Veterinary Surgery February 2026 – Soft Tissue Part 4: Foreign Body Decision-Making & EndoGIA Lobectomy

In this Simini Small Animal Surgery Podcast episode, we wrap up our soft tissue coverage from the February 2026 issue of Veterinary Surgery with two studies that refine decision-making at the intersection of diagnostics and technique.

From predicting laparoscopic success in GI foreign bodies to rethinking stapling technology in open thoracic surgery, these papers emphasize how better planning—and better tools—can improve outcomes in high-stakes procedures.

In this episode:

✅ Toth et al. — A prospective study evaluating abdominal ultrasound for surgical planning in canine GI foreign bodies. Ultrasound correctly identified foreign body type and morphology in 96.8% of cases, but consistently underestimated size. Importantly, location—not size—determined surgical success, with a 0% success rate for laparoscopic-assisted removal when objects were lodged at the caudal duodenal flexure. Linear foreign bodies were safely managed laparoscopically only if they did not extend past this anatomic bottleneck. 

✅ Weaver et al. — A retrospective study of 46 open lung lobectomies using the EndoGIA stapler, traditionally reserved for minimally invasive procedures. The device achieved zero major intraoperative complications, with over 82% of cases complication-free intraoperatively. While postoperative complications occurred (~10.8%), these were linked to underlying disease severity, not device failure. The EndoGIA’s articulating design and triple-staple row deployment improved maneuverability, hemostasis, and air leak prevention in confined thoracic spaces. 

Together, these studies highlight a key surgical principle: the best outcomes come from matching the right approach—and the right tools—to the underlying anatomy and pathology.

🎓 Journal Articles Discussed

• Toth et al. — Diagnostic accuracy of ultrasonographic evaluation prior to laparoscopic-assisted gastrointestinal foreign body removal in 30 dogs
• Weaver et al. — Use of the Endo GIA™ stapler for lung lobectomy in dogs and cats undergoing open thoracic procedures (intercostal, transdiaphragmatic thoracotomy or median sternotomy): A retrospective study of 46 lung lobectomies

📚 From the February 2026 issue of Veterinary Surgery

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Transcript

SPEAKER_01 0:04

Hi, I'm Carl Damiani, and this is the Simini Small Animal Surgery Podcast, your fast focused update on what matters most from the latest small animal surgical literature. In each episode, we break down key articles from the veterinary journals and translate them into surgical insight you can use. Today, not someday. This episode continues our soft tissue coverage from the February 2026 issue of veterinary surgery. And we're focusing on decision making at the interface of diagnostics and technique. First, we'll look at a study by Toth et al. evaluating the diagnostic accuracy of abdominal ultrasound prior to laparoscopic assisted foreign body removal in dogs. The numbers are strong. Ultrasound correctly identified foreign body type nearly 97% of the time and provided clinically useful information on location and morphology. But the real takeaway is how this imaging translates into surgical planning, predicting which cases are suitable for minimally invasive approaches and which are likely to convert. Then we turned to Weaver et al. who explore the use of the endo GIA stapler for lung lobectomy performed through open thoracic approaches. In over 40 lobectomies, complication rates were low with no major intraoperative issues and strong short-term outcomes, highlighting this device as a versatile and effective alternative to traditional stapling or ligation techniques, even outside of minimally invasive surgery. Two studies, one shared theme, making smarter intraoperative decisions by combining better pre-operative information with evolving surgical tools. Let's dive in.

SPEAKER_02 1:58

So imagine you're looking at a pre-op ultrasound of a dog's blocked gut.

SPEAKER_00 2:02

Right, a very familiar scenario.

SPEAKER_02 2:04

Yeah, and the imaging is um it's like 96% accurate on the shape and type of the object. So why, when you actually make the incision, does the plan so often just fall apart?

SPEAKER_00 2:14

It's incredibly frustrating for sure.

SPEAKER_02 2:16

It really is. Well, welcome to today's deep dive. For you veterinary surgeons listening, managing GI foreign bodies usually means aiming for minimally invasive laparoscopic assisted intestinal surgery.

SPEAKER_00 2:28

Or LAS, yeah. Which is always the goal.

SPEAKER_02 2:30

Exactly. But today we are extracting the clinical punchline from a recent study. It's uh Toth et al. 2026. We want to figure out exactly when LAIs fails and forces an emergency conversion to an open laparotomy.

SPEAKER_00 2:44

Right, because our mission here is to give you the exact parameters so you know precisely which patients are right for LAI and you know which ones just need an open approach from the very first cut.

