Unraveling surgical strategies: a multicenter analysis of laparoscopic nephrectomy for dioctophymatosis in dogs in Brazil

Desvendando estratégias cirúrgicas: uma análise multicêntrica da nefrectomia laparoscópica para dioctofimatose em cães no Brasil

ABSTRACT:

This study reported 15 laparoscopic nephrectomies in dogs infected withDioctophyme renale, performed across seven Brazilian veterinary centers. Among the 15 cases, 4 presented hematuria as the clinical sign. Surgical approaches included: exclusive right flank access (11 cases), combined umbilical-flank portal placement (3 cases), and midline access (1 case). Hemostasis was achieved with titanium clips in 13 cases, while two cases utilized vascular sealing (LigaSure™). All procedures successfully removed the parasitized kidneys. The analysis demonstrated that this technique;although, technically demanding, is feasible when performed by experienced teams, requiring careful patient positioning (using flank rolls), precise port placement, and appropriate instrumentation. The findings established laparoscopy as an effective treatment for dioctophymosis, combining the benefits of minimally invasive techniques with successful outcomes. We recommended its adoption by centers with advanced laparoscopic expertise, adhering to the described technical criteria.

Key words:
dioctophymosis; laparoscopic surgery; laparoscopic nephrectomy

RESUMO:

O objetivo deste estudo é relatar 15 casos de nefrectomias laparoscópicas em cães com infecção por Dioctophyme renale, realizadas em sete centros veterinários brasileiros. Dos 15 casos, quatro apresentaram hematúria como sinal clínico. As abordagens cirúrgicas incluíram: a) acesso exclusivo pelo flanco direito (11 casos), b) combinação de portal umbilical com flanco direito (3 casos) e c) acesso pela linha média (1 caso). Além disso, a hemostasia foi obtida com clipes de titânio em 13 casos, enquanto os outros dois casos utilizaram selamento vascular (LigaSure™). Todos os procedimentos alcançaram sucesso na remoção dos rins parasitados. A análise de dados demonstrou que a técnica de nefrectomia laparoscópica, embora complexa, é viável quando executada por equipes experientes, requerendo atenção especial ao posicionamento do paciente (com por exemplo, rolo no flanco), colocação precisa dos portais e instrumentação adequada. Portanto, é possível confirmar a laparoscopia como método eficaz para dioctofimose, combinando os benefícios das técnicas minimamente invasivas com resultados satisfatórios. Recomenda-se sua adoção por centros com expertise em cirurgia laparoscópica avançada, seguindo os critérios técnicos descritos.

Palavras-chave:
dioctofimatose; cirurgia laparoscópica; nefrectomia laparoscópica.

INTRODUCTION

The first report of nephrectomy performed by videosurgery to treat a dog parasitized by Dioctophyme renale was reported in 2002 in Brazil (BRUN et al., 2002). Since then, few studies have reported the application of videosurgery to treat the infection caused by this parasite (CAYE et al., 2023; HART et al., 2020; HARTMANN et al., 2018; SECCHI et al., 2010), a large nematode that can cause chronic and irreversible destruction of the renal parenchyma (PEDRASSANI & NASCIMENTO, 2015). The parasitosis, called dioctophymosis, is a cosmopolitan zoonosis that occurs in various regions of the planet and is frequently reported in Brazil (CAYE et al., 2020a; PEDRASSANI et al., 2017a; PERERA et al., 2021; RAPPETI et al., 2017).

D. renale infection is poorly responsive to conventional antiparasitic therapies and typically requires surgical intervention (PEDRASSANI & NASCIMENTO, 2015). In addition to renal parasitosis, dogs are often affected by the ectopic form of the disease, presenting free nematodes in the abdominal and thoracic cavities (CAYE et al., 2021). Subsequently, parasitized animals are commonly treated using conventional open surgery techniques or laparoscopic surgical procedures (BUTTI et al., 2019; CAYE et al., 2020b; 2021; 2023; 2024; MILECH et al., 2022; STAINKI et al., 2011).

This study analyzed the variations in surgical techniques used in 15 laparoscopic nephrectomies for the treatment of Dioctophyme renale infection in Brazilian institutions.

