Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Feline Parasternal Thoracotomy via Sternocostal Disarticulation
Surgical options for our feline patients often lack the robust documentation available for canine procedures. Dr. Kristen Gabriel tackles this gap with her groundbreaking research on parasternal thoracotomy via sternocostal disarticulation in cats—a technique that offers promising results for thoracic exploration when traditional approaches fall short.
The conversation delves into the origins of this technique, which began with documentation in canine patients before Dr. Gabriel recognized its particular value for cats. As she explains, cats present unique challenges during median sternotomies due to their tiny sternums, where surgeons can accidentally slip off midline or even completely off the sternum. This alternative approach provides a solution to these anatomical challenges while delivering good short-term outcomes.
Perhaps most fascinating is Dr. Gabriel's candid discussion of the radiographic abnormalities discovered in nearly half of the post-operative cases. Despite this seemingly high complication rate, she emphasizes that most were minor or incidental findings without significant impact on patient recovery—a crucial distinction for both veterinarians and pet owners to understand. Looking forward, she outlines important research directions including longer-term follow-up studies and comparative analyses examining factors like patient comfort, surgical time, and visualization between different approaches. For practitioners, this technique offers not just a primary option but a valuable backup plan when median sternotomies don't go as expected.
Whether you're a cat surgeon facing the frustrations of traditional thoracic approaches, a general practitioner wanting to expand your surgical options, or simply passionate about advancing feline-specific medicine, this episode provides valuable insights into an underreported technique with promising clinical applications. Subscribe to Veterinary Vertex for more cutting-edge discussions at the intersection of research and clinical practice.
JAVMA article: https://doi.org/10.2460/javma.25.03.0153
INTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA ® OR AJVR ® ?
JAVMA ® : https://avma.org/JAVMAAuthors
AJVR ® : https://avma.org/AJVRAuthors
FOLLOW US:
JAVMA ® :
Facebook: Journal of the American Veterinary Medical Association - JAVMA | Facebook
Instagram: JAVMA (@avma_javma) • Instagram photos and videos
Twitter: JAVMA (@AVMAJAVMA) / Twitter
AJVR ® :
Facebook: American Journal of Veterinary Research - AJVR | Facebook
Instagram: AJVR (@ajvroa) • Instagram photos and videos
Twitter: AJVR (@AJVROA) / Twitter
JAVMA ® and AJVR ® LinkedIn: https://linkedin.com/company/avma-journals
From the makers of vet-recommended Greenies dental treats comes an easy way to support your dog's wellness. Greenies Smart Essentials dry food delivers complete, balanced nutrition with science-backed recipes. Greenies Supplements, developed by a team of PhD animal nutritionists, offers options to help support healthy joints, digestion and more, Whether it's mealtime or mobility support Greenies helps you care for your dog from the inside out. Learn more at Greeniescom.
Speaker 2:You're listening to Veterinary Vertex, a podcast for the APMA Journals. This episode we chat about how parasternal thoracotomy via the sternocostal disarticulation can be performed in cats with good short-term outcomes, with our guest Kristen Gabriel.
Speaker 3:Welcome listeners. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today, we have Kristen joining us to talk about a novel surgical approach for our cat patients. Kristen, thank you so much for taking the time to be with us here today.
Speaker 4:Yeah, thank you guys so much for having me. I'm excited to be here.
Speaker 2:All right, let's dive right in. So, kristen, your Jabma article discusses how a parasternal thoracotomy may be a suitable alternative to traditional approaches when thoracic exploration is indicated in cats. Please share with our listeners the background on this article.
Speaker 4:Yeah, so the background kind of started with one of my resident mates, anna, who actually was the first one to publish this technique in canine patients and it's something that we had seen several surgeons at our hospital performing with you know, seemingly good outcomes and no major concerns.
Speaker 4:And then you know we all kind of realized, like this isn't actually documented anywhere and published anywhere.
Speaker 4:You know, discussed how they'd seen other people do it and learned it from people and were like this needs to be, you know, written down so people can learn from it and decide, you know, if and when it should be used as opposed to other approaches. And particularly in cats, we find that sometimes people have issues with median sternotomies, particularly with their sternums being so tiny and, you know, accidentally getting off midline and sometimes even off of the sternum when trying to access the thorax that way. And so I thought you know, particularly in a group of cats where they're all kind of similar size and they all have, you know, that same issue when you're sometimes trying to do other approaches that this would be a really good thing to just document and get out there, and this is obviously a very preliminary study, just putting things out in the world and in the literature, but certainly kind of opens the door to do more in-depth comparisons and analysis of if and when this approach is useful.
