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Objective: To investigate the relationship between physical attributes and difficulty performing laparoscopic maneuvers with the prevalence of self-reported musculoskeletal injury., Study Design: Online survey., Sample Population: Surgeons (n = 140) with 3 or more years of laparoscopic experience., Methods: Electronic survey distributed via LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, presence of musculoskeletal injuries, and surgical practice data. Statistical analysis was performed using the Shapiro-Wilk test, linear regression, logistic regression, and Wilcoxon rank sum tests., Results: A total of 52 of the 140 respondents reported a musculoskeletal injury with 38 specifying at least one injury (72%). Neck strain was the most prevalent reported musculoskeletal injury (18/52, 34.6%), followed by shoulder tendinopathies (16/52, 30.8%), arm/hand tendonitis (8/52, 15.4%), carpal tunnel (7/52, 13.5%), back pain (4/52, 7.7%) and arm/hand arthritis (1/52, 1.9%). Women were significantly more likely to report a musculoskeletal problem than men (p = .011) with the odds of women reporting a musculoskeletal injury 2.59 times greater than men. Women and surgeons with smaller glove sizes were significantly more likely to report shoulder tendonitis (p = .034, p = .1) and neck strain (p = .009, p = .001). Respondents with a musculoskeletal problem experienced significantly more difficulty using rotating cup biopsy forceps (p < .001) and perceived this as difficult a greater amount of time (p = .006)., Conclusion: Female surgeons report more musculoskeletal injuries than their male counterparts. Surgeons with musculoskeletal injuries experience more difficulty performing particular laparoscopic maneuvers., Clinical Significance: Improving ergonomics for women and surgeons with smaller glove sizes must be prioritized to improve surgeon health and laparoscopic instrument use., (© 2024 American College of Veterinary Surgeons.)

Equine minimally invasive surgical techniques are frequently utilized in the treatment of a variety of conditions. Standing sedated endoscopic surgery is commonly selected in horses, requiring specialized facilities, anesthetic protocols, and surgeon and assistant expertise. This review examines current methods and potential strategies in equine soft tissue surgery, in which there is an emphasis on laparoscopic urogenital and gastrointestinal diagnostic and therapeutic procedures. Thoracoscopy is less frequently reported in horses and may be underutilized. Optimizing procedures and outcomes in soft tissue surgery relies on innovation and interdisciplinary collaboration. Modern advances in surgical equipment and emerging medical technologies support development in these fields. Participation in continuing education is effective in acquiring and sustaining knowledge and skills and improving clinical practice. Forums with an integrated approach could rapidly expand knowledge across species., (© 2024 American College of Veterinary Surgeons.)

Objective: To report the use of intraoperative sentinel lymph node (SLN) mapping with indocyanine green (ICG) and near-infrared (NIR) imaging in a dog with a primary pulmonary carcinoma that underwent lung lobectomy via a video-assisted thoracoscopic approach., Study Design: Case report., Animals: A 9-year-old female spayed Labrador retriever., Methods: A solitary, 6.5 cm diameter, right caudal pulmonary mass was identified on contrast-enhanced thoracic and abdominal computed tomography, with no overt metastatic disease or other primary neoplastic diseases. The dog underwent video-assisted thoracoscopic surgery. A right-sided thoracoscopic approach was initially performed for right caudal pulmonary ligament transection and image-guided peritumoral (intrapulmonary) ICG injection. Due to the large size of the mass, a wound retractor was then placed in the right 6th intercostal space for right caudal lung lobectomy. Sentinel lymph node mapping was performed via NIR imaging, and the SLN was extirpated for histologic assessment., Results: The right tracheobronchial lymph node was identified as sentinel via NIR fluorescence following peritumoral ICG injection. Right caudal lung lobectomy and right tracheobronchial lymph node extirpation were performed without complication, and histologic evaluation revealed a grade 1 pulmonary adenocarcinoma with pneumonia and a reactive lymph node., Conclusion: Peritumoral ICG administration with NIR imaging appears to be an effective method for intraoperative SLN mapping in dogs with primary pulmonary tumors. The technique utilized in this report can be applied to open or minimally invasive procedures. Large-scale studies with SLN mapping are needed to determine an accurate incidence of nodal metastatic disease and any effect of extirpation of early metastatic disease via SLN mapping techniques on oncologic outcomes in dogs with primary pulmonary carcinoma., (© 2024 American College of Veterinary Surgeons.)

Objective: To determine the feasibility of open cholangioscopy using disposable flexible endoscopes in canine cadavers and describe the surgical approach., Study Design: Ex vivo experimental cadaveric study., Sample Population: Eight canine cadavers., Methods: Cadavers ranging from 5.8 to 43.8 kg underwent open transcholecystic cholangioscopy using a disposable flexible endoscope with a 3.8 mm outer diameter and 1.2 mm working channel and the surgical approach was described. The most distal anatomical region of the biliary tree towards the duodenal papilla that was visualized with the endoscope was recorded in each cadaver. A 2.7 mm rigid endoscope and a 1.9 mm flexible endoscope were also trialed and findings recorded. Endoscopic tools were trialed and their usage recorded., Results: The disposable flexible endoscope was feasible for visualization of the junction of the common bile duct, cystic duct, and hepatic ducts in all eight dogs. Cholangioscopy using a 2.7 mm rigid endoscope did not provide further distal visualization. The 1.9 mm flexible endoscope was able to traverse down to the level of the major duodenal papilla in a 43.8 kg cadaver. Use of certain endoscopic tools can be considered through the disposable flexible endoscope although fluid instillation was affected., Conclusion: A 3.8 mm disposable flexible endoscope could be placed through an open transcholecystic approach to provide intraluminal endoscopic evaluation up to the level of the junction of the common bile duct, cystic duct, and hepatic ducts in dogs without cholecystic disease., Clinical Significance: Open transcholecystic cholangioscopy with a disposable flexible endoscope could provide a low-cost diagnostic and therapeutic tool in cases of obstructive biliary disease up to the level of the common bile duct., (© 2024 American College of Veterinary Surgeons.)

Objective: The aim of the present study was to quantify the amount of biologic debris present within disposable bipolar vessel sealing devices after each use for canine splenectomies and determine the aerobic bacterial load of the debris following instrument resterilization with ethylene oxide., Study Design: Prospective observational clinical study., Study Population: Client-owned dogs (n = 40) presenting to a single specialty hospital for open, routine, or emergency splenectomies., Methods: A total of 16 bipolar vessel sealing devices were randomly assigned to undergo one, two, three, or four splenectomies, manual hand cleanings, and ethylene oxide sterilizations before being dismantled. After final use and sterilization, each handset was agitated in phosphate-buffered saline before disassembly, which was submitted for aerobic culture. Following aseptic disassembly, all biological residue was photo-documented, collected, quantified using a subjective scoring system, and submitted for culture., Results: Biologic debris was present within the inner mechanics of all devices, specifically under the blade used for vessel transection. A linear increase in debris was not appreciated amongst devices used once versus devices used multiple times. None of the devices nor any of the biologic debris cultured positive following sterilization with ethylene oxide., Conclusion: The presence of biologic debris was documented after the initial use of disposable bipolar vessel sealing devices, but no devices or debris yielded positive culture results following ethylene oxide sterilization after splenectomies., Clinical Significance: Increased risk of iatrogenic surgical site contamination from reused vessel sealing devices is unlikely when they have been cleaned and sterilized with ethylene oxide after up to four splenectomy surgeries., (© 2024 American College of Veterinary Surgeons.)