MATERIALS AND METHODS

Patients diagnosed with D. renale in the right kidney and submitted to laparoscopic nephrectomy in seven Brazilian institutions were recruited. Data collection included the analysis of epidemiological, clinical, surgical, and parasitological records. The data analyzed species, sex, race, age, clinical signs, diagnostic methods, surgical techniques employed, trans- and postoperative complications, and the analysis of parasites removed. The results were analyzed descriptively. Procedures that required conversion to conventional surgery were excluded in order to only assess the development of laparoscopic techniques.

RESULTS

Data were obtained from 15 dogs parasitized by D. renale submitted to laparoscopic nephrectomy in seven institutions in the Brazilian states of Rio Grande do Sul (n = 4), Paraná (n = 2), and Espírito Santo (n = 1) (Table 1). Epidemiological analyses revealed ten females, four males, and one patient without informed sex; all animals were of undefined breed. Two patients were young (six and 11 months old), whereas the others were adults (n = 10), elderly (n = 1), or of unreported age (n = 2). As for the body weight, nine records were found, with an average of 12.7 kg (5-22 kg).

Table 1
Data of dogs undergoing laparoscopic nephrectomy for the treatment of dioctophymosis in different institutions in Brazil.

Local	Sex	Body weight (Kg)	Age	Number of portals	Abdominal access site	Surgical time (min)	Transoperative complications
1	Female	12.9	Adult	3	RF	-	Diffuse bleeding
	Female	5	Adult	3	RF	-	Diffuse bleeding
	Female	12.8	Elderly	3	RF	155	No
	Female	-	Adult	3	RF	150	No
2	Female	11.3	Adult	3	RF	178	No
	Female	12	Adult	3	RF	138	No
3	Female	-	-	3	RF	160	Bleeding after renal vein section
4	-	-	-	3	RF	130	No
5	Female	13.5	Young	3	AM	120	No
6	Male	-	Adult	4	AM and RF	50	No
	Female	-	Adult	4	AM and RF	45	No
	Male	-	Young	4	AM and RF	60	No
7	Male	22	Adult	4	RF	155	No
	Male	13	Adult	4	RF	166	No
	Female	12	Adult	4	RF	135	No

• Legend: RF - right flank; AM - abdominal midline.

Clinical signs of parasitosis were few, with only hematuria (n = 4) reported. The remaining patients were asymptomatic and diagnosed incidentally in other routine evaluations. In some cases, concomitant changes were reported, including the presence of a transmissible venereal tumor (n = 2), vaginal discharge (n = 1), and breast neoplasm (n = 1). Abdominal ultrasonography was the definitive diagnostic method in all patients (n = 15). Seven patients had parasite eggs in the urine.

The 15 patients presented parasitosis in the right renal location; in two animals, free parasites were found in the abdominal cavity. The patients were submitted to right nephrectomy by laparoscopy. The surgical techniques varied regarding the abdominal access site and the number of portals used. The most frequent form was the right flank access (n = 11), with the use of three (n = 8/11) (Figure 1A) and four (n = 3/11) portals for optical and instrumental access. In these cases, the patient was placed in left lateral decubitus. The flank region was elevated by placing a positioning roll beneath the left flank to improve renal exposure.

Figure 1
Laparoscopic nephrectomy in dogs with Dioctophyme renale in the right kidney. A - Position of the three portals in a triangular arrangement in the right flank for surgical access to the kidney. B - Ligature of the ureter (white arrow) with titanium clips (black arrows) and sectioning with video-surgical Metzenbaum scissors. C - Dissection and hemostasis of the renal hilum (white arrow) with vascular sealer (LigaSure™). D - Storage of the kidney (^*), after total resection of its adhesions, in a tissue extractor bag. E - Exteriorization of the tissue extractor bag and removal of the right kidney (black arrow) and D. renale parasite through an 11-mm portal surgical access. F - Final aspect after suture of four video-surgical accesses, with one portal positioned in the umbilical scar (white arrow) and three positioned in a triangular arrangement in the right flank (black arrows). Legend: Ca - caudal; Cr - cranial.

In one case, abdominal access was performed by placing three midline portals. In three procedures, there was an association between midline access with one portal and right flank access with three portals in a triangular arrangement. In all cases, there was insufflation of the abdominal cavity with medicinal CO₂; pressure was maintained between 8 and 12 mmHg with an insufflation speed of 1.5-2 L/min to visualize the splanchnic structures. In two cases where free ectopic parasites were present in the abdominal cavity, they were immediately removed using tissue grasping forceps.

