Desmotomy of the Accessory Ligament of the Deep Digital Flexor Tendon in Horses: An Update

Desmotomy of the accessory ligament of the deep digital flexor tendon is advocated to allow for lengthening of the deep digital flexor musculotendinous unit and axial realignment of the bones of the digit. This procedure has several indications. It can be performed using either the open or the minimally invasive surgical approach. This article describes both surgical approaches. Corrective shoeing before surgery contributes to success in both surgical approaches. The cosmetic results obtained after the minimally invasive procedure are much better as compared with those after the open surgical procedure. The minimally invasive approach compares favorably with results reported after using an open surgical approach and offers the advantages of minimally invasive surgery including reduced incision length, reduced morbidity, and improved cosmetic outcome. The minimally invasive approach may be also performed on the standing sedated horse.     

Hand-assisted laparoscopic ovariohysterectomy in the mare

OBJECTIVE: To develop a minimally invasive, hand-assisted laparoscopic ovariohysterectomy (HALS-OHE) technique in the mare and to evaluate safety and any associated complications. STUDY DESIGN: Experimental study. ANIMALS: Eight, 11-24-year-old mares with anatomically normal urogenital tracts. METHODS: The surgical technique was developed in 2 non-survival mares and subsequently evaluated in 6 survival procedures. Food was withheld for 48 hours, then mares were anesthetized and positioned in dorsal recumbency for laparoscopic surgery. A hand access device (Omniport) was placed followed by 4 laparoscopic portals. Transection of the ovarian pedicles and broad ligaments was achieved using a combination of a laparoscopic stapling instrument (Endo GIA II), an ultrasonically activated instrument (Harmonic Scalpel), and endoscopic clips (Endo Clip II ML). The genital tract was exteriorized through the laparotomy, and the uterus transected and sutured in a conventional pattern. Horses were evaluated through postoperative day 14 when a necropsy was performed. RESULTS: Four mares recuperated well after surgery, 1 mare was euthanatized because of bilateral femur fracture during anesthetic recovery, and another developed severe pleuropneumonia. At necropsy all but 1 abdominal incision was healing routinely. One mare had abscessed along the celiotomy incision and developed visceral adhesions. Uncomplicated healing of transected mesovarial, mesometrial, and uterine remnants was observed. CONCLUSIONS: Ovariohysterectomy in horses can be accomplished using HALS technique. CLINICAL RELEVANCE: HALS-OHE technique represents a minimally invasive and technically feasible alternative for conventional OHE. Careful patient selection and preparation may reduce the complications observed. The HALS technique may be useful in other laparoscopic surgical procedures.     

Recent advances in soft tissue minimally invasive surgery

Advancements in soft tissue minimally invasive surgery have been rapid and comprehensive since its inception in human medicine approximately 25 years ago. From its origins in traditional laparoscopy, followed rapidly by video‐assisted thoracoscopic surgery, minimally invasive surgery in human medicine has evolved through a number of different platforms that now include single‐port approach devices, robotic surgery as well as natural orifice transluminal endosurgery. Whilst some of these remain beyond the reach of veterinary medicine for now, largely because of technical challenges and the prohibitive costs of some single‐use disposable components, veterinary minimally invasive surgery is advancing rapidly allowing our small animal patients to benefit from some of the many documented advantages that a minimally invasive approach affords the patient .     

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.     

The Use of Pneumatic Impact Lithotripsy in a Laparoscopic Retrieval Pouch for Removal of Large Cystoliths in Two Female Horses

Two mares, aged 15 and 21 years, were examined because of urinary incontinence, intermittent hematuria, and urine scalding. On admission of both horses, physical parameters were within normal limits and urine scalding of the skin at the ventral perineum was noted. Transrectal palpation and cystoscopy revealed a large type I cystolith (>10 cm) with associated hyperemia and focal ulceration of the bladder mucosa. In horse 1, hemogram, serum biochemical analysis, and renal ultrasound were not performed because of owner finances. In horse 2, results from hematological and serum biochemical analysis were unremarkable and renal ultrasonography did not reveal any abnormalities. Pneumatic impact lithotripsy in a laparoscopic retrieval pouch was performed under cystoscopic guidance after caudal epidural anesthesia, with the horses standing and under sedation. A laparoscopic retrieval device was passed alongside a flexible endoscope into the urinary bladder and the cystolith was manipulated into the pouch. A customized single stainless-steel rod scaler attached to an air compressor was used for fragmentation of the cystolith contained within the retrieval pouch. Lithotripsy time was 42 minutes for horse 1 and 31 minutes for horse 2. Both horses were released from hospital the day of surgery. Both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 27 and 19 months for horse 1 and horse 2, respectively. Pneumatic impact lithotripsy in a laparoscopic retrieval pouch provided a time-efficient and minimally invasive surgical treatment option for removal of large cystoliths in mares.     

