Comparison of video-assisted and open umbilical vein marsupialization technique in bovine fetuses (cadaveric study)

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A cadaveric study was conducted using 16 bovine fetuses obtained from slaughterhouses. The fetuses were divided into a control group (CG), undergoing laparotomy, and a videosurgical group (GV), undergoing a video-assisted technique with two lateral accesses on the right flank. Results demonstrated a statistical difference in the time required to access the abdominal cavity and visualize the umbilical vein and adjacent structures. However, no significant difference was observed in the time taken for umbilical vein clamping, dieresis, and marsupialization between laparotomy and laparoscopy. The surgical time for abdominal cavity exposure was significantly longer in the CG group compared to the GV group (P < 0.0001). Additionally, the total surgical time was markedly shorter in the GV group (12.00 ± 0.45 min) than in the CG group (35.41 ± 0.58 min) (P < 0.0001). The study concluded that video-assisted umbilical vein marsupialization with two portals is a minimally invasive alternative to the conventional technique, allowing for reduced surgical time while achieving the same procedural outcomes. Clinically, this technique offers a faster and more efficient approach, suggesting its potential as an alternative for treating liver abscesses in calves, with possible benefits in reducing surgical stress and improving recovery. Health sciences/Anatomy/Cells Health sciences/Anatomy/Endocrine system cadaveric model laparoscopy liver abscess treatment minimally invasive surgery umbilical vein Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Newborn calves can be affected by disorders of the umbilical components: omphalourachitis, omphaloarteritis, omphalophlebitis, and inflammation of the umbilical vein. 1 carrying blood rich in oxygen and nutrients, the umbilical vein is located cranially until it reaches the fetal liver . 2 If not properly treated after birth, this connection can be a gateway, facilitating the path of bacteria to the liver, resulting in hepatitis, liver abscesses, and septicemia. 3 Depending on the severity, omphalophlebitis treatment consists of a combination of systemic antibiotics and surgical resection; if drug treatment is not sufficient, it requiressurgical procedures. 4 , 5 In most liver abscess cases, complete resection of all infected tissue is unfeasible, and the recommendation is to perform umbilical vein marsupialization after an exploratory laparotomy. 4 , 6 In young calves, videolaparoscopy allows a quick and complete assessment of umbilical cord disorders. 7 Due to its minimally invasive advantages, with a greater field of view, this technique can be applied in several surgical procedures of the umbilical structures of calves, in addition to being intraoperative faster compared to conventional ones. 8 Since videolaparoscopy provides greater advantages in umbilical disorder therapy, this work’s objective is to describe a video-assisted technique for umbilical vein marsupialization. Materials and methods Ethics approval and cadaveric samples of the bovine fetuses This study was carried out in accordance with the recommendations of the National Council for Experimentation Control in Brazil (CONCEA). This research was approved by the Animal Ethics and Welfare Committee of the Federal University of Pará (protocol N ° 4848261017). As the study corresponds to a new experimental technique, all surgical procedures were performed on cadavers from a local slaughterhouse in accordance with inspection requirements. Thus, the procedures did not cause pain or suffering in animals, as they were performed on bovine fetuses from the slaughtered of pregnant cows. The experiment was conducted at the Institute of Veterinary Medicine (IMV) in Campus II of the Federal University of Pará (UFPA), located in the municipality of Castanhal, Pará, Brazil, the and involved the video-assisted vein marsupialization technique in bovine fetuses in 16 anatomical specimens (weighing between 30 and 40 kg, bovine fetuses from cows slaughtered in the last third of gestation. This research followed the precepts of ethics study in animal experimentation approved by the Ethics Committee in Research with Animals and Experimentation of the 1. From slaughterhouse disposal, sixteen bovine fetuses were used weighing between 25 and 30 kg, from pregnant cows sent to slaughter. All procedures were performed on cadavers without causing animal pain or suffering. The specimens were divided into two groups: 8 bovine fetuses in the control group, submitted to the umbilical vein marsupialization technique by laparotomy (GC, n = 8); 8 fetuses using a video-assisted umbilical vein marsupialization technique (GV, n = 8). Operative techniques Sato et al. 6 and adapted Marchionatti et al. 4 technique was used for the CG. The specimens were positioned in the supine position, a right paramedian access of 15–20 cm was performed, and the abdominal cavity was explored (Fig. 1 A,B). Immediately, the umbilical vein was located from its proximal portion connected to the liver to its distal insertion in the umbilical component (Fig. 1 C). Subsequently, in the left ventral paramedian region, cranial to the umbilical region, an incision of approximately 1 cm was made making a small gallery and entering the abdominal cavity (Fig. 1 D). After this step, in its distal portion, the umbilical vein was double clamped (Fig. 1 E), performing a ligature with a Muller knot in the distal region, followed by the dieresis to decouple it from the abdominal wall (Fig. 1 F). The umbilical vein was pulled through the gallery performed by the incision and fixed with single isolated stitches (Fig. 1 G,H). With a Mayo imbrication suture, the access was reversed (Fig. 2 A), the subcutaneous tissue was reduced (Fig. 2 B), and dermorrhaphy was performed with isolated stitches and a U suture (Fig. 2 C). In GV, it was based on Monteiro et al. 8 technique adapted but working with two laparoscopic portals in the right flank region (Fig. 3 A and 3 B) and an additional access for video-assisted umbilical vein clamping. UA 10 and a 5-mm trocar (Bhio Supply, Sapucaia do Sul, RS, Brazil) was used. Using the adapted open technique (Fig. 3 B) and video-assisted, respectively, the first and second portals were inserted a pneumoperitoneum of 8 mmHg and an inflation rate of 5L/min. was used, controlled by an electronic CO 2 insufflator (Access 40, Dyonics, Michigan, USA). With a diameter of 0°, a 10-mm rigid endoscope (Karl Storz SE & Co, Tuttlingen, Germany) was used, coupled to a microcamera system (Combo Endosurgery System, GDI, Ribeirão Preto, SP, Brazil) and the lighting (Cabo de Luz 495 Fiber Ótica, Karl Storz SE & Co, Germany), connected to the light source (Led Light Source, GDI, Ribeirão Preto, SP, Brazil). The Zscan plate capture system (Image Capture Software, Zscan, Goiânia, GO, Brazil) was used. After establishing the pneumoperitoneum, an abdominal exploration was performed, identifying the umbilical ring and the umbilical structures, umbilical vein up to the liver insertion (Fig. 3 C). Next, similar to the conventional technique, in the left ventral paramedian region, an incision approximately 1 cm was made, cranial to the umbilical region (Fig. 4 A and 4 B), making a small gallery and entering the abdominal cavity. The tweezers were introduced hemostatic through this gallery. It was possible to visualize in a video-assisted way the introduction of the hemostatic clamp and the apprehension of the umbilical vein near the umbilical ring. Continuously, through the second portal, a 5-mm laparoscopic scissors (Karl Storz SE & Co) was introduced for the resection of this structure in the space between the hemostatic forceps and the umbilical ring (Fig. 4 C and 