Laparoscopy-assisted percutaneous correction of abdominal wall defects in the umbilical region in a cadaveric model of bovine fetus

Abstract

Abdominal wall defects in calves are commonly diagnosed and treated via laparotomy. This technique has witnessed several advancements in the management of these disorders. This study aimed to create a study model and evaluate the feasibility of video-assisted percutaneous correction of abdominal wall defects in bovine fetuses (corpses) compared with the conventional technique. Sixteen bovine fetuses from pregnant cows slaughtered in slaughterhouses were included in this study. The fetuses were categorized into the control group (CG, n = 8), which was subjected to umbilical abdominorrhaphy via laparotomy, and the video-surgical group (VG, n = 8), which received video-assisted percutaneous sutures with two lateral accesses on the right flank. An abdominal wall defect was created in the VG group to generate a study model, which was corrected using the laparoscopic technique. The procedures were performed in two steps. The first step consisted of creating an abdominal wall defect in the umbilical region by laparoscopic approach in an iatrogenic manner (Step 1: E1). The second stage consisted of conventional abdominorrhaphy of the umbilical region wall defect in the CG group and video-assisted percutaneous suturing of the edges of the iatrogenic abdominal wall defect in the VG group, until reversal of the laparoscopic accesses (Step 2: E2). Step 1 showed no statistically significant difference between the two groups. However, a significant statistical difference (p < 0.0001) was observed between the two groups in step 2. The surgical time of step 2 was longer in the CG group (33.10 ± 0.43 minutes) than that in the VG group (10.13 ± 0.68 minutes, p < 0.0001), and the total surgical time was also longer in the CG group (38.48 ± 0.35 minutes) than that in the VG group (15.86 ± 0.67 minutes). The proposed laparoscopic technique allowed the creation of a study model for video-assisted percutaneous suturing with two portals and reduced the surgical time compared with the conventional technique. However, this method needs to be studied further in live animals.

Fig 1. Umbilical abdominorrhaphy and dermorrhaphy in the laparotomy technique.

(A) Beginning of the suture (white arrow) using interrupted stitches, jacket type. (B) Stitches (*) before being finished. (C) Peritoneum/muscle suture completed. (D) Subcutaneous suture to reduce dead space, and (E) dermorrhaphy with U suture. Cr, cranial; Cd, caudal; L, left; R, right.

Fig 2. Creation of the study model for performing the percutaneous suture.

(A) Resection of the umbilical vein (UV). (B) Resection of the right (RUA) and left (LUA) umbilical arteries and urachus (U). (C) Umbilical ring (UR) after resection of the umbilical structures. (D) Beginning of the abdominal wall lesion. (E) End of the abdominal wall lesion. (F) Final result of the defect (white arrows) in the abdominal wall.

Fig 3. External view during the video-assisted percutaneous suturing technique.

(A) Beginning of the suture using the guide catheter (white arrow) and (B) completion of the percutaneous suture with isolated stitches (*).

Fig 4. Schematic representation of the video-assisted percutaneous suturing technique.

(A) Identification of anatomical structures. (B) Introduction of the guiding catheter on one side of the wound edges and placement of the nylon thread. (C) Nylon thread passed through the wound edges after removal of the catheter. (D) Nylon thread re-passed via the catheter directed on the opposite side to the first placement. (E) Nylon thread after removal of the catheter at the edges of the wound. (F) Finishing the stitch with a surgery knot in the subcutaneous region. I-Skin. II-Muscle. III-Subcutaneous. IV-Catheter.

Fig 5. Internal view during video-assisted percutaneous suturing technique.

(A) Introduction of the mandrel (white arrow) of the catheter into the abdominal cavity, (B) Beginning of the first stitch, with the mandrel directed to the other side of the edge of the surgical wound, (C) Nylon threads applied to the surgical wound, and (D) Completion of the video-assisted percutaneous suture technique.