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Ovariectomy: laparotomy versus laparoscopy? Indications Routine endoscopic surgical procedures have been developed and have become the standard in the treatment of many human disease processes. Companion animal endoscopic surgery prostata iperecogeno esso slowly progressing and often remains in an experimental phase. Celioscopic ovariectomy celOVE is the most common endoscopic procedure performed at the major veterinary institutions and gains more popularity in local veterinary prostata iperecogeno esso.
CelOVE has the advantage that it is minimally invasive and that it allows a perfect visualization of the genitourinary tract. Additionally, a fast abdominal exploratory is possible on every patient before closure.
Laparoscopic surgery is a additionally perfect tool to teach veterinary students the normal anatomy of the prostata iperecogeno esso abdomen and augments the understanding of the ovariectomy technique. Surgical technique The abdomen is approached through three portals inserted in the midline of the abdomen.
The exact location prostata iperecogeno esso the 10 mm caudal portal is in between the pubis and the umbilicus, the middle 5 mm portal is located just behind the umbilicus and the cranial 5 mm portal just cranial to the umbilicus.
The most caudal portal is inserted using the open pediatric technique. After trocar insertion, the proper location of the portal is checked and the abdomen is insufflated with CO2 to an intra-abdominal pressure of 8 mm Hg. The two other trocars and portals are inserted under endoscopic guidance. With a 5 mm 0 degree optic the abdomen is inspected through the middle portal and two grasping forceps are used to locate and mobilize the left bursa ovarica.
A bipolar electrocoagulation forceps is used to coagulate the proper and suspensory ligaments. After sharp dissection of these ligaments the ovarian pedicle is coagulated and severed. The ovary is placed to the right of the bladder and the procedure is repeated for the right ovary.
Both ovaries are removed gently through the most caudal portal. The CO2 is evacuated and the incisions are closed routinely. Results Four studies were recently performed at Utrecht University. The first study evaluated the effect of using monopolar. Mean surgical time prostata iperecogeno esso 47 minutes range, 27 - min.
BEC decreased laparoscopic ovariectomy time, decreased intraoperative hemorrhage, and with the technique used, facilitated exteriorization of the ovaries. The effect of neuromuscular blockade NMB was tested in study II, a prospective, double-blinded, randomized clinical trial.
Laparoscopic ovariectomy was performed in forty female dogs with bipolar electrocoagulation by one surgeon using a standard protocol, in which one ovary was removed under NMB, and the other without NMB.
With NMB, mean duration of surgical excision of the ovary 5. The use of NMB as a standard part of the anaesthetic protocol in canine laparoscopic ovariectomy can not prostata iperecogeno esso recommended. The use of a Nd:YAG surgical laser for laparoscopic ovariectomy in dogs was investigated in study III through comparison with laparoscopic bipolar electro-surgery. Laser-surgery resulted in a higher occurrence of intra-operative mesovarial bleeding and caused a 2 minute delay for transection of the left ovary compared to prostata iperecogeno esso electro-surgery.
Therefore it was concluded that bipolar electro-surgery is still the method of choice for laparoscopic ovariectomy, also considering investments and safety-precautions accompanying the use of a surgical laser. Overall surgery duration was Both methods were successful and without complications, but the right ovary was more difficult to access, however.
Both ovaries were easy to manipulate because of the relatively long suspensory ligament. The ovarian ligaments contained minimal amounts of fat and thus in contrast to celOVE in dogs obesity did not influence surgery duration. Convalescence period was short 0.
Pitfalls LapOVE can be performed rapidly and with a smaller incision than required for conventional OVE, but requires expensive equipment and a brief interval of training to use the equipment properly. The abovementioned studies showed a rapid postoperative recovery and wound healing for both dogs and cats which is highly appreciated by de dog owners. Surgery times and complications, such as incontinence and wound swelling are comparable to OVE per laparotomy.
Bipolar coagulation prostata iperecogeno esso the overall surgery time and the times to resect the individual ovaria. Also, coagulation of peroperative bleeders is facilitated by the bipolar technique. References Brenner W.
Laparoscopic sterilization with electrocautery, spring-loaded clips, and silastic bands: Technical problems and early complications. Fertility and Sterility ; Brugmans F. Minimaal invasieve chirurgie door middel van laparoscopische en thoracoscopische technieken. Vlaams Diergeneesk Tijdscr, ; Freeman L. Minimally invasive surgery of the reproductive system. In: Veterinary Endsurgery. Ed: Freeman LJ. Mosby, St Louis Hulka J.
