Laparoscopic sterilization of Sardinia donkeys using an endoscopic stapler

OBJECTIVE: To describe a laparoscopic technique for sterilization of the male donkey using an endoscopic linear stapler (ELS). STUDY DESIGN: Clinical report. ANIMALS: Male Sardinia donkeys (n=6), aged 24-36 months. METHODS: Laparoscopic sterilization was performed under standing sedation or recumbent under general anesthesia. An endoscopic linear stapler was used to transect, and control hemorrhage of, the spermatic cord. Serum testosterone concentrations were measured preoperatively and at 3, 6, and 12 months after sterilization. One testis from each of 2 donkeys was collected at 12 months for histologic examination. RESULTS: Sterilization was successfully achieved. The only minor intraoperative complication experienced was hemorrhage from 1 spermatic cord stump, which was re-stapled. No other major short- or long-term complications occurred. Serum testosterone concentrations were < 15 ng/dL at 3, 6, and 12 months after surgery in all donkeys. Testicular atrophy without evidence of revascularization was observed in the 2 testes examined histologically. CONCLUSIONS: Sterilization of descended testes by intraabdominal laparoscopic transection of the spermatic cord is a simple practical method, with minimal intraoperative or postoperative complications. Testicular revascularization did not occur. CLINICAL RELEVANCE: Laparoscopic sterilization in donkey can be performed using an endoscopic linear stapler as an alternative to scrotal castration.     

The complex blood supply to the equine testis as a cause of failure in laparoscopic castration

REASONS FOR PERFORMING STUDY: Intra-abdominal ligation/ transection of the spermatic cord may result in necrosis of the testis; castration of abdominal cryptorchids via laparoscopy has therefore become common. Notwithstanding some adaptations of the technique, a small percentage of operations fail, prompting research into the anatomical background and clinical relevance of the procedure. HYPOTHESIS: That an alternate blood supply may prevent complete necrosis of the testis after spermatic cord transection. OBJECTIVE: To establish the prevalence of the problem in normal and cryptorchid stallions. METHODS: In a preliminary study, the spermatic cords of 8 normal stallions were ligated and transected at different sites and in various manners. Five weeks later the testes were removed and the vitality of both the testes and epididymes was evaluated. In a prospective clinical trial, intra-abdominal spermatic cord transection was performed in 241 cryptorchid and normal stallions. In cases of surgical failure, the testes were removed and histology performed. RESULTS: Examination of the specimen removed from the 8 animals of the preliminary study revealed that all epididymes were completely or largely spared. All except one testis were completely necrotic. In the patients that underwent surgery all abdominally retained testes (n = 123) were necrotic, while 5 out of 88 inguinally retained and 8 out of 236 normally descended testes had partially survived. The pattern of survival differed between inguinally retained and normally descended testes. The epididymes of these 13 horses were (largely) vital. The (partial) survival of the epididymes and inguinally retained testes was ascribed to an alternate blood supply via anastomosing vessels derived from the cremasteric artery. A tributary from the external pudendal artery was considered responsible for the partial survival of normally descended testes. CONCLUSIONS AND POTENTIAL RELEVANCE: After intra-abdominal transection of the entire spermatic cord, 5.6% of inguinally retained and 3.4% of normally descended testes failed to become completely necrotic, as a result of an alternate blood supply via the cremasteric and/or external pudendal artery. Therefore, laparoscopic castration without orchidectomy cannot be recommended as a trustworthy method for castration of inguinal cryptorchids and normal stallions.     

Unsuccessful laparoscopic castration in a cryptorchid Frisian stallion

A 2-year-old unilateral inguinal cryptorchid Frisian stallion was castrated by bilateral laparoscopic intra-abdominal spermatic cord transection. Because blood testosterone levels were still high on postoperative day 7, both testicles were removed using an open approach. Pathology revealed the presence of vital Leydig-cells in both testes. Failure of the laparoscopic castration in this horse was attributed to an alternate blood supply to the testes by vessels derived from the cremaster and/or external pudendal artery.     

