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.     

Isobaric (gasless) laparoscopic liver and kidney biopsy in standing steers

The purpose of the current study was to investigate the suitability of an isobaric laparoscopic procedure, using a single port, for obtaining serial kidney and liver biopsy samples from standing steers. The samples were used in support of a pharmacokinetic tissue–fluid correlation study. Laparoscopic access was performed 3 times in each of 8 healthy Holstein steers, alternating from the right side to the left side and then to the right side again. The surgery was performed in standing stocks after the animals were given 3 doses of sulfadimethoxine sulfate intravenously and fasted for at least 18 h. Sedation and analgesia were achieved with acepromazine and xylazine. Lidocaine 2% was injected at the center of the paralumbar fossa (left or right), and an incision was made for introduction of a trocar–cannula assembly. Room air was allowed to enter the abdomen through the cannula at the time of insertion. Once the peritoneal cavity was reached, an operating endoscope was inserted. No pressurized insufflation was performed. A biopsy forceps was introduced into the operating channel of the endoscope to obtain a 100-mg kidney or liver sample. No complications were encountered. The 24 laparoscopic procedures provided 24 kidney and 16 liver samples. The results suggest that the isobaric (gasless) single-port laparoscopic technique is feasible for kidney and liver biopsy on standing steers. The procedure can be performed in a reliable and efficient manner in the sedated standing bovine.     

One-port video assisted laparoscopic kidney biopsy in standing steers

The purpose of this study was to simplify the two-port laparoscopic renal biopsy technique used in support of pharmacokinetic studies through the application of a one-port system. Twelve Holstein steers were fasted for 24 h and sedated with acepromazine and xylaxine in preparation for laparoscopic surgery in standing stocks. Lidocaine 2% was injected to provide local anesthesia for introduction of the trocar-cannula assembly. The operating endoscope was inserted and the abdomen was insufflated with CO₂. A biopsy forceps was introduced into the channel of the operating endoscope to obtain a 100 mg kidney cortex sample. Eighteen laparoscopic procedures provided 18 kidney samples suitable for pharmacokinetic studies. No complications were encountered. The one-port laparoscopic kidney biopsy is feasible and safe, and advanced skill required for triangulation is not necessary for its performance.     

A rapid and strong laparoscopic-assisted gastropexy in dogs

OBJECTIVE: To develop a technique for laparoscopic gastropexy in dogs and evaluate effects on stomach position and strength of the adhesion between the stomach and abdominal wall. ANIMALS: 8 healthy dogs. PROCEDURE: Dogs were anesthetized, and the abdomen was insufflated with carbon dioxide. A laparoscope was placed through a cannula inserted on the abdominal midline caudal to the umbilicus. Babcock forceps placed through a cannula inserted lateral to the right margin of the rectus abdominus muscle were used to exteriorize the pyloric antrum, a longitudinal incision was made through the serosa and muscular layer of the pyloric antrum, and the seromuscular layer of the pyloric antrum was sutured to the transversus abdominus muscle. After surgery, positive-contrast gastrography was used to evaluate stomach position and the onset of gastric emptying, and ultrasonography was used to assess stomach wall activity and mobility. Dogs were euthanatized 1 month after surgery, and tensile strength of the adhesion was tested. RESULTS: In all dogs, stomach position and the onset of gastric emptying were normal 25 days after surgery, and the pyloric antrum was firmly attached to the abdominal wall 30 days after surgery. Mean +/- SD ultimate load of the adhesion in tension was 106.5 +/- 45.6 N. CONCLUSIONS AND CLINICAL RELEVANCE: The laparoscopic gastropexy technique described in the present study could be performed quickly and easily by an experienced surgeon, resulted in a strong fibrous adhesion between the stomach and abdominal wall, and appeared to cause minimal stress to the dogs.     