Speaker 2:Very cool. And since this is a technique, have you heard of our technical tutorial videos?
Speaker 4:Yes, I have and I've been thinking about, you know, if we need to make a video demonstration, that would probably be very helpful. Very cool yeah.
Speaker 2:Especially with cats. We don't have a lot of just cat videos in general, or cat articles either, for that matter.
Speaker 4:So looking for those and what are some important take-home messages from this Javma article I think the biggest take-home messages right now are again just kind of knowing that this technique is out there and that so far, with our kind of preliminary data, it seems non-inferior to a lot of the other techniques that are out there and that you know, even though there is kind of a high complication rate noted in the paper, that a lot of those complications are very minor and even really more incidental findings that we identified and they don't really seem to have a significant morbidity or mortality to our patients.
Speaker 3:Kristen. I'm an equine orthopedic surgeon, so we do everything with a scope. Why not do an exploratory with a? Now they have like tiny needle scopes that have curved lenses too.
Speaker 4:Yeah, and that's definitely something that people are doing. It's very equipment dependent Now. Even a lot of specialty hospitals, you know, don't have all the equipment for for a coscopy, and sometimes the like one lung ventilation is very helpful for that and not everyone is comfortable or has the equipment to do that successfully. The other big issue is with those minimally invasive procedures you can't remove a large like mediastinal mass or a large lung mass. You end up having to make a pretty big incision to get some of those things out of the thorax anyway. So it's certainly a useful technique for exploration but not always, you know, useful for removing or performing what we need to do.
Speaker 3:Great Plays right into the spectrum of care. Yeah, absolutely. What sparked your interest in feline surgery?
Speaker 4:I've always been a cat person and so as I've kind of progressed in my career as a doctor and then as a resident and everything you start realizing, kind of like we alluded to earlier, there's just not as much information out there about cats and we know there are some differences obviously between them and dogs and the way they heal and just some of their you know musculature and their anatomy differs just in subtle ways, and so I think it's really nice to be able to have separate information on cats. A lot of times they just kind of get lumped together into some of the bigger studies that are majority dogs and then a couple of cats and you don't really know how that plays into things.
Speaker 3:Yeah, when I took over as editor, it was one of the most striking things to me is how popular cats are as patients and as veterinary patients. Yeah, but very, very little literature on them.
Speaker 4:Yeah, I feel like it's newer, Like as we're advancing our technology and able to do more things. I feel like people are able and willing to do more for cats, whereas previously it was very, very dog heavy just in veterinary care in general, in small animal at least.
Speaker 3:What surprised you from this article?
Speaker 4:I think for me personally, one of the surprises I had in kind of gathering all the data and putting it together was the amount of abnormalities that we did identify on radiographs. I had, like I said previously, seen some of these procedures being done and seen some of these post-op radiographs that we had. I kind of expected the number of complications or abnormalities that we found to be lower, just again because of my clinical experience being that you know these patients do really well. And so when our radiologist came back and said you know, almost half of these radiographs that you sent me have some sort of abnormality, I was kind of like oh, that's not what I expected, but certainly not something I wanted to hide or try to cover up in the literature. You know it's out there and it's something we need to be aware of and keep an eye on to make sure that it is not a clinically significant problem going forward.
Speaker 2:Kristen, I'm also a fellow cat lady. I have two cats that are currently laying in the sun grooming themselves right now as we record this episode. So what are the next steps for research in this topic?
Speaker 4:I think the next steps kind of have to be two different directions. One, just longer term follow-up, again making sure that some of those abnormalities we're seeing on x-rays are truly not causing issues down the line, and just getting a little bit more information on it's sub-disease, dependent with this type of surgery that you know. Obviously some of these patients you know they like media and sternopne and saying, okay, well, let's compare things like patient comfort postoperatively, let's compare surgical time visualization that you're able to get during surgery. I think all of those things are important in order to help people make decisions going forward as far as you know what approach is going to be best for their patients.
Speaker 2:And AI is such a hot topic right now. It's everywhere. Do you see a role for AI in?
Speaker 4:this area of research, I think in any research, I think it can be helpful just as far as you know, extracting data from records and kind of speeding that process up for people. I also was thinking like I don't know how this would work. I don't know enough of the details of the technology, but I feel like there's probably a way to if we're comparing things like visibility in surgery, to have AI or some sort of technology calculate based on a couple examples you give them of. This is what we were able to see and here's our kind of landmarks in surgery. They can probably apply that to like a bunch of CT scans that you know are patients you don't even necessarily have to have done surgery on. They could do a theoretical calculation of. You know, with this approach. Here's what you can easily see, here's what you can maybe reach surgically, and that way you get a lot more patients that didn't actually have to undergo surgery and you can kind of start collecting some of that theoretical data.