Cystic intra-abdominal testicles: Standing laparoscopic removal in two colts

This case report describes the laparoscopic approach for removal of cystic intra-abdominal testicles in the standing colt. One 3-year-old Tobiano and one 2-year-old Warmblood colts were referred for abdominal cryptorchidectomy. The horses were clinically and ultrasonographically examined and a presumptive diagnosis of unilateral abdominal cryptorchidism was made. A laparoscopic approach via the flank was used to localise each abdominal testicle. In both colts the abdominal testicle was enlarged and cystic. Each spermatic cord was ligated and fluid was aspirated from the testicle. By reducing the size of the mass minimally invasive removal through an enlarged instrumental portal was possible. Histopathology revealed a cystic rete testis in the Tobiano and a teratoma in the Warmblood. In these cases the cystic enlarged testicles were nonpainful and were incidental findings. A cystic testicle might be developmental (Tobiano case) or arise due to neoplastic transformation (Warmblood case). The laparoscopic approach for enlarged cyst-like testicles in the standing horse offers a secure minimally invasive method for removal.     

The use of lasers for treatment of upper respiratory tract disorders.

Lasers have become important tools for the equine surgeon in the treatment of upper respiratory tract disease in the horse. Multiple wavelengths and delivery systems are available. Indications for the use of lasers in the upper respiratory tract primarily include minimally invasive procedures not possible with conventional surgical instrumentation. New applications for the use of lasers to treat upper respiratory disease are likely to evolve with the development and introduction of new wavelengths and delivery systems.     

Removal of a metallic foreign body from the tongue of three horses

The objective of this case report is to describe the diagnostic and surgical techniques for removal of a metallic foreign body in the tongue of three adult horses. The three horses were presented for evaluation and treatment of dysphagia and marked hypersalivation of 3–5 days duration. Radiographs of the head revealed the presence of a metallic foreign body in the tongue of each horse. The foreign bodies could be precisely localised under general anaesthesia using palpation and lingual ultrasonography and/or lingual radiography in combination with a forceps as a marker. The foreign bodies were successfully removed using laparoscopic instruments creating minimal soft tissue trauma. The use of long (43 cm) small laparoscopic (5 mm) instruments enabled good visualisation of the surgical field, providing optimal conditions for successful minimally invasive surgical treatment of horses with foreign bodies in the tongue. The three horses made uneventful recoveries and 12 months after surgery were eating normally and could be ridden with a bit as per usual routine. It was concluded that using long laparoscopic instruments in combination with palpation, ultrasonography and/or radiography allowed removal of the foreign body creating minimal soft tissue trauma and allowing optimal conditions for a fast recovery.     

Laparoscopic ovariectomy and ovariohysterectomy in llamas and alpacas.

The minimally invasive nature of laparoscopic techniques and shorter convalescent periods have made these techniques increasingly popular for use in New World camelids (llamas and alpacas). This article outlines the instruments and steps needed to perform laparoscopic surgery on the female reproductive tract in llamas and alpacas.     

LAPAROSCOPIC SONOGRAPHY IN THE URINARY SYSTEM

This work reports the use of laparoscopic-transducer sonography for the examination of the urinary system in a swine model. Animals underwent a two-phase study. In the first phase, the urinary system was examined using laparoscopic sonography. In the second a partial ureteral obstruction was induced, and sonographic changes were recorded and evaluated. Sonography was used to evaluate kidneys, ureters, and bladder. Anatomic structures were evaluated and the following pathological findings were identified: renal cysts, one polycystic kidney, dilation of the renal pelvis, hydronephrosis, and one perirenal pseudocyst. Where necessary, contrast digital fluoroscopy (excretory urography and retrograde ureteropyelography) was also performed. Laparoscopic sonography mainly is used for evaluation prior to laparoscopic surgery to guide decisions relating to surgery. The quality of the images obtained laparoscopically is superior to that of percutaneous or transabdominal images, because artifacts are reduced and the contact surface of the transducer is placed directly over the study area. Laparoscopic sonography proved highly effective for studying renal and ureteral disorders prior to minimally invasive surgery.     

