Wound Retractor Laparoscopic Port System for Standing Laparoscopic Cryptorchidectomy in the Horse: A Case Report

Cryptorchidectomy is the most commonly performed laparoscopic procedure in horses. However, its use for the extraction of an abdominal testis has disadvantages such as loss of a resected testis from grasp and fragmentation of the specimen because of the excessive tension required for extraction through a thick body wall. The ring wound retractor laparoscopic port system was recently used in human and small animal surgery to perform laparoscopic-assisted procedures and retrieve large specimens from the abdomen. In the present case, the wound retractor was placed as the ventral port in the right flank through a minilaparotomy. Thereafter, the cap with the gas inlet and instrument port was connected. The other two ports were placed dorsally using 10-mm stainless steel cannulas. Grasping forcep was introduced through the ventral port, and the laparoscope and vessel-sealing devices were introduced through the dorsal ports. After the testis was resected, it was retrieved from the abdomen through the retractor without the grasping forceps jaw being released. This is the first case report describing the use of the wound retractor laparoscopic port system for standing cryptorchidectomy in a horse. This system can be a feasible and safe option for flank laparoscopy in horses, and it facilitates specimen retrieval from the abdominal cavity, but further studies should confirm this preliminary report.     

Small intestinal biopsy and resection in standing sedated horses

Diagnostic laparotomy and laparoscopy are surgical techniques commonly used for the investigation of chronic abdominal disease and weight loss. They can both be usefully carried out in the standing sedated horse, allowing a thorough examination of the dorsal abdominal cavity and biopsies to be harvested. Small intestinal disease is an important cause of weight loss and recurrent colic. Inflammatory or neoplastic bowel disease may not always be apparent grossly and histopathological assessment of full thickness biopsies may be required to provide a definitive diagnosis. Details of cases of 15 horses that underwent small intestinal biopsy or enterectomy while sedated and standing are presented. Three incisional infections occurred causing delayed wound healing. Three horses were subjected to euthanasia before hospital discharge: two had persistent gastric reflux and one had colitis. A further six were subjected to euthanasia in the first 4 months due to their underlying inflammatory bowel condition. One horse was subjected to euthanasia for severe laminitis that was presumed to be caused by treatment with a corticosteroid 4 years later, and one died of acute colic 2.3 years after successful resection and anastomosis. Five horses were alive at the time of review, median 2.7, range 1.2–4.3 years. Overall therefore, 3 (20%) horses died during hospitalisation and 5 (33%) were still alive at the end of the study. Results from this series suggest that minimising the number of intestinal biopsies may reduce morbidity, but the underlying pathological process appears to be the most important prognostic factor for survival. Resection and anastomosis in the standing sedated horse proved feasible.     

Standing laparoscopic castration in an equine male pseudohermaphrodite

This report describes the surgical anatomy and successful removal of the internal gonads in a 6-year-old male pseudohermaphrodite Friesian horse by standing laparoscopy. Gonads could not be identified by physical or ultrasonographic examination and bilateral standing flank laparoscopy revealed the presence of intra-abdominal gonads suspended from the dorsal aspect of the abdominal cavity by 10–15 cm long vascular pedicles. No evidence of female internal genitalia such as a uterus was found and bilateral gonadectomy was performed laparoscopically. Histological analysis of the excised gonads confirmed the diagnosis of male pseudohermaphroditism. Minor cosmetic surgery of the external genitalia to correct urinary misdirection was successfully performed 3 months after laparoscopic castration. Standing flank laparoscopic examination was excellent for identification and surgical removal of internal genitalia. Standing flank laparoscopy should be considered for inspection and removal of internal genitalia in intersex horses.     

