Quiz Question
In Azuma 2024 et al., on 3D vs 2D laparoscopy, which group might benefit most from 3D laparoscopy based on the study’s discussion?
🔍 Key Findings
- 3D laparoscopy significantly reduced time to first endoclip placement compared to 2D (median 76 vs. 238 seconds, p = .016).
- Total surgical time was not significantly different between 3D and 2D groups.
- No differences were observed in intraoperative complications such as cystic duct injury, clip dislodgment, or gallbladder perforation.
- Cystic duct stump length was comparable between groups (median 2.5 mm).
- Liver parenchyma attachment severity did not differ significantly between 2D and 3D groups.
- All procedures were performed by an experienced surgeon, potentially reducing the benefit seen with 3D visualization.
- No conversions to open surgery occurred, and no intraoperative complications were reported.
- The study suggests 3D laparoscopy may aid less experienced surgeons due to enhanced depth perception.
Veterinary Surgery
4
2024
Three-dimensional versus two-dimensional laparoscopy for cholecystectomy in a canine cadaveric study
2024-4-VS-azuma-5
In Stoneburner 2024 et al., on MIS survey results, what was the most cited reason for performing MIS techniques?
🔍 Key Findings
- The survey included 111 practicing surgeons and 28 residents from ACVS, ECVS, and ANZCVS. 98.2% had performed soft tissue minimally invasive surgery (MIS).
- In the past year, surgeons reported a median caseload of 90% basic laparoscopy, 0% advanced laparoscopy, and 10% thoracoscopy; for residents: 100% basic laparoscopy, 0% advanced, 0% thoracoscopy.
- Laparoscopic ovariectomy and OHE were the most commonly performed MIS procedures, with most respondents proficient in basic laparoscopy, but few performing advanced laparoscopy or thoracoscopy.
- Top barriers to MIS adoption were: lack of consistent caseload, lack of training, difficult learning curve, equipment limitations, and cost.
- 76.6% of surgeons and 92.9% of residents received MIS training during residency. Those trained had completed residency median 6 years ago, compared to 22 years ago for those without MIS training (p < .001). Perceived adequate training correlated with higher proficiency.
- MIS was recognized as having a steep learning curve, but patient benefits (mean score 4.0/5) were the top motivation — less pain, faster recovery, improved visualization.
- The authors conclude basic laparoscopy is widely adopted, but advanced and thoracoscopic MIS remain underutilized. Training and access are key to future growth.
- Expanded training and improved access to equipment are necessary to promote broader integration of MIS into veterinary soft-tissue surgery.
Veterinary Surgery
5
2024
Laparoscopy and thoracoscopy in small animal surgery: A 2020 survey of small animal surgical diplomates and residents
2024-5-VS-stoneburner-5
In Petchell 2025 et al., on CORA-based CCWO, which of the following methods showed the least variability in postoperative outcomes across all breeds?
🔍 Key Findings
- The CORA-based cranial closing wedge ostectomy (CCWOCORA) consistently achieved the target postoperative TPA of 5° across all tibial morphologies.
- CCWOCORA produced significantly less variability in postoperative TPA compared to other methods (TPA range: 5.00–5.00°; p < .001).
- Mechanical axis advancement (MAA) was precisely controlled at 3° in CCWOCORA, leading to greater surgical predictability.
- Other techniques (e.g., CCWOTPA, CCWOTPA–5, CCWOISO) showed greater variance in TPA, MAA, and tibial length.
- In small-breed dogs, increasing the MAA from 3° to 5° did not affect TPA outcomes, but increased proximal bone stock, improving feasibility.
- Wedge angles and tibial length changes varied by method, but CCWOCORA maintained length better than TPA-based methods.
- The technique allows preoperative planning of both desired MAA and TPA, enhancing predictability and customization.
- CORA methodology enables precise geometric correction and alignment of mechanical axes, reducing reliance on trial-and-error alignment.
Veterinary Surgery
7
2025
An in silico comparison of a novel CORA-based cranial closing wedge ostectomy methodology with three other techniques
2025-7-VS-petchell-4
In Lampart 2023 et al., on manual laxity testing, which test showed the greatest interobserver variability in compressive force applied?
🔍 Key Findings
- Cranial drawer (CD), tibial compression (TCT), and tibial pivot compression test (TPCT) showed 100% sensitivity and specificity in differentiating intact from CCL-deficient stifles in this ex vivo model.
