Ovário-salpingo-histerectomia videolaparoscópica em gatos domésticos: técnica com dois portais
Ferreira, Márcio PolettoSchiochet, FabianaStedile, RafaelBeck, Carlos Afonso de CastroAlievi, Marcelo MellerNóbrega, Fernanda SilveiraDal-Bó, Isis dos SantosTessari, Jardel Pereira
Background: Ovariohysterectomy (OH) is the most frequently performed surgical procedure in Veterinary Medicine, and the traditional OH technique involves the removal of the ovaries and uterus by direct visualization through median celiotomy. Minimum invasive surgery is among the most used technique to perform OH. In addition to minimizing surgical trauma, it has the following benefits: reduced recovery period, reduction of post-operative discomfort, minimum bleeding, reduction of post-operative pain and reduction of adherences. The first videolaparoscopic OH (VLOH) of small animals was performed in dogs, and it has been performed also in cats. Several studies assessed the VLOH in domestic cats or dogs, but the two port access has never been used in these species before. The objective of the current study is to describe the OH technique in nine female cats, solely using the two port videolaparoscopic access to perform all surgical stages of the procedure. Materials, Methods & Results: Nine healthy adult cats with weights ranging between 1.3 kg to 3.8 kg were used. After clinical and hematological examination, the animals were submitted to the VLOH. A 1.5 cm incision was made during the surgical procedure, which was 5 cm cranially to the umbilical scar and, through this incision, a 10 mm trocar was introduced, thus allowing the passage of a rigid endoscope and the establishment of the pneumoperitoneum, at a pressure of 10 mmHg. After inspection of the cavity, a second 0.8 cm incision was made for the passage of the instrument through a 5 mm trocar. This incision was made 3 cm laterally and 1 cm caudally to the first incision on the right side of the animal. The uterine body was located and attached to the caudal ventral abdominal wall through a transcutaneous repair point, and the hemostasis of the organ and of its vessels was made through a bipolar electrocoagulator. The ovaries were pulled towards the abdominal wall and the ovarian pedicle was attached to the right or left lateral ventral abdominal wall through a transcutaneous repair point. The ovarian arteriovenous complex was cauterized and cut close to the ovary. The uterus and the ovaries were removed from the abdominal cavity through the 5 mm port. The average surgery time was 55 min. This time was shorter than the one observed in the three port VLOH (81.88 min) and longer than the time needed for the OH through median celiotomy. However, it is important to point out that both the surgeon and the team that performed the procedures were new to videosurgical procedures. The sum of the size of the two skin incisions was 2.3 cm, which was smaller than the incision used in the conventional OH (3 cm). A 10 mm rigid endoscope was used, which required a 1.5 cm incision; however, this incision could have been smaller if a 2.7 mm endoscope was used, which would require a 0.5 cm incision. Discussion: The decision to use only two ports and the selection of their position, as well as the location of the transcutaneous repair points provided sufficient access and space for the movement of the instrument and handling of the uterus and ovaries. The attachment of the uterine body and ovarian pedicles to the abdominal wall through transcutaneous repair points was not considered a complex procedure, thus avoiding the need to introduce a third trocar and allowing the adequate cauterization of the blood vessels, only with the use of a bipolar electrocoagulator. Ovarian arteriovenous complex or uterus bleeding are among the complications observed in VLOH; however, in our study, the main complication observed was rupture of the uterine body during the procedure to place the repair point, which was observed in two animals. We concluded that the ovariohysterectomy technique, performed solely through videolaparoscopic access with two ports, was efficient and safe for the sterilization of the cats in this study.(AU)
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