Use of an endoscopic suturing device for laparoscopic resection of the apex of the bladder and umbilical structures in normal neonatal calves

Abstract

Objective: To develop a laparoscopic technique using an endoscopic suturing device for the resection of the apex of the bladder and the umbilical structures in large-animal neonates. Study Design-Experimental study. Animals or Sample Population-Seven healthy male Holstein calves.

Methods: A laparoscopic technique for resection of the apex of the bladder was developed on 2 calf cadavers, then evaluated on 5 anesthetized calves. The calves were positioned in dorsal recumbency, and 4 ventral abdominal portals were used. The umbilical vessels were double-ligated using an endoscopic suturing device and subsequently transected. The apex of the bladder was transected between a row of laparoscopic clips applied near the apex and atraumatic laparoscopic forceps applied distally; then, the edges were apposed using an endoscopic suturing device. The dissected umbilical remnants were removed from the abdomen through a small incision centered at the umbilicus. One month later, the calves were euthanatized and a second-look laparoscopy performed; then, bladders were collected for gross and histologic examination.

Results: No major complications occurred during or after surgery. The endoscopic suturing device permitted both effective ligation of the umbilical vessels and closure of the bladder. During second-look laparoscopy, healing of the peritoneal surface of the bladder and umbilical vessels was assessed to be excellent in 4 calves. A focal adhesion of omentum to the bladder suture line was observed in 1 calf. Focal adhesions of the omentum to the umbilical incision site occurred in 2 calves. The bladder mucosa was completely healed at the surgical sites.

Conclusion and clinical relevance: Resection of the apex of the bladder and umbilical vessels in calves can be accomplished laparoscopically using an endoscopic suturing device.