PMC9549965_01
Diagnostic images of computed tomography angiography before (A,B) and after (C,D) laparoscopic attenuation of canine splenophrenic shunt using thin-film banding. Asterisk, shunting vessel; arrow, vascular gap of complete closure; c, ligation clip.
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F1
When a CTA with maximum intensity projection was performed, there was a shunting vessel, which originated from the splenic vein (Figures 1A,B). It demonstrated a gap of contrast discontinuity about 1 cm around the clips on the same plane as in preoperative CTA, which was interpreted as a complete closure of the shunting vessel (Figures 1C,D).
Laparoscopic tower set-up (A) and portal sites (B) for laparoscopic attenuation of canine splenophrenic shunt using thin-film banding. x, xiphoid process; 1, primary port; 2, second port; 3, third port; asterisk, umbilicus; arrow, mini-laparotomy site for cystolithotomy; p, prepuce.
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F2
The endoscopic tower was located rostral to the patient, while the surgeons stood on the opposite side (Figure 2A). Three 5-mm ports were placed using the Hasson technique (Figure 2B) as follows: primary port (cranial to umbilicus) for the telescope (5 mm, 0 , 1488 HD; Stryker, Portage, Michigan, USA), second port (right paramedian near the costal arch), and third port (left paramedian caudal to the primary one) for laparoscopic surgical instruments. Under stable anesthesia, a cystolithotomy was performed via a 2 cm mini-laparotomy on the right caudolateral to the prepuce (Figure 2B), and 98 urinary stones with 1~4 mm in diameter were removed.
Surgical images of laparoscopic attenuation of canine splenophrenic shunt using thin-film banding. (A) Laparoscopic view of diaphragm in left upper abdomen, (B) a suture being placed to the stomach for marionette retraction, (C) a shunting vessel entering the diaphragm, (D) dissecting shunting vessel from surrounding fat, (E) thin film band being passed through a perivascular window, (F) an arterial vessel identified inside the loop of thin film banding, (G) phrenic artery running alongside the shunting vessel, (H) completed thin film banding after additional intervascular dissection, and (I) final view after intraabdominal organs restored their position. Asterisk, shunting vessel; Li, liver; St, stomach; dotted line, incised line of the triangular ligament; TFB, thin-film band; arrowheads, arterial branch heading to the diaphragm; black arrow, the tip of the TFB; Sp, spleen.
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When the upper abdomen was explored, a portion of the shunting vessel was identified in the tendinous center of the diaphragm, covered with a left lateral liver lobe (Figure 3A). A 3-0 polydioxanone suture, with a tapered point and round bodied needle, was introduced through the port, and a stay suture was placed at gastric fundus near the lesser curvature, tied intracorporeally (Figure 3B). It was identified that a shunting vessel was running along the lesser curvature, making a flexure before entering the diaphragm (Figure 3C). After laparoscopic visualization was secured, the shunting vessel was dissected using Maryland forceps and right angle forceps before the flexure (Figure 3D). An ethylene oxide-sterilized thin-film band, folded in three layers (10 cm long and 5 mm in width), was introduced via the port, and it was passed through the window (Figure 3E). When the band was wrapped around the shunt and a fixation clip was about to be applied, arterial pulsation was identified inside the loop (Figure 3F). The initial band was removed, and the arterial vessel was found to be running alongside the dorsomedial aspect of the shunting vessel to the diaphragm (Figure 3G). Exercising a caution not to squeeze the diameter of the shunt, a medium-sized polymer locking ligation clip (PLLC; Hem-o-Lok , Weck polymer ligation System, USA) was applied first, and three more titanium ligation clips (TLCs) were applied distally to the primary PLLC (Figure 3H). After the stay suture was released, the liver and stomach were restored to their location (Figure 3I).