- TPCT elicited the highest cranial tibial translation (CTT) and internal tibial rotation, though differences in rotation did not reach statistical significance.
- Inter- and intraobserver agreement for CTT was excellent across all tests (ICC >0.9).
- Rotation and force application had greater variability, particularly with less experienced observers and during CD.
- Forces applied during CD were significantly higher in intact limbs and correlated with observer experience.
- Subjective CTT estimates strongly correlated with objective kinematic measurements (r = 0.895), with a median absolute error of 1.31 mm.
- TPCT may be particularly useful for assessing rotational instability, mimicking the pivot-shift test used in human ACL exams.
- Study supports development of a grading system for manual laxity testing, especially in acute CCLR cases.
Veterinary Surgery
5
2023
Evaluation of the accuracy and intra‐ and interobserver reliability of three manual laxity tests for canine cranial cruciate ligament rupture—An ex vivo kinetic and kinematic study
2023-5-VS-lampart-4
In Devriendt 2022 et al., on EHPSS blood testing, what was a noted **limitation** of the SHA test in clinical practice?
🔍 Key Findings
- Fasting ammonia (FA) was the most specific test (100%) for confirming EHPSS closure postoperatively.
- Serum hyaluronic acid (SHA) and MEGX at 15 minutes post-lidocaine were the most sensitive tests (96.9% and 96.2%, respectively).
- SHA combined with MEGX T15, or with FA or postprandial serum bile acids (SBA), provided 100% sensitivity with good specificity (72.4–82.8%).
- SHA levels remained elevated in all dogs with persistent shunting, even when other tests were normal.
- Paired SBA had moderate sensitivity (90%) and variable specificity (89%).
- The L/MEGX test at 30 min was less useful than at 15 min for assessing closure.
- Traditional SBA testing showed reduced utility postoperatively; normal values did not rule out persistent shunting.
- Blood tests improved when combined, but imaging remains essential to definitively confirm EHPSS closure.
Veterinary Surgery
7
2022
Evaluation of different blood tests in dogs with extrahepatic portosystemic shunts to assess shunt closure after surgical treatment
2022-7-VS-devriendt-5
In Cheon 2025 et al., on guide accuracy in DFO, what was a notable advantage of the patient-specific guide?
🔍 Key Findings
- Both patient-specific and universal guides yielded correction errors <2°, with no statistically significant difference in accuracy.
- Universal guide corrected aLDFA up to 24° and AA up to 20°, addressing multiplanar deformities effectively.
- Patient-specific guides allowed for preoperative simulation, providing more stable pin placement and potentially aiding less-experienced surgeons.
- Universal guide eliminated the need for CT-based customization, reducing time and cost.
- Cadaver and bone model trials showed consistent accuracy, validating both methods in vitro and ex vivo.
- No significant differences in outcome when correcting uniplanar (aLDFA) vs biplanar (aLDFA + AA) deformities.
- Universal guide's fixed size presented limitations in small dogs, potentially requiring multiple size options.
- Universal guide showed potential for standard use, offering repeatable outcomes with minimal prep despite needing precise intraoperative placement.
Veterinary and Comparative Orthopaedics and Traumatology
3
2025
Comparing the Accuracy of Patient-Specific Guide and Universal Guide for Distal Femoral Osteotomy in Dogs
2025-3-VCOT-cheon-3
In Alvarez-Sanchez 2023 et al., on SLN mapping in canine MCT, how often did the anatomic lymph node (ALN) match the SLN identified by ICTL?
🔍 Key Findings
- Combined ICTL and NIRF detected the same SLN in 80% of cases; each method alone missed sentinel lymph nodes in some dogs.
- ICLT failed in 5% of dogs, while NIRF failed in 20%; combined use resulted in only 5% failure in SLN detection.
- Metastatic lymph nodes were detected in 95% of dogs, despite most tumors being low or intermediate grade (95%).
- 27 of 41 nodes (65.8%) were histologically metastatic (HN2 or HN3), many of which would have been missed using ALN alone.
- ALN matched the SLN in only 45% of cases with ICTL and 30% with NIRF, supporting the need for SLN mapping.
- ICLT and NIRF were complementary, often identifying different SLN, with some only fluorescent or enhanced in one modality.
- Subcutaneous MCT had higher metastatic rates (7/8 dogs) than previously reported, challenging older assumptions about benign behavior.
