{"title":"Endoscopic-assisted laser sphincterotomy of the intramural common bile duct: A cadaveric pilot study.","authors":"Hiroshi Miyagi, Galina M Hayes","doi":"10.1111/vsu.14280","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To (1) develop a minimally invasive technique for endoscopic-assisted retrograde catheterization (EARC) of the major duodenal papilla (MDP) in dogs and (2) pilot a safe method of endoscope-guided laser sphincterotomy of the intramural segment of the common bile duct (ICBD).</p><p><strong>Study design: </strong>Descriptive study.</p><p><strong>Animals: </strong>Twenty fresh canine cadavers.</p><p><strong>Methods: </strong>Following mini-midline celiotomy and exteriorization of the distal duodenum, endoscopy of the duodenal lumen was performed under saline irrigation via a 5 mm cuffed endoscopic port using a 2.7 mm 30° rigid cystoscope and HoYag laser fiber. Endoscopic-assisted retrograde catheterization of the MDP and laser sphincterotomy extended to the end of the ICBD was performed. The duodenal segment was dissected under magnification following the endoscopic procedure. The length of the ICBD and the incidence of iatrogenic injury were recorded.</p><p><strong>Results: </strong>The EARC of the MDP and laser sphincterotomy were successful in 18 of 18 attempts. The ICBD segments ranged from 10 to 21 mm long (n = 20) (body weight 6.6-37.0 kg). There was no correlation between body weight and length of the ICBD (Pearson's rho = .06, p = .79). Partial thickness lateral perforations occurred in two specimens. Division of the submucosal layer during ablation heralded the start of the extramural segment and could be identified consistently (16/18; 88%).</p><p><strong>Conclusion: </strong>Endoscopic-assisted retrograde catheterization and extended laser sphincterotomy appeared feasible and safe in canine cadavers. Further evaluation in a live-animal setting is warranted.</p><p><strong>Clinical significance: </strong>Endoscopic-assisted retrograde catheterization may have advantages over current open techniques for accessing the duodenal papilla and endoscopic laser sphincterotomy may assist resolution of ICBD obstructions.</p>","PeriodicalId":23667,"journal":{"name":"Veterinary Surgery","volume":" ","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Veterinary Surgery","FirstCategoryId":"97","ListUrlMain":"https://doi.org/10.1111/vsu.14280","RegionNum":2,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"VETERINARY SCIENCES","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To (1) develop a minimally invasive technique for endoscopic-assisted retrograde catheterization (EARC) of the major duodenal papilla (MDP) in dogs and (2) pilot a safe method of endoscope-guided laser sphincterotomy of the intramural segment of the common bile duct (ICBD).
Study design: Descriptive study.
Animals: Twenty fresh canine cadavers.
Methods: Following mini-midline celiotomy and exteriorization of the distal duodenum, endoscopy of the duodenal lumen was performed under saline irrigation via a 5 mm cuffed endoscopic port using a 2.7 mm 30° rigid cystoscope and HoYag laser fiber. Endoscopic-assisted retrograde catheterization of the MDP and laser sphincterotomy extended to the end of the ICBD was performed. The duodenal segment was dissected under magnification following the endoscopic procedure. The length of the ICBD and the incidence of iatrogenic injury were recorded.
Results: The EARC of the MDP and laser sphincterotomy were successful in 18 of 18 attempts. The ICBD segments ranged from 10 to 21 mm long (n = 20) (body weight 6.6-37.0 kg). There was no correlation between body weight and length of the ICBD (Pearson's rho = .06, p = .79). Partial thickness lateral perforations occurred in two specimens. Division of the submucosal layer during ablation heralded the start of the extramural segment and could be identified consistently (16/18; 88%).
Conclusion: Endoscopic-assisted retrograde catheterization and extended laser sphincterotomy appeared feasible and safe in canine cadavers. Further evaluation in a live-animal setting is warranted.
Clinical significance: Endoscopic-assisted retrograde catheterization may have advantages over current open techniques for accessing the duodenal papilla and endoscopic laser sphincterotomy may assist resolution of ICBD obstructions.
期刊介绍:
Veterinary Surgery, the official publication of the American College of Veterinary Surgeons and European College of Veterinary Surgeons, is a source of up-to-date coverage of surgical and anesthetic management of animals, addressing significant problems in veterinary surgery with relevant case histories and observations.
It contains original, peer-reviewed articles that cover developments in veterinary surgery, and presents the most current review of the field, with timely articles on surgical techniques, diagnostic aims, care of infections, and advances in knowledge of metabolism as it affects the surgical patient. The journal places new developments in perspective, encompassing new concepts and peer commentary to help better understand and evaluate the surgical patient.