The renal vessels were dissected and isolated with laparoscopic tissue grasping and dissection forceps. Hemostasis techniques were performed with titanium clips (n = 13) (Figure 1B) and a bipolar energy device with bioimpedance (LigaSure^™) (n = 2). Up to four proximal and two distal titanium clips were used on each vessel, with transection performed between them. Similarly, the ureter was identified, isolated, and ligated near the vesical trigone using the same techniques, and up to three clips were used in its occlusion (Figure 1C). In 12 cases, conventional bipolar energy was used for perirenal adhesiolysis. In cases where LigaSure™ was used for hemostasis, it was also employed for adhesiolysis. In one single case, no energy device was utilized.

After hemostasis and releasing the kidney, the organ was removed from the abdominal cavity. In 10 cases, it was initially packed into a tissue extractor bag and exteriorized through the slightly enlarged abdominal access of one of the portals (Figure 1D). Inside the extractor bag, the kidney was fragmented, and the organ and its parasites were removed (Figure 1E). In five procedures, the kidney was removed from the abdominal cavity by extending the surgical access without using an extractor bag.

The transoperative complications reported were diffuse bleeding, which hindered renal vessel identification (n = 2), and bleeding after renal vein section, requiring a new titanium clip to be placed (n = 1). Suturing of surgical approaches was reported in only eight patients with isolated three-layer suture patterns (Figure 1F). Surgical time was recorded in 13 procedures, with a mean of 126 min (45-178 min). Only one postoperative complication was reported, a subcutaneous hematoma in the right inguinal region of a patient submitted to the right-flank abdominal access. The alteration was treated and solved conservatively. After removing the renal interior, the parasites were identified as D. renale. The number of parasites ranged from one to five and ranged from 12.5 to 112 cm in size (Figure 2A and Figure 2B).

Figure 2
Result of laparoscopic right nephrectomy in a dog with Dioctophyme renale. A - Male parasite of the species D. renale. B - Kidney and ureter after removal of the cavity using a tissue extractor bag.

DISCUSSION

The results showed a rise in the choice of minimally invasive methods in the therapy of D. renale infection. As a complex surgery requiring a high level of expertise from the surgical team, laparoscopic nephrectomy was applicable and curative in all patients evaluated, with no serious complications or deaths.

Although, there are no known studies providing evidence of sexual predilection of the parasitosis, in this study, females were more affected than males, as also reported elsewhere (CAYE et al., 2020a; PEDRASSANI et al., 2017b; RADMAN et al., 2017). Non-breed animals are often parasitized since they are the majority of the animals in the study (CAYE et al., 2020a; PEDRASSANI et al., 2017b); they are primarily stray animals and end up coming into contact with food contaminated by infective D. renale larvae (PEDRASSANI & NASCIMENTO, 2015; PERERA et al., 2021). The cycle of this parasitosis is complex and includes the participation of intermediate (Lumbriculus variegatus) and paratenic hosts (fish and frogs). The definitive host is contaminated by consuming the intermediate host or raw meat from paratenic hosts (PEDRASSANI & NASCIMENTO, 2015; PERERA et al., 2021).

Hematuria is one of the most commonly reported clinical signs in dogs parasitized by D. renale; nevertheless, the absence of symptoms is also frequent (CAYE et al., 2020b; 2021; 2024; HART et al., 2020). Abdominal ultrasonography was used in all cases for diagnostic confirmation as it provides a view of the cylindrical intrarenal structures with hyperechogenic borders and a hypoechogenic center (CAYE et al., 2020a; 2024; SILVEIRA et al., 2015), which is compatible with parasitosis.

The most commonly used technique was surgical access through the right flank, as described by another authors (BRUN et al., 2015; CAYE et al., 2023; MILECH et al., 2022). This technique allows transperitoneal access to the affected kidney, and, as reported herein, three to four portals are recommended for visceral manipulation. The second technique used was similar to the one described by Mayhew and colleagues (MAYHEW et al., 2013), which consisted of placing a portal in the abdominal midline to insert the scope. There are no comparative studies between the techniques; hence, it is highly recommended that these methods be used according to the surgeon’s familiarity with them.

The authors agreed that placing a soft roll beneath the flank induces renal elevation. It should be positioned caudal to the last rib, resulting in mild patient elevation. This facilitated exposure of the renal hilum and improved adhesiolysis and hemostasis maneuvers.