SPEAKER_02 2:53

So jumping into the data, Toth et al. 2026 evaluated 30 dogs using preoperative abdominal ultrasound, and the imaging correctly identified the foreign body type and shape, like 96.8% of the time.

SPEAKER_00 3:05

Which is huge. That gives a surgeon a massive amount of clinical confidence before even scrubbing in.

SPEAKER_02 3:10

It does, but wait, I have to push back here for a second.

SPEAKER_00 3:13

Oh, go ahead.

SPEAKER_02 3:13

If ultrasound is hitting nearly 97% accuracy on shape, why is it consistently missing the size of the object by a full centimeter? I mean, a 10 millimeter underestimation seems like a pretty glaring flaw.

SPEAKER_00 3:27

Well, it definitely sounds like one, but the data reveals that this size discrepancy doesn't actually dictate your surgical success.

SPEAKER_02 3:33

Really?

SPEAKER_00 3:34

How so? So the median size of objects successfully removed via LAI was 51 millimeters. And for those requiring open surgery, it was 50 millimeters.

SPEAKER_02 3:43

Oh wow, they're practically identical. Exactly. So a larger object doesn't inherently block a minimally invasive approach.

SPEAKER_00 3:49

Right, because focusing on absolute size ignores a crucial physical property, which is malleability.

SPEAKER_02 3:56

Oh, okay. The squish factor.

SPEAKER_00 3:58

Yeah, the squish factor. Many of these foreign bodies are um textiles or soft toys. They squish. A rigid plastic toy is an entirely different surgical challenge than, say, a cotton sock.

SPEAKER_02 4:09

Aaron Ross Powell, even if they measure the exact same length on a screen.

SPEAKER_00 4:12

Exactly. Because you can manipulate that softer material out of a very small incision.

SPEAKER_02 4:16

Okay, so if size isn't the limiting factor forcing a conversion to open surgery, the barrier has to be the anatomy itself, right?

SPEAKER_00 4:25

You hit the nail on the head.

SPEAKER_02 4:26

Specifically, where the object gets stuck. I mean, I picture this like trying to move a large couch around a tightly angled stairwell.

SPEAKER_00 4:35

That is a great analogy.

SPEAKER_02 4:37

Right. If the foreign body is lodged at the caudal duodenal flexure, you're dealing with the tethering of the duodenicolic ligament.

SPEAKER_00 4:45

Yes. Which acts as an absolute physical barrier to pulling that intestine out of the abdomen.

SPEAKER_02 4:51

And the data from the study backs up that physical reality, doesn't it?

SPEAKER_00 4:55

Aaron Powell Completely. There was a 0% success rate for LAI when the foreign body was at the caudal duodenal flexure. Zero.

SPEAKER_02 5:01

Wow. So if it's lodged there, you are converting to an open laparotomy, period.

SPEAKER_00 5:06

Aaron Ross Powell No question about it. But you know, it's interesting because linear foreign bodies used to be considered an automatic open surgery across the board.

SPEAKER_02 5:13

Aaron Powell Right, no matter where they were located.

SPEAKER_00 5:15

Historically, yes. But TOTH et al. 2026 proved they can actually be safely removed via LAIs.

SPEAKER_02 5:22

Aaron Powell Wait, really? With no exceptions?

SPEAKER_00 5:24

Well, with one strict condition, the linear material cannot extend past that exact same caudal duodenal flexure. Uh if it stops before that anatomical bottleneck, you can safely pull it back through the stomach.

SPEAKER_02 5:36

Aaron Powell Okay, but even if you navigate that anatomy perfectly and um you extract the object without fully opening them up, the gut has still been compromised.

SPEAKER_00 5:46

Yeah, that's the lingering issue.

SPEAKER_02 5:48

You're staring at an enterotomy site. So the immediate threat shifts from a mechanical blockage to bacterial leakage.

SPEAKER_00 5:55

And this is where we run into a major vulnerability in standard closure protocols.

SPEAKER_02 5:59

Right, because independent head-head studies show that standard saline rinsing leaves a 42% delta.

SPEAKER_00 6:05

Yeah, which means it leaves 42% of the bacteria behind in the surgical site.

SPEAKER_02 6:09

Blushing with saline is basically just moving the bacteria around, not eliminating it.

SPEAKER_00 6:12

Exactly.

SPEAKER_02 6:13

Leaving nearly half the bacteria behind is a massive, invisible risk right before you stitch up.

SPEAKER_00 6:18

Which is exactly why many clinical teams have shifted to Semini Protect Livage at the point of closure. Aaron Powell Right.

SPEAKER_02 6:25

The non-antibiotic lavage.

SPEAKER_00 6:26

Yeah. And it leaves zero percent of bacteria behind.

