Lynetta Freeman | Purdue University (original) (raw)

Papers by Lynetta Freeman

Veterinary Clinics of North America-small Animal Practice, Sep 1, 2009

Minimally invasive surgery (MIS) is becoming more widely adopted in veterinary medicine. The purp... more Minimally invasive surgery (MIS) is becoming more widely adopted in veterinary medicine. The purpose of this article is to review the current status and application of laparoscopic surgery involving the gastrointestinal tract in small animals. LIGATION OF VASCULAR RING ANOMALY Although it is technically feasible to perform MIS procedures in the esophagus and these procedures are widely applied in human surgery, only one procedure has been adopted in veterinary medicine: ligation of the vascular ring anomaly persistent right aortic arch (PRAA). The benefits of the procedure include improved operative visualization and faster recovery from surgery. In 2001, minimally invasive surgery was reported by Dr. Eric Monnet as being used to treat a vascular ring anomaly in a puppy with PRAA and two other animals subsequently underwent surgery. 1 Selective ventilation of the right lung was performed to create a working space in the left hemothorax. Three-milliliter syringes were used as ports placed in the third and fifth intercostal spaces for insertion of a 5-mm telescope and dissecting forceps. A lung retractor was positioned from a port in the seventh intercostal space to enable the left cranial lung lobe to be retracted caudally. Dissection of the ligamentum arteriosum was performed, and clips were placed before transection of the ligament. Dissection was continued to remove all constricting fibers around the esophagus. The esophagus was dilated and repeat endoscopy confirmed release of the esophageal stricture. The animal made an uneventful postoperative recovery. Since then, Dr. Monnet has performed several other procedures successfully using the 5-mm LigaSure LAP bipolar electrocautery device (LigaSure, Valleylab, Boulder, Colorado) and converted one to an open procedure because of the presence of a double aortic arch. A complete review of this procedure is available in a separate article in this issue. Ligation of the ligamentum arteriosum to treat PRAA is usually performed in young animals and is challenging because of a small optical cavity, dissection in and around

PubMed, Aug 1, 1995

Endoscopically assisted rectus abdominis plication is a safe and effective method of repair in pa... more Endoscopically assisted rectus abdominis plication is a safe and effective method of repair in patients with mild to moderate central abdominal wall flaccidity. A procedure was developed in animals and in a human cadaver using a single umbilical incision, gasless dissection of the anterior rectus abdominis fascia, and suture plication under endoscopic guidance. This procedure was performed successfully in three patients. Early postoperative results were comparable to those obtained by standard rectus abdominis plication. Moreover, adjunctive suction lipectomy or a limited abdominal skin resection can be used to expand the contouring capability of this technique.

PubMed, Oct 1, 2000

Purpose: To obtain large, serial biopsy samples from the liver and spleen by using laparoscopy. L... more Purpose: To obtain large, serial biopsy samples from the liver and spleen by using laparoscopy. Large samples were needed for measurement of inflammatory mediators during various stages of schistosomiasis. Methods: Each of the seven female baboons (Papio sp.) underwent as many as three laparoscopies, for a total of 19 laparoscopic procedures. This process permitted sampling of the liver, spleen, and mesenteric lymph nodes before and at 6 and 9 weeks after infection with Schistosoma mansoni. All surgery was performed through three trocar sites. Postoperative care included preemptive analgesia. After surgery, we monitored the animals' appetite and measured the core body temperature and activity by using implanted radiofrequency transmitters. Results: We obtained samples of the liver and splenic biopsies during all 19 laparoscopic procedures. The mean weight of the liver biopsies was 3.7 g and that of the spleen samples was 5.3 g. We encountered small adhesions during 5 of the 12 reoperations. Eating and activity rapidly returned after surgery. Conclusions: Laparoscopy permitted collection of large, serial biopsies with apparently limited stress to the animals. Laparoscopy can be used for biopsies in studies to characterize disease response, confirm normal organ histology prior to drug toxicity studies, determine target-organ drug concentrations in pharmacokinetic studies, and measure drug residues. This refinement likely will reduce required animal numbers by decreasing the effect of surgery compared to that of the experimental conditions, enhance animal well-being, and permit repeated measurements in an animal that serves as its own control.

