Studies On Clinical Application Of Laparoscopic Technology In Urology Surgery To Cats

Minimally invasive surgery is the development direction of surgical in21st. And as an important component part of the minimally invasive surgery, laparoscopic technique has been widely used in medicine for the advantages of excellent visualization, less bleeding, minimally invasive, less pain, faster postoperative recovery and so on. However, laparoscopic technique has a slow development in veterinary, especially in urinary surgery of small animal. There is no correlative report about basic research or clinical application of laparoscopic technique to cats in China, so far. Therefore, the purpose of this study was to design and perform a selection trial of the optimum pneumoperitoneum in surgery of cat, to perform laparoscopic abdominal cavity exploration at the optimum CO2pneumoperitoneum pressure, to perform laparoscopic cystotomy and sutura, assistant-laparoscopic anastomosis of ureter, laparoscopic nephrotomy and pyelotomy and sutura at the optimum CO2pneumoperitoneum pressure, and to compare the advantages and disadvantages of laparoscopic surgery (LS) and open surgery (OS).Fifty cats (female or male) mean weight3kg were selected and breed for one month in the same constitution, and were used as experimental animals after health examination in clinic and laboratory. Aropine sulphate was subcutaneous injected by0.04mg/kg-weight15min before anesthesia. Propofol was intravenous injected by1mL/kg·weight for induction of anaesthesia. No.3.0trachea cannula was intubated with laryngoscope, and attached to the anesthetic gas machine. Isoflurane was inhaled for maintenance of anesthesia. Inspiratory/expiratory was set1:2. Tidal volume (TV) was15～20ml/kg. Respiration rate (RR) was15～20times/min.Experimental animals were randomly selected for five groups, named group A, group B, group C, group D and group E,10in each group. Group A was anesthesia control group, group B, C, D, and E were respectively subjected to CO2pneumoperitoneum at pressure4mmHg,6mmHg,8mmHg and10mmHg. Body temperature (BT), respiratory function index, cardiovascular function index, electrOSardiogram (ECG) and electroencephalogram (EEG) were recorded at9time points which were before inflation (T0), inflated10min (T1),20min (T2),30min (T3),45min (T4),60min(T5),90min(T6), after deflation10min(T7),30min(T8), and correspondingly anesthetized0min (T0),10min (T1),20min (T2),30min (T3),45min (T4),60min (T5),90min (T6),100min (T7),120min (T8). Meanwhile, abdominal bulge and exposure of abdominal organs were observed at different CO2pneumoperitoneum pressure.Experimental animals were randomly selected for seven groups,6in each group. At the optimum CO2pneumoperitoneum pressure, laparoscopic surgeries were performed such as laparoscopic abdominal cavity exploration, laparoscopic cystotomy and sutura, assistant-laparoscopic anastomosis of ureter, laparoscopic nephrotomy and pyelotomy and sutura. At7time points which were preoperative (T0), postoperative instantly(T1), postoperative1d (T2),2d (T3),3d (T4),4d (T5),5d (T6),7d (T7), body temperature (BT), respiratory rate (RR), heart rate, WBC, liver function (AST, ALT), renal function (Scr, BUN), CORT, CA, MDA, SOD, GSH, IL-6, CRP, PGE2,5-HT, SDS and VAS were recorded to compare with which in opened technique.The results showed that:1. The influence of different CO2pneumoperitomeum on physical function of catIn the study, during the pneumoperitoneum prOSess, along with abdominal pressure inereasing and hold-time extension, the monitoring index had changed accordingly. The much bigger was pneumoperitoneum pressure and the much bigger change was. We found that the6mmHg pneumoperitoneum pressure was safe and satisfied laparoscopic surgery on urinary system.1OmmHg and above pneumoperitoneum pressure should be avoided as far as possible.2. Application of laparoscopic technique to abdominal cavity exploration of cat.Laparoscopic approach was performed at6mmHg pneumoperitoneum pressure. It was showed that wide visual field, clear level, scale effect, and clear anatomical position and structure even lesions of abdominal organs, reduced blind exploratory, and MDAe for determining modus operandi and incision lOSation. Therefore, it has a considerable value in clinical diagnosis and treatment.3. Application of laparoscopic technique to urinary surgery of cat.At6mmHg pneumoperitoneum pressure,18of cases laparoscopic cystotomy and sutura, assistant-laparoscopic anastomosis of ureter, laparoscopic nephrotomy and pyelotomy and sutura were performed, also and18cases of homologous opened technique. There was all primary healing and no postoperative complication. The monitoring index showed that laparoscopic surgery had much more advantages than open surgery. The fact that laparoscopic techniques could be applied on urinary surgery of cat was verified.On the whole, the laparoscopic surgery on cats was firstly studied in China. This study determined the optimum PP of cat, compared the effects of laparoscopic and traditional surgery, and certified the practicability and feasibility of laparoscopic techniques applied to urinary surgery of cat. That will be the basis for applying of LS to domestic veterinary clinic.