Objective: To describe the signalment, treatment, complications, and outcomes of cats treated surgically for ectopic ureters., Study Design: Retrospective, multi-institutional study., Animals: Twelve client-owned cats., Methods: Medical records of cats diagnosed with unilateral or bilateral ectopic ureters were reviewed and analyzed. Data reported included signalment, clinical signs, diagnostics, open celiotomy, or cystoscopic surgical interventions, and outcomes., Results: Seven of the 12 cats in the study population were female or female spayed and the median age at time of presentation was 4 years, with an interquartile range (IQR) of 6 months-14 years. Presurgical diagnostic imaging diagnosed ectopic ureters by abdominal ultrasound (8/10), contrast enhanced computed tomography (3/3), fluoroscopic urography (3/4), or cystoscopy (6/7). Eight of 12 cats had extramural ectopic ureters and six cats were affected bilaterally. Eight affected cats underwent ureteroneocystostomy, one cat underwent neoureterostomy, two cats underwent cystoscopic laser ablation, and one cat underwent nephroureterostomy. Immediate postoperative complications occurred in three cats; one cat required additional surgical intervention. Short-term complications occurred in three cats, and long-term complications in two cats. All cats that underwent surgical or cystoscopic intervention had improvement of their urinary incontinence scores, with complete resolution in 11 cats., Conclusion: Surgical correction of ectopic ureters in cats is associated with good long-term outcomes. Ectopic ureters in cats are commonly extramural and bilateral. Postoperative outcomes were acceptable and there were few postoperative complications, with varying forms of surgical correction., Clinical Significance: Ectopic ureters in cats are rare but urinary incontinence can be corrected or improved successfully with surgery., (© 2024 American College of Veterinary Surgeons.)

Objective: The objective was to describe the successful thoracoscopic treatment of esophageal entrapment resulting from a vascular ring anomaly (VRA) comprising a persistent right aortic arch (PRAA) and left ligamentum arteriosum (LA) in a Babydoll sheep wether., Study Design: Case report., Animal: Eight month old Babydoll sheep wether, 13 kg., Methods: The patient presented with a weight half that of its sibling, persistent regurgitation following eating, and delayed growth noted from the age of approximately 2 months, coinciding with the introduction of solid feed into the diet. Plain thoracic radiographs were within normal limits but computed tomography angiography (CTA) confirmed multiple congenital vascular anomalies. The primary finding was esophageal and tracheal entrapment by a PRAA and left LA. Thoracoscopic transection of the LA was performed with a bipolar vessel sealing device with the aid of transesophageal endoscopy., Results: Immediate improvement in attitude and absence of regurgitation were observed. The patient was discharged and subsequently reintroduced to grazing and long-stem hay, which were previously not tolerated. By 6 months post discharge, the patient's weight was 36 kg, comparable to an age-matched sibling and considered appropriate for the stage of growth., Conclusion: Thoracoscopic transection of the LA in sheep is a feasible treatment for esophageal compression resulting from a VRA. Surgical intervention resolved the clinical signs and allowed normal digestive rumination, restoring bidirectional esophageal function in a ruminant., (© 2024 American College of Veterinary Surgeons.)

This article details the rise of surgical robots in the human surgical sphere as well as their use in veterinary medicine. Sections will describe in detail the equipment required for these procedures and the advantages and disadvantages of their use. Specific attention is given to the articulated instrumentation, which affords psychomotor benefits not only for surgical precision but also for surgeon ergonomics. A discussion of the possible indications and current use of robotics in veterinary medicine and the challenges to integrating robotics is also provided., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To assess attempts to proficiency of experienced veterinary surgeons for 2 surgical tasks when using a robotic simulator (Mimic dV-Trainer; Surgical Sciences) and determine factors associated with the successful performance of these tasks., Methods: Veterinary surgeons with rigid, minimally invasive surgery experience performed 2 tasks ("pick and place" and "knot the ring 1") using the simulator until they attained proficiency. Individual performance variables were recorded. The number of attempts to proficiency was recorded. Performance variables were also assessed for effect on proficiency by the Kendall tau correlation and hierarchical multiple linear regression. The study period was from July 25, 2022, through December 14, 2022., Results: The 18 surgeons enrolled required a median of 8.5 attempts (95% CI, 7 to 12; range, 6 to 22) to reach proficiency for the basic task versus 27 attempts (95% CI, 21 to 38; range, 10 to 63) for the advanced task. Surgeons took a median of 6 minutes (range, 3 to 11 minutes) to complete training for the basic task and 12 minutes (range, 4 to 46 minutes) for the advanced task. The number of attempts to reach proficiency correlated strongly with economy of motion (tau = 0.72), instrument collisions (tau = 0.72), and time to completion (tau = 0.96)., Clinical Relevance: Although experienced surgeons required a high number of attempts to gain proficiency in robotic simulator tasks, they did achieve proficiency quickly, encouraging future investigations into their use for training. Specific motion metrics were identified which improved efficiency during training.

Objective: To investigate the impact of variables on use and preference of common laparoscopic instruments., Study Design: Online survey., Sample Population: Surgeons (n = 140) with 3 years or more laparoscopic experience., Methods: Electronic survey distributed via specialty group LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, preferences, and surgical practice data. Statistical analysis was performed using Fishers exact, ANOVA, Tukey Kramer honestly significant difference (HSD) test, linear regression, and logistic regression., Results: Ninety-eight of 140 respondents answered instrument-related questions and the completion rate of these questions was 76%: 48% of females and 49% of males responded to the survey. The median glove size of respondents was size 7 (range, 5.5 to 8.5). Closing laparoscopic Babcock forceps (p = .018), rotating cup biopsy forceps (p = .003), and manipulating endoscopic staplers (p < .001) were more difficult for surgeons with smaller glove sizes. The median difficulty score for the endoscopic stapler was 4/10 and the median percentage of time this was found difficult was 25%. Reusable instruments were preferred over disposable single-use instruments. The pistol grip was preferred for grasping and retracting (54/98, 55%) and fine dissection (46/96, 48%), while the axial grip was preferred for suturing and knot tying (61/98, 62%)., Conclusion: Surgeons with smaller glove sizes (<6.5) experience more difficulty when using common laparoscopic instruments. The endoscopic stapler was the most difficult to use., Clinical Significance: When purchasing laparoscopic instrumentation, surgeons should review all available options in handle size and design to improve ergonomics during minimally invasive procedures., (© 2023 The American College of Veterinary Surgeons.)

