Professional Documents
Culture Documents
Pure-transvaginal
Santa Maria,natural
v.42, n.7,
orifice
p.1237-1242,
transluminal
jul,endoscopic
2012
surgery (NOTES) ovariohysterectomy in bitches:...
1237
ISSN 0103-8478
Ovrio-histerectomia transvaginal pura por abordagem endoscpica transluminal por orifcios naturais
(NOTES) em cadelas: estudo preliminar de factibilidade da tcnica
Marco Augusto Machado SilvaI Gilson Hlio ToniolloII Karym Christine de Freitas CardosoIII
Carolina QuarteroneI Maurcio Veloso BrunIV
ABSTRACT
Natural orifice transluminal endoscopic surgery
(NOTES) is a relatively new surgical access for minimally
invasive surgery, which is being widely studied in human
medicine. However, few studies focusing on its applicability in
the small animal practice have been performed so far. The aim
of the current study was to evaluate the feasibility of pureNOTES transvaginal ovariohysterectomy in bitches. Five bitches
were evaluated. The abdomen was accessed through an 11mm
trocar inserted through a vaginal incision. Using a rigid
endoscope with working channel, the ovarian pedicles were
coagulated and sectioned using bipolar diathermy. The uterine
horn was pulled into the trocar and exteriorized along with the
cannula. The uterine body and vessels were coagulated or
ligated. The uterine stump was replaced into the abdominal
cavity and the pneumoperitoneum drained. Pure-NOTES OHE
was successfully accomplished in four out of five bitches. In the
first try, it was converted to a hybrid-NOTES technique due to
instrument failure. Mean surgical time was 52.1 (SD11.5
minutes) for the pure-NOTES technique. Pure-NOTES OHE is
feasible in bitches, which may result in no major complications
and excellent surgical recovery.
INTRODUCTION
RESUMO
Cirurgia endoscpica por orifcios naturais
(NOTES) constitui um acesso cirrgico relativamente novo
para abordagem minimamente invasiva, a qual vem sendo
amplamente estudada na medicina humana. Porm, poucos
I
Departamento de Clnica e Cirurgia, Faculdade de Cincias Agrrias e Veterinrias (FCAV), Universidade Estadual Paulista Jlio
de Mesquita Filho (UNESP), Jaboticabal, SP, Brasil.
II
Departamento de Medicina Veterinria Preventiva e Reproduo Animal, FCAV, UNESP, Jaboticabal, SP, Brasil.
III
Faculdade de Medicina Veterinria, Universidade de Franca (UNIFRAN), Franca, SP, Brasil.
IV
Centro de Cincias Rurais (CCR), Universidade Federal de Santa Maria (UFSM), Avenida Roraima, 1000, Cidade Universitria,
Camobi, 97105-900, Santa Maria, RS, Brasil. E-mail: mbrun@upf.br. *Autor para correspondncia.
1238
1239
1240
DISCUSSION
The pure-transvaginal NOTES OHE
technique was feasible in small or medium-size bitches.
The surgical procedures presented similar operative
time to those of other laparoscopic techniques for OHE.
A three-portal laparoscopic ovariohysterectomy with
harmonic scalpel in bitches was described. The mean
Table 1 Intra-operative time (min) of each stage of the transvaginal pure-NOTES ovariohysterectomy in bitches.
------------------------------Animal Id (no)-----------------------------Surgical stages
Transvaginal access
Pneumoperitoneum
Approach to the right ovarian pedicle
Approach to the left ovarian pedicle
Exteriorization of the uterus
Hemostasis of the uterine body
Inactive/inoperative time*
Overall surgical time
9.7
2.7
92.5
9.2
2.0
14.5
12.5
7.8
6.3
16.5
68.8
8.3
1.5
8.7
7.2
7.0
0.9
9.9
43.5
4
9.5
3.0
8.0
10.0
6.0
1.5
11.8
49.8
Mean
SD
8.1
1.8
10.7
11.3
5.9
2.8
11.5
52.1
1.9
1.0
3.0
3.5
2.2
2.4
3.7
11.5
5
5.4
0.7
11.6
15.5
2.7
2.5
7.7
46.1
Including time spent for cleaning the lens of the endoscope, repositioning the patient and inspecting the abdominal cavity and ovarian
pedicles. Animal no 1 was excluded from the assessment of the global surgical time.