Diode laser and endoscopic laser surgery.

Two functionally important differences exist between the diode laser and the carbon dioxide (CO2) laser (used more commonly in small animal surgery). Diode laser energy is delivered through a quartz fiber instead of being reflected through an articulated arm or waveguide. Quartz fibers are generally more flexible and resilient than waveguides and can be inserted through an endoscope for minimally invasive procedures. Laser-tissue interaction is the other significant difference. The CO2 laser is completely absorbed by water, which limits the effect to visible tissue. The diode wavelength is minimally absorbed by water and may affect tissue as deep as 10 mm below the surface in the free-beam mode. With proper respect for the tissue effect, these differences can be used to the advantage of the patient.     

Intestinal surgery in small animals: historical foundations,current thinking,and future horizons

Intestinal wounds require precise closure after intestinal biopsy, enterotomy, or enterectomy in small animals. Preexisting factors such as intra‐abdominal sepsis and hypoalbuminemia as well as poor surgical technique increase the risk of intestinal dehiscence, with considerable negative impact on patient morbidity and mortality. Live dog studies have demonstrated the dangers of mucosal eversion especially in the septic abdomen. Approximating patterns preserve luminal diameter, heal optimally, and have equal bursting strength compared with inverting patterns after 24 hours. Simple interrupted and simple continuous suture patterns and disposable skin staples are established alternatives for manual wound closure. Knotless quilled suture currently used in laparoscopic gastropexy techniques shows bursting strength equal to monofilament sutures in dog cadaveric intestine. Dehiscence rates with hand sewn vs titanium automated stapling anastomosis are similar in uncomplicated cases; however, auto stapling devices may be the preferred method of anastomosis when preexisting abdominal sepsis is present and when patient size allows it. Regardless of the technique, current standard of care involves leak testing and omental wrapping, followed by early postoperative feeding. The past decade has ushered in an exciting new era of laparoscopic assisted techniques that have the potential to reduce postoperative pain and patient morbidity. An understanding of these applications will establish the future of minimally invasive small animal intestinal surgery for veterinary specialists. In summary, surgeons have a variety of methods at their disposal for optimal clinical outcome in small animal intestinal surgery.     

Surgical approaches to the equine abdomen

Factors to consider when deciding on a surgical approach to explore the abdomen of a horse include facilities and equipment available, experience of the surgeon, temperament of the horse and the necessity for cosmesis. An approach performed with the horse standing may be necessary when anaesthesia or recovery from anaesthesia is considered risky or when the owner imposes a financial limitation that does not allow surgery to be performed with the horse anaesthetised. Approaches performed with the horse standing include the flank and colpotomy approaches. Each approach has benefits and risks inherent to it.     

Transcatheter intravascular stent placement to relieve supravalvular pulmonic stenosis

Valvular pulmonic stenosis has been successfully treated in dogs via minimally invasive transcatheter balloon dilation procedures for almost 20 years. Supravalvular pulmonic stenosis however is not amenable to balloon dilation procedures. Although several surgical procedures are described for treatment of pulmonic stenosis, the morbidity and mortality of these procedures are significantly higher than for transcatheter approaches.Two cases of supravalvular pulmonic stenosis are presented, one acquired and one congenital, which were successfully treated with transcatheter intravascular stent placement. The procedure alleviated the stenotic lesion and resolved clinical signs.     

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 novel wireless data acquisition system for the measurement of hoof accelerations in the exercising horse

REASONS FOR PERFORMING STUDY: A device is needed to safely and wirelessly evaluate accelerations experienced by the horse hoof under a variety of surface conditions with the horse exercising at training or racing speeds. OBJECTIVES: To develop a miniaturised wireless data acquisition system (WDAS) which reliably records hoof accelerations and the times over which they occur in a minimally invasive manner in the exercising Thoroughbred. METHODS: The following criteria were set for device development: production of a lightweight and minimally invasive system, which provides an adequate acceleration range, appropriate frequency response to capture high speed events, and compatibility with a low power wireless telemetry system. Following device development, the WDAS was calibrated, and tested in 6 Thoroughbred horses over a variety of surfaces. RESULTS: Collection of acceleration in seven trials using 6 horses over a variety of surfaces resulted in repeatable acceleration data with respect to the overall characteristic shape of the impact profile. Impact accelerations varied with surface, ranging 34.8-191.7 g. Accelerations on take off were in a similar range, although higher in some trials. Peak impact accelerations tended to larger over the grass paddock surface, than either the indoor arena or the dirt track. During dirt track trials, accelerations on take-off were often comparably larger than those observed on impact within the same footfall. CONCLUSIONS: This study reports the development of a wireless system that successfully measures hoof acceleration in a minimally invasive manner over a variety of surface and exercise conditions. POTENTIAL RELEVANCE: The WDAS will be used in further studies to evaluate various components of the horse-racetrack interface, in an attempt to identify risk factors for musculoskeletal injury in the Thoroughbred racehorse.     