Objective: To report the perioperative outcome and complications in cats undergoing minimally invasive splenectomy., Animals: 17 client-owned cats., Methods: Perioperative data were collected from cats undergoing minimally invasive splenectomy from September 2010 to June 2023. Data included history, signalment, preoperative examination and diagnostic testing results, operative technique and time, perioperative outcomes, complications, hospitalization duration, histopathological diagnosis, and outcome., Results: 13 spayed females and 4 neutered males were included, with a median age of 144 months (48 to 196 months). Seven cats underwent total laparoscopic splenectomy (TLS), with 1 cat requiring conversion from TLS to laparoscopic-assisted splenectomy (LAS) due to splenomegaly and an additional cat requiring conversion from TLS to open splenectomy due to uncontrollable splenic capsular hemorrhage. Ten cats underwent LAS, with 1 cat requiring conversion to open splenectomy due to splenomegaly. Additional procedures were performed in 13 cats, with the most common being liver biopsy in 10 cats. Median operative times were 50 minutes (45 to 90 minutes) for TLS and 35 minutes (25 to 80 minutes) for LAS. An intraoperative complication occurred in 1 cat. All but 1 cat survived to discharge. Median follow-up time was 234 days (18 to 1,761 days), with 15 of 16 cats confirmed alive at 30 days and 9 of 16 cats alive at 180 days postoperatively., Clinical Relevance: Minimally invasive splenectomy in this cohort of cats was associated with short operative times and a low perioperative complication rate. Veterinary surgeons may consider minimally invasive splenectomy as an efficient and feasible technique in the treatment of splenomegaly or modestly sized splenic masses for diagnostic and therapeutic purposes in cats.

Surgical training of students is one of the most difficult aspects of veterinary medical education. Competing interests of house officers, owners' wishes, and ethical concerns have led to increasing use of inanimate models for basic surgical skills training. Robotic simulators have benefits for psychomotor training but have not been previously investigated in veterinary medicine. Understanding the necessary practice time for new training devices is important when determining their potential value. The aim of this study was to compare the number of attempts needed for veterinary students to reach proficiency in both a basic and advanced robotic simulator task, and to assess the predictive nature of performance variables. Each student performed a basic and advanced tasks on the Mimic dV-Trainer™ until proficiency was reached. Students required a median of eight attempts (95% CI = 7-8, range: 6-11) to reach proficiency for the basic task versus 22 attempts (95% CI = 20-26, range: 11-62) for the advanced task. The median time required to complete training for the basic and advanced task was 13.5 minutes (range: 8-24 minutes) and 26.5 minutes (range: 11-82 minutes) respectively. The difference in task attempts supports the training protocol and confirms proficiency can be attained in a short period of time. The number of attempts to reach proficiency correlated with specific performance variables that can be used by educators to aid in training students on a robotic simulator. Continued investigations on robotic simulators should be performed to investigate their use in improving psychomotor skills in veterinary students.

Objective: To describe demographics, clinical presentation, shunt anatomy, clinical progression, and complications in large dogs ≥15 kg with single extrahepatic portosystemic shunts (EHPSS) treated with or without surgery., Study Design: Multicenter retrospective (10 university hospitals, one private referral institution)., Animals: Dogs ≥15 kg (n = 63)., Methods: Medical records of dogs ≥15 kg diagnosed with EHPSS between January 01, 2005 and December 31, 2020 were reviewed. Dogs had a minimum follow-up of 90 days. Signalment, clinical signs, diagnostics, shunt anatomy, treatment interventions, and perioperative complications were assessed., Results: Median age was 21.9 months (IQR: 9-36.8). The breed most represented was the Golden retriever (17/63 dogs). Portocaval (17/63) and splenocaval (15/63) shunt configurations were most common. Portal vein hypoplasia was noted in 18 imaging reports. Of the surgically treated dogs, 14/45 (35.6%) had short-term complications, and 3/45 (6.7%) had shunt-related deaths. Medical management was discontinued in 15/40 and reduced in 9/40 of surviving dogs who had surgical attenuation. All medically managed, nonattenuated dogs (18/18) were maintained on their original shunt-related medication regimens., Conclusions: Clinical presentation of dogs ≥15 kg with extrahepatic portosystemic shunts was similar to the more commonly reported small breed dogs. Surgical management of single EHPSS in large dogs ≥15 kg had similar clinical short-term outcomes as small breed dogs., Clinical Significance: Clinicians should be aware that large breed dogs with EHPSS share similar characteristics and clinical outcomes to small breed dogs. The significance of the presence of a hypoplastic portal vein warrants further research. Surgical treatment is a viable option for large breed dogs with EHPSS., (© 2023 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)

Objective: To determine any association between gender and likelihood of first attempt match and overall time to match into an American College of Veterinary Surgery (ACVS)-registered small animal surgical residency program (SASRP)., Study Design: Online survey., Sample Population: A total of 100 (77 female, 23 male) ACVS small animal surgery residents or diplomates participating in a SASRP during the past 5 years., Methods: An online survey was sent to eligible individuals. Respondents anonymously provided information related to demographics, postgraduate internships, and qualifications at the time of each surgical residency application. First attempt and overall match success were evaluated by gender through univariable analysis and then via a multivariable model., Results: Men were 2.89 times more likely to match directly into a SASRP following a rotating internship than women (p = .041), and women completed more total internships than men prior to successful match into a SASRP (p = .030); however, men were found to have more publications at the time of first residency application (p < .001) or successful match (p = .018). Multivariable analysis revealed no association between gender on overall match success or first attempt match rate when considering all other qualifications., Conclusion: No evidence for gender bias was found during the Veterinary Internship and Residency Matching Program (VIRMP) SASRP applicant selection process; however, gender specific patterns in research qualifications were identified., Impact: Gender-blinded assessment is not considered necessary for the VIRMP small animal surgical resident selection process. Efforts should be made to educate applicants about the impact of research on the residency selection process and encourage research engagement of female students and graduates., (© 2023 American College of Veterinary Surgeons.)

Objective: To evaluate the feasibility of laparoscopic vertical sleeve gastrectomy (LVSG) in feline cadavers using endoscopic stapling equipment and report clinical outcomes in two live feline subjects., Study Design: Cadaveric study and experimental case series., Animals: Ten feline cadavers; two feline subjects., Methods: LVSG technique was refined on feline cadavers and included retraction of the liver, dissection of the stomach, assessment of proper location for gastrectomy via stapling, and leak testing. Appropriateness of gastrectomy, gastrectomy %, surgical times and complications were recorded. The procedure was performed on two live feline subjects, and they were followed for 4 months to report surgical complications., Results: LVSG was completed in 9/10 cadavers and both live patients. Stenosis at the incisura was recorded in 2/9 cadavers. No obvious leaks were seen in the 8 cadavers that were tested or either live patient. The mean surgical time for all cadaver procedures and live patients was 110.4 and 115 minutes, respectively. Mean weight of resected cadaver stomach was 10 g and the mean % of the total stomach weight resected was 27.6%. No intra- or postoperative surgical complications occurred in the live subjects., Conclusion: LVSG technique appears feasible and safe for use in live patients., Clinical Relevance: This LVSG technique may be safely used for partial gastric resection in cats. Further studies are necessary to determine if it is effective at reversing the effects of obesity and diabetes in this population., (© 2022 American College of Veterinary Surgeons.)