Advanced hemostasis devices, such as the LigaSure™ vascular sealer and the harmonic scalpel, are options for hemostasis of vessels in the renal hilum. Nevertheless, caution is needed when choosing this hemostatic modality alone, as calibrous vessels may not be fully occluded with the application of energy (MAYHEW et al., 2013). In this study, the LigaSure^™ device was used for hemostasis in only one case, with no transoperative complications. In the other procedures, titanium clips were elected as the hemostasis technique. Only one case presented bleeding after the renal vein section; however, an additional clip was enough to control bleeding, and surgical conversion to the open technique was unnecessary.

Hemorrhage is one of the most common intraoperative complications, including in urologic surgery (CAYE et al., 2024; KORTRAM et al., 2016). Bleeding remains the leading cause of conversion from laparoscopic to open nephrectomy (KORTRAM et al., 2016). This underscores the necessity of advanced surgical expertise to mitigate major hemorrhage.

Diffuse peritonitis and adhesion are frequently reported in animals with parasitosis and may make identifying renal structures challenging (CAYE et al., 2020b; HART et al., 2020); increased difficulty in dissecting these structures may cause surgical conversion (MAYHEW et al., 2013). The mean duration of the procedures was longer than described elsewhere (BRUN et al., 2002; MAYHEW et al., 2013; SECCHI et al., 2010), and this is due to the participation of different surgeons with varying degrees of video-surgical skill in this study. However, there were no serious complications or deaths in the analyzed procedures, which proves the surgical accuracy of the participants in performing complex procedures such as nephrectomies.

The number of parasites removed was considered typical, and high parasite loads have been reported in dogs, with up to 34 parasites in a single animal (CAYE et al., 2020b). Nonetheless, a 112-cm long female parasite was removed in one study, which exceeds the maximum size associated with these parasites (i.e., up to 100 cm) (PEDRASSANI et al., 2018).

The authors contend that the key surgical strategies include: Optimal patient positioning on the operating table; Use of a positioning roll beneath the flank for lateral surgical approaches; Precise placement of laparoscopic ports; and availability of appropriate instruments for hemostasis and adhesiolysis. Advanced bipolar energy devices have also proven to be innovative tools for nephrectomies, demonstrating both efficacy and safety.

The choice of laparoscopic nephrectomy in treating D. renale parasitosis has considerably increased in Brazilian veterinary routines. Given the benefits of video-surgical procedures, which reduce pain and inflammatory response, and the proven feasibility of minimally invasive nephrectomy surgical techniques in dogs (HART et al., 2020; MAYHEW et al., 2013), the authors reinforce this form of procedure recommendation. It is concluded that laparoscopic nephrectomy is safe, feasible and curative in dogs with D. renale.

ACKNOWLEDGMENTS

The authors would like to thank the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) from Brazil. This study was financed by CNPq and CAPES - Financial Code 001.

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• CR-2025-0188.R1
• BIOETHICS AND BIOSECUTIRY COMMITTEE APPROVAL
  As this research constituted a retrospective evaluation of existing data with no animal experimentation or procedures performed, institutional ethics board approval was not required. We authors of the article entitled “Unraveling surgical strategies: a multicenter analysis of laparoscopic nephrectomy for dioctophymosis in dogs in Brazil” declared, for all due purposes, the project that gave rise to the present data of the same has not been submitted for evaluation to the Ethics Committee of the University /Research Institute “Universidade Federal de Santa Maria”, but we are aware of the content of the Brazilian resolutions of the Conselho Nacional de Controle de Experimentação Animal - CONCEA <http://www.mct.gov.br/index.php/content/view/310553.html> if it involves animals. Thus, the authors assume full responsibility for the presented data and are available for possible questions, should they be required by the competent authorities.
• DATA AVAILABILITY STATEMENT
  The data underlying this study are available from the corresponding author upon reasonable request.
• DECLARATION OF USE OF ARTIFICIAL INTELLIGENCE
  Artificial intelligence tools should not be used to write the manuscript or to replace the authors’ activities and skills, such as preparing the abstract, keywords, hypotheses and conclusion of the study.

Edited by

• ASSOCIATE EDITOR:
  Rudi Weiblen (0000-0002-1737-9817)

• SCIENTIFIC EDITOR:
  Fabiola Fukushima (0000-0001-9843-8374)

Data availability

The data underlying this study are available from the corresponding author upon reasonable request.

Publication Dates

• Publication in this collection
  14 Aug 2026
• Date of issue
  2026

History

• Received
  08 Apr 2025
• Accepted
  21 Jan 2026
• Reviewed
  08 June 2026