Quiz Question

In Brisimi 2022 et al., on tracheal anastomosis tension, what suture pattern and material was used for the anastomoses?

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Correct. The study used 2-0 polypropylene in a simple continuous pattern with 4 mm spacing.
Incorrect. The correct answer is Simple continuous with polypropylene.
The study used 2-0 polypropylene in a simple continuous pattern with 4 mm spacing.

🔍 Key Findings

  • Tracheal anastomoses in immature dogs failed at significantly lower distraction forces (44.91 ± 59.03 N) than in adults (149.31 ± 45.36 N; _P_ = .007).
  • Immature tracheae tolerated significantly more elongation before failure (39.75 ± 5.45%) than adult tracheae (30.57 ± 7.19%; _P_ = .0012).
  • All constructs failed by suture tearing through the annular ligament, primarily near the dorsal tracheal ring.
  • Overlapping of tracheal ends was seen in 50% of specimens across both age groups, suggesting limitations in tissue apposition with the chosen technique.
  • Simple continuous pattern using 2-0 polypropylene was used; this pattern provides superior tensile strength compared to simple interrupted, but apposition may be suboptimal.
  • Tracheal elasticity in immature dogs may allow longer resections, but the lower tensile strength necessitates reinforcement.
  • Annular ligament-cartilage technique with 4-mm suture spacing showed variable results; smaller bites and nylon suture may improve outcomes.
  • Ex vivo setup using frozen-thawed tracheae is a limitation, but prior studies support comparability with fresh tissue.

Brisimi

Veterinary Surgery

5

2022

Influence of age on resistance to distraction after tracheal anastomoses in dogs: An ex vivo study

2022-5-VS-brisimi-5

Article Title: Influence of age on resistance to distraction after tracheal anastomoses in dogs: An ex vivo study

Journal: Veterinary Surgery

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In Monnet 2023 et al., on barbed vs conventional suture in vesicourethral anastomosis (VUA), what was the median suturing time for the unidirectional barbed suture group (UBS)?

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Correct. The UBS group had a significantly shorter median suturing time than the conventional group (p < .0002).
Incorrect. The correct answer is 12.7 minutes.
The UBS group had a significantly shorter median suturing time than the conventional group (p < .0002).

🔍 Key Findings

  • Leakage pressure was not significantly different between unidirectional barbed suture (UBS) and conventional (C) suture groups (p = .236).
  • UBS group had a 28% lower median leakage pressure than the C group (8.6 mmHg vs. 11.7 mmHg), suggesting higher biological risk of leakage.
  • UBS significantly reduced suturing time (median 12.7 vs. 17.3 minutes; p < .0002).
  • Fewer suture bites were needed in the UBS group (median 14 vs. 19; p = .012).
  • No suture breakage or urethral narrowing occurred in either group.
  • Leakage site distribution (ventral vs lateral) was similar between groups; no dorsal leaks noted.
  • Leakage occurred as low as 5 mmHg in UBS group, indicating potential for postoperative extravasation.
  • UBS may aid intracorporeal suturing in minimally invasive prostatectomy, but catheterization remains necessary postoperatively.

Monnet

Veterinary Surgery

5

2023

Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study

2023-5-VS-monnet-2

Article Title: Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study

Journal: Veterinary Surgery

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In Azuma 2024 et al., on 3D vs 2D laparoscopy, what was the median length of cystic duct stump left distal to the first endoclip?

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Correct. Both groups had a median stump length of 2.5 mm, consistent with human surgery recommendations.
Incorrect. The correct answer is 2.5 mm.
Both groups had a median stump length of 2.5 mm, consistent with human surgery recommendations.

🔍 Key Findings

  • 3D laparoscopy significantly reduced time to first endoclip placement compared to 2D (median 76 vs. 238 seconds, p = .016).
  • Total surgical time was not significantly different between 3D and 2D groups.
  • No differences were observed in intraoperative complications such as cystic duct injury, clip dislodgment, or gallbladder perforation.
  • Cystic duct stump length was comparable between groups (median 2.5 mm).
  • Liver parenchyma attachment severity did not differ significantly between 2D and 3D groups.
  • All procedures were performed by an experienced surgeon, potentially reducing the benefit seen with 3D visualization.
  • No conversions to open surgery occurred, and no intraoperative complications were reported.
  • The study suggests 3D laparoscopy may aid less experienced surgeons due to enhanced depth perception.

