Paralumbar Fossa Laparoscopic Ovariectomy in Horses With Use of Endoloop Ligatures

Objective —The purposes of this study were to develop a technique of paralumbar fossa laparoscopic ovariectomy using Endoloop ligatures and to avoid a laparotomy incision for ovary removal by using a 33–mm diameter muscle spreader trocar-cannula unit.
Animals or Sample Population —Seven mares.
Methods —Bilateral laparoscopic ovariectomy was performed under general anesthesia in two horses and under neuroleptanalgesia and local anesthesia in five standing mares. Ovaries were approached from the ipsilateral paralumbar fossa through two portal sites located in the paralumbar fossa and a third between the 17th and 18th ribs. Insufflation of the abdominal cavity was achieved using an automatic carbon dioxide insufflator. Two Endoloop ligatures were placed on the mesovarium. The cannula, located in the center of the paralumbar fossa, was removed, and a 33-mm diameter trocar-cannula unit, with a cone-shaped muscle spreader extremity, was inserted through the same portal. The mesovarium was transected between the ovary and the ligatures. The ovaries were removed from the abdomen through the 33-mm diameter cannula. The abdominal wall was closed in a routine manner.
Results —No major complications occurred during or after surgery.
Conclusion —Paralumbar fossa laparoscopic ovariectomy in mares using Endoloop ligatures and the 33-mm diameter trocar-cannula unit was an effective technique for ovariectomy of normal ovaries in this study.
Clinical Relevance —Endoloop ligatures provide a viable alternative for laparoscopic ligation of ovarian pedicles in mares.     

Laparoscopic ovariectomy using sequential electrocoagulation and sharp transection of the equine mesovarium

OBJECTIVE: To describe in horses and ponies a laparoscopic ovariectomy technique facilitated by electrosurgical instrumentation. STUDY DESIGN: Elective ovariectomy was performed in 23 mares using laparoscopic electrosurgical instrumentation. ANIMALS OR SAMPLE POPULATION: Twenty-three mares (13 horses, 10 ponies), aged from 2 to 21 years and weighing 90 to 545 kg. METHODS: Food was withheld for a minimum of 12 hours. Mares were sedated with detomidine hydrochloride (0.02 to 0.03 mg/kg) or xylazine hydrochloride (0.5 to 1.0 mg/kg). Excluding the pony mares, all other mares were restrained in stocks. Portal sites in the paralumbar fossa region were desensitized with 2% mepivacaine. Abdominal insufflation was achieved through a teat cannula positioned in the ventral abdomen or a Verres-type needle placed through the paralumbar fossa. After trocar and laparoscope insertion, the ipsilateral ovary and mesovarium were identified, and the mesovarium, tubal membrane, and proper ligament were infiltrated with 2% mepivacaine. The mesovarium was coagulated using bipolar or monopolar electrosurgical forceps and transected sequentially from cranial to caudal until the ovary was completely freed and then removed. The contralateral ovary was removed in a similar fashion through the opposite paralumbar fossa. RESULTS: Bipolar and monopolar electrosurgical forceps were easy to use and provided adequate coagulation of vessels within the mesovarium. Two mares were euthanatized after the procedure for unrelated reasons. One mare had mild signs of colic 24 hours after ovariectomy. In 1 pony mare, the incision used to remove one ovary dehisced on the 5th postoperative day and was allowed to heal by second-intention. No long-term complications had occurred in 11 horses and 10 ponies, 6 to 24 months after surgery. CONCLUSION: Laparoscopic ovariectomy and hemostasis of the mesovarium can be easily accomplished using electrosurgical instrumentation. CLINICAL RELEVANCE: Standing laparoscopic ovariectomy, using electrosurgical instrumentation, is an effective and safe technique to provide hemostasis of the mesovarium in mares.     

Feasibility of single-portal access laparoscopic ovariectomy in 17 cats

Laparoscopic ovariectomy (LapOVE) using single-portal access was attempted in 17 client-owned cats of different breeds admitted for elective ovariectomy. A 12 mm umbilical portal was placed 1 cm caudal to the umbilicus with the cat in dorsal recumbency. Then, a laparoscope with an operating channel was introduced into the portal with the cat in lateral recumbency. The right ovary was pulled to the abdominal wall using grasping forceps and fixed to the abdominal wall by a transabdominal suspension suture. The ovarian vasculature, suspensory ligament and proper ligament were progressively cauterised and transected with multifunction bipolar electrocoagulation forceps. The resected right ovary was exteriorised through the umbilical portal cannula. The left ovary was then removed from the abdomen in a similar fashion. Surgical time, intraoperative haemorrhage, amount of fat in the ovarian ligament, surgical complications and postoperative pain were recorded. The mean (sd) surgical time was 23 minutes and seven seconds (five minutes and 55 seconds). Intraoperative blood loss and fat deposition of the ovarian ligament were minimal. No intra- and postoperative complications were encountered. No cats needed rescue analgesia within 24 hours postsurgery.     