LAPAROSCOPIC ULTRASONOGRAPHY IN SIX DOGS

The aim of this study was to describe the technique of laparoscopic ultrasonography in six dogs with intra-abdominal disease. Investigation of the abdominal cavity was undertaken initially in each dog by laparoscopy alone. After exploration and visualization of a diseased organ, a 7.5 MHz microconvex ultrasound probe was introduced into the abdomen through a laparoscopic cannula for videoguided ultrasound examination. Laparoscopic ultrasonography allows core biopsy or needle aspiration to be performed by guiding the needle into nonsuperficial lesions, where videoendoscopic guidance alone is not enough. In addition, color Doppler ultrasonography is useful to examine the vascular pattern to minimize or eliminate complications when a biopsy is performed.     

Paralumbar Fossa Laparoscopic Ovariectomy in Horses With Use of Endoloop Ligatures

Objective —The purposes of this study were to develop a technique of paralumbar fossa laparoscopic ovariectomy using Endoloop ligatures and to avoid a laparotomy incision for ovary removal by using a 33–mm diameter muscle spreader trocar-cannula unit.
Animals or Sample Population —Seven mares.
Methods —Bilateral laparoscopic ovariectomy was performed under general anesthesia in two horses and under neuroleptanalgesia and local anesthesia in five standing mares. Ovaries were approached from the ipsilateral paralumbar fossa through two portal sites located in the paralumbar fossa and a third between the 17th and 18th ribs. Insufflation of the abdominal cavity was achieved using an automatic carbon dioxide insufflator. Two Endoloop ligatures were placed on the mesovarium. The cannula, located in the center of the paralumbar fossa, was removed, and a 33-mm diameter trocar-cannula unit, with a cone-shaped muscle spreader extremity, was inserted through the same portal. The mesovarium was transected between the ovary and the ligatures. The ovaries were removed from the abdomen through the 33-mm diameter cannula. The abdominal wall was closed in a routine manner.
Results —No major complications occurred during or after surgery.
Conclusion —Paralumbar fossa laparoscopic ovariectomy in mares using Endoloop ligatures and the 33-mm diameter trocar-cannula unit was an effective technique for ovariectomy of normal ovaries in this study.
Clinical Relevance —Endoloop ligatures provide a viable alternative for laparoscopic ligation of ovarian pedicles in mares.     

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     

Technical note: a technique for multiple liver biopsies in neonatal calves

Our objective was to develop a rapid and safe liver biopsy technique that could be repeated on multiple occasions in individual neonatal calves. A pilot study was performed to verify the efficacy of sedation and restraint procedures and to evaluate different biopsy instruments. Following the pilot experiment, a biopsy trocar was fabricated and an experiment was conducted using this procedure. Liver biopsies were performed in neonatal calves on d 4, 9, 15, 21, and 28 of life to evaluate the effect of vitamin A intake on liver vitamin A concentrations. On these days, a single injection of ceftiofur sodium was administered i.m. 1 to 2 h prior to the procedure. Calves were lightly sedated with xylazine and placed on a surgical table in left-lateral recumbency. The right caudo-thoracic area was clipped and scrubbed with an iodophor agent. Following administration of a local anesthetic (lidocaine), a small incision was made in the skin between the 12th and 13th ribs approximately 15 cm from the dorsal midline. The biopsy trocar was inserted through the body wall and peritoneum and introduced into the liver parenchyma, and a liver sample was collected. Following the biopsy, the cutaneous incision was sutured and an antiseptic agent was applied to prevent infection. An i.m. injection of an analgesic was administered 1 h following the procedure to alleviate postsurgical discomfort. Most calves were able to stand within 2 h after the biopsy. The entire procedure, which could be performed by a single individual, usually required about 20 min from initial sedation until skin closure. Although liver samples of up to 500 mg were obtained, most samples weighed 75 to 150 mg (wet weight). A total of 156 liver biopsies were performed on 33 calves. Complications due to the biopsy procedure were observed in only two calves. Therefore, this procedure can be useful for studies designed to monitor changes in liver composition or enzyme activities over time.     

