Standing female equine urogenital endoscopic surgery.

Standing female urogenital endoscopic surgery is facilitated by the more dorsal location of the organs of the female reproduction tract. The most common reason for laparoscopic surgery on the female urogenital system is ovariectomy; however, the technique has been used to diagnose periparturient or reproductive diseases and to perform surgical embryo transfer. Standing surgical approaches avoid the risk and expense of general anesthesia, but these techniques are limited by the temperament and size of the patient and the availability of facilities for restraint. Owner acceptance of laparoscopic procedures is excellent. It is anticipated that standing endoscopic surgery may become the preferred technique for applicable procedures.     

Dorsally recumbent male equine urogenital endoscopic surgery.

Possibly no other development has revolutionized general surgery more dramatically than laparoscopic surgery in human patients. The development of instrumentation suitable for use in horses has allowed the veterinary surgeon to begin to introduce minimally invasive procedures. Clearly, in people, one of the greatest benefits is reduced patient morbidity and earlier return to function. The author's experience with laparoscopic procedures in the horse would tend to reinforce those observations. The most significant obstacle to widespread acceptance of minimally invasive surgery in the horse is possibly the veterinarian's reluctance to expend the funds necessary to purchase the necessary equipment as well as a hesitancy to abandon time-honored approaches to common surgical conditions. As a profession, veterinarians have been criticized for undervaluing their own services. Clearly, these new minimally invasive procedures can be successfully marketed if the advantages of the approaches in terms of patient well-being are impressed on the client.     

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.     

Standing urogenital surgery

Caslick's, episioplasty, urethroplasty, cervical, and rectovestibular laceration repair are, by preference, performed in the standing patient. Normal castration is performed routinely uneventfully in the standing patient. The duration of the procedures and the ease with which they are accomplished in a standing horse of normal temperament make general anesthesia unnecessary. More invasive procedures, such as removal of urinary bladder calculi in male horses or removal of a neoplastic ovary in a mare, can be accomplished in a standing patient but serious consideration should be given to the use of general anesthesia. For these procedures, the potential complications are increased while the ability to effectively deal with those complications is diminished in a standing patient. For instance, imagine a mare that lays down in the stocks during a standing flank removal of an ovary or a stallion that defecates during a Gokel's approach to the bladder. Only extenuating circumstances justify these risks when general anesthesia is available.     

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.     

Standing endoscopic electrosurgery.

Common equine upper respiratory conditions are diagnosed via endoscopy. Endoscopic surgery facilitates correction of many conditions without general anesthesia or laryngotomy, reducing the morbidity and cost of the procedures. Modalities of endoscopic surgery include the Nd-YAG laser or electrosurgery, which may be complementary. The least expensive method is electrosurgery, and instruments are available that can be passed through the biopsy channel of the endoscope. Conditions amenable to such procedures include entrapped epiglottis, rostral displacement of the palatopharyngeal arch, pharyngeal cysts or polyps, retropharyngeal abscesses within the guttural pouch, guttural pouch tympany, and ethmoid hematoma.     

Standing laparoscopic surgery.

Laparoscopic procedures can replace many more invasive procedures. Guided visceral biopsy, cryptorchid castration, ovariectomy, and limited abdominal exploration may be done laparoscopically in the standing horse.     

Standing musculoskeletal surgery.

Indications for performing orthopedic surgery on the standing horse include inability to tolerate general anesthesia, risk of worsening an injury during recovery from anesthesia, and cost. The surgeon should be aware that performing surgery in the standing horse can be more demanding and require more experience than the same procedures when the time and convenience of general anesthesia are available. Improved sedatives and analgesics have allowed more latitude because the horses now are more tolerant than when older agents were used. Common sense should be applied to each situation before the decision is made to do a procedure, because every horse and problem is unique.     

Standing abdominal surgery.