Use of high-power ultrasonic shears for laparoscopic ovariectomy in mares

A method for performing laparoscopic ovariectomy with high-power ultrasonic shears in mares is described, along with results in 10 mares. Briefly, after epidural administration of detomidine and local anesthesia with mepivacaine, 3 cannulas were placed in each paralumbar fossa. A laparoscope was placed through the most dorsal cannula, and a grasping forceps was placed through the most ventral cannula and used to grasp and manipulate the ovary. The ultrasonic shears was then placed through the middle cannula. The jaws of the ultrasonic shears were closed across a portion of the ovarian pedicle, and the instrument was discharged until tissue within the jaws was transected; the process was repeated until the entire ovarian pedicle was transected. Following removal of the right ovary, it was passed to the left side of the abdomen and both ovaries were removed through an incision in the left paralumbar fossa. No major complications were identified in any of the 10 mares. However, excessive bleeding necessitating reapplication of the ultrasonic shears (2 ovaries) or application of ligating clips (8) was encountered with 10 of the 20 ovaries. Laparoscopic ovariectomy with a high-power ultrasonic shears appears to be safe in mares.     

Ventral Abdominal Approach for Laparoscopic Cryptorchidectomy in Horses

Objective —To report a ventral abdominal approach and a ligating loop technique for laparoscopic cryptorchidectomy in horses.
Study Design —Prospective.
Sample Population—Six horses, aged 1 to 5 years, with retained testes.
Methods —One laparoscopic portal and three to four instrument portals were used for ventral abdominal laparoscopic cryptorchidectomy. Laparoscopic instruments were used to maneuver and secure the testis through a ligating loop (modified Roeder knot) that was secured from outside the abdominal cavity. Only minimal enlargement of one instrument portal was used to remove the testicle.
Results —Three horses were bilateral cryptorchids, and three were unilateral (left side, two; right side, one) cryptorchids. Operative time, defined as the time from laparoscope insertion to removal, ranged from 20 to 25 minutes for unilateral cryptorchids and from 40 to 50 minutes for bilateral cryptorchids.
Conclusions —The reported technique allowed decreased tension on the tissues during ligation and removal of the testis from the peritoneal cavity. Improved observation of the abdominal cavity, ligation security, shortened patient confinement time, and minimally invasive technique are all considered to be benefits of laparoscopic cryptorchidectomy.
Clinical Relevance —Direct observation of retained testes and intraabdominal castration are distinct advantages of the use of laparoscopy in horses that have had previous unsuccessful surgical attempts, horses with unknown histories that have retained testicular tissue, or bilateral abdominal cryptorchids.     

In situ coagulation and transection of the ovarian pedicle: An alternative to laparoscopic ovariectomy in juvenile horses

The feasibility of leaving the ovaries within the peritoneal cavity after laparoscopic coagulation and transection of the ovarian pedicle was assessed in the juvenile horse. Elective ovariectomy was performed on 10 quarter horses, aged 4 to 5 mo, with the fillies in a Trendelenburg position. The mesovarium was isolated, and multiple coagulation and transection cycles were performed until all ovarian attachments had been severed. The ovaries were dropped within the abdomen, and hemostasis of the transected mesovarium was evaluated before closure. The mean surgical time was 33 min (range, 23 to 48 min). Ten weeks after surgery the fillies were humanely euthanized. At postmortem examination, the ovary location within the abdomen was noted. In 1 horse, there was an abdominal adhesion; viscera had been punctured during insufflation. Of the 20 ovaries, 4 were free-floating within the abdominal cavity; the other 16 were enveloped in the free portion of the greater omentum in the cranioventral abdomen. Histologic examination of the ovaries was performed to assess follicle cell viability. In both the free-floating and the attached ovaries, the deep blood vessels and all examined follicular structures were necrotic and partially mineralized. Laparoscopic electrosurgical transection of the ovarian pedicle without removal of the ovaries should be considered an alternative to other ovariectomy techniques that may be performed in young female horses.     

