Evaluation of the incidence of intraoperative and postoperative complications following laparoscopic extirpation of enlarged and no enlarged sentinel medial iliac lymph node in four dogs

Several sentinel lymph node (SLN) mapping techniques, to detect nodal metastasis in canine tumours have been investigated in the last 10years in veterinary oncology. The methods to evaluate Medial Iliac Lymph Node (MILN) include diagnostic imaging, fine needle aspiration(FNA) or excisional biopsy. As abdominal ultrasonography is a useful diagnostic tool for evaluating the morphology and echogenicity ofthe MILN, if there is susceptible evidence of metastasis, including lymphadenomegaly or change of echogenicity, FNA or excisional biopsyof MILN can be recommended for exact diagnosis. MILN extirpation can be a challenge for localization between the deep circumflex iliacand the external iliac arteries. In case of dogs with anal sac adenocarcinoma, extirpation of metastatic MILNs showed a positive effecton the prognosis.The aim of this study is to evaluate incidence of intraoperative and postoperative complications following laparoscopicextirpation of enlarged and no enlarged sentinel medial iliac lymph node in four dogs (SMILN) A Golden retriever male, 8 yo, 30 kg, amixed breed neutered male, 25 kg, 7 yo, a English Bouledogue, male, 6 yo, 30kg, and a mixed breed male, 13 yo, 18 kg presented forextirpation of SMILN secondary to neoplasia. The first case a Golden retriever had an enlarged SMILN, maximum size of approximately3-4 cm with irregular and undefined margins, resulting in moderate osteolysis of the underlying bone tissue and clear destruction of thebone cortex. The SMILN’s mixed breed were mild enlargement. The SMILN’s English Bouledogue was no enlargement. For the firstone the enlarged SMILN no use of blue di metilene was used intra operatory for identify the SMILN, in other cases the blue of metilenewas used. The dogs were positioned in dorsal recumbency. The first portal and the creation of pneumoperitoneum was done by openmodified Hasson technique in midline 2 cm under umbelica.After exploring the entire abdomen with a 5 mm × 29 cm 30° to evaluate theorgans for iatrogenic damage, the second cannula 6 mm × 6.5 cm was inserted at a point equidistant from the midline and the cameraportal on the contralateral side of the MILN under laparoscopic guidance. The third portal was established in the caudal abdomen at alocation approximately one third of the distance between the pubic brim and the ipsilateral instrumental portal. The retroperitoneum wasincised between the right external iliac artery and the testicular vessels. The tissue surrounding the retroperitoneum and the small vesselsattached to the lymph nodes were dissected using blunt dissection and sealing/transection by the vessel-sealing device, respectively.During the procedure, the lymph node was retracted away with laparoscopic Babcock forceps from the large vessels. SMILNs weresuccessfully identified and excised by using the ventral approach in all dogs; no animal required conversion from laparoscopic procedureto open laparotomy.Lim H. et al., Bilateral medial iliac lymph node excision by a ventral laparoscopic approach: technique description J Vet Med Sci29;79(9):1603-1610. 2017 SepSteffey M. et al., Laparoscopic Extirpation of the Medial Iliac Lymph Nodes in Normal Dogs Veterinary surgery 44 Suppl 1:59-65. 2015Bianchi A., et al., A Comparison of Times Taken for the Placement of the First Portal and Complication Rates between the Veress NeedleTechnique and the Modified Hasson Technique in Canine Ovariectomy Laparoscopic Surgery Animals (Basel) 11;11(10):2936. 2021