Jeong Junemoe, Ko Jonghyeok, Lim Hyunjoo, Kweon Oh-Kyeong, Kim Wan Hee
Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea.
Vet Surg. 2016 Nov;45(S1):O102-O110. doi: 10.1111/vsu.12571. Epub 2016 Oct 12.
To develop and describe a laparoscopic retroperitoneal access technique, investigate working space establishment, and describe the surgical anatomy in the retroperitoneal space as an initial step for clinical application of retroperitoneal laparoscopy in dogs.
Cadaveric and experimental study.
Cadaveric (n=8) and healthy (n=6) adult dogs.
The retroperitoneal access technique was developed in 3 cadavers based on the human technique and transperitoneal observation. Its application and working space establishment with carbon dioxide (CO ) insufflation alone was evaluated in 5 cadavers by observing with a transperitoneal telescope and in 6 live dogs by repeated computed tomography (CT) scans at pressure of 0, 5, 10, and 15 mmHg. Recordings of retroperitoneoscopy as well as working space volume and linear dimensions measured on CT images were analyzed.
Retroperitoneal access and working space establishment with CO insufflation alone were successfully performed in all 6 live dogs. The only complication observed was in 1 dog that developed subclinical pneumomediastinum. As pressure increased, working space was established from the ipsilateral to the contralateral side, and peritoneal tearing eventually developed. Working space volume increased significantly from 5 mmHg and linear dimensions increased significantly from 0 to 10 mmHg. With pneumo-retroperitoneum above 5 mmHg, retroperitoneal organs, including kidneys and adrenal glands, were easily visualized.
The retroperitoneal access technique and working space establishment with CO insufflation starting with 5 mmHg and increasing to 10 mmHg provided adequate working space and visualization of retroperitoneal organs, which may allow direct access for retroperitoneal laparoscopy in dogs.
开发并描述一种腹腔镜后腹腔入路技术，研究工作空间的建立，并描述后腹腔空间的手术解剖结构，作为犬后腹腔镜临床应用的第一步。
尸体研究和实验研究。
尸体（n = 8）和健康成年犬（n = 6）。
基于人体技术和经腹腔观察，在3具尸体上开发了后腹腔入路技术。通过经腹腔望远镜观察，在5具尸体中评估了仅使用二氧化碳（CO₂）充气的该技术应用及工作空间建立情况；通过在0、5、10和15 mmHg压力下重复进行计算机断层扫描（CT），在6只活体犬中进行评估。分析了后腹腔镜检查记录以及在CT图像上测量的工作空间体积和线性尺寸。
在所有6只活体犬中均成功完成了仅使用CO₂充气的后腹腔入路及工作空间建立。观察到的唯一并发症是1只犬出现亚临床纵隔气肿。随着压力增加，工作空间从同侧建立到对侧，最终出现腹膜撕裂。工作空间体积从5 mmHg开始显著增加，线性尺寸从0到10 mmHg显著增加。当气腹压力高于5 mmHg时，包括肾脏和肾上腺在内的后腹腔器官易于可视化。
从5 mmHg开始并增加到10 mmHg的CO₂充气后腹腔入路技术及工作空间建立，提供了足够的工作空间并能清晰显示后腹腔器官，这可能允许在犬中直接进行后腹腔镜检查。
