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.     

The use of bipolar electrosurgical forceps for haemostasis in open surgical ovariectomy of bitches and queens and castration of dogs

Objectives

To describe a technique using bipolar electrosurgical forceps for haemostasis during open ovariectomy of bitches and queens and for castration of dogs and to determine whether these forceps reduced surgical time compared to ligation with suture.

Materials and Methods

Bipolar electrosurgical forceps were used for haemostasis in 3744 open surgeries including ovariectomies in bitches (n=1406) and queens (n=859) and castrations in dogs (n=1335). The forceps were also used to assist with ovariohysterectomy in bitches (n=89) and queens (n=55). The effect of bipolar electrocoagulation and other likely factors influencing surgical time was examined using linear regression analysis of 367 surgeries.

Results

The use of the forceps reduced surgical time by 9·7 ±2·8 minutes in bitches and by 3·0 ±1·5 minutes in queens. The complications encountered initially were small superficial skin burns requiring topical treatment and one case of haemorrhage associated with surgical technique.

Clinical Significance

Bipolar electrosurgical forceps reduce surgical time in ovariectomies, and complications are rare. This technique has promise for widespread application in veterinary practice to assist with haemostasis in ovariectomy of bitches and queens.     

Ovarian inhibition of peripheral plasma concentration of follicle stimulating hormone in prepuberal Holstein heifers

The objective of this study was to determine effects of age and castration on follicle stimulating hormone (FSH) secretion in prepuberal heifers. In experiment 1, twelve heifers were bilaterally ovariectomized at 3, 6, or 9 months of age (n = 4/group). Blood was collected at 10 min intervals for 8 hr at 1 week before ovariectomy and 1 and 4 weeks after ovariectomy. Frequency, amplitude and duration of FSH pulses were calculated. Mean plasma concentration of FSH (ng/ml), and frequency (pulses/8 hr), amplitude (ng/ml), and duration (min/pulse) of FSH pulses were not altered by age. Mean concentration of FSH increased (P less than .01) from 1 week before to 1 week and 4 weeks after ovariectomy, respectively, in all age groups. Pulse frequency increased (P less than .05) from 1 week before ovariectomy to 4 weeks after ovariectomy in 3 month old heifers, from 1 week before to 4 weeks after ovariectomy in 6 month old heifers, and from 1 week before to 1 week and 4 weeks after ovariectomy in 9 month old heifers. In experiment 2, twelve heifers were bilaterally ovariectomized at 3, 6 or 9 weeks of age (n = 4/group). Sample collection and measurement of mean concentration of FSH were the same as in experiment 1. Mean concentration of FSH increased (P less than .01) from 1 week before to 1 and 4 weeks after ovariectomy in heifers ovariectomized at 6 and 9 weeks of age.(ABSTRACT TRUNCATED AT 250 WORDS)     

Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation-volvulus

This prospective study describes a simple method of combining laparoscopic ovariectomy and laparoscopic-assisted prophylactic gastropexy and determines the duration of surgery, complications, and long-term outcome including prevention of gastric dilatation-volvulus (GDV). Laparoscopic ovariectomy and laparoscopic-assisted gastropexy were performed on 26 sexually intact female dogs susceptible to GDV. The mean surgery time was 60.8 ± 12.4 min. No GDV episode was seen during the study period (mean follow-up: 5.2 ± 1.4 y). All dogs had an intact gastropexy attachment assessed by ultrasonography at 1 y. Post-operative complications were minor and owners were satisfied with the procedure. Combined laparoscopic ovariectomy and laparoscopic- assisted gastropexy appears to be a successful and low morbidity alternative procedure to both ovariectomy/ovariohysterectomy and gastropexy via open ventral-midline laparotomy.     

Castration of the Vietnamese pot-bellied boar: 8 cases

Surgical techniques for castration of the Vietnamese pot-bellied boar and outcome are described. Vietnamese pot-bellied pig (VPBP) boars (n = 8) were admitted for castration. Data retrieved from medical records (2002–2011) for these pigs included signalment, history, reason for castration, perioperative management, surgical technique, and complications. Follow-up information was obtained from owners. A scrotal approach with closed technique was used for 6 boars with normally descended testes. A scrotal approach and open technique was used in 1 inguinal cryptorchid boar. In a hemicastrated abdominal cryptorchid boar an ipsilateral parainguinal approach was used. No complications occurred. Castration of the Vietnamese pot-bellied boar is associated with minimal complications and a satisfactory cosmetic outcome. We recommend the routine closure of the external inguinal rings, a simple and fast procedure that may prevent post-castration inguinal herniation.     