Laparoscopic-assisted enterostomy tube placement and full-thickness biopsy of the jejunum with serosal patching in dogs

OBJECTIVE: To develop laparoscopic-assisted techniques for enterostomy feeding tube placement and full-thickness biopsy of the jejunum in dogs. ANIMALS: 15 healthy dogs. PROCEDURE Dogs were anesthetized, and positive pressure ventilation was provided. A trocar cannula for the laparoscope was inserted on the ventral midline caudal to the umbilicus. For enterostomy tube placement, a second trocar cannula was placed lateral to the right rectus abdominis muscle, and a Babcock forceps was used to grasp the duodenum and elevate it to the incision made for the cannula. The duodenum was sutured to the abdominal wall, and a feeding tube was inserted. For jejunal biopsy, a third trocar cannula was placed lateral to the left rectus abdominis muscle. A portion of jejunum was elevated to the incision for the second or third cannula, and a full-thickness biopsy specimen was obtained. A second specimen was obtained from another portion of jejunum, and retention sutures for the 2 biopsy sites were tied so that serosal surfaces of the biopsy sites were apposed to each other. Dogs were euthanatized 30 days after surgery. RESULTS: The enterostomy tube was properly positioned and functional in all 8 dogs that underwent laparoscopic-assisted enterostomy tube placement, and sufficient samples for histologic examination were obtained from all 7 dogs that underwent laparoscopic-assisted jejunal biopsy. None of the dogs had any identifiable problems after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in dogs, laparoscopic-assisted procedures for enterostomy tube placement and jejunal biopsy are an acceptable alternative to procedures performed during a laparotomy.     

Development of a technique for serial bilateral renal biopsy in steers

A biopsy procedure was developed to provide serial kidney samples from standing steers. Ten clinically normal steers were given intramuscular injections of gentamicin sulfate, 4 mg/kg body weight. Renal biopsy was performed at 5 separate times. After feed was withheld for 24 h, laparoscopic surgery was performed in standing stocks. Acepromazine, xylazine, and butorphanol were used for sedation and analgesia, and 2% lidocaine was used for local anesthesia. Two incisions approximately 2 cm long were made in the paralumbar fossa to allow for trocar introduction. The abdomen was insufflated with CO2 and, with endoscopic guidance, a biopsy forceps used to remove a kidney sample 2 to 3 mm in diameter, by either a left or a right abdominal approach. Each operation was recorded on videotape, and images were also captured with a digital medical device system. Respiration, heart rate, temperature, appetite, attitude, and postural positions were evaluated at 12, 24, 48, and 72 h after surgery. The 51 laparoscopic procedures provided 48 renal samples (approximately 100 mg each). The 1st and 2nd samples were from the right kidney, and the 3rd sample was from either the left or the right kidney; the 4th and 5th samples were from the left kidney. Adhesions made an approach from the right side difficult for the 3rd sample. No clinical changes were observed in 9 steers after the procedure. One steer died after the 3rd procedure owing to hemorrhage.     

Laparoscopic Anatomy of the Llama Abdomen

Paralumbar laparoscopy was performed, caudal to the last rib, in seven llamas. All animals were anesthetized, instrumented, and placed in sternal recumbency. Systematic exploration was performed in six donated llamas dividing the abdomen into right and left, cranial and caudal quadrants. The main structures of diagnostic significance that could be observed from the right side were the parietal and visceral surface of the liver, diaphragm, first compartment of the stomach (CI), caudal aspect of the third compartment of the stomach (C3), pancreas, kidney duodenum, jejunum, and ascending colon. From the left side CI, varying lengths of jejunum, ileum, ascending colon, and spiral colon were identified. From both approaches the bladder, and in females the uterus and ovaries could be observed. All animals were necropsied immediately following the procedure. Gross examination of the abdominal viscera in the did not yield any abnormalities that had been missed by laparoscopic evaluation. Using a left paralumbar approach, one clinical case presenting with signs of acute abdominal discomfort was evaluated. A diagnosis was made of diffuse enteritis that was confirmed at necropsy. Because of the distensible nature of the South American camelid (SAC) abdominal wall, the small size of the abdominal viscera, and the freely mobile nature of most portions of the gastrointestinal tract a thorough examination was possible in all animals.     

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.     

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.     

