Laparoscopic access to the liver and application of laparoscopic microwave ablation in 2 dogs with liver neoplasia

Abstract

Objective: To determine laparoscopic accessibility of liver lobes and access to the hilus and describe laparoscopic microwave ablation (LMWA) in 2 dogs with hepatic neoplasia. Study design: Experimental/descriptive case series. Sample population: Six canine cadavers and 2 clinical dogs. Methods: Cadavers in dorsal recumbency underwent laparoscopic assessment of the liver. A 17 gauge MWA probe was inserted to create an ablation zone at the most proximal aspect of the hilus. The distance from the center of each ablation zone to the most proximal aspect of the corresponding hilus was determined. Two dogs with hepatic neoplasia underwent LMWA. Results: All lobes of the canine liver were accessible via laparoscopy. The median (interquartile range) distances from the ablation zones to the hilus for the caudate process, left lateral, left middle, quadrate, right lateral, and right middle lobes were 2.

Intestinal surgery in small animals: historical foundations, current thinking, and future horizons

“…Reported reasons for conversion include linear foreign bodies, foreign bodies involving the ileocecocolic and gastroduodenal regions, hemorrhage, peritoneal effusion, and requirement for additional surgical procedures . Low preoperative total solids, presence of a solitary liver tumor, and diagnosis of neoplasia were associated with a conversion rate of 21% in another study . An intestinal lesion diameter of less than 5 cm is thought to be a reasonable upper limit when a laparoscopy‐assisted approach is considered in most dogs and cats .…”

“…Intracorporeal exploration of the liver, gall bladder, pancreas, stomach, descending duodenum, and colon is followed by extracorporeal evaluation of the jejunum, ileum, and ICJ. (Figure A‐C) Patient repositioning is required for intracorporeal evaluation of the descending duodenum and colon . Extracorporeal evaluation of the viscera is most often facilitated by the use of polyurethane wound retractors (Figure C), although small Gelpi retractors and absence of retractors has also been reported .…”

“…[66][67][68][69][70][71][72] Low preoperative total solids, presence of a solitary liver tumor, and diagnosis of neoplasia were associated with a conversion rate of 21% in another study. 73 An intestinal lesion diameter of less than 5 cm is thought to be a reasonable upper limit when a laparoscopy-assisted approach is considered in most dogs and cats. 67 In addition to intestinal diameter, the anatomic region of the affected bowel also appears to be important.…”

“…(Figure 7A-C) 66,67,[69][70][71] Patient repositioning is required for intracorporeal evaluation of the descending duodenum and colon. 69,73 Extracorporeal evaluation of the viscera is most often facilitated by the use of polyurethane wound retractors ( Figure 7C), although small Gelpi retractors and absence of retractors has also been reported. [66][67][68][69][70][71] A second variation involves a planned miniature laparotomy with a large wound retractor (5-9 cm), which helps facilitate handassisted palpation of cranial abdominal viscera such as the stomach and duodenum.…”

Use of a cavitron ultrasonic surgical aspirator for parenchyma‐sparing and complex liver resections in dogs

“…This would be an interesting approach in veterinary surgery when the surgeon is confronted with multiple masses in multiple lobes; nevertheless, it appears to be technically difficult with the current veterinary instruments available. Microwave ablation to specifically manage nodules has been reported in two studies (five and two cases) . However, destruction of hepatic tissue by microwave ablation is not surgical removal, and the potential oncologic interest in veterinary medicine is currently unknown.…”