Laparoscopic ovariectomy in dogs: a comparison of the LigaSure™ and the SonoSurg™ systems

Objectives : The objective of this study was to evaluate the surgical times for removal of ovaries, and the frequency of intra‐operative complications with two different instruments used for canine laparoscopic ovariectomy. Methods : A randomised prospective clinical study. Laparoscopic ovariectomy was performed under general anaesthesia on 10 healthy female dogs admitted for elective ovariectomy. Each ovary was randomly assigned to removal by use of either a SonoSurg? ultrasonic surgical device (Olympus), or a LigaSure? vessel‐sealing system (Valleylab/Covidien). Surgical time for removal of each ovary was measured and the frequency of intra‐operative complications was recorded. A follow‐up was made by interview with the owners, 2·5 years after surgery. Results : The two techniques did not statistically differ with regard to surgical time, or frequency of complications. All owners were very satisfied with the procedure. Clinical Relevance : Both the SonoSurg? and the LigaSure? devices appear to be effective, safe and easy to use when performing laparoscopic ovariectomy in dogs.     

Strain differences in morphometrical characteristics of rat kidneys

To clarify the strain differences in the morphology of the rat kidneys, we investigated the morphometrical characteristics of the kidneys of Slc:Wistar, Slc:SD, and F344/NSlc rats. The diameter of the renal corpuscles in female F344/N rats is smaller than that in female Wistar rats. Although sex differences (males>females) were shown in SD and F344/N rats, no effects of castration were detected in any of the groups. Strain-dependent differences in the percentage of renal corpuscles with a cuboidal parietal layer were found in both male and female groups. The highest percentage of them was noted in male Wistar rats. Effects of castration were observed in female Wistar and male F344/N rats, and the values after castration were significantly higher than those in the intact animals. As for the number of proximal convoluted tubular nuclei, no strain differences were detected in either the male or female groups. Although a sex difference was found in SD rats (female>male), no effects of castration were detected in any of the groups. In female F344/N rats, numerous numbers of PAS-positive granules, which were observed in the proximal convoluted and straight tubular epithelia, were noted. Orchiectomy induced an increase of these granules in male SD and F344/N rats, but ovariectomy showed no effects on them in any strains. This is the first study to clarify the strain differences in the morphological characteristics of the kidneys in ordinary rat strains.     

Evaluation of common vaginal tunic ligation during field castration in draught colts

The objective of this study was to determine if ligation of the common vaginal tunic could prevent or reduce the incidence of omental herniation and eventration in draught colts undergoing routine field castration. It was found that common vaginal tunic ligation, while not completely preventing omental herniation and evisceration, significantly reduced the incidence of these complications and should be considered in those males deemed at increased risk of significant post castration complications.     

Routine castration in 568 draught colts: incidence of evisceration and omental herniation

REASONS FOR PERFORMING STUDY: Castration is one of the most common routine surgical procedures performed in the horse, from which a number of potential complications can arise. We undertook a prospective evaluation of short-term complications associated with castration of draught colts over a 3-year period (1998-2000). OBJECTIVES: To compare castration complications in a large number of draught foals with previously published literature. METHODS: Five hundred and sixty-eight draught colts, age 4 or 5 months, were castrated in field conditions. Foals were observed for complications for 24 h post operatively. RESULTS: There was no significant difference in complication rates between open and closed surgical techniques. Inguinal/scrotal hernia rate was 4.6% (26/568) prior to surgery, and evisceration of the small intestine occurred in 4.8% (27/568). Foals observed to eviscerate underwent immediate surgical correction with an overall survival rate of 72.2% (13/18). Omental herniation was seen in 2.8% (16/568) of colts. CONCLUSIONS: This study showed no difference between the closed and open techniques of castration and the rate of omental herniation or evisceration. The evisceration rate in combination with the omental and presurgical herniation rates approached 12.2%, which is high enough to warrant further examination. POTENTIAL RELEVANCE: Future investigation should help to assess predisposing factors for evisceration. Regardless of the technique employed, herniation appears to pose a significant risk to draught foals undergoing castration.     

Diagnosis, surgical treatment, and performance after unilateral castration in breeding bulls: 21 cases (1989-1999)

OBJECTIVE: To evaluate signalment, surgical treatment, postoperative complications, and future breeding success or semen production in a group of bulls with naturally occurring disease of the scrotum or testis. STUDY DESIGN: Retrospective study. ANIMALS: 21 bulls that underwent unilateral castration after evaluation for scrotal swelling. PROCEDURE: A computer-assisted search of medical records at 2 veterinary teaching hospitals was performed. Historical, diagnostic, surgical, and follow-up data were collected and analyzed for those bulls with scrotal swelling that underwent unilateral castration. RESULTS: Four of 5 pasture breeding bulls and 9 of 10 semen collection-center bulls successfully bred cows or produced viable semen within 6 months of surgery. Fourteen of 21 surgical procedures were performed after induction of general anesthesia. Sixty-six percent of procedures were performed as open castrations. Seventy-one percent of bulls developed postoperative complications, most of which were mild swellings. Unilateral castration returned 13 of 15 bulls with unilateral disease of the scrotum or testis to productive service by 6 months after surgery. CONCLUSION AND CLINICAL RELEVANCE: Unilateral castration is an effective treatment for unilateral disease of the,scrotum or testis in bulls, allowing return to reproductive function.     