Objective: To evaluate custom 3D printed laparoscopic cannulas (3DPC) in a feline cadaveric abdominal surgery model and report their use in two live feline subjects., Study Design: Experimental cadaver study, live subject case series., Animals: Ten feline cadavers; two feline subjects., Methods: Custom 3DPCs were initially modeled in a PLA filament material and then created in an autoclavable dental resin for use in live patients. The surgery time, number of surgical collisions and cannula complications were recorded during cadaver procedures before and after use of 3DPCs. Cannula complications were recorded during live procedures and patients were followed to suture removal to record any incisional complications., Results: There was a significant reduction in mean surgical time (125.6 vs. 95.2 min, p = 0.03), mean number of instrument collisions (6.8 vs. 2.6, p = 0.03), and mean number of cannula complications (10 vs. 2.2, p = 0.03) with the use of only 3DPCs during the procedure. During the live procedures the use of the 3DPCs was successful and no postoperative complications occurred at the incision sites., Conclusion: The use of customized 3DPCs may improve surgical dexterity and decrease complications in advanced procedures and was not associated with any clinical complications in two cats. The use of 3DPCs in veterinary medicine may allow for wider practice of laparoscopic techniques in small animals., (© 2022 American College of Veterinary Surgeons.)

Objective: To compare the differences in the healing of surgically created full-thickness wounds in dogs treated with a novel extracellular matrix (ECM) dressing as compared with a standard wound management protocol and to investigate the effect of antibiotics in these 2 populations., Animals: 15 purpose-bred Beagles, 8 female spayed and 7 males neutered, operated on, and monitored between March 14, 2022, and April 18, 2022., Methods: Four 2 X 2-cm full-thickness skin wounds were created on the trunks of each dog. The right-sided wounds were treated with the novel ECM wound dressing, and the left-sided wounds served as the controls. Wound planimetry and qualitative wound scores were obtained at 12 time points. Wound biopsies for histopathologic assessment of wound repair and wound inflammation were obtained at 6 time points., Results: Wounds treated with ECM had higher percent epithelization at days 7, 9, 12, and 18 postoperatively (P < .001) and better histologic repair scores (P = .024) than wounds treated by the standard protocol. Subjective wound assessment scores of wounds treated with ECM did not differ from those treated by the standard protocol at any time point., Clinical Relevance: Wounds treated with the novel ECM dressing epithelialized more rapidly than wounds treated by a standard protocol.

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession., Competing Interests: AW is employed by Merck and Co. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Steffey, Griffon, Risselada, Scharf, Buote, Zamprogno and Winter.)

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified., Competing Interests: AW is employed by Merck & Co. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Steffey, Griffon, Risselada, Buote, Scharf, Zamprogno and Winter.)

Background: Sleep insufficiency is a worldwide affliction with serious implications for mental and physical health. Occupational factors play a large role in determining sleep habits. Healthcare workers are particularly susceptible to job-mediated sleep insufficiency and inadequate rest in general. Little is published on sleep practices among veterinarians, and overall recognition of the impacts of inadequate rest within the veterinary profession is poor., Objectives and Procedures: This review describes occupational factors affecting sufficiency of rest and recovery, reviews veterinary-specific and relevant adjacent literature pertaining to sleep patterns, and discusses potential solutions for addressing occupational schedules contributing to sleep insufficiency and inadequate rest. Online databases were searched to extract contemporary literature pertaining to sleep, insufficient rest, and occupational factors, with a focus on veterinary medicine and other healthcare sectors., Results: Occupational factors leading to inadequate rest among healthcare workers include excessive workloads, extended workdays, cumulative days of heavy work hours, and after-hours on-call duty. These factors are prevalent within the veterinary profession and may contribute to widespread insufficient rest and the resulting negative impacts on health and well-being among veterinarians., Conclusion and Clinical Relevance: Sufficient sleep quantity and quality are critical to physical and mental health and are negatively affected by many aspects of the veterinary profession. Critical review of current strategies employed in clinical practice is essential to promote professional fulfillment, health, and well-being among veterinarians., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

This study assessed the effects of concurrent intra-articular injection and Tibial Plateau Leveling Osteotomy (TPLO) plate surface treatment with leukoreduced platelet rich plasma (lPRP) on outcomes of dogs undergoing TPLO. A retrospective study of medical records for cases presenting from January 2018 to December 2020 was performed. Client-owned dogs with naturally occurring cranial cruciate ligament rupture that underwent TPLO surgery were divided into two groups. The lPRP group included cases that underwent intra-articular injection and plate surface treatment at the time of their TPLO. The control group (C) underwent TPLO without PRP treatment. Data analyzed included: presence of surgical site infection, implant removal rate, degree of change in OA progression score, lameness score progression and radiographic bone healing. The short- and long-term complication rate, hospitalization and antibiotic therapy were also compared between the groups. Descriptive statistics, comparison analyses (Chi square test, t-test, Fisher's exact test) and multi-level logistic regression models were used for statistical analysis. A total of 110 cases met the study inclusion criteria: 54 = lPRP, 56 = C. There were no significant differences between groups with regard to gender, age, presence of meniscal tear, weight, or body condition score. Significant findings included: improved radiographic healing of the osteotomy in the lPRP group, improved global OA scores in the lPRP group, and improved lameness score at recheck examination in the lPRP group. There was no significant difference between the lPRP and C group with regard to surgical site infection and implant removal rate. Concurrent intra-articular injection and plate surface treatment with leukocyte reduced PRP at the time of TPLO, is beneficial in slowing the progression of OA, hastening the radiographic evidence of osteotomy healing, and improved lameness score on recheck examination. Leukocyte reduced PRP was not a significant factor in reducing SSI or implant removal rate., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Aryazand et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Despite substantial ramifications of insufficient sleep on mental and physical health and general well-being, many individuals are unaware of what constitutes sufficient sleep, or of the short- and long-term extent of sleep deficiency effects, including those that may not be perceived as fatigue., Objectives and Procedures: This review describes the physiology of sleep, defines healthy standards, reviews the pathophysiology and health hazards of acute and chronic sleep insufficiency, and offers concepts for improving individual sleep hygiene. Online databases were searched to extract literature pertaining to sleep, sleep insufficiency, fatigue, and health, with emphasis on literature published in the preceding 5 years., Results: The detrimental effects of acute and chronic sleep loss vary in their range and impact. Individuals often obtain a substandard quantity of sleep, a problem that is poorly recognized by individuals and society. This lack of recognition perpetuates a culture in which sleep insufficiency is accepted, resulting in serious and substantial negative impacts on mental and physical health., Conclusion and Clinical Relevance: Sleep management is one of the most fundamental and changeable aspects of personal health. Improving awareness of the important physiological roles of sleep, healthy sleep habits, and the consequence of insufficient sleep is essential in promoting general well-being and mental and physical health., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Objective: This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management., Study Design: Narrative review., Methods: Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar., Results: Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine., Conclusion: Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur., Clinical Significance (or Impact): A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs., (© 2023 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)

