Preliminary results showed the feasibility and safety of the transvaginal NOTES method in this small initial study population. The technique, developed in our institution, and not transgastric NOTES, may be the preferred approach to serve as the basis for clinical studies.

Natural Orifice Translumenal Endoscopic Surgery is a new development area with potential advantages for patients. However, technical and ethical challenges involved in perforation and closure of a healthy organ, as seen in transgastric access, and lack of comprehension of physiopathology of these approaches haven't allowed clinical application. The present study, based on previous animal experiments, describes the first clinical application of transvaginal Natural Orifice Translumenal Endoscopic Surgery. On March 13, 2007, a 43-year-old female patient with symptomatic cholelithiasis with surgical indication was submitted to elective Natural Orifice Translumenal Endoscopic Surgery transvaginal cholecystectomy using a colonoscope, endoscopic graspers, and vaginal platform instruments. Operative time was 66 minutes, and vaginal access and closure were obtained in 15 minutes. The patient had good postoperative evolution and was dismissed within 48 hours without complications. Recent literature and experience of the present study group suggest possibilities for preliminary clinical applications by transvaginal natural orifice surgery. The access may offer earlier benefits in the literature than the transgastric route because of lack of danger of fistula and peritonitis. Further studies regarding instrument development and physiology of natural orifice surgery are ongoing, possibly bringing solutions for more advanced procedures.

Cervical vertebral canal diameter decreased significantly with extension and increased with flexion. The results support the presence of dynamic impingement possibly playing a role in diseases characterized by vertebral canal stenosis, such as cervical spondylomyelopathy.

Laparoscopy is now a reliable method for staging gastrointestinal cancer, orienting the therapy, and avoiding unnecessary laparotomy. Natural orifice transluminal endoscopic surgery (NOTES) is an emerging concept with potential advantages for patient recovery. The first case of clinical diagnostic application of transvaginal NOTES for diagnostic cancer staging is presented. Informed consent and Institutional Commission approval were obtained for transvaginal clinical trials. On February 28, 2007, a patient with elective surgical indication for diagnostic cancer staging was submitted to transvaginal NOTES procedure, and intra- and postoperative parameters were documented. In a 50-year-old female patient presenting with ascitis, diffuse abdominal pain, and weight loss for 2 months, diagnosis of peritoneal carcinomatosis was suspected, which was also found when a CT scan was performed. Transvaginal NOTES was used for diagnostic staging of the patient, using a colonoscope introduced into the abdomen through a small incision in the vagina. Biopsies of liver, diaphragm, ovaries, and peritoneum were successfully performed. Operative time was 105 min, vaginal access and closure was obtained in 15 min. Abdominal inventory was reliable, and all 16 biopsies taken were positive for ovarian adenocarcinoma. The patient was dismissed 48 hours after the procedure without complications. Recent literature and experience of the study group suggest possibilities for preliminary clinical applications by transvaginal natural orifice surgery for diagnostic purposes.

BackgroundLigation of the mesovarium in female dogs may be cumbersome with risk of complications and is associated with intense noxious stimuli. A resorbable implant, a self-locking loop designed for surgery, was developed as an alternative to traditional ligation. The study aimed to test the feasibility of ligating the canine ovarian pedicle with the implant and to compare its performance to traditional suture ligation.ResultsIn total 45 intact female dogs destined for elective ovariohysterectomy and adoption were included. In 21 dogs the new resorbable implant was used to ligate the mesovarium, and in 24 control dogs traditional suture was used with one encircling ligature. Mean weight of implant dogs was 10.7 ± 5.6 kg (range 3.5–22.0), and mean weight of control dogs was 12.8 ± 6.4 kg, (range 4.1–27.0). The body weight of dogs did not differ between groups (P = 0.25). In total, 42 ovarian pedicles were successfully ligated with the implant. In one control dog, intraoperative haemorrhage from the left ovarian pedicle was diagnosed. The mesovarium was re-ligated and haemostasis was confirmed. All dogs recovered uneventfully. The ligation time of the mesovarium was significantly shortened (P = 0.02) by using the self-locking implant versus a single ligature (3′28′′ ± 1′05′′ and 5′29′′ ± 3′54′′, respectively). Total duration of surgery differed between the groups (P = 0.02) with a shortened duration of surgery when using the self-locking implant (15′56′′ ± 2′47′′ and 20′39′′ ± 8′58′′, study group versus control group, respectively). In both groups, duration of surgery and time required to ligate the ovarian pedicle were longer in larger dogs than smaller dogs.ConclusionThe results of this feasibility study suggested the implant can be used to ligate the canine mesovarium. Compared with traditional suture ligation, the results suggested that time to ligate the ovarian pedicle and duration of surgery were significantly reduced with the implant. More time was required to perform surgeries in larger dogs.