Azuma

Veterinary Surgery

4

2024

Three-dimensional versus two-dimensional laparoscopy for cholecystectomy in a canine cadaveric study

2024-4-VS-azuma-4

Article Title: Three-dimensional versus two-dimensional laparoscopy for cholecystectomy in a canine cadaveric study

Journal: Veterinary Surgery

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In Monnet 2023 et al., on barbed vs conventional suture in vesicourethral anastomosis (VUA), how did the number of suture bites compare between the UBS and conventional groups?

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Correct. UBS group used significantly fewer suture bites (median 14 vs. 19; p = .012).
Incorrect. The correct answer is UBS required fewer suture bites.
UBS group used significantly fewer suture bites (median 14 vs. 19; p = .012).

🔍 Key Findings

  • Leakage pressure was not significantly different between unidirectional barbed suture (UBS) and conventional (C) suture groups (p = .236).
  • UBS group had a 28% lower median leakage pressure than the C group (8.6 mmHg vs. 11.7 mmHg), suggesting higher biological risk of leakage.
  • UBS significantly reduced suturing time (median 12.7 vs. 17.3 minutes; p < .0002).
  • Fewer suture bites were needed in the UBS group (median 14 vs. 19; p = .012).
  • No suture breakage or urethral narrowing occurred in either group.
  • Leakage site distribution (ventral vs lateral) was similar between groups; no dorsal leaks noted.
  • Leakage occurred as low as 5 mmHg in UBS group, indicating potential for postoperative extravasation.
  • UBS may aid intracorporeal suturing in minimally invasive prostatectomy, but catheterization remains necessary postoperatively.

Monnet

Veterinary Surgery

5

2023

Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study

2023-5-VS-monnet-4

Article Title: Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study

Journal: Veterinary Surgery

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In Brisimi 2022 et al., on tracheal anastomosis tension, where did failure most commonly occur?

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Correct. All constructs failed by tearing through the annular ligament near the dorsal ring.
Incorrect. The correct answer is Suture pullthrough at annular ligament.
All constructs failed by tearing through the annular ligament near the dorsal ring.

🔍 Key Findings

  • Tracheal anastomoses in immature dogs failed at significantly lower distraction forces (44.91 ± 59.03 N) than in adults (149.31 ± 45.36 N; _P_ = .007).
  • Immature tracheae tolerated significantly more elongation before failure (39.75 ± 5.45%) than adult tracheae (30.57 ± 7.19%; _P_ = .0012).
  • All constructs failed by suture tearing through the annular ligament, primarily near the dorsal tracheal ring.
  • Overlapping of tracheal ends was seen in 50% of specimens across both age groups, suggesting limitations in tissue apposition with the chosen technique.
  • Simple continuous pattern using 2-0 polypropylene was used; this pattern provides superior tensile strength compared to simple interrupted, but apposition may be suboptimal.
  • Tracheal elasticity in immature dogs may allow longer resections, but the lower tensile strength necessitates reinforcement.
  • Annular ligament-cartilage technique with 4-mm suture spacing showed variable results; smaller bites and nylon suture may improve outcomes.
  • Ex vivo setup using frozen-thawed tracheae is a limitation, but prior studies support comparability with fresh tissue.

Brisimi

Veterinary Surgery

5

2022

Influence of age on resistance to distraction after tracheal anastomoses in dogs: An ex vivo study

2022-5-VS-brisimi-3

Article Title: Influence of age on resistance to distraction after tracheal anastomoses in dogs: An ex vivo study

Journal: Veterinary Surgery

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In Jones 2024 et al., on surgical technique mortality, what was found when comparing CO₂ laser and conventional incisional techniques?