Case Summary: Minimally invasive surgery is an increasingly popular alternative to open surgery in veterinary medicine. Compared with traditional surgical approaches, laparoscopic pancreatectomy provides a less invasive approach and has several potential benefits, including improved visualization, reduced infection rate and decreased postoperative pain. Laparoscopic partial pancreatectomy has been described in humans, dogs and pigs but not cats. Pancreatectomy with or without chemotherapy is a treatment option for exocrine pancreatic carcinoma, a rare but malignant cancer in cats. We report the case of a 16-year-old male neutered domestic longhair cat diagnosed with exocrine pancreatic carcinoma that was treated with laparoscopic partial pancreatectomy, carboplatin and toceranib phosphate. A three-port technique using a 5 mm 0º telescope and bipolar vessel sealing device was performed to remove the entire left limb of the pancreas. No intra- or postoperative complications occurred, and the patient was discharged the following day. Forty days postoperatively, the patient received its first of five doses of carboplatin, which were given every 4-5 weeks over a period of 4 months. A maintenance protocol of toceranib phosphate was started after completion of carboplatin treatment. At the time of this article being submitted, the patient had survived for more than 221 days., Relevance and Novel Information: This is the first report of a laparoscopic partial pancreatectomy performed on a feline patient for pancreatic carcinoma., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Objective: To determine the difference in histologic artifacts and morphologic diagnosis among 3 laparoscopic cup biopsy forceps techniques and wedge hepatic samples., Animals: Cadavers of 20 client-owned dogs following euthanasia for unrelated reasons between January 3 and July 29, 2021., Procedures: Four biopsy techniques were performed from the margin of 3 liver lobes/dog. Laparoscopic techniques used 5-mm cup biopsy forceps to obtain biopsy samples by pulling the forceps forcefully caudally to free a sample (the PULL technique), rotating the forceps 360° in 1 direction until freed (the TWST technique), or pulling the forceps through a 5-mm cannula to remove the sample (the CAN technique); wedge biopsy samples served as the control (CON). Data collected included sample weight, histologic features, diagnosis, and artifact characterization. Gwet AC1 or intraclass correlation coefficients (ICCs) were calculated to detect agreement among techniques., Results: Sample weights for CON and TWST were significantly larger (P < .001 and P = .035, respectively) than for PULL and CAN. There was excellent agreement among all techniques for most diagnostic features (Gwet AC1, 0.93 to 1). The TWST technique resulted in the best overall artifact profile for laparoscopic techniques, with 90% of samples (54/60) having crisp edges and 65% of samples (39/60) having no or mild tearing. The agreement was moderate to good (ICC, 0.73 for edges and 0.76 for tearing) among all cup biopsy forceps techniques., Clinical Relevance: The TWST technique resulted in the largest sample and had the fewest artifacts, supporting its continued use during laparoscopic procedures.

The objective of this study was to report the clinical indications, outcomes, and complications associated with medicinal leech therapy (MLT) in dogs and cats. Medical records (2012-2016) of client-owned dogs (n = 9) and cats (n = 3) treated with MLT at one institution were retrospectively reviewed. Retrieved data included the signalment, indications, physical examination findings, laboratory results, methods of leeching, outcomes, and complications associated with MLT. Following MLT sessions, nine patients (75%) visibly showed clear improvement of the affected tissue. One patient (8%) was euthanized before complete healing owing to pulmonary parenchymal disease. Improvement or appearance of tissue following MLT was not recorded in two patients (17%). Results suggest that MLT may be a safe and effective treatment modality for venous congestion and necrosis in compromised skin flaps and wounds with success in resolving 75% of the lesions in this study. This study is suggestive of the value of MLT when more conventional treatment methods fail in dogs and cats. A data collection form was created for veterinarians to use with the goal of obtaining standardized, objective MLT data for future studies., (© 2022 by American Animal Hospital Association.)

Objectives: The aim of this study was to compare the outcomes of cats undergoing open cystotomy with those undergoing minimally invasive surgery (MIS) for removal of cystic calculi by use of a composite outcome score., Methods: Twenty-eight cats were retrospectively enrolled and divided into two groups: open cystotomy (n = 14) and MIS (n = 14). The primary outcome measure was a composite outcome score, including three variables: pain scores ⩾2 at either 6 or 12 h postoperatively; failure to remove all stones as determined by postoperative radiographs; and postoperative complications requiring a visit to the hospital separate from the planned suture removal appointment. Other data collected included signalment, history, other procedures performed during anesthesia, willingness to eat the day after surgery and the financial cost of the procedures., Results: There was no significant difference in age, weight, sex or breed between the two groups. The risk of experiencing the composite outcome was 3/14 (21.4%) in the MIS group and 10/14 (71%) in the open procedure group ( P  = 0.02). The cats in the open surgery group had 8.3 times greater odds of developing the composite outcome than cats in the MIS group (odds ratio 8.3, 95% confidence interval 1.3-74.4; P  = 0.02). In the MIS group, 10/14 cats were eating the day after surgery vs 3/14 in the open procedure group ( P  = 0.02). The procedural cost was higher in the MIS group, with a median cost of US$945 (interquartile range [IQR] US$872-1021) vs US$623 (IQR US$595-679) in the open group ( P <0.01)., Conclusions and Relevance: In this study the composite outcome score provided evidence to support the use of MIS techniques in cats with cystic calculi. The composite outcome score should be considered in future veterinary studies as a promising method of assessing clinically relevant outcomes.

Objective: To investigate owner perceptions of laparoscopic surgery, including attitudes towards paying more for minimally invasive surgery (MIS)., Study Design: Randomized cross-sectional prospective survey., Sample Population: One hundred owners presenting at a combined general and specialty practice., Methods: Participants were interviewed using a survey tool to assess prior knowledge of laparoscopic procedures, attitude for or against these procedures, reasons for this attitude, and whether they would pay more for the procedures. Demographic data were collected., Results: Fifty-five percent of owners had previous knowledge of laparoscopy. Ninety-two percent of owners would choose laparoscopy over an open procedure for their pet. Reasons given for preferring laparoscopy: less postoperative pain (66.3%), shorter length of hospitalization (26.1%), better cosmesis (20.1%), perception of lower cost (15.2%), faster return to function (14.1%), length of anesthesia (5.4%), and other reasons (26.1%). Ninety-one percent of owners were willing to pay more for MIS. Among owners who indicated they would be willing to pay more, owners presenting with dogs were 2.5 times more likely to be willing to pay at least $1000 more than owners presenting with cats., Conclusion: The majority of owners surveyed at a large hybrid hospital in an urban setting choose laparoscopic over open procedures and were willing to pay more for them., Clinical Significance: The results highlight the importance of client and veterinarian education regarding the options of MIS for pets, as owners who are informed may prefer referral for the procedures. The financial investment to build a MIS practice may be justified., (© 2021 American College of Veterinary Surgeons.)