5 A). The umbilical vein was externalized with hemostatic forceps (Fig. 5 A), and two single isolated stitches were applied, fixing the vein to the external abdominal wall (Fig. 5 B and 5 C), using 4.0 nylon thread. The pneumoperitoneum was undone, trocar cannulae laparoscopic portals were removed, and myorrhaphy (Fig. 6 A) and dermorrhaphy with crossed stitches (Sultan) and U suture (Fig. 6 B) were performed, respectively. Intraoperative analyses For all procedures, the each stage’ transoperative time was measured, recording any intercurrence. For the GC and GV, data on total operative time and steps were submitted to descriptive statistics. The procedures were divided as follows: access until visualization and exploration of the umbilical vein (step 1 – E1); umbilical vein clamping, dieresis, and marsupialization (step 2 – E2); and final exploration until reversal of accessions (stage 3 –E3). To confirm that the data were within the normal range, the Shapiro–Wilk test was used. The T test was used to compare the total and each step operative time with the post-test Mann–Whitney test (Wilcoxon) and for non-normal distribution. Using the Bioestat 5.3 package, statistical evaluation was performed, working p ≤ 0.05, considered significant. Results The bovine fetus model was efficient to establish the operative technique and perform the tested groups’ comparison. In all specimens, there was good visualization of the umbilical structures. It was possible to perform the technique without major complications in 100% of the animals (16/16) with pneumomeritoneum and accesses, the decubitus position allowed complete visualization and manipulation of the structures, including additional access with hemostat using the conventional technique and video-assisted umbilical vein marsupialization technique. A small CO 2 leak ran through this access, but without compromising the pneumoperitoneum. This complication occurred in one animal from the GV (n = 1, 12.5%). Access to the abdominal cavity was faster for visualization and exploration of the umbilical vein by laparotomy (Table 1 ), with incisions of approximately 10.7–14.5 cm, mean 12.75 cm. For the introduction of the two portals, by laparoscopy, two incisions of approximately 3–5 mm were made. For umbilical vein clamping, access of approximately 1 cm was added in both groups. Table 1 Results of surgical time for each step of laparotomy and laparoscopy performed for umbilical vein marsupialization in bovine fetuses. Operative moments GC GV p value Accesses to visualization and exploration of the umbilical vein 3.65 ± 0.17 4.73 ± 0.16 < 0.0001* Clamping, dieresis and marsupialization of the umbilical vein 6.54 ± 0.45 5.74 ± 0.40 0.0022 Closure of the abdominal cavity 25.22 ± 0.32 1.53 ± 0.16 < 0.0001* Total surgical time 35.41 ± 0.58 12.00 ± 0.45 < 0.0001* Note: *Significant difference, with p ≤ 0.05. Abbreviation: GC, group control; GV, video-surgical group; p, probability of significance. It was possible to perform umbilical vein clamping, dieresis, and marsupialization by laparotomy and laparoscopy (Table 1 ). In the CG group, during the performance of the small gallery, there were two small complications, for fixing the skin’s vein (02/08) 25%, requiring divulsion with forceps to deepen until entering the abdominal cavity, but without compromising the technique. The surgical time for abdominal cavity closure took longer in the GC group (Table 1 ) compared to the GV group. By laparotomy, the dieresis for the abdominal cavity closure was performed with Mayo imbrication suture of the peritoneum and muscle layer; the subcutaneous tissue was reduced with simple continuous suture and the dead space with anchorage of the subcutaneous tissue to the musculature. With a U suture, dermorrhaphy was performed that created a post-surgical wound of 15–20 cm. In the GV group, myorrhaphy was performed, and dermorrhaphy with crossed stitches, with a U suture in the post-surgical wound of approximately 5 mm. The total surgical time was longer in the GC group compared to the GV group (Table 1 ). Discussion Omphalophlebitis treatments consist of a combination of systemic antibiotics and in some cases surgical resection of the umbilical vein by laparotomy. 5 In patients with liver abscesses, complete resection of the umbilical vein and all infected tissues may be unfeasible, and the recommendation is to perform umbilical vein marsupialization after an exploratory laparotomy. 6 In the GC group, it was possible to perform the surgical procedures for umbilical vein marsupialization, but with limited space for the structures involved. In the GV group, it allowed a wider view of the abdominal cavity. At laparoscopy, it is possible to visualize all umbilical structures, as well as the entire length of the umbilical vein and the liver’s visceral surfasse. 7 Umbilical vein infection diagnosis and treatment delay leads to umbilical vein abscesses that require drainage by marsupialization of this structure, as the abscesses that reach the porta hepatis are difficult to remove. 7 In the first step, the umbilical vein was visualized fixed ventrally to the liver using the access by laparotomy. By laparoscopy, due to the laparoscope focusing directly and allowing a complete inspection, the first structure to be inspected was the umbilical vein. 8 Between the groups, there was a statistically significant difference in the time to access the umbilical vein and other umbilical structures. In the GV group, the access time was longer; in this phase, the time to perform the pneumoperitoneum was included. In laparoscopy, the skin incisions were smaller for trocar placement. These incisions allow them to be introduced slowly and carefully without abdominal organ injury and without CO 2 loss during pneumoperitoneum. 8 For access by laparotomy, the incisions were superior for exploring the abdominal cavity and performing umbilical vein marsupialization. During the exploration of the abdominal cavity in the GV, a better inspection and manipulation of the umbilical structures and adjacent organs was possible due to image magnification and abdominal cavity insufflation. Compared to other studies, this step was shorter using the exploration of the abdominal cavity for umbilical disorder diagnosis, performed with a time of 7 minutes. 7 By laparotomy, the exploration of the abdominal cavity in the CG was limited close to the access, and few structures were inspected, and manipulation was restricted. In suspected umbilical disorder cases, the clinical examination can be complemented with the use of ultrasound, but due to the high false negatives rates and low sensitivity, other alternatives are indicated; some neonates with dry external umbilicus, may appear completely normal, and they may be critically ill due to intra-abdominal inflammation of the urachus, arteries, and/or umbilical veins. 9 The use of laparoscopy is an efficient method used for umbilical disorder diagnosis. 7 In the omphalophlebitis treatment, umbilical vein marsupialization is recommended to wash through this structure, improving drainage and preventing premature closure. Lavage is not without potential complications, such as bacteremia, vein rupture, generalized peritonitis, and sudden death. 10 – 13 To effectively and safely reduce the septicemia and embolization risks, the introduction of a small-caliber catheter into the marsupialized vein minimized pressure within the vein and allowed the lavage solution to flow freely around the catheter. 4 It was possible to efficiently perform video-assisted umbilical vein marsupialization; for surgical treatment in cases of pathological changes in the umbilical vein, a possibility of using this minimally invasive technique was found. In cases of insufficient therapeutic treatment, the most indicated method is surgical treatment. 