Single‐port laparoscopic incisional hernia repair in a horse

A 16‐year‐old Italian Saddle Horse gelding was referred for treatment of an incisional hernia that developed 7 months after a ventral midline laparotomy for treatment of acute abdominal pain. Physical examination revealed a hernia approximately 20 cm long and 15 cm wide on the ventral aspect of the abdomen. Ultrasonography revealed the dimensions of the hernia ring to be approximately 15 cm in length and 10 cm in width. A single‐port laparoscopic incisional hernia repair using an operating 0° laparoscope was performed with an appropriately sized (24 × 18 cm) piece of mesh fixed in place with simple interrupted transabdominal sutures. At 4 weeks post operatively, follow‐up physical examination and ultrasonography confirmed healing of the surgical site with no evidence of hernia recurrence. The same evaluation was done 6 months post operatively, and the horse returned to its previous level of activity 8 months post operatively. In horses, laparoscopic application of mesh should be considered among the treatment options for incisional hernia. In the present case, this technique was performed with a single port using an operative laparoscope, in contrast to the multiportal techniques reported previously. The case presented here demonstrates that single‐port laparoscopic herniorrhaphy is feasible, and allows proper placement of an expanded polytetrafluoroethylene intraperitoneal mesh in horses     

Surgical Treatment of an Abdominal Abscess Caused by a Migrating Iron Wire From the Ventral Colon,a Case Report

A 13-year-old mare presented for evaluation of recurrent colic episodes. The horse was diagnosed with a mass within the spleen at the ultrasound examination of the abdomen; the levels of Serum Amyloid A and the fibrinogen were high and so a presumptive diagnosis of an abscess involving the spleen was made base on clinical, ultrasonographic and laboratory findings and it was decided to perform n exploratory laparotomy for a definitive diagnosis and possible treatment. Upon abdominal exploration a mass involving the spleen, the lateral wall of the ventral colon adherent to the left abdominal wall was diagnosed and with an intraoperative ultrasound examination a linear hyperechoic foreign body was diagnosed within the mass. It was removed through an enterotomy of the left ventral colon that allowed the digital exploration of the mass without spilling of pus within the peritoneal cavity. The horse was discharged and the long term follow-up revealed no complications and no more signs of abdominal pain.     

Laparoscopic intestinal exploration and full-thickness intestinal biopsy in standing horses: a pilot study

OBJECTIVE: To assess a laparoscopic technique for equine intestinal biopsy. STUDY DESIGN: Experimental study. ANIMALS: Seven adult horses. METHODS: Food but not water was withheld for 36 hours before laparoscopy. In 3 horses (group A) standing, right laparoscopic access to different small intestinal segments was compared with ventral median celiotomy access. Inaccessible segments were identified at necropsy. In 4 horses (group B), the feasibility of obtaining full-thickness duodenal and cecal biopsies and any associated morbidity were evaluated. Biopsy specimens were collected during standing right laparoscopy using a 2-step procedure and intracorporeal suturing technique, and abdominal lavage was performed. Horses were monitored clinically and by abdominal fluid cytology and microbial culture, and repeat laparoscopy was performed on day 6. RESULTS: Standing right flank laparoscopy provided good observation of small intestinal segments and enabled manipulation of all but 15-20 cm of the duodenum and approximately 40 cm more ileum compared with ventral median celiotomy. Group B horses had no complications, no adhesions, and no bacterial growth from peritoneal fluid samples. None of the horses had signs of abdominal pain. CONCLUSION: A 2-stage intestinal biopsy technique performed during standing, right flank laparoscopy may be a safe alternative to exploratory celiotomy and biopsy in normal horses. CLINICAL RELEVANCE: Right flank laparoscopy allows biopsy of intestinal segments including duodenum and 50% more of the ileum than is accessible by ventral median celiotomy. This technique should be evaluated in clinical patients.     

Laparoscopic Removal of a Large Abdominal Testicular Teratoma in a Standing Horse

Objective— To describe laparoscopic removal of a large testicular teratoma in a standing horse.
Study Design— Clinical report.
Animals— Thoroughbred horse (11 months) with a testicular teratoma.
Methods— A unilateral cryptorchid testicle could not be removed by an inguinal approach under general anesthesia because of it s large size. After recovery from general anesthesia, ultrasound evaluation revealed a 24 × 19 cm fluid-filled testicular mass. The mass was removed by paralumbar fossa laparoscopy with the horse in a standing position. After fluid aspiration of the mass, the mesorchium and ductus deferens were ligated with extracorporeal knots and the mass retrieved inside a laparoscopic specimen pouch. Morphologic features were consistent with a teratoma.
Results— Laparoscopic-guided aspiration of fluid from the teratoma decreased mass size and increased ease of manipulation and retrieval. Retrieval of the teratoma in a laparoscopic specimen pouch prevented loss of abdominal insufflation, helped reduce fluid leakage, and potential seeding of neoplastic cells.
Conclusion— Use of laparoscopy for removal of neoplastic cryptorchid testicles offers many advantages including minimal invasiveness and increased safety associated with good visibility of structures.
Clinical Relevance— Standing laparoscopic surgery should be considered for removal of testicular neoplasms in horses.     