Objective: This study aimed to describe the technique and clinical outcomes in dogs undergoing Laparoscopic Adipose-Derived Stem Cell Harvest via bipolar sealing device (LADSCHB) for degenerative orthopaedic and neurologic disease., Study Design: Descriptive retrospective case series., Animals: Eleven dogs with orthopaedic disease and one dog with degenerative spinal disease were enrolled in the study., Methods: Medical records of dogs undergoing LADSCHB were reviewed for signalment, weight, reason for the procedure, anaesthesia time, surgery time, other procedures performed, post-operative pain protocols, incision size, amount of adipose tissue collected, number of viable cells collected, days to discharge, short-term complications, and owner satisfaction., Results: The median weight of the population was 34.2 kg (range 9.2-62 kg), the median surgery time was 39 min (range 15-45 min), mean incision length was 2.5 cm, the median amount of adipose collected was 60 g, and the median number of viable stem cells was 21 million cells. Conversion to open laparotomy was not needed. The most common reason for the harvest was osteoarthritis of the elbow (8/12 cases). Nine cases had other procedures performed at the same time as the harvest. No complications were noted during the procedure or within the post-operative period. All owners surveyed were satisfied with the laparoscopic harvest procedure., Conclusions: LADSCHB was technically feasible, productive, and not associated with any complications. This procedure was performed rapidly and was paired with other surgical procedures., Clinical Significance: LADSCHB allows for stem cell harvest with commonly utilized laparoscopic equipment. This surgical technique could lead to the increased ability to treat patients with diseases that benefit from stem cell therapy., (© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Objective: To report the perioperative characteristics and outcomes of dogs undergoing laparoscopic-assisted splenectomy (LAS)., Animals: 136 client-owned dogs., Procedures: Multicentric retrospective study. Medical records of dogs undergoing LAS for treatment of naturally occurring splenic disease from January 1, 2014, to July 31, 2020, were reviewed. History, signalment, physical examination and preoperative diagnostic test results, procedural information, complications, duration of hospitalization, histopathologic diagnosis, and perioperative outcomes were recorded. Perioperative complications were defined using the Veterinary Cooperative Oncology Group - Common Terminology Criteria for Adverse Events (VCOG-CTCAE v2) guidelines., Results: LAS was performed for treatment of a splenic mass (124/136 [91%]), immune-mediated disease (7/136 [5%]), splenomegaly (4/136 [3%]), or immune-mediated disease in conjunction with a splenic mass (1/136 [1%]). Median splenic mass size was 1.3 cm3/kg body weight. Conversion to open laparotomy occurred in 5.9% (8/136) of dogs. Complications occurred in 78 dogs, with all being grade 2 or lower. Median surgical time was 47 minutes, and median postoperative hospital stay was 28 hours. All but 1 dog survived to discharge, the exception being postoperative death due to a suspected portal vein thrombus., Clinical Relevance: In the dogs of this report, LAS was associated with low rates of major complications, morbidity, and mortality when performed for a variety of splenic pathologies. Minimally invasive surgeons can consider the LAS technique to perform total splenectomy in dogs without hemoabdomen and with spleens with modest-sized splenic masses up to 55.2 cm3/kg, with minimal rates of complications, morbidity, and mortality.

Objective: To evaluate the indications for, complications of, and surgical outcomes of dogs and cats that were treated with double limb amputations., Animals: 14 dogs and 4 cats that underwent double limb amputations., Procedures: Data collected retrospectively included patient-specific (species, age, weight, breed, sex, existing comorbidities) and amputation-specific (indication for amputation, full or partial limb amputation, associated complications, need for revision surgeries) variables. Owner satisfaction scores were also collected., Results: The most common indication for double amputations was trauma (12/18) patients. Eleven patients had both amputations performed simultaneously. Nine patients had double partial limb amputations versus full limb amputations. Twelve patients underwent bilateral pelvic limb amputations, 4 underwent bilateral thoracic limb amputations, and 2 had 1 pelvic and 1 contralateral thoracic limb amputated. Five patients had reported complications over the course of the follow-up period, and complications for 3 patients were considered major. Revision surgery was reported for 2 animals. Owner satisfaction scores were reported as very satisfied/excellent (14/18), mildly satisfied (3/18), and strongly dissatisfied (1/18). Median time to follow-up was 450 days (range, 85 to 4,380 days)., Clinical Relevance: Double limb amputation may be a viable alternative to advanced limb-sparing procedures or humane euthanasia based on the owner satisfaction data and the relatively low rate of major complications in this study. Future studies should clarify patient selection criteria and differences in function between surgical types.

Wound healing is a complex process that traverses 4 main phases which overlap and are interdependent. Many patient-related factors can impede healing by disrupting the normal pathways from one phase to the next. Wound-related factors also determine the best techniques or dressings for each patient. Species differences between cats and dogs must be understood for the successful treatment of cats. New techniques such as fish skin graft application, photobiomodulation, and bioelectric dressings hold promise as an addition to our armamentarium against wounds. NPWT, hyperbaric oxygen, regenerative medicine techniques, and low-level laser therapies yield mixed results and large-scale controlled studies are needed., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

A 3-year-old male neutered French bulldog was presented for an anatomical degloving injury of the left pinna following a conflict with a larger dog at a park. Approximately 2/3 of the dorsal skin was removed from the convex surface of the left pinna along with an irregular, full thickness injury on the lateral aspect of the pinna distal to the cutaneous marginal pouch. A caudal auricular axial pattern flap (CAAPF) was used to reconstruct the pinna. The flap healed with no noted necrosis over the long-term. Postoperative cellulitis was noted for approximately 3 mo. The dog was medically managed for bilateral otitis externa multiple times over the course of recovery. Long-term function and cosmesis at 1.5 y after surgery revealed adequate functional movement of the pinna and acceptable cosmesis. It is concluded that, rather than a pinnectomy, a CAAPF can be offered as a surgical option in dogs that have injuries localized to the pinna. Key clinical message: A CAAPF is an alternative to pinnectomy for reconstruction of the pinna after degloving injury and yields a functional and cosmetically acceptable outcome., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Minimally invasive surgery continues to be an active area of experimental and clinical research in veterinary medicine. The advances we make in this field correspond to multiple benefits for our patients. New MIS approaches (retroperitoneal, NOTES, robotics) continue to be investigated to provide better visualization and manipulation of important anatomic structures for specific procedures. Increasing the number of MIS techniques available to our patient population is of utmost concern for clinicians and owners and is encouraging exciting new clinical research. New technologies (near-infrared fluorescence, barbed suture, 3D printing) are at the forefront of these developments., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To determine the rate of full-length publication for the 2004-2019 Veterinary Endoscopy Society (VES) annual meeting abstracts and to identify abstract and author characteristics as predictors of publication., Study Design: Observational bibliographical study., Sample Population: Three hundred and eighty-nine abstracts., Methods: Abstracts from 2004-2019 Veterinary Endoscopy Society (VES) proceedings and matching full-length publications retrieved from bibliographic databases were systematically reviewed. Variables assessed included species, specimen type (cadaver, live animal, etc.), subdiscipline (orthopedics, internal medicine, etc.), institution, country of origin, study design, level of evidence (LoE), time to publication, number of authors, their credentials, and gender. Logistic regression, Fisher's exact tests and t-tests were used to assess the bivariate relationship between publication and characteristics of the authors and publications., Results: The overall publication rate for presented abstracts published as full-length articles in peer-reviewed journals was 26%. Median time from abstract presentation to full-length article publication was 430 days. Factors associated with full-length article publication were identified: affiliated institution (P = .01), species studied (P = .04), subdiscipline focus (P = .01), level of evidence (P = .01), number of authors (P = .01), and first author's gender (P = .03)., Conclusion: Veterinary Endoscopy Society abstracts were commonly categorized into a lower LoE. Abstracts from academic institutions regarding canine patients and soft tissue surgery topics were more likely to be published. Abstracts citing female first authors or with more than 1 author had higher odds of publication., Clinical Significance: Data reported provide authors with predictors for publication and identify topics for research opportunities. Veterinary specialty societies may utilize this information when evaluating abstracts., (© 2022 American College of Veterinary Surgeons.)