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.     

Bilateral ovariectomy as a treatment for chronic pyometra in four horses

The objective of this retrospective study was to describe the use of bilateral laparoscopic ovariectomy without hysterectomy for chronic pyometra in horses. Four client-owned horses were included, each having chronic pyometra that was unresponsive to treatment. Bilateral laparoscopic ovariectomy was performed on the horses under standing sedation. A final uterine lavage was performed either 24 hours before or after surgery, with no further treatment of the uterus. No complications were encountered during surgery or post-operatively, and each horse had resolution of the pyometra without recurrence of clinical signs over at least 3 years. All owners were satisfied with the procedure. Following histopathology, one horse was found to be a true hermaphrodite, with one vestigial testis and one ovotestis. Ovariectomy alone was an effective treatment for four horses with chronic pyometra, without complications. Ovarian steroids and abnormal uterine or cervical conformation are important influences in the pathogenesis of pyometra, and removal of the hormone source via ovariectomy should be considered to avoid a more invasive surgery and the potential complications associated with ovariohysterectomy in horses.     

A Review of Laparoscopic Cryptorchidectomy

Laparoscopic cryptorchidectomy has provided the surgeon with an easy, efficient means of locating and castrating abdominally retained testes without the complications associated with routine open approaches. It is especially useful when the horse's castration history is unknown, or if previous attempts at cryptorchid castration have been made. With the direct visualization that laparoscopy provides, surgeons are able to visualize both vaginal rings for presence of intra abdominal and inguinal testis in addition to testicular remnants and adhesion formation from previous surgical manipulations. Furthermore, because it is minimally invasive, laparoscopy shortens patient confinement time and reduces postoperative complications such as eventration. With experience, it is a technically easy procedure and can safely be performed on anesthetized or standing sedated horses.     

Equine castration: review of anatomy, approaches, techniques and complications in normal, cryptorchid and monorchid horses

Complications associated with equine castration are the most common cause of malpractice claims against equine practitioners in North America. An understanding of the embryological development and surgical anatomy is essential to differentiate abnormal from normal structures and to minimise complications. Castration of the normal horse can be performed using sedation and regional anaesthesia while the horse is standing, or under general anaesthesia when it is recumbent. Castration of cryptorchid horses is best performed under general anaesthesia at a surgical facility. Techniques for castration include open, closed and half-closed techniques. Failure of left and right testicles to descend occurs with nearly equal frequency, however, the left testicle is found in the abdomen in 75% of cryptorchid horses compared to 42% of right testicles. Bilateral cryptorchid and monorchid horses are uncommon. Surgical approaches described for the castration of cryptorchid horses include an inguinal approach with or without retrieval of the scrotal ligament, a parainguinal approach, or less commonly a suprapubic paramedian or flank approach. Laparoscopic castration of cryptorchid horses has recently been described but the technique has limited application in practice at this time. A definitive diagnosis of monorchidism can only be made after surgical exploration of the abdomen, removal of the normal testis and hormonal testing. Hormonal assays reported to be useful include analysis of basal plasma or serum testosterone or oestrone sulphate concentrations, testosterone concentrations following hCG stimulation, and faecal oestrone sulphate concentrations. Reported complications of castration include postoperative swelling, excessive haemorrhage, eventration, funiculitis, peritonitis, hydrocele, penile damage and continued stallion-like behaviour.     

Comparison of the use of a braided multifilament transfixation suture for field castration with other castration techniques

Complications with castrations occur commonly and are usually not life-threatening, with the exception of evisceration or haemorrhage, which are uncommon. Primary closure castration (closing deeper tissue layers and skin) or use of a transfixation ligature alone to prevent evisceration has been recommended. The goal of this study was to investigate the use of a closed technique with multifilament suture for transfixation of the spermatic cord alone in field castrations. The results of this study support our hypothesis that a closed castration technique with a multifilament, transfixing ligature (No. 2 polyglactin 910) did not result in additional post-operative complications when compared with a closed castration technique without ligature placement or a primary closure castration technique in a hospital setting.     