1241
Figure 2 Linear distribution of the surgical time of the first five attempts
of transvaginal pure-NOTES ovariohysterectomy (OHE) in
bitches. OHE of the patient no 1 was converted to the hybridNOTES technique.
1242
AKNOWLEDGEMENTS
The authors would like to thank Mrs. Vilma
Peixeiro (Marketing and Sales Manager of WEM Electronic
Equipment, Ribeiro Preto, SP, Brazil) and Mr. Niclas Woye
(International Sales Manager of LINA Medical, Copenhagen
area, Denmark) for providing the Lina Tripol Powerblade for
the development of the current study.
ACQUISITION SOURCES
a H.B. Strattner, Ribeiro Preto-SP.
b Lina Tripol Powerblade, WEM and Vivamed, Ribeiro
Preto-SP.
c HF-120, WEM and Vivamed, Ribeiro Preto-SP.
REFERENCES
AL-BASSAM, M.A. et al. Normal postpartum involution of
the uterus in the dog. Canadian Journal of Compared
Medicine, v.45, n.3, p.217-232, 1981. Available from: <http:/
/www.ncbi.nlm.nih.gov/pmc/articles/PMC1320212/pdf/
compmed00019-0009.pdf>. Accessed: Jun. 10, 2011.
DE BOSSCHERE, H. et al. Cystic endometrial hyperplasiapyometra complex in the bitch: should the two entities be
disconnected? Theriogenology, v.55, n.7, p.1509-1519, 2001.
Available from: <http://www.sciencedirect.com/science/article/
pii/S0093691X01004988>. Accessed: Mar. 15, 2011.
doi:10.1016/S0093-691X(01)00498-8.
DEVITT, C.M. et al. Duration, complications, stress, and pain
of open ovariohysterectomy versus a simple method of
laparoscopic-assisted ovariohysterectomy in dogs. Journal
of the American Veterinary Medical Association, v.227,
n.6, p.921-927, 2005. Available from: <http://www.avma.org/
avmacollections/spay_neuter/javma_227_6_921.pdf>.
Accessed: Jan. 15, 2011.
FREEMAN, L.J. et al. Oophorectomy by natural orifice
transluminal endoscopic surgery: feasibility study in dogs.
Gastrointestinal Endoscopy, v.69, n.7, p.1321-1332, 2009.
Available from: <http://www.sciencedirect.com/science/article/
pii/S0016510708028186>.
Accessed: Mar. 15, 2011.
doi:10.1016/j.gie.2008.10.02.
FREEMAN, L.J. et al. Comparison of pain and postoperative
stress in dogs undergoing natural orifice transluminal endoscopic
surgery,
laparoscopic,
and
open
oophorectomy.
Gastrointestinal Endoscopy, v.72, n.2, p.373-380, 2010.
Available from: <http://www.sciencedirect.com/science/article/
pii/S0016510710001392>.
Accessed: Jun. 10, 2011.
doi:10.1016/j.gie.2010.01.066.
HANCOCK, R.B. et al. Comparison of postoperative pain
after ovariohysterectomy by harmonic scalpel-assisted
laparoscopy compared with median celiotomy and ligation in
dogs. Veterinary Surgery, v.34, p.273-282, 2005. Available
from: <http://onlinelibrary.wiley.com/doi/10.1111/j.1532950x.2005.00041.x/pdf>.
Accessed: Jun. 10, 2011.
doi:10.1111/j.1532-950X.2005.00041.x.
KAVIC, M.S. Natural orifice translumenal endoscopic surgery:
NOTES. Journal of the Society of Laparoscopic
Surgery, v.10, p.133-134, 2006. Available from: <http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC3016136/pdf/jsls-102-133.pdf>. Accessed: Jan. 28, 2011.
PEARL, J.P.; PONSKY, J.L. Natural orifice translumenal
endoscopic surgery: a critical review.
Journal
Gastrointestinal Surgery, v.12, p.1293-1300, 2008.
Available from: <http://www.springerlink.com/content/
50x3601453572q50/fulltext.pdf>. Accessed: Jun. 10, 2011.
doi: 10.1007/s11605-007-0424-4.