BackgroundPrevious studies in humans have reported that the dimensions of the intervertebral foramina change significantly with movement of the spine. Cervical spondylomyelopathy (CSM) in dogs is characterized by dynamic and static compressions of the neural components, leading to variable degrees of neurologic deficits and neck pain. Studies suggest that intervertebral foraminal stenosis has implications in the pathogenesis of CSM. The dimensions of the cervical intervertebral foramina may significantly change during neck movements. This could have implication in the pathogenesis of CSM and other diseases associated with radiculopathy such as intervertebral disc disease. The purpose of this study was to quantify the morphological changes in the intervertebral foramina of dogs during flexion, extension, traction, and compression of the canine cervical vertebral column. All vertebral columns were examined with magnetic resonance imaging prior to biomechanic testing. Eight normal vertebral columns were placed in Group 1 and eight vertebral columns with intervertebral disc degeneration or/and protrusion were assigned to Group 2. Molds of the left and right intervertebral foramina from C4-5, C5-6 and C6-7 were taken during all positions and loading modes. Molds were frozen and vertical (height) and horizontal (width) dimensions of the foramina were measured. Comparisons were made between neutral to flexion and extension, flexion to extension, and traction to compression in neutral position.ResultsExtension decreased all the foraminal dimensions significantly, whereas flexion increased all the foraminal dimensions significantly. Compression decreased all the foraminal dimensions significantly, and traction increased the foraminal height, but did not significantly change the foraminal width. No differences in measurements were seen between groups.ConclusionsOur results show movement-related changes in the dimensions of the intervertebral foramina, with significant foraminal narrowing in extension and compression.

A resorbable self-locking device (LigaTie) was developed to enable safe and easy surgical ligation of blood vessels. The aim of this study was to compare the long-term in vivo resorption of the device to a commercially available suture of equivalent material (Maxon) following ovarian pedicle ligation. After ovariohysterectomy follow-up ultrasound examinations were performed monthly on 21 dogs ligated with the device and 22 dogs ligated with the suture material until no hyperechoic remnants, acoustic shadowing or local tissue reactions were detected. In both groups, the ovarian pedicles gradually decreased in size. Ligation material was considered macroscopically resorbed when ultrasound showed no signs of the device or suture, ovarian pedicle or tissue reaction. Macroscopic resorption had occurred without signs of complications and was complete by four months for sutures and 5.5 months for the device. The results show that resorption time in vivo for the resorbable self-locking device is mildly longer than suture of the same material and that no complications of device resorption were detected, supporting that the resorbable self-locking device is safe for in vivo use.

Numerous diseases are carried and can be transmitted from the African buffalo (Syncerus caffer) to livestock. Therefore, buffaloes may only be moved with a special transport permit. Disease-free buffaloes are in demand amongst private game farmers. Current disease-free animals derive from a small genetic pool and hence there is a special interest in bringing new genetic material into the disease-free populations. Different breeding programs were developed in the past, which allow producing disease-free offspring from an infected herd. In this study epididymal sperm from 16 mature African buffalo bulls were frozen with Triladyl™ and AndroMed ® (both Minitüb, Germany) with or without the addition of bovine seminal plasma. Post-thaw motility, longevity and acrosomal integrity were compared by means of paired two-tailed t-tests. For both cryodiluents the post-thaw motility was mostly higher when no seminal plasma was added: no differences could be seen for the acrosomal integrity. Triladyl™ was superior to AndroMed ® in regards to total post-thaw motility. This study indicates that the use of bovine seminal plasma in a concentration of 10% is detrimental rather than beneficial in regards to the post-thaw motility. Triladyl™ rather than AndroMed ® should be used to freeze buffalo epididymal sperm, since it is superior in terms of post-thaw motility, even though the former, containing egg yolk, is not a defined medium and therefore lacks quality standards and carries a hygiene risk. Cette étude montre que l'utilisation decplasma séminal bovin à la concentration de 10% est plus nuisible que bénéfique en ce qui concerne la motilité post-congélation. Triladyl TM devrait être préféré à Andromed ® pour congeler le sperme épididymal de bison, puisqu'il est meilleur en ce qui concerne la motilité post-congélation, même s'il contient du jaune d'oeuf et n'est pas un milieu défini ( pas de standards de qualité), ce qui sous-entend un risque hygienique. Zusammenfassung