4 , 14 In both groups, there were minor complications without impairing the techniques’ performance; in two calves (25%) in the CG during the technique’s performance, to enter the abdominal cavity, a small gallery in the divulsion was performed with the forceps, in addition to the use of a scalpel blade. In GV, because the abdomen was distended, all incisions were performed with a scalpel blade; performing this procedure was faster (GC − 6.54 min and GV − 5.74 min). The event in which there was a small CO 2 leakage through the access that occurred in the GV in a calf (12.5%) during hemostatic forcep placement did not compromise the technique’s performance. Laparoscopy is a minimally invasive procedure that can be used to improve outcomes and reduce complications. 15 In the second stage, between the groups, there was no statistical difference in the execution time of the umbilical vein marsupialization technique. By laparotomy, the double umbilical vein clamping in its distal portion and ligation with a Muller's knot were done. By laparoscopy, the procedure was simple to perform and faster due to the performance of a simple clamping of the umbilical vein for dieresis and marsupialization. The use of laparoscopy has facilitated the performance of the procedures with minimum equipment and reduced costs in farm animals. 16 Both groups were able to perform the umbilical vein marsupialization technique. This surgical treatment by laparotomy allows the umbilical vein’s lumen to be exposed to the external environment, in order to carry out the treatment with alcohol and iodine solution and facilitate the drainage of the contents. 4 In multiple liver abscess cases in which the umbilical vein is not compromised, partial hepatectomy is necessary. 17 In the third stage, during abdominal cavity closing, there was a statistical difference between the groups. The surgical time was longer in the GC than in the GV, due to the larger incision (9.4–14.5 cm) of the abdominal cavity by laparotomy. To reverse the large access by laparotomy, three layers of suture are needed: first layer, suture of the peritoneum and muscle with interrupted stitches, the second layer, suture of the subcutaneous tissue and simple anchorage of continuous points in the musculature, aiming to reduce the dead space, and the third layer, dermorrhaphy performed with cross stitches interrupted. 18 The laparoscopic technique’s total surgical time was significantly shorter compared to that performed by laparotomy. In the GA group, the conventional open cavity closure step significantly affected the total surgical time. After removing the two portals in the GV, the smaller incisions (3 to 5 cm) compared to the laparotomy technique, it was possible to perform in less time. Because access is smaller, it is usually carried out in the myorrhaphy, interrupted cross stitch, and in dermorrhaphy, an isolated stitch, suture in U. For laparotomy, more sutures are needed due to the surgical wound size. 18 Conclusions In conclusion, the video-assisted technique of umbilical vein marsupialization with two portals allowed the performance of umbilical vein clamping, dieresis, and marsupialization in a minimally invasive way and with a shorter surgical time compared to the conventional technique. In calves, this could be a viable alternative for exploration and a possible umbilical disorder surgical treatment, specifically in umbilical vein infections that extends to the liver parenchyma. For the technique’s execution with small adaptations for live animals, more studies are needed to verify each surgical step proposed in organs and structures with pathological changes. Abbreviations GC group control GV video-surgical group p probability of significance. Declarations Acknowledgements. The authors gratefully thank the team of the video surgery, obstetrics, and reproduction group (VOR), the National Council for Scientific and Technological Development (CNPq, Brazil), the Coordination for the Improvement of Higher Education Personnel (CAPES, Brazil) and the Research and Postgraduate Pro-Rector of Pará Federal University (Propesp/UFPA) through the Qualified Publication Support Program - PAPQ for financial support in this study. Authors contributions: C.R.G.S. (Investigation, Data Curation), T.S.C. (Investigation, Data Curation), M.E.M.F. (Investigation, Data Curation), L.S.C. (Investigation, Data Curation), J.L.S.G. (Investigation, Data Curation), J.H.G.R. (Investigation, Data Curation), H.J.G. (Investigation, Data Curation), J.P.M.B. (Investigation, Data Curation), L.H.V.A. (Investigation, Data Curation), L.E.S.A. (Investigation, Data Curation), L.A.S. (Investigation, Data Curation), L.P.A.A. (Investigation, Data Curation), M.A.M.S. (Writing - Review & Editing, Supervision), F.D.O.M.* (Conceptualization, Methodology, Writing - Review & Editing, Supervision, Project administration), P.P.M.T.+ (Conceptualization, Methodology, Writing - Review & Editing, Supervision, Project administration, Funding acquisition). All authors reviewed the manuscript. Additional Information: Have no conflicts of interest or financial ties to disclose. Ethics declarations: Human Ethics and Consent to Participate declarations: not applicable. Funding Declaration: This research received no external funding. Data availability: All data generated or analysed during this study are included in this published article [and its supplementary information files]. References Steerforth, D.-D. & Van Winder, S. Development of clinical sign-based scoring system for assessment of omphalitis in neonatal calves. Vet. Rec. 182 , 549 (2018). Baird, A. N. Surgery of the Umbilicus and Related Structures . Vet. Clin. North Am. Food Anim. 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Supplementary Files Marsupializao.mp4 SUPPLEMENTARY MATERIALS The following supplemental material is available for this article online: Video Clip S1. Video-assisted marsupialization of the umbilical vein This material is available as part of the online article from: Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 14 May, 2026 Reviewers agreed at journal 13 May, 2026 Reviews received at journal 08 Mar, 2026 Reviewers agreed at journal 23 Feb, 2026 Reviewers invited by journal 02 Sep, 2025 Editor assigned by journal 11 Aug, 2025 Editor invited by journal 11 Jun, 2025 Submission checks completed at journal 07 Jun, 2025 First submitted to journal 07 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Vilela","lastName":"Araújo","suffix":""},{"id":511414393,"identity":"be4909d4-3023-4258-9fdf-d7ae8972827e","order_by":9,"name":"Luis Enrique Soza Altamirano","email":"","orcid":"","institution":"Veterinary Hospital, Institute of Veterinary Medicine, Federal University of Pará -UFPA","correspondingAuthor":false,"prefix":"","firstName":"Luis","middleName":"Enrique Soza","lastName":"Altamirano","suffix":""},{"id":511414394,"identity":"c5afb8dd-0434-4dd6-8ae5-d58a1e4b7934","order_by":10,"name":"Loise Araújo De Sousa","email":"","orcid":"","institution":"Veterinary Hospital, Institute of Veterinary Medicine, Federal University of Pará -UFPA","correspondingAuthor":false,"prefix":"","firstName":"Loise","middleName":"Araújo","lastName":"De Sousa","suffix":""},{"id":511414396,"identity":"f306513f-9ef6-4d80-8243-2e831c13a7ee","order_by":11,"name":"Luiza Paula Araújo Alcântara","email":"","orcid":"","institution":"Veterinary Hospital, Institute of Veterinary Medicine, Federal University of Pará -UFPA","correspondingAuthor":false,"prefix":"","firstName":"Luiza","middleName":"Paula Araújo","lastName":"Alcântara","suffix":""},{"id":511414397,"identity":"70ecbf18-ec79-47a8-bb39-4aadd5d255c6","order_by":12,"name":"Marco Augusto Machado Silva","email":"","orcid":"","institution":"School of Veterinary and Animal Science, Federal University of Goiás - UFG","correspondingAuthor":false,"prefix":"","firstName":"Marco","middleName":"Augusto