- Removing both ALN and SLN (from both methods) improved detection of metastasis to 85–95%, reducing risk of understaging.
Veterinary Surgery
3
2023
Comparison of indirect computed tomographic lymphography and near-infrared fluorescence sentinel lymph node mapping for integumentary canine mast cell tumors
2023-3-VS-alvarez-sanchez-3
In Schneider 2025 et al., on axillary LN extirpation, which statement best reflects the accuracy of cytology for staging ALNs?
🔍 Key Findings
- Lateral approach to ALN extirpation was successful in 100% of cases (44 dogs, 48 ALNs) with consistent anatomical landmarks (costochondral junction of rib 1 and caudal scapular edge).
- Median time for ALN removal was 16.6 minutes, highlighting a fast and efficient dissection method.
- No intraoperative complications were recorded (e.g., hemorrhage or inability to find the lymph node).
- Postoperative complications occurred in 18% of cases, including seromas (n=2), wound dehiscence (n=4), lameness (n=1), and discomfort (n=1).
- Histopathology revealed 56% of ALNs had tumor-related pathology, including overt metastases, early metastasis (HN2), or premetastatic changes (HN1).
- Normal-sized ALNs (<2 cm) still harbored metastases in 22% of cases, emphasizing the unreliability of size as a staging criterion.
- False negatives in cytology occurred in 4 cases, underlining the limitations of cytologic evaluation for staging.
- The technique was reproducible without specialized tools, suggesting wide applicability in general and referral practice.
Veterinary Surgery
6
2025
Axillary lymph node removal for staging cancer; description of a lateral approach and application in 44 tumor-bearing dogs
2025-6-VS-schneider-5
In Scheuermann 2023 et al., on femoral MIPO alignment, what was a noted limitation of the prototype FRS?
🔍 Key Findings
- Precontoured plates using 3D-printed femoral models achieved near-anatomic alignment in all cadaver limbs.
- Fracture reduction system (FRS) required significantly fewer fluoroscopy images than intramedullary pin (IMP) methods (7 vs 26, P = .001).
- Despite longer surgical time (43 vs 29 minutes, P = .011), FRS showed equally accurate or better alignment compared to IMP.
- Femoral length, frontal, sagittal, and axial alignment were all within near-anatomic thresholds (<10 mm or <5° deviation) in both groups.
- FRS was associated with more consistent length maintenance, with IMP showing a median shortening of 2.3 mm (P = .03).
- Axial plane deviation was statistically different in the FRS group (P = .04), but still clinically acceptable.
- Study highlights potential for custom 3D-printed guides to reduce radiation exposure and improve precision in MIPO procedures.
- Authors caution that FRS was time-consuming and cumbersome, suggesting design refinements needed for clinical use.
Veterinary Surgery
6
2023
Minimally invasive plate osteosynthesis of femoral fractures with 3D‐printed bone models and custom surgical guides: A cadaveric study in dogs
2023-6-VS-scheuermann-5
In Nagahiro 2023 et al., on quadriceps-femoral mismatch, which variables were significantly associated with a decreased QML/FL in the final regression model?
🔍 Key Findings
- Quadriceps muscle length/femoral length ratio (QML/FL) was significantly lower in dogs with grade IV MPL than grades I–III (p ≤ .002).
- Shortened QML was associated with increased femoral torsion angle (FTA) and increased aLDFA, indicating correlation with femoral deformity.
- QML/FL increased with age, possibly due to muscular development or reduced deformity in older dogs (p = .004).
- Grade IV MPL dogs had QML/FL < 0.87, the lower normal limit based on healthy beagles, suggesting clinically significant muscle shortening.
- PLL/PL ratio (used to diagnose patella alta) was not associated with QML/FL or MPL severity in small breeds.
- QML/FL can help preoperatively identify candidates for femoral shortening ostectomy, improving femoropatellar alignment.
- Multivariate regression model confirmed QML/FL is independently influenced by age, FTA, and aLDFA (R² = 0.45).
- CT-based 3D measurements enabled objective, noninvasive quantification of femoral and muscle alignment parameters.
Veterinary Surgery
4
2023
Evaluation of the quadriceps muscle length to femoral length ratio in small breed dogs with medial patellar luxation
2023-4-VS-nagahiro-3
Quiz Results
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Key Findings