The surgery service at VSH is proud to be a local leader in the field of minimally invasive surge... more The surgery service at VSH is proud to be a local leader in the field of minimally invasive surgery (MIS). Minimally invasive surgery has been recognized as the standard of care for many conditions in humans for over a decade and its use for our veterinary patients is rapidly growing. Our surgeons have extensive training and experience in a variety of surgical techniques, which can be used in the diagnosis and treatment of many orthopedic (arthroscopy), abdominal (laparoscopy) and thoracic (thoracoscopy) conditions.

PubMed, Sep 1, 1997

Endoscopic techniques were used to ovariohysterectomize two hybrid Asian lions (Panthera leo) in ... more Endoscopic techniques were used to ovariohysterectomize two hybrid Asian lions (Panthera leo) in order to reduce the risk of postoperative wound complications associated with standard surgical techniques. One of the lions was aged, overweight, and considered an anesthetic risk. The animals were anesthetized, intubated, catheterized intravenously, and placed in dorsal recumbency with the head lower (Trendelenburg position). Ventilation was assisted mechanically. Following abdominal insufflation, a surgical trocar was placed in the abdominal cavity. Two additional 12-mm surgical trocars were placed under direct visualization using a videoscope. The ovaries and uterus were removed endoscopically, and the abdominal cavity was inspected for hemorrhage under decreased insufflation pressure before closure. The surgery was complicated by obesity, by uterine enlargement from cystic endometrial hyperplasia and endometrial polyps, and by ovarian enlargement and fragility because of bilateral cystic rete ovarii. The procedure and anesthetic recovery were uneventful. Postsurgical recovery time and convalescence lasted less than 3 days, and the animals were reintroduced to an exhibit mate and placed on exhibit within 8 days. The technique is appropriate for use in lions, even those with pathologic reproductive changes, in zoos.

Veterinary Surgery, Aug 1, 2011

To compare surgical trauma, perioperative pain, surgical time, and complication rate in mares und... more To compare surgical trauma, perioperative pain, surgical time, and complication rate in mares undergoing standing bilateral ovariectomy by natural orifice transluminal endoscopic surgery (NOTES) or laparoscopy. Study Design: Experimental study. Animals: Healthy mares (n = 12). Methods: Ovariectomy was performed with a vessel-sealing device by transvaginal NOTES (n = 6) using a flexible endoscope and specialized instruments or by bilateral flank laparoscopy (n = 6). Preoperative and postoperative complete blood count (CBC), plasma fibrinogen concentration, serum amyloid A concentration, peritoneal nucleated cell count, and total protein concentration were compared using repeated measures ANOVA. Surgical times were compared using an unpaired t-test. Mares were monitored for 2 weeks postoperatively and necropsy was performed at 3 weeks (n = 6) or 3 months (n = 6) to assess short-and medium-term effects of each procedure. Complication rate, necropsy, and bacteriology findings were compared using a Fishers exact test. Significance was set at P < .05. Results: All surgical procedures were performed successfully and all but one laparoscopy mare were bright, alert, and maintained a good appetite until euthanasia. Mean ± SD surgical time was similar between groups (NOTES: 100 ± 40 minutes; laparoscopy: 107 ± 47 minutes). There were no significant temporal differences in vital parameters, CBC, plasma fibrinogen concentration, serum amyloid A concentration, peritoneal nucleated cell count, and total protein concentration between groups. Conclusions: Bilateral ovariectomy by transvaginal NOTES or laparoscopy resulted in minimal inflammation and surgical trauma.

