the bladder wall was in closed two layers of buried sutures with polyglycolic acid avoiding the mucous layer. In the first layer, the simple continuous pattern was used; and in the second layer, the suture was made with interrupted Lembert in the first dog Fig.
In the other two animals, a continuous Lembert was employed. The efficacy of the tecniva suture layer was checked by filling the bladder with saline solution by a Foley catheter.
An omental flap was placed over the vesical wound in cistotomiia first patient; but in the others, omentum was sutured in the bladder with simple interrupted sutures.
The specimen retrieval bag was grasped with Kelly forceps and exteriorized from the abdominal cavity through the right trocar. An cistoyomia lengthening of the wound was necessary to break the calculus inside the tissue bag and then they were removed. After the drainage of CO 2 from the cavity and trocar removal, the suture of the larger operative wounds 10mm trocars was made in two layers, one in the parietal musculature and the other in the skin.
The smaller wound 5mm trocar was closed in a simple pattern. A Sultan pattern was used in the musculature; and in the skin an interrupted simple suture using nylon was performed. Postoperative care comprised antibiotics: Cleaning of the operative wounds with saline solution was undertaken every 8 hours. To avoid the recurrence of urolithiasis, a special diet was indicated.
No complication during the operative and post-operative periods was observed.
The number and position of the trocars and the instrumentation were effective for the procedures. The time necessary to remove all the uroliths in each patient was, respectively: All the costotomia were discharged three days after surgery. A special commercial diet 9 was prescribed after surgery.
The Foley catheters were removed on the first or second postoperative day. All the patients ate solid food from the first postoperative day. After seven days, the skin sutures were removed and the wounds healed uneventfully.
In this work, the use of laparoscopic surgery to remove the lithiasis was preferred considering the better results in relation to the conventional surgery, mainly the ones related to the post-operative period Monson et al.
The technique of Rawlings et al. A simple continuous with Lembert suture patterns were selected, as suggested by Waldron and Fossum The continuous horizontal mattress could be used, as mentioned by Rudd and Hendrickson ; but, in this study the authors opted for the continuous simple suture, because it promotes a better occlusion for the water and the air Toombs and Bauer, Differently from Edwards III et al.
The animals of this study were maintained in cistotoomia recumbency without inclination though the Trendelenberg positioning could have tecncia laparoscopy. Respiratory and circulatory dysfunctions were not associated with the adopted position; but be could with the inclination of the patient Allen, The omentopexy followed what Rawlings et al.
According to Rudd and Hendricksonthe position of the intravesical endoscope during surgery facilitated the visualization of the vesical mucosa and the proximal urethra in all patients, aiding disposal of remaining calculus particles, a common mistake associated with the surgical treatment of urolithiasis Fossum, As the only alteration in the patients of this study was the recurrence in the first patient, without correlation with the procedure, the proposed technique can be used as alternative to the cystotomy for celiotomy in treatment of bladder calculi in dogs.
Anesthesia for minimally invasive surgery. Laparoscopic repair of a bladder rupture in a foal.