Machado","lastName":"Silva","suffix":""},{"id":511414398,"identity":"2522de75-c9a1-42bf-ae0b-7fc4ba91ac39","order_by":13,"name":"Francisco Décio de Oliveira Monteiro","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIie3RsYrCMBjA8a8U7JJ661dOuFfoTedQ8FWaxUm6FOSGQwqBdOkDWNB7jMwtBV2Cs5snrgrtfMvFcC5Hq97mkD8ZuvzyJSmAyfSIFXqdsxKAd3zS3wQgvEmIJhK97B5y2VcN4nCb9NdsXzSTIBo5jNfN5xBHTmJ9nThEb0k78eTKL3MxjgkpWZ4LREIK+3XJIR4U7cTfTqByRUUzpMx2Bc4Ihr1nlwOddxzM3x1/yctekYWagqHzfZVsyWWKpUiiSc++Rjw51nehmaTMmq8UkSXzFhuMsfPFqkPdiICm6foA9ccMnZSV9XEaRF2krfM/hf8Ak8lkMv3tByuEWmGxkjicAAAAAElFTkSuQmCC","orcid":"","institution":"Campus Araguatins of the Federal Institute of Education, Science, and Technology of Tocantins (IFTO)","correspondingAuthor":true,"prefix":"","firstName":"Francisco","middleName":"Décio de Oliveira","lastName":"Monteiro","suffix":""},{"id":511414399,"identity":"999ea991-aac6-44bc-bd5c-ae29653895ab","order_by":14,"name":"Pedro Paulo Maia Teixeira","email":"","orcid":"","institution":"Veterinary Hospital, Institute of Veterinary Medicine, Federal University of Pará -UFPA","correspondingAuthor":false,"prefix":"","firstName":"Pedro","middleName":"Paulo Maia","lastName":"Teixeira","suffix":""}],"badges":[],"createdAt":"2025-05-26 19:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6753440/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6753440/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90905387,"identity":"817bbb5e-a326-4f4f-a0b2-ad7425b29eb0","added_by":"auto","created_at":"2025-09-09 13:04:29","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3973936,"visible":true,"origin":"","legend":"\u003cp\u003e(A and B) Cutaneous incision for abdominal access. (C) Umbilical vein identification. (D) Additional skin incision for hemostat introduction. (E and F) Seizure and resection phases of the umbilical vein. (G) Externalization and fixation of the umbilical vein. (H) Internal image after marsupialization of the umbilical vein by laparotomy. Cr: cranial; Cd: flow rate; L: left; A: right; *: marsupialized umbilical vein; 1: umbilical vein; 2: additional access formation; 3: umbilical vein clamping; 4: umbilical vein resection; 5: liver.\u003c/p\u003e","description":"","filename":"Figure1.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6753440/v1/14dfe020684e6288d24751c3.jpg"},{"id":90904854,"identity":"0245a468-2d78-418e-ae68-cc065ad9b1d9","added_by":"auto","created_at":"2025-09-09 12:56:29","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2773326,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Mayo imbrication suture of the peritoneum/muscle. (B) Suture of the subcutaneous tissue. (C) Dermorrhaphy with U suture in the technique of umbilical vein marsupialization by laparotomy. Cr: cranial; Cd: flow rate; L: left; A: right; 1: first suture layer; 2: second suture layer; 3: third suture layer.\u003c/p\u003e","description":"","filename":"Figure2.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6753440/v1/5f562391364db293b8fb1dcf.jpg"},{"id":90903379,"identity":"f2673f1b-be7e-4659-bc94-b18a24f06ecb","added_by":"auto","created_at":"2025-09-09 12:48:29","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":79237,"visible":true,"origin":"","legend":"\u003cp\u003ePosition of bovine fetuses that underwent laparoscopically assisted umbilical vein marsupialization with two laparoscopic portals in the right paralumbar fossa in the left lateral recumbency position. (A, B) Position of the laparoscopic and instrument portals in the paralumbar fossa. (C) Laparoscopic view of the umbilical vein inserted into the umbilical ring (ventral) and the liver (dorsal).\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6753440/v1/d9ba4b35f153d67b490521fa.jpg"},{"id":90903376,"identity":"6d0fa243-18e8-4e18-9a5d-76ec165021a3","added_by":"auto","created_at":"2025-09-09 12:48:29","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":55334,"visible":true,"origin":"","legend":"\u003cp\u003eMinilaparotomy cranial to the umbilical region and hemostatic forceps transpass. (A) Surgical incision cranial to the umbilical region with excavation of a gallery to transpass the umbilical vein. (B) Intra-abdominal view of minilaparotomy with scalpel blade. (C) Intra-abdominal view of surgical resection of the umbilical vein.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6753440/v1/e5592986a566c9b365711b9a.jpg"},{"id":90903374,"identity":"916cde22-16c6-4481-9a7e-77e55c3eb0b9","added_by":"auto","created_at":"2025-09-09 12:48:29","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":63049,"visible":true,"origin":"","legend":"\u003cp\u003eA - Video-assisted seizure and resection of the umbilical vein. B and C - Externalization and fixation of the umbilical vein to the skin\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6753440/v1/4a561e44a9206ccc3d81bd6c.jpg"},{"id":90903404,"identity":"9fad4c97-846a-4649-9859-4f12b7577506","added_by":"auto","created_at":"2025-09-09 12:48:30","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1946155,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Myorrhaphy with cross stitches (Sultan). (B) Dermorrhaphy with U suture in each incision after removal of the trocars. *: X suture (Sultan); black arrows: U suture.\u003c/p\u003e","description":"","filename":"Figure6.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6753440/v1/3e477a172c08fd29e0368391.jpg"},{"id":90907220,"identity":"fbbb03e3-6643-4737-bfce-94f8d98c0206","added_by":"auto","created_at":"2025-09-09 13:20:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":9860849,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6753440/v1/6c62ae38-1174-49a0-b059-2b45f9a96035.pdf"},{"id":90906774,"identity":"02b878a3-4dc8-4b76-b58c-b54d3219d770","added_by":"auto","created_at":"2025-09-09 13:12:30","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13331709,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSUPPLEMENTARY MATERIALS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe following supplemental material is available for this article online:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVideo Clip S1.\u003c/strong\u003e Video-assisted marsupialization of the umbilical vein\u003c/p\u003e\n\u003cp\u003eThis material is available as part of the online article from:\u003c/p\u003e","description":"","filename":"Marsupializao.mp4","url":"https://assets-eu.researchsquare.com/files/rs-6753440/v1/25f2111b03e28948d90b7a3c.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of video-assisted and open umbilical vein marsupialization technique in bovine fetuses (cadaveric study)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNewborn calves can be affected by disorders of the umbilical components: omphalourachitis, omphaloarteritis, omphalophlebitis, and inflammation of the umbilical vein.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e carrying blood rich in oxygen and nutrients, the umbilical vein is located cranially until it reaches the fetal liver .\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e If not properly treated after birth, this connection can be a gateway, facilitating the path of bacteria to the liver, resulting in hepatitis, liver abscesses, and septicemia.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDepending on the severity, omphalophlebitis treatment consists of a combination of systemic antibiotics and surgical resection; if drug treatment is not sufficient, it requiressurgical procedures.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In most liver abscess cases, complete resection of all infected tissue is unfeasible, and the recommendation is to perform umbilical vein marsupialization after an exploratory laparotomy.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn young calves, videolaparoscopy allows a quick and complete assessment of umbilical cord disorders.