SPEAKER_02 6:29

Aaron Powell But how does it manage a complete eradication without relying on antibiotics?

SPEAKER_00 6:33

Aaron Powell It's actually really clever. It works through mechanical and osmotic disruption.

SPEAKER_02 6:38

Oh, interesting.

SPEAKER_00 6:38

So rather than trying to poison the bacteria biologically like an antibiotic would, the lavage physically breaks down the bacterial cell walls upon contact.

SPEAKER_02 6:48

Aaron Powell So you just apply it right before suturing.

SPEAKER_00 6:50

Yep. And in under 60 seconds, it completely neutralizes the surgical field. And it does this without disrupting your standard workflow or contributing to antibiotic resistance.

SPEAKER_02 7:00

That's incredible. So for you in the OR tomorrow, the takeaway from all this is clear. Definitely. Use your preoperative ultrasound to map the object's precise location. If it's hitting the caudal duodenal flexure, skip LA ice entirely and go straight to an open laparotomy.

SPEAKER_00 7:16

And remember that absolute size is just a number. It's the anacomical constraints and the physical material of the object that really dictate your surgical approach.

SPEAKER_02 7:25

Which leaves me with a final, maybe slightly provocative thought for you to mull over.

SPEAKER_00 7:29

Oh, I like these.

SPEAKER_02 7:31

Well, if the malleability of an object matters more than its absolute size, could future diagnostic imaging automatically calculate the squishiness of a foreign body?

SPEAKER_00 7:40

Oh, to perfectly predict LEI success.

SPEAKER_02 7:43

Exactly. Imagine having a squish score right next to the standard measurements on your screen. I mean, an X-ray gives us the broken bone, but maybe tomorrow's ultrasound will give us the exact squish of the squeaky toy.

SPEAKER_01 7:59

Continuing with the next published study.

SPEAKER_00 8:06

So imagine trying to use a really stiff, straight wrench inside a cramped, fully assembled engine block.

SPEAKER_02 8:13

Aaron Ross Powell Oh, that sounds miserable.

SPEAKER_00 8:15

Right. But I mean, that's exactly what it feels like for you, a busy, small animal vet surgeon, when you're doing an open lung lobectomy with a traditional TA stapler.

SPEAKER_02 8:24

Yeah. In a deep chest cavity, it just uh it doesn't articulate at all.

SPEAKER_00 8:28

Aaron Ross Powell Exactly. It's entirely rigid. And then you know, after you finally fire it, you still have to get in there and manually cut the tissue yourself.

SPEAKER_02 8:35

Aaron Ross Powell Which basically means you spend half the surgery just fighting the instrument's physical limitations instead of actually focusing on the tissue. Especially when you're working through like a really tight median sternotomy.

SPEAKER_00 8:46

Trevor Burrus Totally. And um getting you actionable clinical intelligence to solve everyday frustrations like that is exactly our mission on today's deep dive.

SPEAKER_02 8:56

Absolutely.

SPEAKER_00 8:56

So we are looking at Weavert et al. 2026. They essentially asked whether the endo GIA stapler could be the solution here.

SPEAKER_02 9:06

Aaron Ross Powell, which is fascinating because historically that's an instrument we reserve strictly for minimally invasive thoracoscopy.

SPEAKER_00 9:13

Aaron Powell Right. It's a scope-specific tool. But they wanted to see if bringing it into an open procedure would actually work.

SPEAKER_02 9:19

Aaron Powell And well they looked at a pretty solid retrospective cohort, 46 open approach lung lobectomies.

SPEAKER_00 9:26

Aaron Powell Uh Across 33 dogs and four cats.

SPEAKER_02 9:29

Exactly. And the clinical data they pulled is just striking. Over 82% of these lobectomies had absolutely zero intraoperative complications.

SPEAKER_00 9:38

Wow.

SPEAKER_02 9:38

Yeah. And across all 46 procedures, there were zero major intraoperative complications. None.

SPEAKER_00 9:45

Aaron Ross Powell Okay, but um and this is what initially caught my eye and made me a little skeptical. If you look at the post op data, there is a near 11% catastrophic complication rate.

SPEAKER_02 9:55

Aaron Powell Right, the 10.8%.

SPEAKER_00 9:56

Yeah. So I mean if this articulating stapler is supposedly so much safer, why are we seeing that kind of post-op spike? Doesn't that suggest it's actually risky?

SPEAKER_02 10:05

Aaron Powell Well you really have to separate the mechanics of the tool from uh the underlying pathology of the patients in this specific cohort.

SPEAKER_00 10:11

Okay, what do you mean?