Clinical findings in 10 horses diagnosed with monorchidism following exploratory laparotomy or standing laparoscopic surgery

Monorchidism describes the complete absence of one testis and is rare in horses. This study reports the clinical findings in 10 horses diagnosed as monorchids by standing laparoscopy or exploratory laparotomy. Hospital records for all horses undergoing cryptorchidectomy (2000–2016) in four centres were reviewed from which horses diagnosed with monorchidism were identified. Surgery was by either standing flank laparoscopy or an inguinal exploration and subsequent exploratory laparotomy under general anaesthesia. Ten horses were diagnosed as monorchids, five by laparoscopy (one bilateral laparoscopy) and five by laparotomy. Nine horses had a normally descended scrotal testicle, which was also removed at surgery. The right testicle was absent in three horses, and the left testicle was absent in seven horses. Anatomical findings were recorded in each case; the vaginal process was present in all horses, ductus deferens and epididymis were present in 80% of horses and the ligament of the tail of the epididymis and testicular vessels were present in 50% of horses. Laparoscopy allowed easy identification of spermatic structures enabling a prompt diagnosis of monorchidism. In conclusion, when monorchidism occurs, most other associated spermatic structures are likely to be present. A diagnosis of true monorchidism is reliant on hormonal testing and absence of testicular tissue on histopathology and so some of these horses may strictly be somewhere on the spectrum of testicular degeneration. This information is particularly useful in the surgical situation when it is not clear whether the testicle is present or not.     

Anaerobic peritonitis caused by Clostridium septicum as a complication of routine castration in a 2‐year‐old Warmblood horse

This case report describes an unusual case of anaerobic peritonitis in a 2‐year‐old horse following castration. The horse was evaluated 2 weeks following castration for signs of acute, severe abdominal pain and swelling surrounding a previous castration site. Physical examination revealed marked scrotal and ventral abdominal oedema that was cool and crepitant upon palpation. Ultrasonographic evaluation was unrewarding because gas shadowing distributed throughout the subcutis prevented imaging of the abdominal cavity. Ventral midline celiotomy revealed a copious amount of malodorous, serosangious, cloudy peritoneal fluid that was submitted for culture. Abdominal exploration revealed the gastrointestinal tract to be in its anatomically correct position. There was diffuse petechiation of the small intestine and large intestine, oedema and crepitant swelling surrounding the left inguinal ring and body wall. The abdomen was lavaged with 10 l of sterile saline prior to closure of the celiotomy and the left castration incision was opened digitally, releasing a large volume of serosanguinous fluid and gas that flowed freely from the incision site and deeper inguinal tissues. The horse was placed in the recovery box where it suffered cardiac arrest. Culture of the peritoneal fluid revealed heavy growth of Clostridium septicum. This case of anaerobic peritonitis represents an unusual complication following castration not previously reported in the horse.     

Surgical management of duodenal obstruction in an adult horse

A 3-year-old Standardbred stallion was admitted for treatment of acute enterocolitis. The horse improved in response to empiric treatment, but subsequently developed ventral edema, scrotal abscessation, and severe laminitis. Improvement again was seen, but on day 29 of hospitalization, the horse developed rapid heart rate and signs of abdominal pain. Exploratory celiotomy revealed complete obstruction of the descending portion of the duodenum, 20 cm caudal to the duodenal sigmoidal flexure. Three-tier duodenojejunostomy and jejunojejunostomy were performed to bypass the duodenal obstruction.     