Objective: To evaluate outcomes in cats undergoing subtotal colectomy for the treatment of idiopathic megacolon and to determine whether removal versus nonremoval of the ileocecocolic junction (ICJ) was associated with differences in outcome., Animals: 166 client-owned cats., Procedures: For this retrospective cohort study, medical records databases of 18 participating veterinary hospitals were searched to identify records of cats with idiopathic megacolon treated by subtotal colectomy from January 2000 to December 2018. Data collection included perioperative and surgical variables, complications, outcome, and owner perception of the procedure. Data were analyzed for associations with outcomes of interest, and Kaplan-Meier survival time analysis was performed., Results: Major perioperative complications occurred in 9.9% (15/151) of cats, and 14% (12/87) of cats died as a direct result of treatment or complications of megacolon. The median survival time was not reached. Cats with (vs without) a body condition score < 4/9 (hazard ratio [HR], 5.97), preexisting heart disease (HR, 3.21), major perioperative complications (HR, 27.8), or long-term postoperative liquid feces (HR, 10.4) had greater hazard of shorter survival time. Constipation recurrence occurred in 32% (24/74) of cats at a median time of 344 days and was not associated with retention versus removal of the ICJ; however, ICJ removal was associated with long-term liquid feces (OR, 3.45), and a fair or poor outcome on owner assessment (OR, 3.6)., Conclusions and Clinical Relevance: Results indicated that subtotal colectomy was associated with long survival times and a high rate of owner satisfaction. Removal of the ICJ was associated with less favorable outcomes in cats of the present study.

Objective: To identify factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs., Animals: 170 client-owned dogs that underwent gastrointestinal surgery from 2010 to 2016., Procedures: Medical records of all included dogs were reviewed to collect information on preoperative (breed, sex, age, body weight, American Society of Anesthesiologists [ASA] physical status classification, emergency status, and plasma lactate concentration), intraoperative (indication for surgery, type of surgery, and whether bacterial peritonitis was identified), and postoperative (development of dehiscence and survival status at 2 weeks after surgery) factors. Preoperative and intraoperative factors were evaluated for associations among each other and with postoperative factors., Results: Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L). Multivariate analysis controlling for age, body weight, and plasma lactate concentration revealed that dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06). Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs., Conclusions and Clinical Relevance: These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis.

Objective: To review the relevant human and veterinary literature regarding the timing of surgical intervention for trauma patients and the impact on outcome., Data Sources: Original research, clinical studies, and review articles with no date restrictions from both human and veterinary literature., Human Data Synthesis: Despite extensive research into the ideal timing of surgical intervention for human trauma victims, debate is ongoing and views are still evolving. Prior to the 1970s, the standard of care consisted of delayed surgical treatment, as these patients were considered too ill to undergo surgery. Beginning in the 1970s, and continuing for nearly 2 decades, early definitive surgical treatment was recommended. The most recent evolution of human trauma management incorporates the concept of damage control surgery, which acknowledges the importance of early skeletal stabilization or laparotomy for reducing morbidity while attempting to avoid complications such as acute respiratory distress syndrome or multiple organ dysfunction syndrome., Veterinary Data Synthesis: Despite a relatively large amount of literature available regarding veterinary trauma, no evidence exists to provide the clinician guidance as to the ideal timing of surgery for trauma patients. With the exception of diaphragmatic hernia, no studies were identified that attempted to evaluate this variable., Conclusions: Veterinary-specific studies are needed to evaluate the impact of surgical timing on outcome following trauma. The information that can be obtained from studies in this area can improve veterinary trauma care and may be used as models for human trauma care through translational applications., (© Veterinary Emergency and Critical Care Society 2015.)

Objective: To determine whether epidural administration of opioids was associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures., Design: Retrospective cohort study., Animals: 179 client-owned dogs undergoing elective surgery for cranial cruciate ligament rupture., Procedures: Medical records of 179 dogs that underwent surgical correction for cranial cruciate rupture between January 2009 and October 2012 were reviewed; 120 received epidural administration of opioids and 59 did not. Signalment, type of procedure, administration of epidural analgesia, time to first postanesthetic urination, and number of urinations during the first 24 hours were evaluated and compared between groups., Results: Administration of preservative-free morphine into the epidural space was not significantly associated with time to first urination following anesthetic recovery or the total number of urinations within the first 24 hours of anesthetic recovery. Administration of a hydromorphone bolus IV following surgery was significantly associated with urinary retention, compared with administration of either morphine boluses or fentanyl constant rate infusions following surgery. No other variables were significantly associated with urinary retention., Conclusions and Clinical Relevance: Administration of preservative-free morphine into the epidural space was not associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures. Systemic administration of opioids may be associated with urinary retention.

The medicinal leech, Hirudo medicinalis, has been used for hundreds of years in human medicine for a variety of diseases, most recently including venous congestion following reconstructive surgeries (skin flaps and reimplantations), excessive lingual and periorbital swelling, and non-traditional treatments for osteoarthritis, compartment syndrome and sialoadenitis. The treatment of venous congestion in animals using leeches has been mentioned anecdotally, but the only published report pertains to the use of leeches in a cat suffering from polycythemia vera. We report the use of medical grade leeches in a one-year-old male castrated Domestic Shorthaired cat presenting with severe swelling of the paw after sustaining a constrictive injury from a bandage. The limb use had become compromised and the swelling was not responsive to compression bandages so leech therapy was instituted for four days and the swelling dramatically improved. The patient's limb use improved back to normal and the constrictive wound went on to heal without complication. The use of leeches in this case allowed for resolution of severe venous congestion and a full return to function in this patient with no continued skin loss. The mechanism of action of hirudotherapy for venous congestion is to allow for an alternative egress of pooled venous blood leading to a reduction in capillary pressure and increases in arterial reperfusion of capillary beds. The human and veterinary applications, method, and potential complications with hirudotherapy are discussed in this review.

