Comparison between single and three portal laparoscopic splenectomy in dogs
© Khalaj et al.; licensee BioMed Central Ltd. 2012
Received: 9 September 2011
Accepted: 27 August 2012
Published: 10 September 2012
Single incision laparoscopic surgery (SILS) is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs. Mongrel dogs (n = 18), weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional). The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments.
All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min) and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P < 0.001). There were no post-operative wound complication including inflammation, infection, hernia formation and dehiscence up to one month after surgery. Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches.
This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional) for splenectomy in dog.
The application of laparoscopy, minimally invasive technique, along with its advantages and superiorities, has become an alternative approach to conventional surgery in small animal veterinary medicine [1–3]. Laparoscopy created huge changes in the field of surgery from large incisions in open surgeries to very small incisions. Within the context of laparoscopy, single incision laparoscopy is a newly growing technique to reduce the invasiveness of conventional multiple portal laparoscopic surgery. Single incision laparoscopic surgery (SILS) reduces surgical trauma and adhesion through implementing a small number and/or size of portals [4–6]. SILS is a feasible technique for different ablative and reconstructive procedures such as cholecystectomy, appendectomy and splenectomy in human [7–10].
Splenectomy in dog is a common operation for tumors . In human, hematological immune mediated diseases, non responsive to medical treatment, ITP and hemolytic anemia are the most common indications of splenectomy [12, 13]. The ideal indication for the laparoscopic splenectomy is an elective splenectomy in blood donor dogs to prevent transmission of hemobartonella infection . Clinical and experimental researches were conducted to elaborate laparoscopic and open splenectomy [14, 15] resulting in the recognition of laparoscopy as a gold standard procedure for splenectomy [16, 17]. In veterinary medicine, the feasibility of multiple portal laparoscopic splenectomy and its superiority over the conventional open technique was documented [11, 18]. Conventional laparoscopy performed safely in laboratory animals, porcine, caprine, canine and human [18–21]. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs.
Clinical and operative findings following splenectomy by single incision laparoscopic surgery (SILS; n = 10) and conventional (3 portals) laparoscopy (n = 6) in dogs
Operative time (min)
Scar length (mm)
29.1 ± 1.65a
51.6 ± 1.34a
28.9 ± 0.80a
10.1 ± 0.82a
275.4 ± 9.09a
42.0 ± 2.69b
72.0 ± 1.63b
31.2 ± 0.87a
9.3 ± 1.56a
288.3 ± 6.14a
The purpose of this study was to investigate the possibility of replacing SILS with conventional standard 3 portals laparoscopy for splenectomy in dog. Accordingly, the operative time and scar length were found to be significantly less in SILS compared to conventional method. Single portal position in SILS provided similar visualization, manipulation and exposure of splenic hilum as in conventional laparoscopy. Insertion of single umbilical portal reduced the chance of accidental injury to splenic parenchyma compared to inserting three separate portals in conventional method.
Recently, the application of SILS techniques has been described in many intra-abdominal procedures in human . The goal of single port access (SPA) surgery is to minimize the incision required to perform the procedure while maintaining the surgeon’s comfort . To the authors’ knowledge, this is the first report in using SILS for splenectomy in dog. In general, less morbidity, short length of hospital stay, less post operative pain and excellent cosmetic results were considered as advantages of SILS to the conventional multiple portals laparoscopic surgeries . Moreover, SILS splenectomy seems to be safe for intra operative visualization of the splenic hilum during transection of vessels and removal of spleen .
The operative time is an important parameter for surgical assessment. In the present study, the operative time was shorter in SILS (29.1 ± 1.65 min) than conventional method of laparoscopy (42.0 ± 2.69 min) for splenectomy in dog. Part of this difference might be due to the use of ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments. Also, the experience of the surgeons has great impact on the outcome and operative time of this study. In one study on splenectomy using conventional laparoscopy in dog, the operative time was quite long in conventional three portals laparoscopy (115 ± 13.4 min) compared to open surgery (50.2 ± 6.6 min; 11). Apparently, experience of the surgeon could explain, in part, a long operative time. In other words, laparoscopic surgical times and complications tend to decrease with an increase in the level of the surgeon's experience, denominated learning curve [25–27].
The most time consuming part of the laparoscopic splenectomy is the time dedicated to remove spleen from the abdomen, which may be associated with the rupture of spleen. In the present study, 4 dogs (SILS: 3 dogs; Conventional: 1 dog) had slight and superficial rupture of spleen with negligible minor bleeding. This was managed successfully but elongated the surgical time.
The single incision laparoscopic surgery (SILS) could be an available, feasible and safe alternative to multiport laparoscopy for dogs undergoing elective splenectomy. It presented advantages in relation to operative time and surgical scar, without any particular complication. The use of the appropriate vessel sealer to ensure hemostasis would facilitate the procedure and decreases the operative time.
This study was approved by the ethical committee of the Faculty of Veterinary Medicine, University of Tehran (BNS717/25.07.2009). Mongrel dogs (n = 18), weighting 15 ± 3 kg, were collected from Dog’s Shelter House, Animal Welfare Society. Experimental dogs were kept in individual pens and received standard balanced diet throughout experiment. Dogs were returned to the Shelter House after experiment.
Following 8 hours food restriction, experimental dogs received acepromazine (0.1 mg/kg; IM) and buprenorphine (10 μg/kg; IV) for premedication and the combination of ketamine (5.5 mg/kg; IV) and diazepam (0.2 mg/kg; IV) for induction of anesthesia. The anesthesia was maintained by inhalation of isoflurane and oxygen through anesthetic machine. Cefazolin (22 mg/kg; IV) was administered as a preoperative prophylaxis at the time of inducing anesthesia.
Data were analyzed using Student t-test after examining the assumptions of parametric tests using SAS/STAT . Data were presented as Mean ± SE.
Authors wish to express their sincere appreciation to Dr Azin Tavakoli for some help during experiment, Research Council of the Faculty of Veterinary Medicine, University of Tehran, Center of Excellence for Veterinary Research on Indigenous Domestic Animals and Rasoul Akram Research Center of Laparoscopic Surgery for provision of financial assistance to complete this research.
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