Single-port laparoscopic cryptorchidectomy in dogs and cats: 25 cases (2009–2014)

• Autores: Jeffrey J. Runge
• Localización: JAVMA: Journal of the American Veterinary Medical Association, ISSN-e 0003-1488, Vol. 245, Nº. 11, 2014, págs. 1258-1265
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Objective—To describe the operative technique for single-port laparoscopic cryptorchidectomy (SPLC) in dogs and cats and evaluate clinical outcome for patients that underwent the procedure.

    Design—Retrospective case series.

    Animals—25 client-owned dogs (n = 22) and cats (3).

    Procedures—Dogs and cats that underwent SPLC with 3 commercially available single-port devices between 2009 and 2014 were retrospectively identified through a multi-institutional medical records review. Surgery was performed via a single-port device placed through a 1.5- to 3.0-cm abdominal incision either at the region of the umbilicus or caudal to the right 13th rib. The cryptorchidectomy was performed with graspers, a bipolar vessel sealing device, and a 30° telescope.

    Results—SPLC was performed with a single-incision laparoscopic surgery port (n = 15), a multitrocar wound-retractor access system (8), or a metal resterilizable single-port access device (2). Median age was 365 days (range, 166 to 3,285 days). Median body weight was 18.9 kg (41.6 lb; range, 1.3 to 70 kg [2.9 to 154 lb]). Median surgical time was 38 minutes (range, 15 to 70 minutes). Thirty-two testes were removed (12 left, 6 right, and 7 bilateral). Four patients had 1 additional abdominal surgical procedure performed concurrently during SPLC. No intraoperative or postoperative complications were encountered.

    Conclusions and Clinical Relevance—Results suggested that SPLC can be performed in a wide range of dogs and cats with cryptorchidism and can be combined with other elective laparoscopic surgical procedures. The SPLC technique was associated with a low morbidity rate and provided a potentially less invasive alternative to traditional open and multiport laparoscopic techniques.

    Since 1976, laparoscopy has been used in human patients as the primary method for localization of impalpable cryptorchid testes,1 and it is now accepted in children that laparoscopy, rather than ultrasonography, is the gold standard for diagnosis of the condition.2 In human patients, laparoscopy also enables minimally invasive treatment of this condition, which typically consists of either orchidopexy or orchidectomy. Thus, treatment can often be combined with diagnosis.1,3,4 In veterinary medicine, cryptorchidism is a hereditary condition and is one of the most common congenital defects in small animal practice.5 Reported incidences of cryptorchidism range from 1.2% to 12.9% in dogs6,7 and from 1.3% to 3.8% in cats.7,8 Undescended testes are 13.6 times as likely to develop neoplasia and are also at an increased risk for torsion; therefore, the surgical removal of both testes is recommended.9,10 Although the open abdominal surgical technique for the treatment of cryptorchid testes has been described in considerable detail,11,12 a smaller amount of literature has existed since 1993 describing the use of the multiport laparoscopic technique to treat this condition in dogs and cats.8,13–16 The single-port platform in human laparoscopy has shown promise as a potentially less invasive and less traumatic alternative to multiport laparoscopic techniques.17,18 The single-port platform enables all of the individual laparoscopic instruments, including the telescope, to pass through the same single abdominal incision without compromising the safety and efficacy of the surgical procedure. In human medicine, many common laparoscopic procedures, such as cholecystectomy,19 appendectomy,20 and nephrectomy,20 are now routinely performed in adults and children by means of the single-port approach. Recent studies in the veterinary literature have found use of the single-port platform to be a viable surgical approach for a wide range of abdominal procedures in companion animals, including ovariectomy,21–23 enterotomy and enterectomy,24 and ovariectomy in combination with gastropexy.25 In children, single-port laparoscopic orchidectomy18 and orchopexy20,26–28 have been shown to be safe and effective techniques for the treatment of impalpable testes. Currently, there are no reports in the veterinary literature describing the use of this method for treating small animals with undescended testes. The purpose of the study reported here was to describe the operative technique for SPLC in dogs and cats and report short-term clinical outcome for dogs and cats that underwent the procedure.