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.     

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 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.     

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.     

Standing Laparoscopic Ovariectomy Technique with Intraabdominal Dissection for Removal of Large Pathologic Ovaries in Mares

Objective: To describe a standing laparoscopic ovariectomy technique with intraabdominal ovarian dissection inside a specimen retrieval bag for removal of large pathologic ovaries through small incisions. Study Design: Case series. Animals: Mares (n=43) aged 2–21 years and weighing 380–680 kg. Methods: Unilateral laparoscopic ovariectomy was performed on 43 standing sedated mares. Ovaries were approached via 3 portal sites, 2 in the paralumbar fossa and a 3rd between the 17th and 18th ribs on the ipsilateral side. Ovaries were dissected free using either a LiNA Tripol‐bipolar laparoscopic forceps or a Ligasure™ Vessel Sealing Device and removed by enlarging the proximal portal site ventrally using a grid technique. Use of a plastic specimen retrieval bag and cannula suction device facilitated intraabdominal dissection of very large ovaries into 2 or more pieces, before removal through small incisions. Results: Regardless of size, all ovaries were removed successfully through small incisions (range, 5–10 cm), with no major complications and an excellent cosmetic result. All sport horses returned to previous levels of work or higher, with 93% of breeding mares successfully bred in the 1st season after surgery. Conclusions: Large pathologic ovaries can be easily and safely removed by standing laparoscopic ovariectomy on the mare. Clinical Relevance: Standing laparoscopic ovariectomy combined with a small flank incision is a safe and highly effective technique for removal of large pathologic ovaries in the mare, negating the requirement for general anesthesia or large incisions.     

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.     

Intraoperative pain responses following intraovarian versus mesovarian injection of lidocaine in mares undergoing laparoscopic ovariectomy

OBJECTIVE: To compare intraoperative pain responses following intraovarian versus mesovarian injection of lidocaine in mares undergoing laparoscopic ovariectomy. DESIGN: Randomized controlled trial. ANIMALS: 15 mares between 4 and 20 years old. PROCEDURE: Standard bilateral laparoscopic ovariectomy was performed. Prior to manipulation of the ovary, 2% lidocaine (10 mL) was injected into the ovary and saline (0.9% NaCI) solution (10 mL) was injected into the mesovarium on 1 side, with saline solution (10 mL) injected into the ovary and 2% lidocaine (10 mL) injected into the mesovarium on the other side. Presence (yes vs no) and severity (visual analogue scale) of pain were scored at 5 times (grasping of the ovary, dissection of the mesosalpinx, tightening of the first loop ligature, tightening of the second loop ligature, and transection of the ovarian pedicle) by 2 individuals blinded to treatment and each other's observations. RESULTS: During 4 of the 5 observation periods, significantly fewer mares had signs of pain following mesovarian injection of lidocaine, and during 2 of the 5 observation periods, visual analogue scale score was significantly lower. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that mesovarian injection of lidocaine is associated with significantly lower pain responses, compared with intraovarian injection, in horses undergoing laparoscopic ovariectomy.     

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.     

Evaluation of a Motorized Morcellator for Laparoscopic Removal of Granulosa‐Theca Cell Tumors in Standing Mares

Objective: To describe a motorized morcellator technique for laparoscopic removal of granulosa‐theca cell tumors (GCT) in standing mares and to evaluate long‐term outcome. Study Design: Case series. Animals: Mares (n=7) aged 4–15 years, with unilateral GCT. Methods: Tumor size was determined by transrectal palpation and ultrasonography. Standing sedated mares had 3 laparoscopic portal sites in the paralumbar fossa. After laparoscopic observation of the GCT, the mesovarium was desensitized, the ovarian pedicle transected with a LigaSure^® device, and the ovary grasped with forceps and cut in cylindrical tissue blocks using a motorized morcellator. Tissue blocks were removed through the laparoscopic sleeve. Outcome was determined by telephone interview of owners 6–40 months after surgery. Results: Estimated ultrasonographic median GCT diameter was 17 cm (range, 10–22 cm). Surgical time was 2–4.5 hours. There were no surgical complications. Two mares had mild subcutaneous emphysema at the portals after surgery. Convalescence was short, owners were satisfied with cosmetic outcome, and clinical signs associated with GCT did not recur. Conclusion: The motorized morcellator allows piecemeal removal of large GCT through a relatively small laparoscopic portal. Surgical complications were rare and the cosmetic outcome is favorable. Clinical Relevance: A motorized morcellator is a safe and minimally invasive technique for laparoscopic removal of GCT in mares.     

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.     

Ligature slippage during standing laparoscopic ovariectomy in a mare

Suture ligature failure is a potential complication during laparoscopic ovariectomy techniques utilizing ligatures as a means of hemostasis. This complication in the standing mare and the successful use of laparoscopic electrosurgical instrumentation as the sole means of providing hemostasis to the mesovarium of a mare are described.     