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Due to its minimally invasive advantages, with a greater field of view, this technique can be applied in several surgical procedures of the umbilical structures of calves, in addition to being intraoperative faster compared to conventional ones.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eSince videolaparoscopy provides greater advantages in umbilical disorder therapy, this work\u0026rsquo;s objective is to describe a video-assisted technique for umbilical vein marsupialization.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and cadaveric samples of the bovine fetuses\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e This study was carried out in accordance with the recommendations of the National Council for Experimentation Control in Brazil (CONCEA). This research was approved by the Animal Ethics and Welfare Committee of the Federal University of Par\u0026aacute; (protocol N \u0026deg; 4848261017). As the study corresponds to a new experimental technique, all surgical procedures were performed on cadavers from a local slaughterhouse in accordance with inspection requirements. Thus, the procedures did not cause pain or suffering in animals, as they were performed on bovine fetuses from the slaughtered of pregnant cows.\u003c/p\u003e\u003cp\u003eThe experiment was conducted at the Institute of Veterinary Medicine (IMV) in Campus II of the Federal University of Par\u0026aacute; (UFPA), located in the municipality of Castanhal, Par\u0026aacute;, Brazil, the and involved the video-assisted vein marsupialization technique in bovine fetuses in 16 anatomical specimens (weighing between 30 and 40 kg, bovine fetuses from cows slaughtered in the last third of gestation.\u003c/p\u003e\u003cp\u003e This research followed the precepts of ethics study in animal experimentation approved by the Ethics Committee in Research with Animals and Experimentation of the 1. From slaughterhouse disposal, sixteen bovine fetuses were used weighing between 25 and 30 kg, from pregnant cows sent to slaughter. All procedures were performed on cadavers without causing animal pain or suffering. The specimens were divided into two groups: 8 bovine fetuses in the control group, submitted to the umbilical vein marsupialization technique by laparotomy (GC, n\u0026thinsp;=\u0026thinsp;8); 8 fetuses using a video-assisted umbilical vein marsupialization technique (GV, n\u0026thinsp;=\u0026thinsp;8).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eOperative techniques\u003c/h2\u003e\u003cp\u003eSato et al.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e and adapted Marchionatti et al.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e technique was used for the CG. The specimens were positioned in the supine position, a right paramedian access of 15\u0026ndash;20 cm was performed, and the abdominal cavity was explored (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA,B). Immediately, the umbilical vein was located from its proximal portion connected to the liver to its distal insertion in the umbilical component (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC). Subsequently, in the left ventral paramedian region, cranial to the umbilical region, an incision of approximately 1 cm was made making a small gallery and entering the abdominal cavity (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAfter this step, in its distal portion, the umbilical vein was double clamped (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eE), performing a ligature with a Muller knot in the distal region, followed by the dieresis to decouple it from the abdominal wall (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eF). The umbilical vein was pulled through the gallery performed by the incision and fixed with single isolated stitches (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eG,H). With a Mayo imbrication suture, the access was reversed (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA), the subcutaneous tissue was reduced (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB), and dermorrhaphy was performed with isolated stitches and a U suture (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn GV, it was based on Monteiro et al.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e technique adapted but working with two laparoscopic portals in the right flank region (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB) and an additional access for video-assisted umbilical vein clamping. UA 10 and a 5-mm trocar (Bhio Supply, Sapucaia do Sul, RS, Brazil) was used. Using the adapted open technique (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB) and video-assisted, respectively, the first and second portals were inserted a pneumoperitoneum of 8 mmHg and an inflation rate of 5L/min. was used, controlled by an electronic CO\u003csub\u003e2\u003c/sub\u003e insufflator (Access 40, Dyonics, Michigan, USA).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWith a diameter of 0\u0026deg;, a 10-mm rigid endoscope (Karl Storz SE \u0026amp; Co, Tuttlingen, Germany) was used, coupled to a microcamera system (Combo Endosurgery System, GDI, Ribeir\u0026atilde;o Preto, SP, Brazil) and the lighting (Cabo de Luz 495 Fiber \u0026Oacute;tica, Karl Storz SE \u0026amp; Co, Germany), connected to the light source (Led Light Source, GDI, Ribeir\u0026atilde;o Preto, SP, Brazil). The Zscan plate capture system (Image Capture Software, Zscan, Goi\u0026acirc;nia, GO, Brazil) was used. After establishing the pneumoperitoneum, an abdominal exploration was performed, identifying the umbilical ring and the umbilical structures, umbilical vein up to the liver insertion (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC).\u003c/p\u003e\u003cp\u003eNext, similar to the conventional technique, in the left ventral paramedian region, an incision approximately 1 cm was made, cranial to the umbilical region (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB), making a small gallery and entering the abdominal cavity. The tweezers were introduced hemostatic through this gallery.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIt was possible to visualize in a video-assisted way the introduction of the hemostatic clamp and the apprehension of the umbilical vein near the umbilical ring. Continuously, through the second portal, a 5-mm laparoscopic scissors (Karl Storz SE \u0026amp; Co) was introduced for the resection of this structure in the space between the hemostatic forceps and the umbilical ring (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA). The umbilical vein was externalized with hemostatic forceps (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA), and two single isolated stitches were applied, fixing the vein to the external abdominal wall (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eB and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eC), using 4.0 nylon thread. The pneumoperitoneum was undone, trocar cannulae laparoscopic portals were removed, and myorrhaphy (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eA) and dermorrhaphy with crossed stitches (Sultan) and U suture (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eB) were performed, respectively.