Javma-journal of The American Veterinary Medical Association, Mar 15, 2014

Case Description—A 4-year-old spayed female Mastiff was evaluated for treatment of chronic nonhea... more Case Description—A 4-year-old spayed female Mastiff was evaluated for treatment of chronic nonhealing pressure wounds over both elbow regions resulting from attempts at hypertrophic callus excision. Clinical Findings—The wound bed granulation tissue was mottled red and yellow with hyperemic, rolled epithelial edges. The right wound communicated with a large fluid pocket along the thoracic wall. The dog had an inflammatory leukogram with a left shift. Treatment and Outcome—The wounds were debrided, and tissue specimens were collected for histologic evaluation, microbial culture, and bacterial identification by means of molecular diagnostic techniques. The left wound was closed immediately. Calcium alginate rope with silver was packed into the right wound. Vacuum-assisted closure was applied for 6 days. Debridement was repeated, and a thoracodorsal axial pattern flap was used to cover the wound. Systemic treatment with antimicrobials was initiated, and pressure over the elbow regions was relieved. Bacterial biofilms were identified histologically in tissue specimens from both wounds. Staphylococcus intermedius, Staphylococcus epidermidis, and Streptococcus canis were cultured and identified by 16S rRNA fragment sequencing. Pyrosequencing identified multiple bacterial species and no fungal organisms. Both wounds healed successfully. Clinical Relevance—Biofilms are implicated in infected orthopedic implants in veterinary patients; however, this is the first report of a bacterial biofilm in chronic wounds in a dog. In human wound care, extensive debridement is performed to disrupt the biofilm; a multimodal treatment approach is recommended to delay reformation and help clear the infection. In this case, biofilm reformation was prevented by systemic treatment with antimicrobials, by reducing local pressure on the wounds, and by wound closure.

Gastrointestinal Endoscopy, Aug 1, 2010

Background: Few studies are available to compare the potential benefits of natural orifice transl... more Background: Few studies are available to compare the potential benefits of natural orifice transluminal endoscopic surgery (NOTES) approaches to traditional surgery.

Javma-journal of The American Veterinary Medical Association, Jan 15, 2012

Gastrointestinal Endoscopy, Apr 1, 2008

Journal of The American Animal Hospital Association, Nov 1, 2011

Kidney biopsies in dogs are commonly obtained using automated spring-loaded biopsy instruments. I... more Kidney biopsies in dogs are commonly obtained using automated spring-loaded biopsy instruments. Interpretation of biopsies from dogs with glomerular disease requires examination of at least 5-10 glomeruli, with at least two biopsies usually required for full evaluation. The purpose of this study was to compare quality and interpretability of renal biopsies obtained from healthy dogs with a large-gauge, vacuum-assisted biopsy instrument versus two biopsies obtained with a spring-loaded biopsy needle. Twenty dogs were randomized into two groups, and percutaneous, ultrasound-guided renal biopsies were evaluated using standard criteria. There were no significant differences in the number of biopsies that contained renal tissue, cortex, or medulla. Biopsies obtained with either instrument contained an adequate number of glomeruli and an equivalent number of arterioles and severity of tissue compression. Differences included easier penetration of the renal capsule and collection of sufficient tissue for interpretation with only one instrument pass when using the vacuum-assisted device (vs two passes required with the spring-loaded instrument). Before use in client-owned dogs, future studies should evaluate whether these differences are clinically relevant advantages in the diagnostic evaluation of dogs with kidney disease, and determine the prevalence and severity of complications when using this larger gauge device.

Veterinary Surgery, May 1, 2017

Objective: To determine which of 2 suture materials would be superior in terms of closure time an... more Objective: To determine which of 2 suture materials would be superior in terms of closure time and leakage pressure in open single-layer cystotomy closure. Study design: Experimental study. Animals: Twenty-four freshly harvested porcine urinary bladders. Methods: A cystotomy was performed and the incision closed with a single layer simple continuous suture pattern with barbed (n 5 12) or smooth (n 5 12) suture. Time required for closure was measured. Each bladder was connected to a system for monitoring intraluminal pressure while inflated with saline until leakage occurred. Intraluminal pressure at time of initial leakage and leakage site were recorded. Twosample t tests were used to compare maximum leakage pressure and closure time between the 2 groups. P < .05 was considered significant. Results: All bladders were sutured successfully with no difference in mean closure time (barbed suture 296 6 46 seconds; smooth suture 293 6 26 seconds) (P 5 .821). There was no difference in mean leakage pressure of porcine urinary bladder incisions closed in a single layer with barbed suture (28.8 6 10.4 mm Hg) compared with smooth suture (30.6 6 8.8 mm Hg) (P 5 .642). Conclusions: Barbed suture provides comparable cystotomy repair to smooth suture, and no benefit to its use was identified in an open procedure. Barbed suture closure should be evaluated for adequate tensile strength in the presence of urine, satisfactory in vivo healing of cystotomies, and lack of long-term urolith formation in dogs and cats.