Decision Making for Cryptorchid Castration; a Retrospective Analysis of 280 Cases

The location of an undescended testicle influences the choice of surgical technique for efficient cryptorchid castration. We review a standardized protocol for preoperative examination to dictate surgical approach to cryptorchidism. Cases are split into two periods: 2004–2006 and 2007–2014. In 2004–2006, conventional cryptorchidectomy and laparoscopic cryptorchid castration (standing) were both offered, but the choice of technique was based primarily on owners' preference for a recumbent or standing procedure. In 2007–2014, ultrasonography was used to locate the testes and dictate the preferred surgical approach; for abdominal testes, laparoscopic intraabdominal spermatic cord ligation without orchidectomy was preferred and for inguinal testes, conventional open orchidectomy. The numbers of animals requiring a second procedure to complete castration were compared between the two periods. In addition, failure rates for individual testes grouped by location were determined separately for the different techniques, and the value of preoperative ultrasonography to locate the retained testes was assessed. In 2004–2006, 15.3% (20/131) of the cryptorchids needed more than one surgery to complete castration, compared to 0.7% (1/144) in 2007–2014. Failure rates for laparoscopic castration were 0/168 (0%) for abdominal, 3/40 (7.5%) for inguinal, and 9/55 (16.4%) for scrotal testes; for conventional castration, failure was recorded for 3/12 (25%) abdominal and 0/92 (0%) inguinal testes. For 94% (156/166) of retained testes, ultrasound-based preoperative advice on surgical approach was correct. Using a standardized preoperative examination to determine choice of surgical technique significantly (P < .001) reduced the number of second surgeries needed to complete castration. Preoperative ultrasound is therefore a useful aid to determining the surgical approach to cryptorchid castration.     

Laparoscopic-assisted colopexy and sterilization in male dogs: short-term results and physiologic consequences

Objective: To describe laparoscopic‐assisted colopexy and sterilization, and evaluate outcome and effects in healthy male dogs. Study Design: Experimental study. Animals: Male Beagle dogs (n=7). Methods: A laparoscopic‐assisted, extracorporeally sutured colopexy, and sterilization by ligation and section of the testicular vessels and ductus deferens were evaluated 11 weeks after surgery. Ex vivo tensile tests were performed on the colopexy sites and loss of testicular function was assessed by monitoring serum testosterone, and by ultrasonographic and histologic examinations of the testes. Systemic inflammation and potential iatrogenic colonic functional disorders were investigated by monitoring serum C‐reactive protein (CRP) in the perioperative period and from a sulfapyridine (SP) kinetic profile obtained before and 10 weeks after surgery. Results: No intraoperative complications were recorded and clinical outcome was considered fair in all dogs. A mean tensile force of 42 N was required to disrupt colopexies. No relevant postoperative increase in CRP concentrations or changes in SP kinetics were observed. Testicular function was lost. Conclusions: Laparoscopic‐assisted colopexy achieved adhesion of the colon to the abdominal wall and testicular endocrine function and spermatogenesis were eliminated by laparoscopic castration.     

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.     

Anti-Müllerian Hormone as a Diagnostic Marker for Equine Cryptorchidism in Three Cases with Equivocal Testosterone Concentrations

Cryptorchidism is a developmental disorder which can be diagnosed by a variety of different tests. Still, equine field veterinarians often rely on endocrine markers to detect retained testicular tissue. This report describes the value of anti-Müllerian hormone (AMH) as a diagnostic marker for cryptorchidism in three stallions suspected of cryptorchidism, with equivalent serum testosterone concentrations. A single measurement of AMH identified cryptorchidism, with inconclusive testosterone concentrations as either gelding or stallion. Furthermore, a human chorionic gonadotropin (hCG) stimulation test or surgery was performed to support the diagnostic value of AMH. To conclude, the endocrine panel for cryptorchidism should be expanded to include determination of serum AMH, as this determination can increase the diagnostic accuracy of a single blood sample.     