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eIntraoperative analyses\u003c/h3\u003e\n\u003cp\u003eFor all procedures, the each stage\u0026rsquo; transoperative time was measured, recording any intercurrence. For the GC and GV, data on total operative time and steps were submitted to descriptive statistics. The procedures were divided as follows: access until visualization and exploration of the umbilical vein (step 1 \u0026ndash; E1); umbilical vein clamping, dieresis, and marsupialization (step 2 \u0026ndash; E2); and final exploration until reversal of accessions (stage 3 \u0026ndash;E3). To confirm that the data were within the normal range, the Shapiro\u0026ndash;Wilk test was used. The T test was used to compare the total and each step operative time with the post-test Mann\u0026ndash;Whitney test (Wilcoxon) and for non-normal distribution. Using the Bioestat 5.3 package, statistical evaluation was performed, working p\u0026thinsp;\u0026le;\u0026thinsp;0.05, considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe bovine fetus model was efficient to establish the operative technique and perform the tested groups\u0026rsquo; comparison. In all specimens, there was good visualization of the umbilical structures. It was possible to perform the technique without major complications in 100% of the animals (16/16) with pneumomeritoneum and accesses, the decubitus position allowed complete visualization and manipulation of the structures, including additional access with hemostat using the conventional technique and video-assisted umbilical vein marsupialization technique. A small CO\u003csub\u003e2\u003c/sub\u003e leak ran through this access, but without compromising the pneumoperitoneum. This complication occurred in one animal from the GV (n\u0026thinsp;=\u0026thinsp;1, 12.5%).\u003c/p\u003e\u003cp\u003eAccess to the abdominal cavity was faster for visualization and exploration of the umbilical vein by laparotomy (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), with incisions of approximately 10.7\u0026ndash;14.5 cm, mean 12.75 cm. For the introduction of the two portals, by laparoscopy, two incisions of approximately 3\u0026ndash;5 mm were made. For umbilical vein clamping, access of approximately 1 cm was added in both groups.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of surgical time for each step of laparotomy and laparoscopy performed for umbilical vein marsupialization in bovine fetuses.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative moments\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAccesses to visualization and exploration of the umbilical vein\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClamping, dieresis and marsupialization of the umbilical vein\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e6.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e5.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0022\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClosure of the abdominal cavity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e25.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal surgical time\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e35.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: *Significant difference, with p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviation: GC, group control; GV, video-surgical group; p, probability of significance.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIt was possible to perform umbilical vein clamping, dieresis, and marsupialization by laparotomy and laparoscopy (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the CG group, during the performance of the small gallery, there were two small complications, for fixing the skin\u0026rsquo;s vein (02/08) 25%, requiring divulsion with forceps to deepen until entering the abdominal cavity, but without compromising the technique.\u003c/p\u003e\u003cp\u003eThe surgical time for abdominal cavity closure took longer in the GC group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) compared to the GV group. By laparotomy, the dieresis for the abdominal cavity closure was performed with Mayo imbrication suture of the peritoneum and muscle layer; the subcutaneous tissue was reduced with simple continuous suture and the dead space with anchorage of the subcutaneous tissue to the musculature. With a U suture, dermorrhaphy was performed that created a post-surgical wound of 15\u0026ndash;20 cm. In the GV group, myorrhaphy was performed, and dermorrhaphy with crossed stitches, with a U suture in the post-surgical wound of approximately 5 mm. The total surgical time was longer in the GC group compared to the GV group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOmphalophlebitis treatments consist of a combination of systemic antibiotics and in some cases surgical resection of the umbilical vein by laparotomy.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In patients with liver abscesses, complete resection of the umbilical vein and all infected tissues may be unfeasible, and the recommendation is to perform umbilical vein marsupialization after an exploratory laparotomy.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn the GC group, it was possible to perform the surgical procedures for umbilical vein marsupialization, but with limited space for the structures involved. In the GV group, it allowed a wider view of the abdominal cavity. At laparoscopy, it is possible to visualize all umbilical structures, as well as the entire length of the umbilical vein and the liver\u0026rsquo;s visceral surfasse.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Umbilical vein infection diagnosis and treatment delay leads to umbilical vein abscesses that require drainage by marsupialization of this structure, as the abscesses that reach the porta hepatis are difficult to remove.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn the first step, the umbilical vein was visualized fixed ventrally to the liver using the access by laparotomy. By laparoscopy, due to the laparoscope focusing directly and allowing a complete inspection, the first structure to be inspected was the umbilical vein.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eBetween the groups, there was a statistically significant difference in the time to access the umbilical vein and other umbilical structures. In the GV group, the access time was longer; in this phase, the time to perform the pneumoperitoneum was included. In laparoscopy, the skin incisions were smaller for trocar placement. These incisions allow them to be introduced slowly and carefully without abdominal organ injury and without CO\u003csub\u003e2\u003c/sub\u003e loss during pneumoperitoneum.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e For access by laparotomy, the incisions were superior for exploring the abdominal cavity and performing umbilical vein marsupialization.\u003c/p\u003e\u003cp\u003eDuring the exploration of the abdominal cavity in the GV, a better inspection and manipulation of the umbilical structures and adjacent organs was possible due to image magnification and abdominal cavity insufflation. Compared to other studies, this step was shorter using the exploration of the abdominal cavity for umbilical disorder diagnosis, performed with a time of 7 minutes.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e By laparotomy, the exploration of the abdominal cavity in the CG was limited close to the access, and few structures were inspected, and manipulation was restricted.\u003c/p\u003e\u003cp\u003eIn suspected umbilical disorder cases, the clinical examination can be complemented with the use of ultrasound, but due to the high false negatives rates and low sensitivity, other alternatives are indicated; some neonates with dry external umbilicus, may appear completely normal, and they may be critically ill due to intra-abdominal inflammation of the urachus, arteries, and/or umbilical veins.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The use of laparoscopy is an efficient method used for umbilical disorder diagnosis.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn the omphalophlebitis treatment, umbilical vein marsupialization is recommended to wash through this structure, improving drainage and preventing premature closure. Lavage is not without potential complications, such as bacteremia, vein rupture, generalized peritonitis, and sudden death.