Laparoscopic cauterisation of the testicular arteries to manage haemoperitoneum in a gelding

A Thoroughbred gelding had chronic episodic intra‐abdominal haemorrhage following standing castration, presumed to originate from a testicular artery. No coagulopathy could be detected and resolution of haemorrhage was achieved by laparoscopic electrocoagulation of both testicular arteries 6 weeks after castration. Blood drained from the abdomen during surgery was filtered then auto‐transfused. Post operative complications included pigmenturia, incisional pain and large colon impaction.     

Bilateral laparoscopic ovariectomy in standing mares: 22 cases

OBJECTIVE: To describe a technique for laparoscopic bilateral ovariectomy in standing mares and report the outcome of 22 clinical cases. STUDY DESIGN: Prospective study. ANIMALS OR SAMPLE POPULATION: A total of 22 mares between 4 and 23 years of age, weighing between 360 and 600 kg. METHODS: Mares with normal ovaries, as determined by palpation per rectum, were restrained in standing stocks and sedated with detomidine (0.01 to 0.02 mg/kg intravenously [i.v.]) and butorphanol (0.01 to 0.02 mg/kg i.v.). The laparoscope and instrument insertion sites were infiltrated with 2% lidocaine before incision. One laparoscope portal and two instrument portals were located in each paralumbar fossa. Ovariectomy was accomplished by intracorporeal dissection and ligation of the ovarian pedicles. The two instrument portals in each flank were ultimately connected resulting in a 4 to 5 cm laparotomy to facilitate ovarian removal. RESULTS: No major operative or postoperative complications occurred. Minor complications included incomplete hemostasis of an ovarian pedicle with a single ligature (three mares), transient inappetence, pyrexia and incisional infection. Owner satisfaction and cosmetic results were considered excellent. CONCLUSIONS: Standing laparoscopic ovariectomy appears to eliminate many of the potential complications associated with traditional surgical methods for ovariectomy and avoids the risk of general anesthesia. CLINICAL RELEVANCE: This technique requires minimal laparoscopic instrumentation and will provide surgeons with an alternative approach for bilateral ovariectomy in mares.     

Ventral Abdominal Approach for Laparoscopic Ovariectomy in Llamas

Objective —To evaluate a technique for laparoscopic ovariectomy by a ventral abdominal approach in the llama.
Study Design —Prospective evaluation.
Animal Population —Six healthy adult female llamas, aged 2 to 6 years.
Methods —Laparoscopic ovariectomy was performed with the llamas in a 30-degree Trendelenburg position. The mesovarium and proper ligament of the ovary were isolated, and two Hulka clips were placed in opposite directions across each mesovarium and proper ligament of the ovary. Ovaries were removed through either the instrument cannula or instrument portal.
Results —The ovaries, mesovarium, and proper ligaments of the ovaries were easily identified using laparoscopy by a ventral abdominal approach. The Hulka Clip Applicator was easy to use, and the Hulka Clips provided secure hemostasis of the vessels within the mesovarium. Mean duration of surgery was 35 minutes (range, 17 to 85 minutes). Two llamas were depressed after surgery but improved within 24 hours. No other complications occurred during an 18-month follow-up period.
Conclusions —Laparoscopic ovariectomy in the llama was facilitated by the use of Hulka Clips placed across the mesovarium and proper ligament of the ovary.
Clinical Relevance —Laparoscopic ovariectomy in the llama can be accomplished easily with few complications.     

Comparison of post-operative inflammatory response in horses undergoing elective castration treated preoperatively with ceftiofur crystalline free acid or procaine penicillin G

Castration is among the most common surgical procedures performed in the horse (Equus Caballus) and a variety of post-operative complications can occur. This study aims to determine if a single dose of long-acting ceftiofur crystalline free acid (CCFA) used as a preoperative antimicrobial in equine field castrations offers any reduction in post-operative inflammatory markers when compared to procaine penicillin G (PPG). Sixty-five horses aged 8 months to 2 years were randomly assigned to the CCFA (n = 33) or PPG (n = 32) treatment groups. Horses were castrated under general anaesthesia using a closed castration technique with removal of the median raphe. Quantitative and qualitative inflammatory markers were measured and short-term complications were recorded post-operatively on Days 3, 8 and 14. No clinically significant difference in any post-operative inflammatory markers between the CCFA and PPG group was detected. In the CCFA group, 48% of horses experienced short-term post-operative complications compared to 31% in the PPG group. Regardless of the preoperative treatment, castration induced significant elevation in serum amyloid A (P<0.0001), preputial oedema (P<0.0001) and scrotal oedema (P<0.0001) at Day 3. These values returned to baseline levels by Day 8. Horses with grade 3 or above preputial oedema had elevated serum amyloid A values (P<0.001). The data from this study indicate CCFA used as a preoperative antibiotic for routine castration offers no advantages over PPG. The difference in complication rate between groups is likely of minimal clinical importance, as all complications were mild and self-limiting.