Behavioural assessment of pain in 66 horses,with and without a bit

Horses can be ridden with or without a bit. Comparing the behaviour of the same horse in different modes constituted a ‘natural experiment’. Sixty-nine behaviours in 66 bitted horses were identified as induced by bit-related pain and recognised as forms of stereotypic behaviour. A prototype questionnaire for the ridden horse was based on 6 years of feedback from riders who had switched from a bitted to a bit-free bridle. From a template of 69 behavioural signs of pain derived from answers to the questionnaire, the number of pain signals shown by each horse, first when bitted and then bit-free, was counted and compared. After mostly multiple years of bit usage, the time horses had been bit-free ranged from 1 to 1095 days (median 35). The number of pain signals exhibited by each horse when bitted ranged from 5 to 51 (median 23); when bit-free from 0 to 16 (median 2). The number of pain signals for the total population when bitted was 1575 and bit-free 208; an 87% reduction. Percentage reduction of each of 69 pain signals when bit-free, ranged from 43 to 100 (median 87). The term ‘bit lameness’ was proposed to describe a syndrome of lameness caused by the bit. Bit pain had a negative effect on proprioception, i.e. balance, posture, coordination and movement. Only one horse showed no reduction in pain signals when bit-free. The welfare of 65 of 66 horses was enhanced by removing the bit; reducing negative emotions (pain) and increasing the potential to experience positive emotions (pleasure). Grading welfare on the Five Domains Model, it was judged that – when bitted – the population exhibited ‘marked to severe welfare compromise and no enhancement’ and – when bit-free – ‘low welfare compromise and mid-level enhancement.’ The bit-free data were consistent with the ‘one-welfare’ criteria of minimising risk and preventing avoidable suffering.     

Small intestinal adenomatous polyps resulting in chronic obstruction in a 3-year-old Quarter Horse gelding

A 3-year-old, Quarter Horse gelding was admitted to Kansas State University Veterinary Health Center with a primary complaint of colic. The horse had a 3-month history of recurrent colic and progressive weight loss. On physical examination, the horse was quiet, alert and responsive. The horse's mucous membranes were pink and capillary refill time was 2 s. His rectal temperature was 37.6°C (99.6°F), heart rate was 56 beats/min and respiration rate was 16 breaths/min. Rectal palpation revealed an approximately 5 cm dilated, firm, tubular, mass traversing from left caudal abdomen to mid abdomen. Nasogastric intubation obtained 6 L net reflux. A 5 cm diameter small intestinal intraluminal mass was detected by abdominal ultrasound. Complete blood count, serum chemistry and peritoneal fluid analysis were performed and all results were unremarkable. The horse was humanely euthanised due to pain and financial constraints. Post-mortem examination and histopathology revealed a 15 × 5 × 5 cm polyp with multiple smaller satellite polyps that obstructed the distal duodenum. Colic was considered secondary to small intestinal obstruction and luminal distension caused by the adenomatous polyps. To the authors’ knowledge, this is the first report to include ultrasound images of a small intestine adenomatous polyp that caused small intestinal obstruction and colic in a 3-year-old horse.     

Use of laparoscopy for diagnosing experimentally induced acute pancreatitis in dogs

Diagnosis of acute pancreatitis in dogs remains a significant challenge despite the development of advanced diagnostic methodologies. Visual inspection and pancreas biopsy using laparoscopy are generally considered to be procedures free of complications when conducted on healthy animals. However, the usefulness of laparoscopy for diagnosing acute pancreatitis has not been assessed. In the present study, the efficacy of laparoscopy for diagnosing acute pancreatitis in dogs was evaluated in animals with experimentally induced acute pancreatitis. Gross appearance of the pancreatic area was examined by laparoscopy to survey for the presence of edema, adhesions, effusion, pseudocysts, hemorrhage, and fat necrosis. Laparoscopic biopsy was performed and the histopathologic results were compared to those of pancreatic samples obtained during necropsy. The correlation between laparoscopy and histopathologic findings of the pancreas was evaluated. The presence of adhesions, effusion, and hemorrhage in the pancreatic area observed by laparoscopy significantly correlated with the histopathologic results (p < 0.05). There was no significant relationship between the histopathologic and laparoscopic biopsy findings. Results of this study suggested that laparoscopic evaluation of gross lesions has clinical significance although the laparoscopic biopsy technique has some limitations. This method combined with additional diagnostic tools can be effective for diagnosing acute pancreatitis in dogs.     