Unilateral Nephrectomy in a Juvenile Llama

Objective —The purpose of this study was to decribe the clinical presentation, diagnostic evaluation, and surgical management of a llama with an ectopic ureter.
Animals or Sample Population —Nine-month-old female llama.
Results —The diagnostic evaluation included the use of computed tomography and an excretory ureterogram to confirm and identify the location of the ectopic ureter. Surgical management involved a unilateral nephrectomy.
Conclusions and Clinical Relevance —Computed tomography is a valuable asset to diagnose the presence and terminal location of an ectopic ureter in llamas, and nephrectomy appears to be a viable procedure to resolve the subsequent urinary incontinence.     

Ventral Abdominal Approach for Laparoscopic Ovariectomy in Horses

Eleven mares and four mules were ovariectomized by a ventral abdominal laparoscopic technique. This approach required tilting the operative table about 30 degrees elevating the pelvis to allow observation of the ovaries. A triangulation technique with a single laparoscopic portal and four instrument portals was used. The ovarian pedicles were ligated and the ovaries were removed through a single enlarged instrument portal. Females ranged in age from 5 months to 18 years. Mean operative time was 44 minutes (range 20 to 90 minutes); mean operative time of the last seven animals was 26 minutes. Signs of abdominal pain occurred in three mules and one mare in the immediate postoperative period. Peritoneal fluid collected from six animals 48 hours after surgery had a mean leukocyte count of 34,463/μL: (range, 21,000 to 62,800/μL), mean protein concentration of 3.1 g/dL (range, 2.2 to 4.6 g/dL), and mean differential leukocyte count of 74% neutrophils and 26% mononuclear cells. The animals were confined for 2 weeks after surgery. Signs of estrus were observed in two mares within 6 months after ovariectomy. All owners reported satisfaction with the results of laparoscopic ovariectomy. The ventral abdominal laparoscopic approach permitted efficient and safe ovariectomy of foals and adults.     

Laparoscopic Adhesiolysis in a Horse

Objective —The purpose of this report was to describe the use of laparoscopy as a method of treatment for abdominal adhesions in the horse.
Clinical Report —Unilateral ovariectomy for removal of a granulosa cell tumor was performed through a diagonal paramedian approach in a 14-year-old Arabian mare. Progressive incisional swelling and hemorrhage culminated in acute incisional dehiscence with herniation of ileum on the sixth postoperative day. Septic peritonitis that responded to parenteral antibiotic therapy was identified 7 days after hernia repair. Seven days later, the mare had signs of abdominal pain, and adhesions of small intestine to the paramedian incision were identified on rectal palpation. Transrectally assisted laparoscopic adhesiolysis was performed. No further complications occurred.
Clinical Relevance —Laparoscopic adhesiolysis may provide better observation of adhesions and reduced postoperative morbidity compared with laparotomy.     

Evaluation of a vessel-sealing device for laparoscopic granulosa cell tumor removal in standing mares

OBJECTIVE: To describe a laparoscopic technique for granulosa cell tumor removal using a vessel sealing device (LigaSuretrade mark) in standing mares. STUDY DESIGN: Retrospective study. ANIMALS: Eight mares (8-24 years old; weighing, 406-525 kg). METHODS: Before surgery, ovarian size and adjacent body wall thickness was determined by ultrasonography. Mares were sedated and after local anesthesia (inverted L and local infiltration), laparoscopic cannulation was performed without insufflation. The mesovarium was anesthetized and the LigaSure instrument applied to the mesovarium for hemostasis and resection to remove the affected ovary. Mares were hospitalized for 24 hours before discharge. RESULTS: Median ovarian diameter was 10.5 cm (range, 6-14 cm). Median surgery time was 75 minutes (range, 40-180 minutes). Hemostasis was achieved using the LigaSure device in all mares. Median length of the abdominal wall incision made to remove the ovary was 13 cm (range, 5-17 cm); no incisional complications occurred. CONCLUSIONS: The LigaSure vessel sealing device provided adequate hemostasis for removal of larger neoplastic ovaries in standing mares. CLINICAL RELEVANCE: Concerns of ligature placement can be alleviated by use of the LigaSure device and standing laparoscopic technique provides excellent observation of the surgical field ensuring hemostasis.     

