Objective

To evaluate surgical techniques, perioperative complications and outcome of laparoscopic surgery for unilateral and bilateral ovariectomy in mares.



Study Design

Retrospective multicenter case series.



Animals

Mares (n = 157).



Methods

Indications for surgery were neutering, fertility problems, elimination of hormone-related abnormal behavior, ovarian tumors as well as nonregressive ovarian hematomas or cysts. Ovariectomy (n = 206) were performed by a standard laparoscopic procedure in 157 standing sedated mares. Dissection and hemostasis were achieved by using either (1) a linear stapling device, (2) bipolar electrosurgical instruments, with or without a modified Roeder knot, (3) a vessel-sealing system, or (4) a diode-laser with ligation. For some larger ovarian masses (>20 cm diameter), a 2-step surgical procedure was used with standing flank laparoscopic ovariectomy followed by ovarian retrieval through a median celiotomy. Surgical techniques, outcome, and perioperative complications of each method were recorded and analyzed.



Results

Laparoscopic dissection of the ovary was accomplished in all mares. Because of the size of the ovarian tumor (n = 7) or in 1 mare with behavioral problems (n = 1), the dissected ovary was removed through a median celiotomy under general anesthesia. Seventeen mares (10.8%) developed postoperative complications (eg, incisional drainage, incisional infection, seroma formation, dehiscence, transient fever and mild abdominal discomfort). All mares with flank incisional problems had ovarian size >12 cm and in 15 (88%) of these mares electrosurgical instruments were used for mesovarial dissection.



Conclusions

Laparoscopic ovariectomy in standing sedated mares provides good surgical access and is associated with low morbidity.

Unilateral and bilateral laparoscopic ovariectomy in 157 mares: a retrospective multicenter study

Disorders of the Gastrointestinal System

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

Comparison of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES®) and Laparoscopy for Elective Bilateral Ovariectomy in Standing Mares

Minimally invasive surgery in the human was first identified in mid 900's The procedure as is more commonly practiced now was first reported in 1912 There have been many advances and new techniques developed in the past 100 years Equine laparoscopy, was first reported in the 1970's, and similarly has undergone much transformation in the last 40 years It is now considered the standard of care in many surgical techniques such as cryptorchidectomy, ovariectomy, nephrosplenic space ablation, standing abdominal exploratory, and many other reproductive surgeries This manuscript describes the history of minimally invasive surgery, and highlights many of the techniques that are currently performed in equine surgery Special attention is given to instrumentation, ligating techniques, and the surgical principles of equine minimally invasive surgery

https://downloads.hindawi.com/archive/2012/492650.pdf

A Review of Equine Laparoscopy

Objective: To compare the presence or absence of pain, pain-related behavioral responses, and hormonal responses to noxious stimuli during standing laparoscopic ovariectomy in mares sedated with continuous intravenous (IV) detomidine infusion and caudal epidural detomidine.



Study Design: A double blind prospective study.



Animals: Mares (n=12)



Methods: Mares were divided into 2 treatment groups; 6 were sedated using continuous IV detomidine infusion and 6 were sedated with caudal epidural detomidine. All mares received IV xylazine (0.33 mg/kg) and butorphanol tartrate (5 mg) premedication before detomidine administration. Venous blood samples were taken to assess serum cortisol levels in each mare at 4 time points: a baseline cortisol measurement after the mares' arrival to the clinic, 10 minutes before surgery, at the removal of the 2nd ovary, and 10 minutes postsurgery. Two surgeons performed bilateral ovariectomy and at 8 time points involving surgical manipulations, noted the presence or absence of pain (yes/no) and scored the patient's response on a 10 cm visual analogue scale (VAS) for pain assessment with 0 indicating no pain responses and 10 cm indicating pain so severe that the mare required additional sedation or analgesia to complete the procedure. Each mare was also assigned a VAS score by each surgeon for the overall satisfaction of analgesia during the entire procedure.



Results: Serum cortisol levels between the 2 detomidine administration groups differed significantly at the baseline (precortisol) measurement but not at the 3 remaining time points. Seven of the procedures within the surgeries did not differ significantly in VAS scores between the 2 groups. The initial grasp of the left ovary (the 1st ovary) in the continuous infusion group had a significantly higher (P=.05) median VAS score compared with the caudal epidural group.



Conclusions: Mares sedated with a continuous IV infusion of detomidine have similar hormonal and behavioral responses to painful stimuli during standing laparoscopic ovariectomy as mares sedated with caudal epidural detomidine.



Clinical Relevance: Sedation using a continuous IV infusion of detomidine can be used for laparoscopic ovariectomy in mares.

Comparison of intraoperative behavioral and hormonal responses to noxious stimuli between mares sedated with caudal epidural detomidine hydrochloride or a continuous intravenous infusion of detomidine hydrochloride for standing laparoscopic ovariectomy.

Objective— To describe use of a polyamide tie-rap to ligate the mesovarium during standing laparoscopic ovariectomy in mares.



Study Design— Prospective study.



Animals— Ten mares.



Methods— Bilateral ovariectomy was performed in 10 mares. Standing laparoscopic ovariectomy was performed using 3 portals in the paralumbar fossa. A commercial polyamide tie-rap was prepared as a loop and marked with 4 colored lines close to the buckle, to enable us to check whether the loop was tightened securely. The ovary was grasped with forceps and after the mesovarium was minimally transected cranially and caudally, the loop of the tie-rap was inserted in the abdomen and placed around the mesovarium. It was firmly tightened, until at least 3 of the 4 marks were visible, then the end of the tie-rap was cut. The ovary was transected and removed through an enlarged 3rd portal. The contralateral ovary was removed similarly through the opposite paralumbar fossa. Repeat laparoscopy was performed in 8 mares, 2, 3, 4, and 12 weeks later.