Laparoscopic Cryptorchid Castration in Standing Horses

Objective — This article describes a new technique for laparoscopic cryptorchid castration in standing horses. Study Design — Prospective study. Animals or Sample Population — Eight horses aged 11 months to 3 years and weighing between 300 and 643 kg. Methods — Food was withheld for 24 to 36 hours, and then horses were sedated with detomidine HC1 (0.02 to 0.03 mg/kg) and butorphanol tartrate (0.02 mg/kg). The paralumbar fossa region was desensitized with 2% mepivacaine in an inverted “L” pattern and caudal epidural anesthesia was administered with either xylazine (0.18 mg/kg diluted to 10 to 15 mL with 0.9% sodium chloride) or a combination of 2% mepivacaine and xylazine (0.18 mg/kg). Initial laparoscopic exploration was performed from the left flank; in three horses, right flank laparoscopy was needed to complete the procedure. The spermatic cord was ligated within the abdomen with one or two sutures of 0 polydioxanone suture, and the testis or testes removed through a flank incision. Results — In five horses with no palpably descended testes, standing laparoscopy was the only procedure performed, whereas in two horses, the abdominal testis was removed laparoscopically, and the descended testis was removed under short acting anesthesia. In one horse, with nonpalpable testes, it was determined by laparoscopic observation that the testes were in the inguinal canal, and castration was performed under general anesthesia. No surgical or postoperative complications were noted. The right side of the abdomen, and especially the right vaginal ring, could be easily observed from the left side by passing the laparoscope through a small perforation in the mesocolon of the descending colon or by elevating the descending colon with an instrument or by use of an arm in the rectum. Conclusions — The standing laparoscopic approach combined with or without short-acting anesthesia to remove the descended testis is easily performed. Clinical Relevance — This approach will provide surgeons with another option to castrate cryptorchid stallions.     

Evaluation of ‘Section‐Ligation‐Release (SLR)’ Technique Devised for Castration in the Stallion

A novel technique [Section‐Ligation‐Release (SLR)] was evaluated for castration in the horse. Clinical traits, serum testosterone concentrations after challenge with human chorionic gonadotrophin (hCG), and histopathological changes of the testicular tissue were assessed. Five stallions, aged 24–48 months, were castrated using SLR technique under general anaesthesia. Both spermatic cords in each stallion were exposed at the scrotal neck by two 5‐cm long incisions, followed by sharp dissection through the parietal vaginal tunic. Both vascular and non‐vascular structures in the cords were triple clamped, transected and ligated. Both testes were left in situ. Serum testosterone concentrations were measured pre‐operatively and at 2 months after castration following IV administration of 1 × 10⁴ IU of hCG. Both testes from each castrate were collected at 2 months for histopathologic examination. SLR castration was successfully achieved. Moderated scrotal and preputial swelling was the only experienced short‐term complication. Serum testosterone concentrations were significantly lower than basal pre‐operative levels at 2 months after castration, and did not respond to hCG. On histopathology, hyalinization of the seminiferous tubules and loss of testicular interstitial tissue were indicative of complete avascular necrosis. This novel primary closure castration technique of stallion is a simple practical method, with minimal post‐operative complications; and could be safely advocated as an alternative to the traditional castration techniques allowing for second intention healing of scrotal wounds.     

Effect of bilateral orchidectomy on serum testosterone levels in boars]

Bilateral orchidectomy caused a marked decrease in the concentration of testosterone in the bood plasma of boars already in the early post-castration stage of three hours after the operation. In the period from 3 to 207 days after castration, the pre-operation levels of plasma testosterone decrease by 84.4%, on an average. Adreno-cortical compensation of the concentration of the hormone did not occur in the post-castration period. The conclusion is that the levels of testosterone in the blood of boars are mostly of testicular origin and can be considered as the main criterion of the incretion function of the testes. The discussion concerns the practical importance of the determination of testosterone levels in the blood of boars for clinical evaluation of the hormonal function of the testes and for diagnostics of incretion hypogonodism.     

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.     

Laparoscopic Closure of the Renosplenic Space in Standing Horses

OBJECTIVE: To report a technique for laparoscopic ablation of the renosplenic space in standing horses. STUDY DESIGN: Development of a technique to perform laparoscopic renosplenic space ablation in standing horses. ANIMALS: Five healthy horses, aged 3 to 13 years, weighing 380 to 520 kg. METHODS: Horses were restrained in standing stocks and sedated with detomidine (0.01 mg/kg intravenously [IV]) and butorphanol (0.01 mg/kg IV). Portal sites in the left paralumbar fossa were infiltrated with 2% mepivacaine. A laparoscopic portal was placed between the 17th and the 18th ribs. Two instrument portals were located caudal to the 18th rib. Closure of the renosplenic space was accomplished by apposing the dorsomedial splenic capsule to the dorsal portion of the renosplenic ligament with 1 polyglactin 910 in a continuous pattern. All horses had repeat laparoscopy 3 weeks after initial surgery. RESULTS: Laparoscopic closure of the renosplenic space required 35 minutes (range, 20-65 minutes) and was successful without intraoperative or postoperative complications. On laparoscopic re-examination at 3 weeks, there was smooth connecting fibrous-like tissue between the dorsal splenic capsule and the dorsal portion of the renosplenic ligament. CONCLUSIONS: Laparoscopic closure of the renosplenic space can be efficiently and safely performed in standing horses. CLINICAL RELEVANCE: Laparoscopic-assisted closure of the renosplenic space can be performed in standing horses and may be useful in preventing recurrent incarceration of viscera in this space.     