USE OF COMPUTED TOMOGRAPHY TO EVALUATE THE INTESTINAL TRACT OF ADULT LLAMAS

In the llama, signs of colic are obscure and may be exhibited as persistent sternal recumbency and anorexia even in the presence of a surgical lesion. Diagnostic methods for evaluation of abdominal disorders are limited. As a result, surgical intervention may be prolonged and increase the risk of mortality and postoperative complications. The objective of this study was to determine the feasibility of computed tomography to evaluate the llama intestinal tract. Eighteen hours prior to the computed tomography scan, six llamas were given barium sulfate (15%) via an orogastric tube. Following induction of general anesthesia, the llamas were positioned in sternal recumbency, and 10 mm contiguous slices were obtained from the diaphragm to the tuber ischiadicum. Structures that were consistently identified included the first, second, and third compartments (C1, 2, and 3), small intestine, spiral colon, and ascending colon. C1 was easily identified in the cranial aspect of the abdomen due to its large size relative to the other compartments and characteristic saccules. C2 was located cranial, ventral, and to the right of Cl, while C3 was visualized as a tubular structure to the right and ventral to C1 and C2, C3 was traced caudally until it turned dorsally and continued cranially to a dilated ampulla in the right cranial abdomen delineating the entrance to the small intestine. The spiral colon was identified consistently in the left ventral caudal abdomen. Structures that could not be conclusively identified included the cecum and mesenteric lymph nodes. Computed tomography allowed a consistent evaluation of the major intestinal structures associated with colic in the llama. Thus, computed tomography is a potentially valuable noninvasive diagnostic tool to effectively evaluate the abdominal cavity and differentiate medical from surgical lesions in the llama.     

Laparoscopic ovariectomy in mares using a polyamide tie-rap

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 Dogs: Comparison Between Single Portal and Two-Portal Access

Objective: To compare surgical times and perioperative complication rates of single portal access and 2-portal laparoscopic ovariectomy (LapOVE) in dogs using a bipolar vessel sealer/divider device, and to evaluate the performance of novice laparoscopists for right ovariectomy.
Study Design: Controlled clinical trial.
Animals: Female dogs (n=42).
Methods: Dogs were divided into groups: 1=single portal and 2=2 portal. LapOVE was performed using a 5 mm vessel sealer/divider device and a 10 mm operating laparoscope (Group 1) or a 5 mm laparoscope (Group 2). Dog characteristics (weight, body condition score, ovarian ligament fat score), operative time, and perioperative complication rate were compared between groups. Right ovariectomy duration was evaluated for 2 novice laparoscopists.
Results: No significant difference was found in mean total surgical time between group 1 (21.07 min/s) and group 2 (19.06 min/s). Factors significantly affecting times included body condition scores, ovarian ligament fat score, ovarian bleeding, and surgeon expertize. Minor complications (bleeding from ovaries or after splenic trauma) occurred and were similar in both groups. Bleeding was correlated to body condition score and ovarian ligament fat score. Interindividual differences were found among surgeons for right ovariectomy time.
Conclusions: Single portal access LapOVE using vessel sealer/divider device is feasible, safe, and does not significantly increase total surgical time in comparison with 2-portal approach. Laparoscopic skills may play a role in ability to perform single portal LapOVE.
Clinical Relevance: LapOVE can be performed using single portal access.     

Laparoscopic Anatomy of the Abdomen and Laparoscopic Ligating Loops,Electrocoagulation, and a Novel Modified Electroligation Ovariectomy in Standing Mare

The purpose of this study was to provide a detailed laparoscopic anatomy of the caudal abdominal region of mare in a standing position and to evaluate and modify a technique for standing laparoscopic ovariectomy using combination between hand-tied ligating loop and electrocoagulation techniques, as the ligating loops, electrocoagulation, and modified electroligation laparoscopic ovariectomy were applied using nine adult mares. Laparoscopy was practical and effective for direct visual examination of internal abdominal organs in the mare. Ventral dislocation of abdominal viscera after pneumoperitoneum was established with the mare in standing position, which provided an excellent inspection of the dorsal and ventral structures in the peritoneal cavity on the right and left sides. Standing laparoscopic ovariectomy using an electroligation modified method was considered a safe and effective method for hemostasis of the mesovarium, technically easy, time saving, and economical. The mean surgical time for bilateral ovariectomy was 40 ± 7.63, 60 ± 5.25, and 85 ± 6.43 minutes for electroligation-modified technique, ligating loops technique, and electrocoagulation technique, respectively.     