Influence of centrally administered diltiazem on behavioural responses, clinical symptoms, reticulo-ruminal contractions and plasma catecholamine level after experimentally induced duodenal distension in sheep

A different role of L-type antagonists for voltage-gated calcium channels (VGCC) has been previously identified in different types of experimental and clinical pain in man and animals. Present study examined the role of VGCC blocker - diltiazem administered icv (0.25, 0.5, 1.0 and/or 2.0 mg in toto) on the development of pain related symptoms, clinical signs, plasma catecholamine level and the inhibition of reticulo-rumen motility caused by 5 min lasting mechanical duodenum distension (DD) in the sheep. Experimental DD was conducted by insertion (during surgery) of rubber balloon into the duodenum and the distension by 40 ml of warm water. Duodenal distension resulted in a significant increase of behavioural pain responses, tachycardia, hyperventilation, inhibition of reticulo-rumen contractions rate (from 85% to 45% during 15-20 min), an increase of plasma catecholamine concentration (over sevenfold increase of epinephrine during 2 h following DD, two-times norepinephrine and 84% increase of dopamine). Diltiazem infusion given 10 min before DD decreased intensity of visceral nocifensive responses such as: behavioural changes, tachycardia, hyperventilation, reticulo-rumen motility and efficiently prevented appearance of catecholamine release. These data demonstrated that the development and persistence of acute duodenal pain depends on the activation of Ca²⁺ ion flux leading to neurotransmitters release and modulation of membrane excitability. It seems that diltiazem given icv 10 min prior to DD (as a source of acute visceral pain), inhibited specific receptors α₁ subunits of VGCCs in target tissues, prevent depolarization of cell membranes and release of neurotransmitters responsible for pain sensitivity in sheep. The observed antinociceptive action of VGCCs type-L blockers suggests that these channels play a crucial role in the modulation of acute visceral pain in sheep.     

动物腹腔镜技术的应用研究进展

在国外,腹腔镜技术已经用于动物疾病诊疗、活体检查、组织取样、卵巢卵泡发育情况及局部解剖观察,以及辅助进行动物的人工授精、胚胎移植等;还可以进行犬、猫等动物的子宫、卵巢切除术、牛皱胃左方变位整复术等手术操作。在国内,动物腹腔镜技术起步较晚,目前仅局限于胚胎移植或人工授精过程中对卵巢卵泡发育情况的观察,或进行简单的操作。文章阐明了腹腔镜技术创伤小、恢复快、对机体影响小等优点,分析了目前动物腹腔镜技术相对滞后的原因,指明了该技术在动物上的应用前景。     

Laparoscopic Cryptorchid Castration in Standing Horses

Objective — This article describes a new technique for laparoscopic cryptorchid castration in standing horses. Study Design — Prospective study. Animals or Sample Population — Eight horses aged 11 months to 3 years and weighing between 300 and 643 kg. Methods — Food was withheld for 24 to 36 hours, and then horses were sedated with detomidine HC1 (0.02 to 0.03 mg/kg) and butorphanol tartrate (0.02 mg/kg). The paralumbar fossa region was desensitized with 2% mepivacaine in an inverted “L” pattern and caudal epidural anesthesia was administered with either xylazine (0.18 mg/kg diluted to 10 to 15 mL with 0.9% sodium chloride) or a combination of 2% mepivacaine and xylazine (0.18 mg/kg). Initial laparoscopic exploration was performed from the left flank; in three horses, right flank laparoscopy was needed to complete the procedure. The spermatic cord was ligated within the abdomen with one or two sutures of 0 polydioxanone suture, and the testis or testes removed through a flank incision. Results — In five horses with no palpably descended testes, standing laparoscopy was the only procedure performed, whereas in two horses, the abdominal testis was removed laparoscopically, and the descended testis was removed under short acting anesthesia. In one horse, with nonpalpable testes, it was determined by laparoscopic observation that the testes were in the inguinal canal, and castration was performed under general anesthesia. No surgical or postoperative complications were noted. The right side of the abdomen, and especially the right vaginal ring, could be easily observed from the left side by passing the laparoscope through a small perforation in the mesocolon of the descending colon or by elevating the descending colon with an instrument or by use of an arm in the rectum. Conclusions — The standing laparoscopic approach combined with or without short-acting anesthesia to remove the descended testis is easily performed. Clinical Relevance — This approach will provide surgeons with another option to castrate cryptorchid stallions.     

