Ovariossalpingo-histerectomia em cadelas: comparação da dor e análises cardiorrespiratória, pressórica e hemogasométrica nas abordagens convencional, por NOTES híbrida e NOTES total

Abstract

RESUMOA cirurgia endoscópica por orifícios naturais (NOTES) é um novo conceito de abordagem videocirúrgica, que surge como alternativa à cirurgia convencional, eliminando incisões abdominais e as possíveis complicações relacionadas a ela. A proposta deste artigo foi comparar técnicas de ovariossalpingohisterectomia (OSH) em cadelas, buscando determinar o procedimento que oferece menores alterações hemodinâmicas e menos estímulos dolorosos trans e pós-operatório. Para tanto, foram utilizadas 21 cadelas alocadas em três grupos. No primeiro, os pacientes foram submetidos à OSH por celiotomia (GC), no segundo por meio da técnica de NOTES híbrida (GNH) e no terceiro (GNT), utilizando-se a técnica de NOTES total. O tempo cirúrgico do GNH foi significativamente maior que nos demais grupos. Em ambos os grupos de cirurgia NOTES, verificou-se diminuição das pressões arteriais médias e diastólicas no transoperatório. Apenas o grupo GNH desenvolveu acidose severa no transoperatório. Levando-se em consideração as avaliações da dor, apenas o grupo convencional necessitou de analgesia resgate transcirúrgica. No pós-operatório, observou-se que os cães do GC apresentaram índices mais elevados na escala visual analógica e na escala de Melbourne que os animais dos demais grupos, sendo necessária analgesia resgate em 100% deles. Em contraste, no GNT nenhum dos cães requereram complementação analgésica pós-operatória. Conclui-se que a técnica de OSH por NOTES total apresenta parâmetros cardiorrespiratórios e hemogasométricos semelhantes à técnica convencional e mais estáveis que a técnica de NOTES híbrida, bem como resulta em menor dor trans e pós-operatória que a técnica convencional.Palavras-chave: cão, cirurgia endoluminal, cirurgia sem incisão, videocirurgia ABSTRACT

Canine ovariectomy by hybrid or total natural orifice transluminal endoscopic surgery: technical feasibility study and pain assessment

“…None of the animals from either group required rescue analgesia in the intraoperative period, as described by Basso et al, for OVH by transvaginal NOTES, corroborating the low intensity of pain stimuli associated with NOTES in bitches. Rapid return to a normal diet and to normal activities in the postoperative period as well as absence of rescue analgesia in dogs from both groups within 72 hours has also been described for OVE by transgastric NOTES .…”

“…The advantage of the hybrid technique is that the transvaginal port can be placed under direct visualization, virtually eliminating the risk of inadvertent punctures of the abdominal and pelvic organs during the procedure. This technique can also be performed through a small abdominal access, which may be very small if small‐diameter endoscopes are used, as previously described for OVH performed with a 2.7‐mm scope . In the present study, the hybrid technique had some intraoperative complications associated with the laparoscopic access port (splenic trauma and subcutaneous emphysema); however, both of these complications were considered minor.…”

“…Regardless of the method used, exteriorization of the ovaries proved to be technically challenging, as has also been pointed out by other authors . Most studies involving different laparoscopic OVE methods that established a correlation between body condition score and ovarian adipose tissue as a function of each surgical step provided evidence that such factors affected and significantly increased surgical time, although other studies have not found this correlation .…”

“…Although the vaginal bleeding observed in 33.3% of dogs subjected to OVH by total NOTES 17 was attributed to the absence of vaginal wound suture, in our study, this type of bleeding was detected in 2 dogs from the TNG, despite suture of the wound. Given this potential risk of vaginal bleeding, vaginal access should be sutured in total NOTES, even if healing of the vaginal wound by second intention is assumed …”

“…NOTES can be performed with the hybrid technique, which combines laparoscopic and natural orifice accesses, or the total approach, which uses only natural orifice access. Although elective ovariohysterectomy (OVH) by hybrid transvaginal NOTES and by total transvaginal NOTES has been described for dogs, ovariectomy (OVE) has been performed on these animals with the transgastric NOTES approach (flexible endoscopy) …”