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Correct. Mortality rates were statistically equivalent between CO₂ laser and conventional techniques (p = .890).
Incorrect. The correct answer is No significant difference in mortality.
Mortality rates were statistically equivalent between CO₂ laser and conventional techniques (p = .890).

🔍 Key Findings

  • Study compared 606 dogs (English Bulldogs, French Bulldogs, Pugs) undergoing partial staphylectomy via CO₂ laser, bipolar vessel sealing device (BVSD), or conventional incision.
  • Mortality rate: 4.0% (24/606).
  • BVSD was associated with significantly increased perioperative mortality compared to other methods (OR = 6.0, 95% CI: 1.3–28.4, p = .023).
  • High-grade laryngeal collapse (stage II or III) independently increased mortality risk (OR = 4.6, 95% CI: 1.8–11.8, p = .002).
  • No difference in mortality between CO₂ laser and conventional incision techniques.
  • CO₂ laser and conventional techniques had similar complication rates.

Jones

Veterinary Surgery

1

2024

Comparison of mortality of brachycephalic dogs undergoing partial staphylectomy using conventional incisional, carbon dioxide laser, or bipolar vessel sealing device

2024-1-VS-jones-4

Article Title: Comparison of mortality of brachycephalic dogs undergoing partial staphylectomy using conventional incisional, carbon dioxide laser, or bipolar vessel sealing device

Journal: Veterinary Surgery

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In Jones 2024 et al., on surgical technique mortality, what possible reason was proposed for increased mortality with BVSD?

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Correct. Authors hypothesized that thermal injury and edema may contribute to complications.
Incorrect. The correct answer is Thermal injury causing pharyngeal edema.
Authors hypothesized that thermal injury and edema may contribute to complications.

🔍 Key Findings

  • Study compared 606 dogs (English Bulldogs, French Bulldogs, Pugs) undergoing partial staphylectomy via CO₂ laser, bipolar vessel sealing device (BVSD), or conventional incision.
  • Mortality rate: 4.0% (24/606).
  • BVSD was associated with significantly increased perioperative mortality compared to other methods (OR = 6.0, 95% CI: 1.3–28.4, p = .023).
  • High-grade laryngeal collapse (stage II or III) independently increased mortality risk (OR = 4.6, 95% CI: 1.8–11.8, p = .002).
  • No difference in mortality between CO₂ laser and conventional incision techniques.
  • CO₂ laser and conventional techniques had similar complication rates.

Jones

Veterinary Surgery

1

2024

Comparison of mortality of brachycephalic dogs undergoing partial staphylectomy using conventional incisional, carbon dioxide laser, or bipolar vessel sealing device

2024-1-VS-jones-5

Article Title: Comparison of mortality of brachycephalic dogs undergoing partial staphylectomy using conventional incisional, carbon dioxide laser, or bipolar vessel sealing device

Journal: Veterinary Surgery

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In Monnet 2023 et al., on barbed vs conventional suture in vesicourethral anastomosis (VUA), which of the following best describes the leakage sites observed?

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Correct. Leakage was seen ventrally or laterally between suture bites in both groups; no dorsal leakage was reported.
Incorrect. The correct answer is Leaks were lateral or ventral.
Leakage was seen ventrally or laterally between suture bites in both groups; no dorsal leakage was reported.

🔍 Key Findings

  • Leakage pressure was not significantly different between unidirectional barbed suture (UBS) and conventional (C) suture groups (p = .236).
  • UBS group had a 28% lower median leakage pressure than the C group (8.6 mmHg vs. 11.7 mmHg), suggesting higher biological risk of leakage.
  • UBS significantly reduced suturing time (median 12.7 vs. 17.3 minutes; p < .0002).
  • Fewer suture bites were needed in the UBS group (median 14 vs. 19; p = .012).
  • No suture breakage or urethral narrowing occurred in either group.
  • Leakage site distribution (ventral vs lateral) was similar between groups; no dorsal leaks noted.
  • Leakage occurred as low as 5 mmHg in UBS group, indicating potential for postoperative extravasation.
  • UBS may aid intracorporeal suturing in minimally invasive prostatectomy, but catheterization remains necessary postoperatively.