REPEATABILITY AND REPRODUCIBILITY OF TRANSABDOMINAL ULTRASONOGRAPHIC INTESTINAL WALL THICKNESS MEASUREMENTS IN THOROUGHBRED HORSES

The aims of this study were to assess the repeatability and reproducibility of transabdominal ultrasonography to assess intestinal wall thickness in adult Thoroughbred horses (n=8). Ultrasonographic cineloops were captured by one examiner from each horse for five consecutive days. During each examination at least three cineloops were obtained for five different intestinal tract locations. Measurements were performed by three separate observers to assess reproducibility and measured on three separate occasions by three observers to evaluate short‐term repeatability. The repeatability of measurements from the duodenum (0.3 ± 0.04 cm), jejunum (0.29 ± 0.05 cm), ventral colon (0.37 ± 0.01 cm), and cecum (0.42 ± 0.03 cm) were good ( P >0.291). The reproducibility of measurements from the duodenum, jejunum, and ventral colon were good ( P >0.394). Reproducibility of measurement of the cecal wall was inadequate ( P =0.01), although the maximum difference between observers was 0.07 cm. It was possible to image all areas on all days, with the exception of the duodenum, which could not be imaged in one horse, on 1 day. Equine intestinal wall measurements are therefore repeatable and reproducible with the exception of reproducibility of the measurements of cecal wall. Although an accepted clinical technique, measurement of cecal wall thickness from intestinal ultrasound images in a clinical setting must be interpreted with care.     

Laparoscopic hernioplasty in recumbent horses using transposition of a peritoneal flap

Objective— To evaluate the efficacy of a laparoscopic peritoneal flap hernioplasty (PFH) to close anatomically the vaginal ring and to evaluate its protective effect in horses with a history of strangulated inguinal hernia (SIH) against future herniation.
Study Design— Prospective study.
Animals— A first group of 5 ponies, 3 horses and 1 donkey with no history of SIH and a second group of 4 horses 'clinical cases' with a history of SIH.
Methods— A laparoscopic PFH was effected on all horses under general anaesthesia. Peritoneum ventro-lateral to the vaginal ring was elevated and cut on 3 sides, separated from the underlying muscle, then inverted and attached dorso-medially and laterally to the parietal wall using intra-corporeal stitches (6 cases) or laparoscopic staples (7 cases). Animals of the first group (n=9) underwent a standing laparoscopy 7 days post-operatively to visualize the vaginal rings. Horses of the second group were followed to confirm the absence of re-herniation.
Results— The laparoscopic check-up showed that the vaginal ring had been effectively and completely covered in all cases except the first one. No adhesions was observed. In the four clinical cases, none of the horses have had a reccurence of SIH at the time of writing (6 months to 4 years).
Conclusion— Laparoscopic hernioplasty on a recumbent horse is feasible by closing the vaginal ring with a peritoneal flap. This technique was efficient in our cases to prevent recurrence of SIH but more cases are needed. This technique may reduce inflammation and irritation of the spermatic cord, which could otherwise jeopardise the animal's breeding career.
Clinical Relevance— Laparoscopic PFH coud be used in horses with a history of SIH.     

Diagnostic laparoscopy in the horse

Laparoscopy was performed in 5 clinically normal horses. Abdominal fluid protein content and WBC count increased markedly in all horses. Necropsy findings were confined to an increased amount of slightly turbid abdominal fluid. Five examples of applications of laparoscopy in horses with abdominal problems indicated that laparoscopy can be a valuable diagnostic procedure in the horse.     

Lack of local anaesthetic efficacy of Sarapin® in the abaxial sesamoid block model

Sarapin® is a distillate of the pitcher plant that has long been used in human and veterinary medicine for'regional analgesia'. The mechanism of the reported analgesic response is unknown; however, the agent is purported to provide more effective analgesia for slow, chronic pain than for sharp, acute pain. Reportedly, Sarapin® is also widely used as an analgesic agent in the horse, generally in combination with corticosteroids and other agents. To determine its local anaesthetic efficacy in the horse, we tested Sarapin® in a unilateral abaxial sesamoid block model at two dose levels, 2 mL and 10 mL per site, respectively. Cutaneous pain was induced with a light/heat lamp, and analgesia was assessed by measuring the hoof-withdrawal reflex latency period. Neither dose of Sarapin® altered hoof-withdrawal reflex latency in this experimental model tested over a two-week period. Based on the demonstrated efficacy of this local anaesthetic model, it seems clear that Sarapin® has no significant classical local anaesthetic actions in the horse, and probably not in other species either.