Objective: To evaluate the effect of preoperative antimicrobial administration on culture results in dogs undergoing cystotomy as a treatment for urolithiasis., Design: Prospective controlled study. Animals-41 dogs undergoing cystotomy for cystic calculi removal., Procedures: Urine samples were collected at time of anesthetic induction and during surgery prior to cystotomy, and a mucosal biopsy and culturette swab was collected during surgery from a control group, which received antimicrobials only after surgical culture sample collection, and from an experimental group, which received antimicrobials at the time of anesthetic induction., Results: 17 of 41 patients had positive culture results at anesthetic induction. Twenty of 41 patients had positive results of cultures for the surgical sample. No dogs that had positive results before antimicrobial administration had negative results after antimicrobial administration. There were no significant changes to urinalysis results regardless of group. Calcium monohydrate uroliths were the most common stone removed (24/41), followed by magnesium ammonium phosphate uroliths (11/41)., Conclusions and Clinical Relevance: There was no difference in culture results (positivity and bacterial type) when antimicrobials were given at anesthetic induction versus after surgical culture sample collection for dogs undergoing cystotomy for cystic calculi removal.

The purpose of this study was to describe the appropriate surgical technique, postoperative monitoring, and complications encountered with use of vacuum-assisted closure (VAC) in six dogs with confirmed septic peritonitis. Initial diagnosis of septic peritonitis was performed by measuring either the blood-to-fluid lactate ratio and glucose concentration differences or cytologic verification of intracellular bacteria. After appropriate surgical procedures were performed to manage the primary cause of peritoneal sepsis, a VAC was performed. Serum and abdominal fluid protein levels were measured, and all complications were noted during the postoperative period. Three of the six dogs (50%) survived to the secondary closure and were subsequent discharged, which is similar to previous studies where the abdomen was either closed primarily or treated with open abdominal drainage. No major complications occurred with bandage management during hospitalization. The results of this study support VAC as a feasible technique for managing septic peritonitis.

An adult castrated male cat was evaluated because of a 4 day history of lethargy and partial anorexia. Physical examination revealed abdominal pain with a palpable fluid wave. Cytologic and biochemical analyses of peritoneal effusion were suggestive of septic peritonitis. On surgical exploration of the abdomen, the mesenteric vessels had no palpable pulses and they contained gross thromboses. The intestines were white with no visible peristalsis. Necropsy findings included disseminated, poorly differentiated hemangiosarcoma throughout the abdomen. Mesenteric arterioles contained fibrin thrombi. To the author's knowledge, no previous reports exist of complete mesenteric vascular thrombosis associated with disseminated abdominal visceral hemangiosarcoma in a cat.

A 17-month-old cat presented for frequent swallowing, occasional cough and stertor. Radiographic evaluation revealed a soft tissue mass at the level of the soft palate. Oral examination revealed a soft tissue mass within the soft palate. Surgical resection was performed. Histopathology was consistent with a large developmental cyst. Following surgical management the cat has remained clinically free of signs for 2 months., (Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.)

A 10.5-year-old domestic shorthair presented with a history of progressive inappetence, lethargy and elevated respiratory rate. Clinical and diagnostic findings confirmed the presence of a chylothorax with evidence of a mass or collapsed lung within the right cranial thorax. Computed tomography, sternotomy and histopathology confirmed the presence of a right middle lung lobe torsion associated with a chylothorax. The torsion was successfully managed with surgical removal of the affected lung lobe, and the patient continues to be asymptomatic 6 months postoperatively., (Published by Elsevier Ltd.)

Objective: To determine reasons for conversion from diagnostic laparoscopic procedures to celiotomy in dogs and cats., Study Design: Case series., Animals: Dogs (n=54), cats (40)., Methods: Medical records (2004-2008) were reviewed for dogs and cats that had diagnostic laparoscopic or laparoscopic-assisted biopsy. Numbers of conversions to laparotomy were recorded, including cause and type (elective versus emergent), postoperative complications, and short-term outcome. Specific risk factors for conversion, including signalment, preoperative diagnostics, and surgical findings were assessed; categorical variables were tested by χ(2) and Fisher's exact tests; continuous variables by Student's t-test and Wilcoxon's rank-sum tests; multivariate logistic regression models were created., Results: Twenty animals (21%) had laparoscopic conversion; 13 (65%) were considered elective and 7 (35%) emergent conversions. There was no significant difference between animals requiring and those not requiring conversion for age, weight, sex, body condition score, clinical signs, previous abdominal surgery, or surgeon experience. Significant risk factors for conversion included low total solids (P=.03), presence of a solitary liver tumor (P<.01), and diagnosis of neoplasia (P<.01)., Conclusions: A conversion rate of 21% was found in this population of dogs and cats undergoing laparoscopic diagnostic procedures. A preoperative finding of a solitary liver tumor, low total solids, and diagnosis of malignancy were all significant risk factors for conversion., (© Copyright 2010 by The American College of Veterinary Surgeons.)

Background: Non-contact cranial cruciate ligament rupture (CrCLR) is an important cause of lameness in client-owned dogs and typically occurs without obvious injury. There is a high incidence of bilateral rupture at presentation or subsequent contralateral rupture in affected dogs. Although stifle synovitis increases risk of contralateral CrCLR, relatively little is known about risk factors for subsequent contralateral rupture, or whether therapeutic intervention may modify this risk., Methodology/principal Findings: We conducted a longitudinal study examining survival of the contralateral CrCL in client-owned dogs with unilateral CrCLR in a large baseline control population (n = 380), and a group of dogs that received disease-modifying therapy with arthroscopic lavage, intra-articular hyaluronic acid and oral doxycycline (n = 16), and were followed for one year. Follow-up in treated dogs included analysis of mobility, radiographic evaluation of stifle effusion and arthritis, and quantification of biomarkers of synovial inflammation. We found that median survival of the contralateral CrCL was 947 days. Increasing tibial plateau angle decreased contralateral ligament survival, whereas increasing age at diagnosis increased survival. Contralateral ligament survival was reduced in neutered dogs. Our disease-modifying therapy did not significantly influence contralateral ligament survival. Correlative analysis of clinical and biomarker variables with development of subsequent contralateral rupture revealed few significant results. However, increased expression of T lymphocyte-associated genes in the index unstable stifle at diagnosis was significantly related to development of subsequent non-contact contralateral CrCLR., Conclusion: Subsequent contralateral CrCLR is common in client-owned dogs, with a median ligament survival time of 947 days. In this naturally occurring model of non-contact cruciate ligament rupture, cranial tibial translation is preceded by development of synovial inflammation. However, treatment with arthroscopic lavage, intra-articular hyaluronic acid and oral doxycycline does not significantly influence contralateral CrCL survival.