Safe, effective surgery can be performed in the standing, conscious horse using a combination of mechanical and chemical restraint. Clear indications for performing standing abdominal surgery exist, but many procedures are best performed under general anesthesia. The preferred approach involves a modified grid incision of the left paralumbar fossa. Flank celiotomy allows the surgeon to thoroughly explore the abdominal cavity, but few structures can be exteriorized, and visibility of abdominal contents is poor. Indications for standing abdominal surgery include diagnosis of abdominal masses, drainage and biopsy techniques, correction of left dorsal displacement of the large colon, and evaluation of rectal injuries, and performing loop colostomy techniques, laparoscopy, removal of retained testicles, correction of uterine torsions, surgical embryo transfer, ovariectomy in normal mares, and some experimental procedures. Standing surgical techniques are most useful and appropriate for surgical exploration, to correct uterine torsions, and to perform loop colostomy and surgical embryo transfer techniques. Perioperative antimicrobial and antiinflammatory therapy is recommended. Mild discomfort and ventral incisional swelling after surgery are expected.     

Standing rectal and tail surgery.

A variety of rectal, perirectal, and coccygeal surgeries can be performed in the standing equine patient if appropriate chemical and physical restraints are available and adequate regional anesthesia can be achieved. Some rectal tears and most rectal prolapses, mass lesions, perirectal abscesses, rectal biopsies, and selected injuries of the tail can be managed without prohibitive difficulty. Severe injuries that compromise the small colon cranial to the peritoneal reflection may require flank laparotomy, midline celiotomy, or humane euthanasia to manage the disease process effectively and appropriately. The foremost perioperative consideration beyond the use of effective restraint is the management of tenesmus in horses with rectal tears or prolapses. Medications to control bowel motility, epidural anesthesia, antiinflammatory analgesics, and topical compounds adequate to soothe and lubricate inflamed rectal tissues are an important adjunctive therapy in the aftercare of these surgical patients. Of nearly equal importance is the requirement that a loose fecal consistency be maintained with laxative diets, psyllium, and mineral oil. Failure to maintain a loose consistency of stool after treatment of these conditions may lead to rectal impaction or incisional dehiscence and surgical failure.     

Gastrointestinal endoscopic surgery.

A working knowledge of normal endoscopic anatomy and the effects of positioning must be mastered to take advantage of endoscopic procedures involving the gastrointestinal system. Endoscopic procedures involving the gastrointestinal system offer advantages over conventional surgery in that they are less invasive and provide direct visualization. Laparoscopy can be used to evaluate horses with abdominal pain before and after surgery. It can be used to evaluate and biopsy abdominal masses and parenchymal organs such as the spleen, liver, and kidney. Endoscopic gastrointestinal surgical procedures such as colopexy and adhesionolysis are limited at this time but should continue to be developed as instrumentation and technology evolve.     

Standing surgery of the neck and thorax.

Many surgical procedures of the head and neck can be safely performed in the standing horse, with easy access to all aspects of the surgical field. Some procedures, such as tracheotomy, are easier to perform with the horse standing with the head in a more natural position than with the horse under general anesthesia. Procedures of the neck and thorax that require evacuation of purulent and necrotic material from confined spaces, such as occur in horses with esophageal ruptures and extensive intrathoracic abscesses, can be done as standing procedures to avoid the risks of general anesthesia on severely debilitated patients.     

Standing laser surgery of the head and neck.

The use of carbon dioxide and Nd:YAG lasers has expanded the capabilities of equine surgeons. These lasers are used to incise, vaporize, and coagulate tissue with minimal hemorrhage and reduced morbidity to the patient. In this article, practical fundamentals of laser surgery are briefly reviewed, and selected standing laser procedures of the head and neck are discussed.     

Dorsally recumbent urinary endoscopic surgery.

Laparoscopic cystotomy is the method of choice for treatment of a cystic calculus in the horse. The main advantage of this procedure over others is the excellent ability to view and gain operative access to the urinary bladder. This article describes the procedure, including techniques, instrumentation, preoperative and postoperative care, and complications.