\u003csup\u003e\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e To effectively and safely reduce the septicemia and embolization risks, the introduction of a small-caliber catheter into the marsupialized vein minimized pressure within the vein and allowed the lavage solution to flow freely around the catheter.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIt was possible to efficiently perform video-assisted umbilical vein marsupialization; for surgical treatment in cases of pathological changes in the umbilical vein, a possibility of using this minimally invasive technique was found. In cases of insufficient therapeutic treatment, the most indicated method is surgical treatment.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn both groups, there were minor complications without impairing the techniques\u0026rsquo; performance; in two calves (25%) in the CG during the technique\u0026rsquo;s performance, to enter the abdominal cavity, a small gallery in the divulsion was performed with the forceps, in addition to the use of a scalpel blade. In GV, because the abdomen was distended, all incisions were performed with a scalpel blade; performing this procedure was faster (GC \u0026minus;\u0026thinsp;6.54 min and GV \u0026minus;\u0026thinsp;5.74 min).\u003c/p\u003e\u003cp\u003eThe event in which there was a small CO\u003csub\u003e2\u003c/sub\u003e leakage through the access that occurred in the GV in a calf (12.5%) during hemostatic forcep placement did not compromise the technique\u0026rsquo;s performance. Laparoscopy is a minimally invasive procedure that can be used to improve outcomes and reduce complications.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn the second stage, between the groups, there was no statistical difference in the execution time of the umbilical vein marsupialization technique. By laparotomy, the double umbilical vein clamping in its distal portion and ligation with a Muller's knot were done. By laparoscopy, the procedure was simple to perform and faster due to the performance of a simple clamping of the umbilical vein for dieresis and marsupialization. The use of laparoscopy has facilitated the performance of the procedures with minimum equipment and reduced costs in farm animals.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eBoth groups were able to perform the umbilical vein marsupialization technique. This surgical treatment by laparotomy allows the umbilical vein\u0026rsquo;s lumen to be exposed to the external environment, in order to carry out the treatment with alcohol and iodine solution and facilitate the drainage of the contents.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e In multiple liver abscess cases in which the umbilical vein is not compromised, partial hepatectomy is necessary.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn the third stage, during abdominal cavity closing, there was a statistical difference between the groups. The surgical time was longer in the GC than in the GV, due to the larger incision (9.4\u0026ndash;14.5 cm) of the abdominal cavity by laparotomy. To reverse the large access by laparotomy, three layers of suture are needed: first layer, suture of the peritoneum and muscle with interrupted stitches, the second layer, suture of the subcutaneous tissue and simple anchorage of continuous points in the musculature, aiming to reduce the dead space, and the third layer, dermorrhaphy performed with cross stitches interrupted.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe laparoscopic technique\u0026rsquo;s total surgical time was significantly shorter compared to that performed by laparotomy. In the GA group, the conventional open cavity closure step significantly affected the total surgical time. After removing the two portals in the GV, the smaller incisions (3 to 5 cm) compared to the laparotomy technique, it was possible to perform in less time. Because access is smaller, it is usually carried out in the myorrhaphy, interrupted cross stitch, and in dermorrhaphy, an isolated stitch, suture in U. For laparotomy, more sutures are needed due to the surgical wound size.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, the video-assisted technique of umbilical vein marsupialization with two portals allowed the performance of umbilical vein clamping, dieresis, and marsupialization in a minimally invasive way and with a shorter surgical time compared to the conventional technique. In calves, this could be a viable alternative for exploration and a possible umbilical disorder surgical treatment, specifically in umbilical vein infections that extends to the liver parenchyma. For the technique\u0026rsquo;s execution with small adaptations for live animals, more studies are needed to verify each surgical step proposed in organs and structures with pathological changes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003egroup control\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003evideo-surgical group\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ep\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eprobability of significance.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements.\u0026nbsp;\u003c/strong\u003eThe authors gratefully thank the team of the video surgery, obstetrics, and reproduction group (VOR), the National Council for Scientific and Technological Development (CNPq, Brazil), the Coordination for the Improvement of Higher Education Personnel (CAPES, Brazil) and the Research and Postgraduate Pro-Rector of Pará Federal University (Propesp/UFPA) through the Qualified Publication Support Program - PAPQ for financial support in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions:\u0026nbsp;\u003c/strong\u003eC.R.G.S. (Investigation, Data Curation), T.S.C. (Investigation, Data Curation), M.E.M.F. (Investigation, Data Curation), L.S.C. (Investigation, Data Curation), J.L.S.G. (Investigation, Data Curation), J.H.G.R. (Investigation, Data Curation), H.J.G. (Investigation, Data Curation), J.P.M.B. (Investigation, Data Curation), L.H.V.A. (Investigation, Data Curation), L.E.S.A. (Investigation, Data Curation), L.A.S. (Investigation, Data Curation), L.P.A.A. (Investigation, Data Curation), M.A.M.S. (Writing - Review \u0026amp; Editing, Supervision), F.D.O.M.* (Conceptualization, Methodology, Writing - Review \u0026amp; Editing, Supervision, Project administration), P.P.M.T.+ (Conceptualization, Methodology, Writing - Review \u0026amp; Editing, Supervision, Project administration, Funding acquisition). All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional Information:\u0026nbsp;\u003c/strong\u003eHave no conflicts of interest or financial ties to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations:\u0026nbsp;\u003c/strong\u003eHuman Ethics and Consent to Participate declarations: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eSteerforth, D.-D. \u0026amp; Van Winder, S.\u003c/strong\u003e Development of clinical sign-based scoring system for assessment of omphalitis in neonatal calves. \u003cem\u003eVet. Rec.\u003c/em\u003e \u003cstrong\u003e182\u003c/strong\u003e, 549 (2018).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBaird, A. N.\u003c/strong\u003e \u003cem\u003eSurgery of the Umbilicus and Related Structures\u003c/em\u003e. \u003cem\u003eVet. Clin. North Am. Food Anim. \u003c/em\u003e\u003cem\u003ePract.\u003c/em\u003e \u003cstrong\u003e2\u003c/strong\u003e, 673\u0026ndash;685 (2016).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDogan, E., Yanmaz, L. E., Okumus, Z., Kaya, M., Senocak, M. G. \u0026amp; Cengiz, S.\u003c/strong\u003e Radiographic, ultrasonographic and thermographic findings in neonatal calves with septic arthritis: 82 cases (2006\u0026ndash;2013). \u003cem\u003eAtat\u0026uuml;rk \u0026Uuml;niversitesi Vet. Bil. Derg.\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 6\u0026ndash;12 (2016).