Evaluation of Single-Incision Laparoscopic Ovariectomy in Standing Mares

Our objective was to compare the invasiveness of single-incision laparoscopic surgery (SILS) and multiport laparoscopic surgery (MLS) for ovariectomy in 5 standing healthy adult Thoroughbred mares. First, laparoscopic ovariectomy was performed by SILS or by MLS on the right paralumbar fossa region in a standing mare. One month after surgery, ovariectomy by the other method was performed on the left side. For surgery evaluation, the surgical time, length of incision, and amount of lidocaine used were recorded and compared between SILS and MLS. Physical examination (body temperature, heart rate, and respiration rate) and hematology (number of leukocytes and hematocrit) were performed before surgery and every day for 7 days after surgery. Similarly, the degrees of swelling, heat, pain, and incisional wound healing were evaluated (grades1-4). The length of incision and amount of local anesthetic for SILS were significantly less than those for MLS. Moreover, the scores for swelling, heat, and pain in the SILS group tended to be lower than those in the MLS group for several days after surgery. We concluded that SILS was less invasive than MLS and is therefore useful for ovariectomy in mares.     

Laparoscopic adrenalectomy for treatment of unilateral adrenocortical carcinomas: technique, complications, and results in seven dogs

Objective— To investigate the feasibility of, and outcome after, laparoscopic adrenalectomy in dogs with unilateral adrenocortical carcinoma.
Study Design— Case series.
Animals— Dogs (n=7) with Cushing's syndrome caused by unilateral adrenocortical carcinoma.
Methods— Laparoscopic adrenalectomy with the dog in lateral recumbency on the unaffected side. Three 5-mm portals (1 laparoscopic portal, 2 instrument portals) were placed in the paralumbar fossa. A fourth instrumental portal (5–12 mm) was placed above the kidney. After dissection and hemostatic control of the phrenicoabdominal vein, the adrenal gland was carefully dissected or when there was capsule fragility, necrotic content was partially aspirated. The remaining glandular tissue was removed through the 12-mm trocar site.
Results— Dogs with unilateral adrenocortical carcinoma (3 right-sided, 4 left-sided) without invasion of the caudal vena cava were successfully operated by laparoscopic approach. There were no significant intraoperative complications; 2 dogs died within 48 hours of surgery because of respiratory complications. Five dogs were discharged 72 hours after surgery, and signs of hyperadrenocorticism disappeared thereafter (survival time ranged from 7 to 25 months).
Conclusions— Laparoscopic adrenalectomy is feasible in dogs with either right- or left-sided adrenocortical carcinoma not involving the caudal vena cava.
Clinical Relevance— When performed by experienced surgeons, laparoscopic adrenalectomy offers a minimally invasive alternative to open laparotomy or retroperitoneal surgery for the treatment of unilateral adrenocortical carcinoma in dogs.     

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.     

Standing hand‐assisted laparoscopic removal of large granulosa cell tumours in horses using a specimen retrieval bag and morcellator

This report describes a method for removal of large granulosa cell tumours through small paralumbar incisions using laparoscopic dissection of the mesovarium and subsequent removal of the ovary in a sterile retrieval bag via morcellation. Morcellation allows division of the granulosa cell tumour and subsequent reduction of incision size required for removal. The use of a specimen retrieval bag prevented contamination of the abdomen and incision with tumour cells during activation of the morcellator.     

Equine nonneoplastic abnormal ovary in a draft mare with high serum anti-Müllerian hormone: a case study

We performed a standing hand-assisted laparoscopic ovariectomy in a draft mare that presented with high serum anti-Müllerian hormone (AMH) level and had an enlarged single cystic ovary. Histopathological examination revealed no tumor cell proliferation in the ovary, but the presence of a large ovarian cyst was confirmed. In the diagnosis of abnormal ovaries in mares, a comprehensive assessment should be performed, including the monitoring of ovarian morphology and biomarkers over time, to determine the disease prognosis and treatment plan. The case of this mare with a nonneoplastic abnormal ovary and increased serum AMH level was rare. We suggest that standing hand-assisted laparoscopic ovariectomy is useful for the removal of large ovaries in draft mares.     

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.     

Hand-assisted laparoscopic left nephrectomy in standing horses

OBJECTIVE: To describe a hand-assisted, laparoscopic technique to remove the left kidney in standing horses. STUDY DESIGN: Prospective evaluation. ANIMALS: Eight horses. METHODS: Food was withheld for a minimum of 12 hours. Horses were sedated with detomidine hydrochloride (0.01-0.02 mg/kg, intravenously) and restrained in standing stocks. The left paralumbar fossa was prepared for surgery, and the surgical site was infiltrated with 2% mepivacaine. Hand-assisted, laparoscopic removal of the left kidney was performed through an incision in the center of the paralumbar fossa; the surgeon's hand was used to isolate the left kidney and associated vasculature. The renal artery and vein were isolated and individually ligated. After vessel transection distal to the ligatures, the left kidney was exteriorized, the ureter ligated and transected, and the incision closed. RESULTS: Laparoscopic removal of the left kidney was successfully performed in all horses. Retroperitoneal infiltration of local anesthesia provided adequate anesthesia. Intraoperative hemorrhage occurred in 3 horses. Surgical duration (initial skin incision to transection of the left kidney) ranged from 20 to 90 minutes. In 2 horses, no signs of pain were noted for 48 hours postoperatively. CONCLUSION: Hand-assisted laparoscopic surgery can be used for removal of the left kidney in horses. Clinical Relevance-Hand-assisted laparoscopic nephrectomy can be safely performed in standing horses; however, care should be taken to identify accessory branches of the renal artery to limit potential complications with hemorrhage.     

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 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.