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.     

Ventral Abdominal Approach for Laparoscopic Cryptorchidectomy in Horses

Objective —To report a ventral abdominal approach and a ligating loop technique for laparoscopic cryptorchidectomy in horses.
Study Design —Prospective.
Sample Population—Six horses, aged 1 to 5 years, with retained testes.
Methods —One laparoscopic portal and three to four instrument portals were used for ventral abdominal laparoscopic cryptorchidectomy. Laparoscopic instruments were used to maneuver and secure the testis through a ligating loop (modified Roeder knot) that was secured from outside the abdominal cavity. Only minimal enlargement of one instrument portal was used to remove the testicle.
Results —Three horses were bilateral cryptorchids, and three were unilateral (left side, two; right side, one) cryptorchids. Operative time, defined as the time from laparoscope insertion to removal, ranged from 20 to 25 minutes for unilateral cryptorchids and from 40 to 50 minutes for bilateral cryptorchids.
Conclusions —The reported technique allowed decreased tension on the tissues during ligation and removal of the testis from the peritoneal cavity. Improved observation of the abdominal cavity, ligation security, shortened patient confinement time, and minimally invasive technique are all considered to be benefits of laparoscopic cryptorchidectomy.
Clinical Relevance —Direct observation of retained testes and intraabdominal castration are distinct advantages of the use of laparoscopy in horses that have had previous unsuccessful surgical attempts, horses with unknown histories that have retained testicular tissue, or bilateral abdominal cryptorchids.     

Changes in the pituitary-gonadal axis associated with puberty in Holstein bulls

The temporal pattern of the endocrine changes associated with puberty were studied using 52 bulls born in October or April. Blood samples were taken weekly and at 30-min intervals for 5 h every 4-wk. Bulls were castrated at one of six 4-wk intervals between 12 and 32 wk and blood samples were taken. Season of birth affected concentrations of testosterone (greater for spring-born) in intact bulls, but not luteinizing hormone (LH) or follicle stimulating hormone (FSH). The concentration of FSH increased about 30% between 4 and 32 wk, without evidence of pulsatile discharge. Basal concentration of LH was low and pulsatile discharges were infrequent at 4 or 8 wk. At 12, 16 and 20 wk, however, basal LH concentration was elevated and LH discharges were at less than 2-h intervals. Testosterone concentration did not rise until 18 to 20 wk, but then continued to rise; LH discharge was suppressed concomitantly. Bulls castrated at 16 or 20 wk had higher concentrations of LH in their blood both before and shortly after castration values for bulls, but by 21 d after castration values for bulls of all ages were similar. It was concluded that elimination of an unidentified suppressive factor allows frequent discharges of LH between 12 an 16 wk, but the testes do not respond by secreting more testosterone until 18 to 20 wk. By 24 wk, the testes are secreting more testosterone and pituitary production of LH is restored to a lower level; LH discharges decline in frequency and basal LH level declines. The high frequency discharges of LH between 12 and 20 wk are postulated to induce responsiveness of Leydig cells to LH and, thus, enable elevation of intratesticular testosterone to levels necessary for Sertoli cell differentiation and initiation of spermatogenesis.     

Clinical, hormonal and ultrasonograph approaches to diagnosing cryptorchidism in horses

Cryptorchidism is a partial or total failure of testicular descent. For a proper diagnosis different methods are required. The main aim of this study was to compare different diagnostic methods. Sixty two horses (15 stallions, 32 cryptorchids and 15 geldings) were used in the experiment. They were clinically examined and ultrasonography was used to locate the testes. Blood samples were taken from the animals to measure the plasma level of testosterone and total estrogen (RIA method). In 22 horses suspected of cryptorchidism, the hCG stimulation test was performed. Blood samples were taken every 20 minutes for 8 hours and then 24 and 48 hours after injection. Clinical examination had a 60% success rate in detecting superficial and profound canal cryptorchids. Inguinal ultrasonography had a 100% rate of detection when the retained testes were in the area of the internal or external inguinal ring. The rate of detection with abdominal cryptorchids was 72.7%. The highest levels of testosterone were found in stallions' blood (2.3 ng/ml), they were lower in cryptorchids (0.68 ng/ml) and lowest in geldings (0.15 ng/ml). Total estrogen levels revealed a similar tendency (respectively: 395 pg/ml, 228 pg/ml and 26 pg/ml). Administration of hCG usually increased the level of testosterone from 0.68 ng/ml to 1.05 ng/ml 60 minutes after injection. We found that to successfully diagnose cryptorchids in veterinary practice a combination of clinical, ultrasonographic and hormonal examinations should be used.     