Biomechanical and Histological Evaluation of a Laparoscopic Stapled Gastropexy Technique in Dogs

The biomechanical holding strength and histological characteristics of a laparoscopic stapled gastropexy (LG) adhesion were compared with that of an incisional gastropexy (IG) adhesion. An LG was performed in 14 dogs and an IG was performed in six dogs. During the LG procedure, the abdomen was insufflated with carbon dioxide and three cannulae were placed in the caudal aspect of the right side of the abdomen. A 35 mm laparoscopic stapler was used to staple the gastric antrum to the adjacent right lateral abdominal wall. The IG procedure was performed through a ventral midline celiotomy. A 35 mm IG was made by apposing the gastric antrum to the adjacent right lateral abdominal wall with two continuous rows of suture. Half of each group of dogs was euthanatized at 7 and 30 days after surgery. The mean tensile load to failure at 7 days was 44.86 ± 18.54 N for the LG group and 85.33 ± 23.59 N for the IG group ( P <.05). At 30 days the values were 72.93 ± 18.01 N for the LG group and 71.17 ± 12.11 N for the IG group ( P =.41). The gastropexy adhesions in the 7-day postoperative group contained variable amounts of fibrin, hemorrhage, mononuclear cell inflammation, loose fibrovascular tissue, and mature collagenous connective tissue. Adhesions in the 7-day postoperative group were divided subjectively into three histological subgroups based on the relative amounts of mature connective tissue within the adhesion. The LG and IG adhesions were randomly distributed among these subgroups ( P = 1.0). Adhesions in the 30-day postoperative group contained well-organized fibrous connective tissue. No difference in the amount of connective tissue could be detected histologically in the LG or IG adhesions. Complications with the LG procedure included stomach perforation (2 cases), splenic puncture (2 cases), and subcutaneous emphysema (4 cases).     

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.     

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.     

Laparoscopic cholecystectomy under field conditions in Asiatic black bears (Ursus thibetanus) rescued from illegal bile farming in Vietnam

Nine adult Asiatic black bears (Ursus thibetanus) previously rescued from illegal bile farming in Vietnam were examined via abdominal ultrasound and exploratory laparoscopy for liver and gall bladder pathology. Three bears demonstrated notable gall bladder pathology, and minimally invasive cholecystectomies were performed using an open laparoscopic access approach, standard 10 to 12 mmHg carbon dioxide pneumoperitoneum and a four-port technique. A single bear required insertion of an additional 5 mm port and use of a flexible liver retractor due to the presence of extensive adhesions between the gall bladder and quadrate and left and right medial liver lobes. The cystic duct was dissected free and this and the cystic artery were ligated by means of extracorporeal tied Meltzer knot sutures. The gall bladder was dissected free of the liver by blunt and sharp dissection, aided by 3.8 MHz monopolar radiosurgery. Bears that have had open abdominal cholecystectomies are reported as taking four to six weeks before a return to normal activity postoperatively. In contrast, these bears demonstrated rapid unremarkable healing, and were allowed unrestricted access to outside enclosures to climb trees, swim and interact normally with other bears within seven days of surgery.     

Blood parameters in female Zandi lambs as affected by liver biopsy methodology

The aim of the present study was to investigate the normal blood parameters of Iranian fat-tailed sheep (Zandi) and their changes due to rapid liver biopsy technique with a tru-cut biopsy needle. In ten ewe lambs, blood samples were collected from jugular vein and biopsy needle was inserted through the dorsal one third of the 11th intercostal space, on the right hand side of the lambs and liver specimen was collected. Physical examinations were performed on alternate days during the experiment. Blood collection was done on both before (day 1) and after (day 17) the biopsy. All animals were slaughtered at day 17. Values were compared using paired t test. While biopsy did not make any significant changes in mean values of body temperature, heart rate, respiratory rate, PCV, WBC, neutrophil, lymphocyte, eosinophil, monocyte, total serum protein, AST, ALT, and serum calcium (p > 0.05), it made a significant difference on the values of ALP (p < 0.001), serum inorganic phosphate (p = 0.035), and magnesium (p = 0.013). Necropsy examination revealed the points of hitting the biopsy needles on the diaphragmatic surface of the livers, surrounded by a zone of intense hyperemia. Peritoneal adhesions accompanying with typical strands of fibrous connective tissue between diaphragmatic surface of the liver and adjacent abdominal wall were found in two cases.