Monnet

Veterinary Surgery

5

2023

Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study

2023-5-VS-monnet-3

Article Title: Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study

Journal: Veterinary Surgery

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In Alvarez 2022 et al., on rehabilitation modalities, which statement best reflects the findings on photobiomodulation (PBM)?

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Correct. Only one of three PBM studies (Rogatko et al.) showed improved PVF; others showed no significant benefit despite low RoB.
Incorrect. The correct answer is Only one PBM study showed improved objective outcomes.
Only one of three PBM studies (Rogatko et al.) showed improved PVF; others showed no significant benefit despite low RoB.

🔍 Key Findings

  • Exercise-based rehabilitation showed benefits in 6 of 7 studies, including increased peak vertical force (PVF) and reduced lameness, though most had high risk of bias (RoB).
  • Cold compression therapy (CCT) had 2 high-quality (Level II, low RoB) studies showing improvements in pain scores, range of motion, and swelling, supporting its clinical use.
  • Extracorporeal shockwave therapy (ESWT) was supported by 2 Level II studies; only one had low RoB, showing short-term benefits in patellar ligament thickness and PVF, but no long-term benefit on bone healing.
  • Photobiomodulation (PBM) had mixed results across 3 Level II studies (all low RoB); only 1 showed positive impact on PVF, limiting its recommendation.
  • Low-intensity pulsed ultrasound (LIPUS) showed no significant impact on gait analysis or bone healing in a Level II, low RoB study.
  • Electrical muscle stimulation (EMS) improved lameness and thigh circumference in one Level III study, but had high-moderate RoB and involved experimentally-induced CCL rupture, limiting clinical relevance.
  • No modality beyond exercise and CCT had consistent or strong evidence for efficacy in post-TPLO or extracapsular repair rehabilitation.
  • The absence of standardized protocols, small sample sizes, and inconsistent outcome measures limited the generalizability of findings.

Alvarez

Veterinary Surgery

2

2022

Systematic review of postoperative rehabilitation interventions after cranial cruciate ligament surgery in dogs

2022-2-VS-alvarez-4

Article Title: Systematic review of postoperative rehabilitation interventions after cranial cruciate ligament surgery in dogs

Journal: Veterinary Surgery

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In Wood 2024 et al., on knot security and locking throws, what was the effect of a single locking throw on holding strength?

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Correct. Adding a single locking throw increased the holding strength for all five knots tested.
Incorrect. The correct answer is Increased in all knots.
Adding a single locking throw increased the holding strength for all five knots tested.

🔍 Key Findings

  • Adding a single locking throw significantly increased holding security for specific knots, including the surgeon's throw (p = .0001) and square throw (p = .0002).
  • For the Miller's throw (p = .166) and strangle throw (p = .808), no significant improvement was observed with a locking throw.
  • After locking throw addition, all five knots leaked at similar pressures (p = .5233), and these pressures exceeded physiologic arterial pressures.
  • Surgeon's throw without a locking throw had the lowest leak pressure (62.5 ± 46.2 mm Hg), below physiologic arterial values.
  • The square throw without locking also leaked below physiologic pressures (148.7 ± 109.4 mm Hg), though it outperformed the surgeon's throw.
  • Miller’s and strangle throws performed significantly better than square or surgeon’s throws without locking, achieving leak pressures >200 mm Hg.
  • All knots used 2-0 polyglyconate monofilament (Maxon); no comparisons across suture types or sizes were performed.
  • Authors concluded that correct tensioning and locking throw addition are key to safe vascular ligation. Miller’s, strangle, or slip knots are preferred for challenging surgical fields.

Wood

Veterinary Surgery

4

2024

Influence of a single locking throw on the in vitro holding security of five friction knots using two monofilament suture materials in a canine model

2024-4-VS-wood-3

Article Title: Influence of a single locking throw on the in vitro holding security of five friction knots using two monofilament suture materials in a canine model

Journal: Veterinary Surgery

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Quiz Results

Topic: Suture & Soft Tissue Techniques
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