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Insight – Swift recovery for Gulliver

Hervé Brissot, soft tissue surgeon, explains how laparoscopic and endoscopic procedures were used for the minimally invasive treatment of a three-legged cat with chronic renal failure and a per..

Insight – Swift recovery for Gulliver

Hervé Brissot, soft tissue surgeon, explains how laparoscopic and endoscopic procedures were used for the minimally invasive treatment of a three-legged cat with chronic renal failure and a perinephric pseudocyst.

Gulliver, a nine-year-old entire, male, domestic shorthair cat is an old friend of DVS. We last saw him in 2005 for treatment of a sarcoma invading his left forearm, which eventually required amputation of the limb. He made a swift recovery and has remained incredibly active despite being on only three legs!

In the years following this treatment, Gulliver developed renal disease and was eventually diagnosed with chronic renal failure. This did not appear to affect his quality of life for several years, until he started to show abdominal distension and discomfort. His owner had been alarmed to notice a dramatic reduction in Gulliver’s appetite and vitality, which had developed at the same rate as the increase in Gulliver’s girth. Physical examination of Gulliver showed a greatly enlarged abdomen. and signs of general malaise and debility. Chronic renal failure was confirmed by the blood and urine analyses. The abdominal ultrasound showed a very large renal pseudocyst around the left kidney that appeared to be the cause of the dramatic enlargement of Gulliver’s belly.

Laparoscopic examination was performed under general anaesthesia. Via a single 5mm incision, a surgical camera was introduced into the abdomen and used to check the entire abdomen. A large fluid-filled mass was observed on the left side at the level of the normal location of the left kidney (figure 3-6). Two additional incisions were performed to allow the introduction of surgical instruments within the abdomen. The large ‘cyst’ was opened and all its content was aspirated. Then endoscopic scissors were used to thoroughly remove the ‘cyst’ wall and, eventually, the left kidney was visualised and completely freed from the ‘cyst’. A total of 750 ml of fluid was drained from the abdomen. The procedure took less than an hour and Gulliver woke up very quickly from the anaesthesia. A few hours after the surgery, he was eating comfortably and was discharged 24 hours later.

We re-examined Gulliver two months after the surgery. His owner was very happy and felt that he had a new lease of life as he was behaving like a kitten again, playing and climbing trees more than ever! At the same time she also felt that his appetite was as good as it ever had been. A peri-nephric pseudocyst is a rare condition observed in elderly cats and always associated with renal disease. Resect of the ‘cyst’ is recommended to improve the associated abdominal discomfort and decrease a possible compression of the already damaged renal parenchyma. In theory the surgery should improve the renal function, although case studies show that the surgery can’t reverse the course of chronic renal disease. It is, however, a general belief that decompression of the renal parenchyma might stabilise the degradation of the renal function. In our case, the surgery dramatically improved Gulliver’s quality of life, although two months later minor changes were observed in his blood parameters and similar changes consistent with chronic renal failure were still present.

Traditional surgical management requires a large exploratory laparotomy to allow extensive removal of the ‘cyst’ wall. Minimally invasive surgery achieves the same results as open surgery, in a comparable time with dramatically less tissue trauma. Via three 5 mm skin incisions we were able to assure a thorough exploration of the abdominal cavity and to resection all the abnormal tissues. Intra-abdominal surgery also allowed less traction on the mesenteric root, which is well-known to create peri and post-operative pain. Video and high quality ‘scopes enable magnification of the abdominal structure and improved visualisation. This in turn allows better exposition and more precise dissection. These principles are already well-known in veterinary joint surgery with arthroscopy and have shown to be very efficient in human and equine surgeries. They are now becoming well-recognised as useful techniques in small animal soft tissue surgery.

Pericardial or pulmonary surgery, neutering, abdominal exploration and biopsies are the most common indications of thoraco- and laparoscopy but as these approaches are quickly developing and clearly stimulating interest, there is no doubt that new indications will appear in the next few years. In all the patients, whatever the species, minimally invasive video-assisted surgery has been shown to decrease post-operative pain, post-operative hospitalisation and recovery time, as it has again been the case for Gulliver!

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