Mayhew Philipp D, Balsa Ingrid M, Guerzon Christian N, Gibson Erin A, Keel M Kevin, Brun Maurício Veloso, Lillo Araya Felipe J
Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California.
Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, California.
Vet Surg. 2020 Oct;49(7):1378-1387. doi: 10.1111/vsu.13493. Epub 2020 Aug 19.
To evaluate the feasibility of transanal minimally invasive surgery (TAMIS) for submucosal rectal resection in large breed dogs.
Cadaveric study.
Canine cadavers (n = 6) weighing between 37.5 and 60 kg.
Dogs were positioned in sternal recumbency. After rectal cleansing, a transanal access platform was placed in the rectum, and a pneumorectum was established. An area of ventral rectal wall approximately 2 × 2 cm was resected in a submucosal plane by using laparoscopic instruments and submitted for histopathological evaluation. The rectal wall defect was closed with a single-layer continuous suture pattern with barbed suture. Postoperatively, the rectum was removed en bloc and evaluated for suture or surgical penetration of the serosal surface.
Submucosal rectal resection was successfully completed by using TAMIS in all dogs. The median length of resected specimens after fixation was 24.5 mm (range 9.8-26.5). In two of six dogs, suture was macroscopically visible on the serosal surface, but no dogs had evidence of iatrogenic full-thickness surgical penetration of the rectum. The median distance from the aborad extent of the suture closure line to the anocutaneous junction was 35 mm (range, 35-105).
Submucosal resection of the canine rectal wall was feasible in large breed dogs by using TAMIS. No evidence of full-thickness penetration of the rectal wall was seen in these cadaveric specimens.
Transanal minimally invasive surgery may provide an alternative minimally invasive approach for resection for benign adenomatous rectal polyps in large breed dogs that might otherwise require a rectal pull-through.
评估经肛门微创手术（TAMIS）用于大型犬直肠黏膜下切除术的可行性。
尸体研究。
体重在37.5至60千克之间的犬类尸体（n = 6）。
将犬置于胸骨卧位。直肠清洁后，在直肠内放置经肛门接入平台，并建立直肠充气。使用腹腔镜器械在黏膜下层平面切除直肠前壁约2×2厘米的区域，并送去进行组织病理学评估。直肠壁缺损用带倒刺缝线的单层连续缝合方式关闭。术后，将直肠整块切除，并评估缝线或手术对浆膜表面的穿透情况。
所有犬均通过TAMIS成功完成直肠黏膜下切除术。固定后切除标本的中位长度为24.5毫米（范围9.8 - 26.5）。在6只犬中的2只，浆膜表面在宏观上可见缝线，但没有犬有直肠医源性全层手术穿透的证据。缝线闭合线远侧端到肛门皮肤交界处的中位距离为35毫米（范围35 - 105）。
在大型犬中使用TAMIS进行直肠壁黏膜下切除术是可行的。在这些尸体标本中未见直肠壁全层穿透的证据。
经肛门微创手术可能为大型犬良性腺瘤性直肠息肉切除提供一种替代的微创方法，否则可能需要进行直肠拖出术。