Contained cautery: studies toward safer laparoscopic sterilization technics. Comparison of two surgical techniques in canine celioscopic ovariectomy.
Vet Surg ; Berl Munch Tierarztl Wochenschr ; Thiele S. Kleintierpraxis ; Comparison of Nd:YAG surgical laser and Remorgida bipolar electrosurgery forceps for canine laparoscopic ovariectomy.
Vet Prostata iperecogeno esso. Laparoscopic ovariectomy in cats: comparison of laser and bipolar electrocoagulation. J Feline Med Surg. Neodymium: yttrium aluminum garnet surgical laser versus bipolar electrocoagulation for laparoscopic ovariectomy in prostata iperecogeno esso. La chirurgia endoscopica prostata iperecogeno esso animali da compagnia è in lenta progressione e spesso rimane in fase sperimentale.
Recentemente, presso la Utrecht University sono stati condotti quattro diversi studi. Nello studio IV, quattordici gatti domestici a pelo corto sono stati sottoposti a celOVE utilizzando apparecchiature. Il portale più caudale viene inserito utilizzando la tecnica pediatrica aperta.
Gli altri prostata iperecogeno esso trequarti ed i portali vengono inseriti sotto guida endoscopica. Impiegando una pinza da elettrocoagulazione bipolare si coagulano i legamenti proprio e sospensore. Dopo aver dissezionato con strumenti taglienti questi legamenti, si coagula il peduncolo ovarico e lo si recide. Entrambe vengono poi rimosse delicatamente attraverso il portale più caudale. Entrambe le ovaie erano facili da manipolare grazie alla relativa lunghezza del legamento sospensore.
Gli studi sopracitati hanno dimostrato prostata iperecogeno esso rapido recupero postoperatorio ed una pronta guarigione delle ferite sia nei cani che nei gatti che sono stati ampiamente apprezzati dai proprietari di cani.
Inoltre, la coagulazione dei sanguinamenti perioperatori risulta facilitata dalla tecnica bipolare. Bibliografia Brenner W. Vlaams Diergeneesk Tijdscr, ; Freeman L. Kastration der Hündin durch laparoskopische Ovarektomie. Antibiotics in surgery. Is more really better? Introduction Wound infections are common, potentially serious and often expensive complications of surgery. An understanding of all factors that play a role in the origin of wound infection is essential, in particular since the increase of anaesthesia and surgery in patients with a high risk of postoperative infections.
The issue of antibiotic resistant micro-organisms has become a serious problem as these drugs can no longer be relied upon as a solution for every surgical infection. In that regard, the strict observance of aseptic techniques to minimise wound contamination and to prevent infection are still the mainstays of successful surgery.
Asepsis An aseptic technique can be defined as those methods and actions that prevent wound contamination during surgery. This does not only include the appropriate prostata iperecogeno esso of the surgical environment, but also of the surgical field on the body itself, the operating team and the surgical instruments. In order to achieve this, it is important to work according to a strict protocol.
It is impossible to eliminate all microorganisms from the operating wound and the surgical field; however, an aseptic technique will limit the exposure of the patient to low numbers of micro-organisms which are not harmful under normal circumstances.
Rules for aseptic techniques Working prostata iperecogeno esso disinfected or sterilised instruments at the prostata iperecogeno esso of an prostata iperecogeno esso is no guarantee for contamination-free surgery. In order to ensure that the used instruments and the wound remain sterile, a number of rules need to be observed.
These rules ideally prostata iperecogeno esso be laid down in a standard operating protocol SOP for each operating room OR. Desinfectants Alcohols are widely used in veterinary practice, although they are only effective against certain vegetative bacteria by protein denaturation and have a poor action against spores, fungi and viruses.
They are mildly degreasing, are inactivated by organic debris and have no residual action after evaporation. This allows a very rapid and effective reduction in pathogens. The resident flora is prostata iperecogeno esso reduced considerably. Chlorhexidine diacetate and chlorhexidine gluconate have a rapid and lasting action against bacteria, but a variable and inconsistent efficacy against viruses and fungi.
Chlorhexidine binds to the protein of the stratum corneum of the skin, creating a persisting residue and killing the bacteria that may emerge from the sebaceous glands or hair follicles during prostata iperecogeno esso operation. Chlorhexidine has a low toxicity when used as a skin cleaner or as an aqueous solution for wound asepsis, rinsing of the mouth or the mucosa of the urinary tract. Even though it may. Inorganic iodine has a very wide antimicrobial range when compared to other prostata iperecogeno esso.
It kills bacteria, fungi and viruses although it is a prostata iperecogeno esso sporicide.