SPEAKER_02 10:12

Aaron Ross Powell Those catastrophic post-op complications. They were tied exclusively to severe pre-existing comorbidities.

SPEAKER_00 10:18

Aaron Powell Oh, I see.

SPEAKER_02 10:19

Yeah, we are talking about patients battling pre-existing chylothorax or like massive tumors that were actively invading the phrenic nerve.

SPEAKER_00 10:28

Aaron Ross Powell So it had absolutely nothing to do with stapler failure.

SPEAKER_02 10:31

Aaron Powell Exactly. No stapler failures, no air leaks caused by the device. The tool held up perfectly.

SPEAKER_00 10:38

Ah, okay. The patients were just already in critical condition.

SPEAKER_02 10:42

Right. Because if you isolate the patients that actually survived to reach their 14-day follow-up, 97% of them were completely complication-free.

SPEAKER_00 10:51

Wow, 97%. And I mean that 14-day metric is really the true indicator of the stapler's efficacy on the lung tissue, right?

SPEAKER_02 11:00

Trevor Burrus Absolutely. And mechanically, it makes perfect sense why it performs so well. I mean, the endogia articulates up to 45 degrees in either direction.

SPEAKER_00 11:09

Which is huge.

SPEAKER_02 11:09

And it rotates a full 360 degrees axally. So, you know, instead of contorting yourself.

SPEAKER_00 11:14

Or contorting the patient's anatomy.

SPEAKER_02 11:16

Yes. To accommodate that rigid TA stapler, you just angle the jaws directly where the pathology dictates. Trevor Burrus, Jr.

SPEAKER_00 11:21

It's just a massive ergonomic advantage for the surgeon.

SPEAKER_02 11:24

Aaron Powell It really is.

SPEAKER_00 11:25

Yeah.

SPEAKER_02 11:25

But the true clinical value is, well, it's what happens when you actually fire the device.

SPEAKER_00 11:30

Aaron Powell Right, because it deploys those triple staggered rows of staples.

SPEAKER_02 11:34

Yep.

SPEAKER_00 11:34

Yeah.

SPEAKER_02 11:34

And simultaneously utilizes a built-in blade to transect the tissue.

SPEAKER_00 11:39

Aaron Powell, which fundamentally changes the tension dynamics. I mean, with triple staggered rows, the mechanical stress is distributed so much more evenly across the lung lobe.

SPEAKER_02 11:48

Exactly. You totally avoid that localized tearing you sometimes get with a single rigid crush from a traditional stapler.

SPEAKER_00 11:55

Plus, having the blade automatically perform the transection as you staple, I mean, that eliminates the need to go back in blindly with scissors.

SPEAKER_02 12:02

And that automatic transection saves crucial minutes of OR time.

SPEAKER_00 12:06

For sure.

SPEAKER_02 12:07

But more importantly, gently compressing the tissue while applying those staggered rows. It creates a highly secure seal. You achieve optimal hemostasis and drastically lower the risk of air leaks.

SPEAKER_00 12:18

Even when dealing with severely diseased, friable lung tissue.

SPEAKER_02 12:21

Exactly.

SPEAKER_00 12:22

So the real actionable takeaway here for you listening, it fundamentally challenges how we equip our ORs.

SPEAKER_02 12:28

It really does. The endogIA staplers shouldn't just be locked away on the endoscopy card anymore.

SPEAKER_00 12:33

No, it's a highly maneuverable, structurally superior alternative for open lung lobectomies, especially in those tight spaces, like a median strenotomy.

SPEAKER_02 12:44

It completely neutralizes the challenges of a deep chest cavity.

SPEAKER_00 12:48

Yeah.

SPEAKER_02 12:49

And uh we do have a full link to Weaver et al. 2026 in the show notes if you want a deeper look at the methodology.

SPEAKER_00 12:55

Awesome. And you know, it kind of makes you wonder about the rest of the surgical toolkit.

SPEAKER_02 12:58

Oh, for sure.

SPEAKER_00 12:59

If an instrument engineered specifically for the spatial constraints of minimally invasive surgery actually outperforms our traditional tools in an open chest, what other scope-specific devices should we be repurposing for open surgeries?

SPEAKER_02 13:13

That is a great question.

SPEAKER_00 13:14

Something to keep in mind next time you scrub in.

SPEAKER_01 13:20

That's it for this episode of the Simony Small Animal Surgery Podcast. This show is brought to you by Simony Protect Livage, our interoperative lavage developed to target resistant bacteria and biofilms where traditional solutions of saline and post op antibiotics fall short. If you're interested in learning more or trying out your own procedures, you'll find information and links in the show notes. Listening, and we'll see you in the next episode.