Results— None of the mares had postoperative discomfort. On repeat laparoscopy, there was complete encapsulation of the stump and tie-rap after 3–4 weeks. In 2 mares, an adhesion between the left stump and the mesentery of the descending colon was observed.



Conclusion— Ligation of the mesovarium can be easily and safely performed using a polyamide tie-rap during standing laparoscopic ovariectomy in mares.



Clinical Relevance— Standing laparoscopic ovariectomy using a polyamide tie-rap is a safe, technically easy and reliable surgical procedure in the mare.

Laparoscopic Ovariectomy in Mares Using a Polyamide Tie‐Rap

Laparoscopic ovariectomy in mares using a polyamide tie-rap

Summary
Reasons for performing study

Epiploic foramen entrapment (EFE) is, based on the number of reports in the literature, a relatively important life-threatening cause of colic in horses that could be prevented by closing the epiploic foramen (EF) in horses at risk of developing EFE.



Objectives

To describe the laparoscopic foramen epiploicum mesh closure (FEMC) technique and its outcome.



Study design

Descriptive experimental study.



Methods

The EF of 6 horses was closed with the FEMC technique. A diabolo-shaped constructed mesh was introduced into the omental vestibule through the EF under laparoscopic visualisation in the standing sedated horse. Clinical and laboratory parameters were recorded during the post operative period. Four weeks after the intervention, repeat laparoscopy was performed in all horses. Three horses were subjected to euthanasia one, 2 and 3 months after the intervention, and were examined on necropsy and histopathology. The remaining 3 horses were followed clinically for 6 months.



Results

The 6 FEMC procedures were performed successfully in a median surgery time of 22 min (range 18–27 min). One horse was treated for large colon impaction in the immediate post operative period. On repeat laparoscopy at 4 weeks all 6 EFs were closed and no undesired adhesions were identified. This was confirmed on gross and histopathological examination of the 3 horses that were subjected to euthanasia. The 3 remaining horses were clinically normal in the 6-month post operative observation period.



Conclusions

This FEMC technique provides a fast, simple, reliable and safe procedure to obliterate the EF and may be useful in horses at risk for EFE.

Development of a new laparoscopic Foramen Epiploicum Mesh Closure (FEMC) technique in 6 horses

Objectives

To evaluate the epiploic foramen using laparoscopy in horses previously treated for epiploic foramen entrapment to determine if spontaneous epiploic foramen closure had occurred.



Study Design

Non-consecutive case series.



Animals

Seven horses.



Methods

The epiploic foramen was inspected by right flank laparoscopy between 35 and 71 days after successful surgical treatment for epiploic foramen entrapment. Data were collected on the presence of behavior vices, details of surgery for epiploic foramen entrapment (time from colic onset to surgery, site and length of entrapped intestine, direction of entrapment, compromise of the intestine, intestine resected), the time between surgery for epiploic foramen entrapment and laparoscopy, and the laparoscopic appearance of the epiploic foramen. If the epiploic foramen was open, a mesh was introduced to obliterate the epiploic foramen (Foramen Epiploicum Mesh Closure [FEMC]). Clinical progress of the horses was followed by owner telephone interview at 1 and 4 months after laparoscopy, and a final interview between 135 and 282 days after laparoscopy. Owners were questioned on specific postoperative complications and the exercise level of the horse.



Results

At laparoscopy, 3/7 horses had complete closure of the epiploic foramen by dense fibrous tissue. The FEMC was performed in 4 horses without major complications. Postoperative colic episodes were recorded in 3 horses, all of them displaying windsucking/cribbing behavior.



Conclusion

Laparoscopic evaluation after celiotomy for epiploic foramen entrapment revealed spontaneous closure of the epiploic foramen in 3/7 horses. This finding could explain the reported low recurrence rate after surgical treatment for epiploic foramen entrapment.

Laparoscopic Evaluation of the Epiploic Foramen after Celiotomy for Epiploic Foramen Entrapment in the Horse.

Summary
Reasons for performing study

There are no previous studies correlating the anatomy of the equine epiploic foramen and its defining structures with laparoscopic images.



Objectives

The purpose of this study was to describe the precise anatomy of the epiploic foramen and omental vestibule, to quantify the dimensions of the epiploic foramen and to relate these findings to laparoscopic images.



Study design

Descriptive study of cadaver material and laparoscopic images.



Methods

Thirty-two horses subjected to euthanasia for reasons unrelated to colic were studied. Two cadavers were used to make vascular casts of the coeliac artery and portal vein. In 30 cadavers the epiploic foramen and omental vestibule were cast with a polyurethane prepolymer immediately after euthanasia. The cast served as a landmark during dissection and the circumference of the epiploic foramen was measured from these casts. Histology was performed on structures defining the epiploic foramen in 2 horses. Laparoscopic images from 6 standing right flank procedures were reviewed.



Results

The defining structures of the epiploic foramen and omental vestibule are the hepatoduodenal ligament, hepatogastric ligament and the gastropancreatic and hepatopancreatic folds. The hepatoduodenal ligament has a secondary fold which forms the ventral border of the epiploic foramen, consisting of a central connective tissue core of mainly elastin fibres. The hepatic artery for part of its course is incorporated in the hepatoduodenal ligament. All these structures are clearly visible laparoscopically. The mean circumference of the epiploic foramen is 11.6 ± 2.6 cm and its circumference is positively correlated with body weight but is unrelated to age or gender.



Conclusions

Several clinically relevant structures delineate the epiploic foramen. Its defining structure consists, in part, of elastin fibres. Anatomical and laparoscopic knowledge may assist surgeons in developing interventions to treat diseases involving the epiploic foramen.

A topographic anatomical study of the equine epiploic foramen and comparison with laparoscopic visualisation

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