Comparison of Nd:YAG surgical laser and Remorgida bipolar electrosurgery forceps for canine laparoscopic ovariectomy

Objective— To investigate and compare technique, surgical time, and complications of canine laparoscopic ovariectomy using Nd:YAG surgical laser and Remorgida bipolar electrosurgery forceps.
Study Design— Randomized, prospective clinical trial.
Animals— Female dogs (n=40) for elective ovariectomy.
Methods— Dogs had bilateral ovariectomy with one ovary randomly assigned to removal by use of Nd:YAG surgical laser with a 600 μm optical fiber in contact mode and the other ovary to removal by use of a Remorgida forceps (featuring bipolar electrocoagulation with simultaneous sharp resection). Duration of predetermined surgery intervals and complications were compared between techniques. Additionally, the effects of several intraoperative variables on surgical time were evaluated.
Results— Ovariectomy by use of Remorgida forceps required significantly less time than laser ovariectomy but intraoperative hemorrhage was not reduced. Surgical time was significantly increased in obese dogs, depending on the amount of fat in the ovarian ligament. Intraoperative hemorrhage had no significant influence on surgical time.
Conclusion— Both ovariectomy techniques were effective but the Remorgida forceps can be used as a relatively inexpensive, stand-alone device that decreases surgical time compared with Nd:YAG laser ovariectomy.
Clinical Relevance— Novel techniques, such as laser and combined bipolar electrosurgical and cutting forceps aim to reduce surgery duration, complication rates and recovery time in laparoscopic surgery.     

Dorsally recumbent female equine urogenital endoscopic surgery.

The ventral abdominal approach for laparoscopy is versatile. Reported techniques using a ventral approach in the mare include bilateral ovariectomy and granulosa cell tumor removal. Laparoscopic ovariectomy is performed by way of four instrument portals in the caudoventral aspect of the insufflated abdomen. The procedure has several advantages over the traditional approaches of colpotomy and celiotomy, including tension-free closure of all incisions and minimal invasiveness.     

Laparoscopic ovariectomy in cats: comparison of laser and bipolar electrocoagulation

Fourteen mixed-breed domestic cats underwent laparoscopic ovariectomy (lapOVE) using paediatric equipment, an Nd:YAG laser and a bipolar electrocoagulation forceps. Cats were placed in 10 degrees Trendelenburg position (head down) and insufflation pressure was kept at 4mmHg, while surgery was performed through three midline portals. Randomly-assigned unilateral laser resection of one ovary (laserOVE) and bipolar electrocoagulation (BECOVE) of the contralateral ovary were performed. Duration of predetermined surgery intervals was recorded, as well as occurrence of intra- and postoperative complications. Both methods were successful and without complications. Duration of laserOVE was significantly increased compared to BECOVE. The right ovary was more difficult to access; however, both ovaries were easy to manipulate because of the relatively long suspensory ligament. The ovarian ligaments contained minimal amounts of fat and obesity did not influence surgery duration. Convalescence period was short (0.9+/-0.4 days) and owner satisfaction high.     

Standing hand-assisted laparoscopic ovariectomy in 65 mares

Objective: To review the efficacy and safety of unilateral ovariectomy by use of a standing hand‐assisted laparoscopic approach and evaluate the effect of ovary size on posttransection hemorrhage after application of a linear stapling device. Study Design: Case series. Animals: Horses (n=65) aged 2–20 years. Methods: Medical records of mares that had ovariectomy performed by use of a standing hand‐assisted laparoscopic approach were reviewed. Data retrieved were signalment, ovary removed (left, right), ovarian size, ovarian pathology, intraoperative and postoperative complications, and length of hospitalization. Results: Mean ovarian diameter was 17 cm. Histopathology (52 mares) confirmed 41 granulosa cell tumors (79%), 8 ovarian cysts (15%), 1 teratoma (2%), and 2 ovaries (4%) without abnormalities. Hemorrhage was observed laparoscopically in 16 mares after transection of the mesovarium. Complications encountered during surgery included 1 mare collapsing in the stocks and 1 mare that hemorrhaged excessively from the incision. Postoperative complications included 2 cases of mild colic. Overall complication rate was 6%. Conclusions: All attempts to remove the target ovary were successful. The approach is safe for the mare, as complications encountered were similar to those recently reported for other approaches.     

Evaluation of Postoperative Peritoneal Lavage in Standing Horses for Prevention of Experimentally Induced Abdominal Adhesions

Objective —To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses.
Study Design —Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery.
Animals or Sample Population—12 horses.
Methods —Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions.
Results —All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less ( P <.0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain.
Conclusions —Peritoneal lavage reduced the frequency of intraabdominal adhesions.
Clinical Relevance —When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.