American Journal of Veterinary Research, May 1, 2017

OBJECTIVE To determine the effects of 3 topically applied treatments (1% silver sulfadiazine crea... more OBJECTIVE To determine the effects of 3 topically applied treatments (1% silver sulfadiazine cream [SSC], triple antimicrobial ointment [TAO], and hyperosmolar nanoemulsion [HNE]) on microbial counts, exuberant granulation tissue (EGT) development, and reepithelialization of contaminated wounds at the distal aspect of the limbs of horses. ANIMALS 8 healthy adult horses. PROCEDURES A 2.5 X 2.5-cm, full-thickness, cutaneous wound was created at the dorsal aspect of each metacarpus and metatarsus (1 wound/limb/horse), covered with nonadhesive dressing, and bandaged. Wounds were inoculated with bacteria and fungi the next day. Each wound on a given horse was randomly assigned to 1 of 4 treatment groups (SSC, TAO, HNE, or no topical treatment [control]). Bandage changes, culture of wound samples, treatments, photography for wound measurements, and biopsy were performed at predetermined time points. Time (days) until wound closure, number of EGT excisions, microbial counts, and scores for selected histologic characteristics were compared among groups. RESULTS Median time to wound closure for all groups was 42 days. Time to wound closure and histologic characteristics of wound healing did not differ among groups. Least squares mean microbial counts were significantly higher for HNE-treated wounds on days 9 and 21, compared with SSC-treated and TAO-treated wounds, but not controls. Proportions of SSC-treated (7/8) or HNE-treated (5/8) wounds needing EGT excision were significantly greater than that of TAO-treated (1/8) wounds. The proportion of SSCtreated wounds with EGT excision was greater than that of controls (3/8). CONCLUSIONS AND CLINICAL RELEVANCE None of the treatments resulted in more rapid wound closure, compared with that for untreated control wounds under the study conditions. When treatment is warranted, TAO may help to limit EGT formation.

Journal of Magnetic Resonance Imaging, 2005

To develop an MR-compatible vacuum-assisted core needle breast biopsy system. A vacuum-assisted b... more To develop an MR-compatible vacuum-assisted core needle breast biopsy system. A vacuum-assisted breast biopsy system (Mammotome Hand Held; Ethicon Endo-Surgery, USA) was modified for freehand MRI-guided biopsy in an open, interventional 0.5-T scanner (Signa SP; GE, USA). Probes (11 gauge [G]) were fabricated without significant susceptibility artifact. These mate with an electromechanical hand piece and control system that were modified for use within the MRI scanner. A total of 62 breast lesions were simulated in the mammary tissues of six recently lactating sows by injecting between 0.1 and 1.0 mL of an aqueous gel containing dilute gadopentetate dimeglumine (Gd-DTPA) that formed a bright mass on T1-weighted imaging. Mechanical performance was satisfactory. Magnetic susceptibility and radiofrequency (RF) artifacts from the 11-G probe were negligible. T1-weighted fast spin echo (FSE) was used to guide biopsy. Up to eight samples were removed per lesion. Overall, 461 samples were obtained in 493 attempts (94%). Sample weights averaged 54 mg (N = 493) compared to 4.6 mg (N = 24) from 14-G titanium MRI-compatible needles. On average, 59% of the attempted samples yielded target lesion material. Preliminary results demonstrate the feasibility of a vacuum-assisted breast biopsy system in the MRI environment. Small 0.1-mL lesions can be biopsied without needle artifacts obscuring the target.

Veterinary Surgery, Jul 24, 2023

Gastrointestinal Endoscopy, Apr 1, 2009