Equine Embryo Sexing and Ultrasonographic Foetal Sexing – Interests and Applicability

The ability to choose the sex of the offspring is of upmost economic importance for horse breeders. Unlike other species, horses present several reproductive peculiarities that interfere with assisted reproductive technologies used in other large animals (such as bovine) and make them difficult to apply. Thus, there is a great interest to determine the sex of the offspring as soon as possible. This has led to the development of several technologies to serve this purpose, which can be classified into two categories. One is equine embryo sexing by either non‐invasive biotechnological methods, such as monitoring of X‐linked enzymes before X chromosome inactivation and detection of sex‐specific antigen, or by invasive biotechnological methods, such as cytogenetic analysis and polymerase chain reaction (PCR). The other one is equine foetus sexing using ultrasound scanning in different stages of its development (early, mid or late), by different approaches (transrectally or transabdominally). This can be performed with classic B‐mode ultrasound machines or using 3D‐mode and Doppler‐mode scanners. This review article offers a comprehensive overview of the current status of these procedures as well as an assessment of their interests and applicability.     

SINGLE PORT LAPAROSCOPIC-ASSISTED OVARIOHYSTERECTOMY IN 3 RABBITS

Single incision laparoscopic surgery (SILS) involves only a single 2-3 cm incision in the ventral midline of the patient with entry of the port, particularly the foam SILS Port multiple access port. This type of minimally invasive surgery using only 1 port and a controlled Hasson approach provides decreased risk of iatrogenic abdominal viscera penetration. This SILS Port (Covidien, Medtronic, Minneapolis, MN) also allows easy transition of instruments, telescope, and bipolar electrocautery devices amongst the 3 built-in cannulae for ideal triangulation for each side of the patient. In these 3 cases, the body wall incision length was reduced as compared to an open technique, involved fewer incisions as compared to a multiple port access technique, and subjectively proposed less risk to the cecum with the foam port. The median surgery time was 50 minutes (45-55 minutes), and no intraoperative or immediate postoperative complications were encountered in this series. The purpose of this clinical technique article is to describe and illustrate the laparoscopic-assisted ovariohysterectomy procedure via SILS for the domestic rabbit.     

Minimally invasive desmotomy of the accessory ligament of the deep digital flexor tendon in horses

This retrospective study describes ultrasound guided desmotomy of the accessory ligament of the deep digital flexor tendon in 35 cases, and a modification of this procedure using an adapted surgical instrument. The procedure was successful in 97% of cases. Wound healing was excellent in all except 4 cases. Corrective shoeing prior to surgery contributes to success. The procedure can be performed on the standing horse and offers the advantages of minimally invasive surgery which include: reduced incision length, reduced morbidity and improved cosmetic outcome. The adapted surgical instrument can be an alternative to isolate the ligament under ultrasound guidance.     

Bilateral intracorporeally sutured inguinal herniorrhaphy using 3-dimensional laparoscopy in a dog

A 7-month-old, intact male, mixed breed dog with bilateral inguinal hernias underwent general anesthesia for laparoscopic bilateral inguinal herniorrhaphy via a 3-port approach. A 3-dimensional laparoscopic system was used to perform the procedure immediately following prescrotal open castration. Intracorporeal suturing with polypropylene was performed, and 2 cruciate sutures were placed to close each inguinal ring. The caudal aspect of each inguinal ring was left slightly open so as not to disrupt the passage or patency of vessels and nerves. No intra- or post-operative complications occurred. One year after surgery, the dog has no evidence of recurrence of the inguinal hernias.Key clinical message:This case report demonstrates a novel minimally invasive approach to inguinal herniorrhaphy in a dog with no reported complications and a good long-term outcome. Intracorporeally sutured inguinal herniorrhaphy is feasible in dogs with good results, although additional cases are needed to gain experience with this technique in dogs with varying presentations of inguinal hernias.