Hand‐assisted laparoscopic nephrectomy in a standing horse for the management of renal cell carcinoma

An 18‐year‐old Quarter Horse gelding was examined for haematuria of 6 weeks' duration. Rectal examination identified an enlarged left kidney and ultrasonographic examination of the kidney identified grossly abnormal renal architecture. Hand‐assisted laparoscopic nephrectomy was performed following laparoscopic exploration of the abdomen for metastatic disease. A laparoscopic stapling device was successfully used to transect and ligate the renal vasculature and ureter. Histopathological examination of the kidney identified renal cell carcinoma. A 7 month survival was documented following surgery. Unilateral nephrectomy should be considered a therapeutic or palliative procedure for horses with renal cell carcinoma.     

Long-Term Follow-up of Partial Limb Amputation in 13 Horses

Thirteen cases of partial limb amputation in horses were reviewed. Nine horses (69%) survived 18 to 111 months (mean, 41 months). Four unsuccessfully treated horses were euthanatized within 21 days of surgery. The horses' ages at amputation were 4 to 13 years (mean, 7.3 years). There was no predilection for the left or right limb nor for fore or hind limb involvement. Osteomyelitis in six horses (46%) was the most common cause for amputation. Severe, open, comminuted fractures of the third metacarpal bone that were impossible to stabilize by any currently available technique in four horses (31%) were the second most common cause for amputation. One gelding was salvaged because of his sentimental value, two horses were used as breeding stallions, and six were broodmares. One stallion lived 30 months, completed two breeding seasons, and started a third. The other stallion began breeding, but became sterile. Three of the mares have produced five foals. One mare died while in foal. One mare aborted near-term twin fetuses and died of uterine hemorrhage. One mare aborted twice before the femoral head ligament on the contralateral limb ruptured, and she was euthanatized.     

Laparoscopic cryptorchidectomy using electrosurgical instrumentation in standing horses

OBJECTIVE: To describe a technique for laparoscopic cryptorchidectomy in standing horses using electrosurgical instrumentation. STUDY DESIGN: Retrospective clinical study. ANIMALS OR SAMPLE POPULATION: Ten horses, 1 to 7 years of age, with unilaterally or bilaterally retained testes. METHODS: Food was withheld for a minimum of 12 to 24 hours. Horses were sedated using xylazine hydrochloride (0.5 to 1 mg/kg) and butorphanol tartrate (0.02 mg/kg) or detomidine hydrochloride (0.02 to 0.03 mg/kg) and restrained in standing stocks. Three portal sites in the paralumbar fossae were locally desensitized using 2% mepivacaine. After trocar and laparoscope insertion, the ipsilateral testicle, mesorchium, and ductus deferens were identified. The cranial mesorchium was coagulated with either monopolar (one horse) or bipolar (nine horses) electrosurgical forceps, and then the mesorchium, ductus deferens, and ligament of the tail of the epididymis were transected from cranial to caudal using laparoscopic scissors. Once the testis was freed, the transected mesorchium was inspected for hemorrhage and the testis was removed by connecting the two instrument portals (eight horses). In two horses, the testis was placed within a laparoscopic retrieval bag and then removed without enlarging the portal incision. If the testes were retained bilaterally, the retained contralateral testis was removed similarly through the opposite paralumbar fossa. If the contralateral testis was descended, it was removed by a standard, standing castration technique. RESULTS: Vessels of the mesorchium were adequately coagulated using bipolar and monopolar electrosurgical forceps. No immediate or short-term complications occurred in 10 horses at 3 to 11 months after surgery. CONCLUSION: Standing laparoscopic cryptorchidectomy can be performed easily and safely using electrosurgical instrumentation as the sole means of providing hemostasis of the equine mesorchium. CLINICAL RELEVANCE: Standing laparoscopic cryptorchidectomy using electrosurgical instrumentation provides a safe, reliable, and efficient alternative to achieve hemostasis of the equine mesorchium.