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      Mapping system for portal placement in laparoscopic procedures of small animals

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          Abstract

          Background

          Current recommendations for portal placement in laparoscopy are often imprecise. The aim of this study was to establish and evaluate a mapping system for portal placement during laparoscopic procedures in small animals.

          Sixty-four final-year veterinary students took part in this in papyro study.

          Descriptions of portal placements of two recent veterinary laparoscopic papers were randomly chosen as templates. The students performed portal placement based either on the description in the papers or based on the orthogonal mapping system for portal placement developed by the authors in a previous pilot study. The participants were randomly divided into two groups and asked to virtually chart positions of the portals on two photographs of a dog’s abdomen. Group A ( n = 31) placed the portals using the mapping system, and Group B ( n = 33) placed the portals based on the explanations provided in two randomly selected studies.

          Results

          Group A achieved an overall correct placement rate of 94.91 % (87.1–100.0 %) with an overall mean distance of 1.31 mm (0.00–3.61 mm) from the desired placement points. Group B achieved an overall correct placement rate of 40.8 % (3.1–93.3 %) with an overall mean distance of 16.97 mm (7.17–27.63 mm) from the desired placement points. The students in Group A performed significantly better than did students in Group B ( P < .05).

          Conclusions

          Use of the mapping system significantly improved correct portal placement in a dog photograph model. Use of such systems in laparoscopy may help facilitate correct portal placement and improve the repeatability of procedures, especially for the novice surgeon.

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          Most cited references16

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          Complications of laparoscopy: a prospective multicentre observational study.

          To determine the incidence and describe the complications of laparoscopic procedures in The Netherlands. A nationwide prospective multicentre observational study. Data on complications were registered from 1 January to 31 December 1994 by 72 hospitals. Any unexpected or unplanned event requiring intra-operative or post-operative intervention was defined as a complication. Complications were classified in two groups: approach and technique related complications. Complication rates were compared with these already published. Of 25,764 laparoscopic procedures, 145 complications occurred (rate 5.7 per 1000 [/1000]); two deaths occurred. In 84 women laparotomy was necessary (rate 3.3/1000). In 83 cases (57%; 95% CI for approach = 49-65%) the complication was caused by the surgical approach; in 62 cases (43%) the technique was at fault. Haemorrhage of the epigastric vein and intestinal injury, often requiring laparotomy (90% of cases) were the most frequently observed complications. The complication rate was 2.7/1000 for diagnostic laparoscopic procedures, 4.5/1000 for sterilisation and 17.9/1000 (chi 2 = 127; dF = 2; P < 0.001) for operative laparoscopy. The highest incidence was registered for complications occurring during laparoscopic (assisted) hysterectomy. Stepwise logistic regression analysis showed that previous laparotomy and surgical experience were associated with complications requiring laparotomy. Most complications occurred during operative laparoscopic procedures (rate 17.9/1000). Residents in training are required to learn diagnostic laparoscopy and sterilisation and this training programme results in a fall in the risk of the complications. However, operative laparoscopic procedures are still hazardous, especially laparoscopic hysterectomy. Women with a previous laparotomy are particularly at risk.
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            Laparoscopic entry: a review of techniques, technologies, and complications.

            To provide clinical direction, based on the best evidence available, on laparoscopic entry techniques and technologies and their associated complications. The laparoscopic entry techniques and technologies reviewed in formulating this guideline include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars, and visual entry systems. Implementation of this guideline should optimize the decision-making process in choosing a particular technique to enter the abdomen during laparoscopy. English-language articles from Medline, PubMed, and the Cochrane Database published before the end of September 2005 were searched, using the key words laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS AND SUMMARY STATEMENT: 1. Left upper quadrant (LUQ, Palmer's) laparoscopic entry should be considered in patients with suspected or known periumbilical adhesions or history or presence of umbilical hernia, or after three failed insufflation attempts at the umbilicus. (II-2 A) Other sites of insertion, such as transuterine Veress CO(2) insufflation, may be considered if the umbilical and LUQ insertions have failed or have been considered and are not an option. (I-A) 2. The various Veress needle safety tests or checks provide very little useful information on the placement of the Veress needle. It is therefore not necessary to perform various safety checks on inserting the Veress needle; however, waggling of the Veress needle from side to side must be avoided, as this can enlarge a 1.6 mm puncture injury to an injury of up to 1 cm in viscera or blood vessels. (II-1 A) 3. The Veress intraperitoneal (VIP-pressure
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              Surgical time and severity of postoperative pain in dogs undergoing laparoscopic ovariectomy with one, two, or three instrument cannulas.

              To determine whether number of instrument cannulas is associated with surgical time or severity of postoperative pain in dogs undergoing laparoscopic ovariectomy.
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                Author and article information

                Contributors
                +43664602576633 , nikola.katic@vetmeduni.ac.at
                Vivian.Fromme@kleintierklinik.uni-leipzig.de
                barbara.bockstahler@vetmeduni.ac.at
                gilles.dupre@vetmeduni.ac.at
                Journal
                BMC Vet Res
                BMC Vet. Res
                BMC Veterinary Research
                BioMed Central (London )
                1746-6148
                16 August 2015
                16 August 2015
                2015
                : 11
                : 212
                Affiliations
                [ ]Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine, Veterinaerplatz 1, 1210 Vienna, Austria
                [ ]Present address: Universität Leipzig, Veterinärmedizinische Fakultät, Klinik für Kleintiere, An den Tierkliniken 23, 04103 Leipzig, Germany
                Author information
                http://orcid.org/0000-0001-6734-5255
                Article
                524
                10.1186/s12917-015-0524-4
                4566970
                26276299
                73f107c5-d1ab-4a05-b807-918754eccb2c
                © Katic et al. 2015

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 31 May 2015
                : 31 July 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Veterinary medicine
                laparoscopy,portal placement,minimally invasive surgery
                Veterinary medicine
                laparoscopy, portal placement, minimally invasive surgery

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