Minimally invasive small intestinal exploration and targeted abdominal organ biopsy with a wound retraction device in 42 cats (2005‐2015)

Abstract

Objective: To describe the surgical technique and evaluate short-term outcome after minimally invasive small intestinal exploration and targeted organ biopsy with a wound retractor device (WRD) in cats.Study design: Multi-institutional retrospective study. Animals: Forty-two cats.Methods: A wound retractor was inserted into the abdomen on the ventral midline through a 2-4 cm incision at the level of the umbilicus. Short segments (6-10 cm long) of intestinal tract were sequentially exteriorized and explored through the WRD. Full thickness, small intestinal biopsies were obtained extracorporeally via the WRD. A commercially available single-port device was inserted through the WRD for laparoscopic exploration of the abdomen.Results: The majority of the small intestine could be exteriorized and explored through the WRD. In all cases, full thickness biopsies of the small intestine of diagnostic quality were obtained. The most common histological findings were inflammatory bowel disease (n 5 16), intestinal lymphoma (n 5 14), and eosinophilic enteritis (n 5 7). Two cases required conversion to a traditional open laparotomy due to abdominal pathology diagnosed after placement of the WRD (abdominal adhesions and need for a splenectomy). Postoperative complications occurred in 4 of 39 cats (10.3%), leading to 2 deaths after discharge from the hospital.Conclusions and clinical relevance: MISIETB with a WRD alone or combined with laparoscopy is a safe technique for small intestinal exploration and targeted abdominal organ biopsy in cats. Single-port laparoscopy can effectively be performed through the WRD for complete abdominal exploration and biopsy of abdominal organs.

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

“…Conversion rates reported in these series ranged between 0% and 23% . 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 .…”

“…A number of recent reports describe the use of diagnostic and therapeutic laparoscopy‐assisted techniques in small animals to explore the GI tract and report excellent outcomes with few complications. Conversion rates reported in these series ranged between 0% and 23% . 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 .…”

“…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 .…”

“…(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 . A second variation involves a planned miniature laparotomy with a large wound retractor (5‐9 cm), which helps facilitate hand‐assisted palpation of cranial abdominal viscera such as the stomach and duodenum .…”

“…In the Mitterman et al study, 85% of the patients were cats with nonobstructive enteropathy; no operative complications occurred, and average surgical time was 95 minutes. Cats with nonobstructive enteropathy were treated with extracorporeal intestinal exploratory surgery in two other studies; complications were rare, and surgical times averaged 65 minutes and 80 minutes . Extracorporeal intestinal exploration is technically easier and faster than intracorporeal exploration, which may account for the reported difference in average surgical time between studies.…”