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMarchionatti, E., Nichols, S., Bakine, M., Fecteau, G., Francoz, D., Lard\u0026eacute;, H. \u0026amp; Desrochers, A.\u003c/strong\u003e Surgical management of omphalophlebitis and long-term outcome in calves: 39 cases (2008\u0026ndash;2013). \u003cem\u003eVet. Surg.\u003c/em\u003e \u003cstrong\u003e45\u003c/strong\u003e, 194\u0026ndash;200 (2016).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eReig Cordina, L., Werre, S. R. \u0026amp; Brown, J. A.\u003c/strong\u003e Short-term outcome and risk factors for postoperative complications following umbilical resection in 82 foals (2004\u0026ndash;2016). \u003cem\u003eEquine Vet. J.\u003c/em\u003e \u003cstrong\u003e51\u003c/strong\u003e, 323\u0026ndash;328 (2018).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSato, R., Shinozuka, Y., Onda, K., Ochiai, H. \u0026amp; Yamada, K.\u003c/strong\u003eEvaluation of marsupialization combined with long-term administration of antibacterial agents in calves with omphalophlebitis and secondary liver abscess. \u003cem\u003eLarge Anim. Rev.\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 107\u0026ndash;110 (2019).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eRobert, M. et al.\u003c/strong\u003e Laparoscopic evaluation of umbilical disorders in calves. \u003cem\u003eVet. Surg.\u003c/em\u003e \u003cstrong\u003e45\u003c/strong\u003e, 1041\u0026ndash;1048 (2016).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMonteiro, F. D. O. et al.\u003c/strong\u003e Intra-abdominal resection of the umbilical vein and urachus of bovine fetuses using laparoscopy and celiotomy: surgical time and feasibility (cadaveric study). \u003cem\u003eSci. Rep.\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 5328 (2021).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eGuerri, G., Vignoli, M., Palombi, C., Monaci, M. \u0026amp; Petrizzi, L.\u003c/strong\u003e Ultrasonographic evaluation of umbilical structures in Holstein calves: a comparison between healthy calves and calves affected by umbilical disorders. \u003cem\u003eJ. Dairy Sci.\u003c/em\u003e \u003cstrong\u003e103\u003c/strong\u003e, 2578\u0026ndash;2590 (2019).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBaird, A. N.\u003c/strong\u003e Umbilical surgery in calves. \u003cem\u003eVet. Clin. N. Am. Food Anim. \u003c/em\u003e\u003cem\u003ePract.\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 467\u0026ndash;477 (2008).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eTrent, A. M. \u0026amp; Smith, D. F.\u003c/strong\u003e Surgical management of umbilical masses with associated umbilical cord remnant infections in calves. \u003cem\u003eJ. Am. Vet. Med. Assoc.\u003c/em\u003e \u003cstrong\u003e185\u003c/strong\u003e, 1531\u0026ndash;1534 (1984).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eEdwards, R. B. III \u0026amp; Fubini, S. L.\u003c/strong\u003e A one-stage marsupialization procedure for management of infected umbilical vein remnants in calves and foals. \u003cem\u003eVet. Surg.\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 32\u0026ndash;35 (1995).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSteiner, A., Lischer, C. 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Methodol.\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 238\u0026ndash;254 (2015).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ePrządka, P. et al.\u003c/strong\u003e Laparoscopic-assisted percutaneous herniorrhaphy as an alternative to open surgery technique in farm swines. \u003cem\u003ePLoS One\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, e0256890 (2021).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSato, R. et al.\u003c/strong\u003e Partial hepatectomy for treatment of multiple liver abscess in a calf: a case report. \u003cem\u003eVet. Res.\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 67 (2021).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBeasley, L.\u003c/strong\u003e Umbilical hernia surgery in calves. \u003cem\u003eLivest. Sci.\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 186\u0026ndash;190 (2017).\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cadaveric model, laparoscopy, liver abscess treatment, minimally invasive surgery, umbilical vein","lastPublishedDoi":"10.21203/rs.3.rs-6753440/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6753440/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aimed to compare the conventional open technique with a video-assisted approach for umbilical vein marsupialization in cadaveric bovine fetuses, evaluating its application, feasibility, and surgical time. A cadaveric study was conducted using 16 bovine fetuses obtained from slaughterhouses. The fetuses were divided into a control group (CG), undergoing laparotomy, and a videosurgical group (GV), undergoing a video-assisted technique with two lateral accesses on the right flank. Results demonstrated a statistical difference in the time required to access the abdominal cavity and visualize the umbilical vein and adjacent structures. However, no significant difference was observed in the time taken for umbilical vein clamping, dieresis, and marsupialization between laparotomy and laparoscopy. The surgical time for abdominal cavity exposure was significantly longer in the CG group compared to the GV group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Additionally, the total surgical time was markedly shorter in the GV group (12.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45 min) than in the CG group (35.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58 min) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The study concluded that video-assisted umbilical vein marsupialization with two portals is a minimally invasive alternative to the conventional technique, allowing for reduced surgical time while achieving the same procedural outcomes. Clinically, this technique offers a faster and more efficient approach, suggesting its potential as an alternative for treating liver abscesses in calves, with possible benefits in reducing surgical stress and improving recovery.\u003c/p\u003e","manuscriptTitle":"Comparison of video-assisted and open umbilical vein marsupialization technique in bovine fetuses (cadaveric study)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 12:48:24","doi":"10.21203/rs.3.rs-6753440/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-15T02:06:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318229623420423101255846151413807722934","date":"2026-05-13T21:49:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-08T20:58:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100053929787356610098912097478236680316","date":"2026-02-23T14:45:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-02T10:04:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-11T14:47:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-11T10:42:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-07T11:00:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-06-07T10:57:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c602640b-d8d0-49d9-838a-02a7b45ccfd5","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-15T02:06:48+00:00","index":121,"fulltext":""},{"type":"reviewerAgreed","content":"318229623420423101255846151413807722934","date":"2026-05-13T21:49:15+00:00","index":120,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":54318079,"name":"Health sciences/Anatomy/Cells"},{"id":54318080,"name":"Health sciences/Anatomy/Endocrine system"}],"tags":[],"updatedAt":"2025-09-09T12:48:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 12:48:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6753440","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6753440","identity":"rs-6753440","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}