Speaker 3:Yeah, we don't even know how AI can help us yet in many ways, right? So many unknowns. I love how you have a curious clinical mind. How did your training in previous work help you to write this article?
Speaker 4:am seeing frequently in my hospital, and so it made for a good project because it sparked that interest of, like you know, why is this something that's not documented anywhere else? Why are we doing this differently? What are the advantages as far as actually writing the paper itself? That's actually something I hope to get more comfort with in the future and to continue to kind of grow in that aspect of my career going forward, because it definitely is challenging in some ways to balance clinical practice and doing all that on top of research and publishing. And I found that as I progressed, you know, from a student to an intern and then a resident, at first I was like, oh, I don't know what I would want to research, like there's, you know, you don't know what questions to be asking. And then, as you get a little bit more experience, you start seeing all these cases and seeing all these things that make you think of questions that you're like, oh, no one actually knows the answer to this question or people just have anecdotal experience. So I think you start learning a lot more questions that you have and sometimes it's hard to answer those questions, especially in medicine, like doing a really good, you know prospective study with enough patients for meaningful data is often really difficult, and so it's something that I hope to keep trying to contribute to in my career.
Speaker 3:Yeah, my words of wisdom would be to find somebody to help with study design, so that you don't get all the way down and you're gathering the wrong data or it's not randomized correctly or any of those things. It's heartbreaking for our editorial staff to get a review back on a manuscript that is like you can't fix it, right, right, and it's all the time.
Speaker 2:Yeah. So Kristen's next set of questions is going to be really important for our listeners, and the first one's going to revolve around the veterinarian's perspective.
Speaker 4:So, kristen, what is one piece of information the veterinarian should know about? Parasternal thoracotomy via sternocostal disarticulation in cats. This approach right away, like I said before, if you are doing median sternotomies and you find that you've slipped off of the sternum at one point, this is, I think, a very helpful article to have just to say that's okay, here's how you can close it still and they're going to do well, and just having that kind of reassurance and that backup plan when things maybe don't go quite as planned for them, I think it's also a good option for you know, if you don't have some of that equipment available, like we talked about spectrum of care earlier, like sometimes you know you might not be able to be referred somewhere else for certain procedures and this is sometimes an alternative that could be done with different equipment.
Speaker 2:On the other side of the relationship. What's one thing that clients should consider when your veterinarian is proposing a surgical option to them.
Speaker 4:Yeah, I think from a client perspective, especially, you know, in this day and age where people can just like Google things really quick and see some of these articles pop up, just knowing that, again, that like 50% complication rate does not necessarily mean you know this is terrible and 50% of them are going to not do well, you know. That's to just not be scared by that and to dig a little bit deeper and see that you know a lot of these are minor complications and really more so, just a means for us to document all of these things that we're seeing.
Speaker 3:Oh fantastic, what a great article. Yeah, as we come to a close, we ask a little more of a fun question. I think I can probably predict this, but we'll see. When you complete a puzzle, kristen, do you do the inside or the border, or do you do, like a mosaic, part of it, like part of the scenery? How do you feel about attacking a puzzle?
Speaker 4:I am definitely a border person and I, yeah, growing up I thought that was the universal answer and I remember the first time I saw some of my friends doing a puzzle, um, in kind of that more mosaic fashion, and and I was like, where are the edges?
Speaker 3:What are you doing here? Sarah and I have a hypothesis that those that are surgically oriented do the borders and the more medicine sort of folks do interior. So we have to look back at our data to see if our hypothesis holds.
Speaker 4:I could see that being true.
Speaker 2:I've spoken like a true surgeon. As soon as I asked that question, I was like we know what you're going to say.
Speaker 1:That's so funny.
Speaker 2:I think before we had one person who was like maybe like a surgeon or they said like middle, but they said they wanted to be an internist at first or something. So there's high results. But thank you so much, kristen, we appreciate you being here with us today, and also for submitting your manuscript, too, to JAMA.
Speaker 4:Much, kristen, we appreciate you being here with us today and also for submitting your manuscript to Javma. Yeah, absolutely, thank you, guys again so much for having me and to our listeners.
Speaker 2:You can read Kristen's article on Javma. I'm Sarah at Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
