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Estabelecimento do pneumoperitoneu para laparoscopia em canídeos : estudo comparativo de três técnicas
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Resumo(s)
A fase mais importante para a laparoscopia de diagnóstico e cirúrgica consiste na entrada na cavidade abdominal com vista à criação de um espaço de trabalho. A técnica mais utilizada consiste na insuflação da cavidade abdominal com gás, designado por pneumoperitoneu. Esta etapa é reconhecida por apresentar um risco considerável de ocorrência de complicações. Com o intuito de diminuir a ocorrência dessas mesmas complicações têm vindo a ser desenvolvidas várias técnicas, instrumentos e abordagens, porém não existem evidências significativas da superioridade de uma técnica em relação a outra.
Assim, pretendeu-se com este trabalho realizar um estudo comparativo entre três técnicas para estabelecimento do pneumoperitoneu, analisando parâmetros como o tempo de insuflação, número de tentativas para a sua execução e ocorrência de lesões iatrogénicas, considerando simultaneamente as características do próprio animal. Avaliou-se ainda um ponto específico proposto para a inserção da agulha de Veress e cateter endovenoso de 16G, com o intuito do estabelecimento do, já referido, pneumoperitoneu.
O estudo considerou trinta animais que foram agrupados, ao acaso e por ordem de chegada, em 3 grupos que se diferenciaram pela técnica de insuflação utilizada: I- Agulha de Veress; II- Cateter; III- Hasson modificada. Durante os procedimentos cirúrgicos foram registados o tempo de insuflação, o número de tentativas para o estabelecimento do pneumoperitoneu e a ocorrência de lesões iatrogénicas.
A técnica de Hasson modificada demonstrou ser estatisticamente mais demorada, comparativamente com a técnica com utilização da agulha de Veress. Também o tempo de insuflação foi significativamente superior nos casos em que foi necessário recorrer a duas tentativas, em vez de uma para a execução da técnica de Hasson modificada. Verificou-se ocorrência de lesão iatrogénica em 6,7% dos casos, apenas aquando da utilização da técnica fechada com recurso ao cateter endovenoso 16 Gauge. Não se obteve associação entre os parâmetros condição corporal, peso e idade dos animais, e a realização das diferentes técnicas.
Tendo em conta as vantagens demonstradas no trabalho realizado, o uso da técnica fechada com recurso à agulha de Veress é sugerida como a técnica de eleição para o estabelecimento do pneumoperitoneu em cães.
ABSTRACT - The establishment of pneumoperitoneum for laparoscopic surgery in canines – comparative study using three techniques - The most important step in a laparoscopic surgery consists in entering into the abdominal cavity in order to create working space. This step is usually accomplished by insufflating carbon dioxide into the abdominal cavity to create pneumoperitoneum and it has been associated with a significant risk for complications to occur. In order to decrease such events several techniques, instruments and approaches have been developed, but there is no significant evidence of the superiority of one technique over the others. Hereupon, this work was intended to be carried out as a comparative study between three techniques of pneumoperitoneum establishment, in which was analyzed the insufflation time, the number of attempts and the occurrence of iatrogenic injuries. These factors were evaluated taking into consideration the animals own characteristics. Other purpose of this study was to define an access entry and to evaluate its clinic use to insert the Veress needle and catheter to perform the pneumoperitoneum. This study was performed in thirty animals which were randomly separated in order of arrival in three different groups that differed by the insufflation techniques that was used: I- Veress needle; II- catheter; III- modified Hasson. During the surgical procedure, the insufflation time, number of attempts to create the pneumoperitoneum and the occurrence of iatrogenic injuries were recorded. The establishment of pneumoperitoneum was significantly slower using the modified Hasson technique than with the Veress needle technique. Also, the insufflation time was significantly higher in cases where it was necessary to use two attempts, instead of one, for the implementation of the modified Hasson technique. The entrance in abdominal cavity led to complication in 6,7% of the patients, but only when the closed technique using the catheter intravenous 16 Gauge was performed. In this study, it wasn´t found any association between body condition, body weight and age of the animals and the different insufflation techniques performed. Taking into account the advantages demonstrated in this study, the closed technique using the Veress needle is recommended for the establishment of pneumoperitoneum in dogs.
ABSTRACT - The establishment of pneumoperitoneum for laparoscopic surgery in canines – comparative study using three techniques - The most important step in a laparoscopic surgery consists in entering into the abdominal cavity in order to create working space. This step is usually accomplished by insufflating carbon dioxide into the abdominal cavity to create pneumoperitoneum and it has been associated with a significant risk for complications to occur. In order to decrease such events several techniques, instruments and approaches have been developed, but there is no significant evidence of the superiority of one technique over the others. Hereupon, this work was intended to be carried out as a comparative study between three techniques of pneumoperitoneum establishment, in which was analyzed the insufflation time, the number of attempts and the occurrence of iatrogenic injuries. These factors were evaluated taking into consideration the animals own characteristics. Other purpose of this study was to define an access entry and to evaluate its clinic use to insert the Veress needle and catheter to perform the pneumoperitoneum. This study was performed in thirty animals which were randomly separated in order of arrival in three different groups that differed by the insufflation techniques that was used: I- Veress needle; II- catheter; III- modified Hasson. During the surgical procedure, the insufflation time, number of attempts to create the pneumoperitoneum and the occurrence of iatrogenic injuries were recorded. The establishment of pneumoperitoneum was significantly slower using the modified Hasson technique than with the Veress needle technique. Also, the insufflation time was significantly higher in cases where it was necessary to use two attempts, instead of one, for the implementation of the modified Hasson technique. The entrance in abdominal cavity led to complication in 6,7% of the patients, but only when the closed technique using the catheter intravenous 16 Gauge was performed. In this study, it wasn´t found any association between body condition, body weight and age of the animals and the different insufflation techniques performed. Taking into account the advantages demonstrated in this study, the closed technique using the Veress needle is recommended for the establishment of pneumoperitoneum in dogs.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Laparoscopia pneumoperitoneu agulha de Veress Cateter Hasson modificada canídeos Laparoscopy pneumoperitoneum Veress needle catheter modified Hasson canine
Contexto Educativo
Citação
Ferrão, I.M.R.D. (2016). Estabelecimento do pneumoperitoneu para laparoscopia em canídeos : estudo comparativo de três técnicas. Dissertação de mestrado. Universidade de Lisboa, Faculdade de Medicina Veterinária, Lisboa.
Editora
Universidade de Lisboa. Faculdade de Medicina Veterinária