Bilateral ovarian leiomyoma treated by standing laparoscopic ovariectomy

An 11‐year‐old Warmblood mare presented to a referral facility due to behavioural problems. A hormonal profile performed prior to referral included increased systemic concentrations of testosterone and progesterone but a low concentration of inhibin. Transrectal ultrasound revealed ovaries consistent with a normal cycling mare. At the request of the owner, standing bilateral laparoscopic ovariectomy was performed without complication. Both ovaries were submitted for histopathological examination which revealed bilateral ovarian leiomyoma.     

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.     

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.     

Unilateral and bilateral laparoscopic ovariectomy of mares by electrocautery

Twelve horses underwent standing laparoscopic ovariectomy using electrocoagulation and fine dissection as the only means of achieving haemostasis of the severed ovarian pedicle. Four mares had bilateral ovariectomy performed as a treatment for aggressive behaviour thought to be associated with the oestrous cycle. Eight mares had unilateral ovariectomy performed for removal of a granulosa thecal cell tumour (gct). Electrocoagulation provided an effective means of haemostasis in both normal and pathological ovaries. Only one case (removal of a gct) had mild haemorrhage following electrocoagulation, necessitating the need for the application of endoscopic clips to achieve haemostasis. Six of the horses developed minor wound complications (none of them requiring any additional treatment). Long-term follow-up information showed complete resolution of abnormal behaviour in all eight horses with gcts, but in one of the four horses with normal ovaries the aggressive behaviour had not been completely resolved.     

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 a vessel-sealing device for use in laparoscopic ovariectomy in mares

OBJECTIVE: To evaluate a vessel-sealing instrument (LigaSure) as a method for hemostasis of the ovarian vasculature. STUDY DESIGN: Prospective study. ANIMALS OR SAMPLE POPULATION: Thirteen mares (8 experimental, 5 patients), aged 2 to 20 years and weighing 405 to 500 kg. METHODS: Thirteen mares had standing bilateral laparoscopic ovariectomy using a vessel-sealing device (LigaSure) to provide hemostasis. Eight reproductively normal experimental mares were divided into 2 groups: 1 group was re-examined laparoscopically 72 hours and the other group 10 days after the initial standing laparoscopic ovariectomy. The vessel-sealing device uses high current and low voltage, along with pressure, to reorganize the collagen into a translucent seal to achieve hemostasis of the ovarian vasculature. RESULTS: No major operative or postoperative complications were encountered. Complete hemostasis of the ovarian pedicle was accomplished. One mare had a fever for 24 hours' postoperatively; this responded to a single dose of flunixin meglumine. CONCLUSIONS: The LigaSure appears to be a safe method for hemostasis of the ovarian vasculature. CLINICAL RELEVANCE: Benefits of the LigaSure include no foreign material remaining in the abdomen and minimal to no need for surgical dissection before application. The LigaSure eliminates complications with potential ligature slippage and bleeding during dissection.     

Evaluation of the harmonic scalpel for laparoscopic bilateral ovariectomy in standing horses

OBJECTIVE: To evaluate use of the Harmonic Scalpel (Ethicon Endo-Surgery Inc., Cincinnati, OH) for performing laparoscopic bilateral ovariectomy in standing horses. STUDY DESIGN: Experimental study. ANIMALS: Eight mares aged 2-20 years and weighing 410-540 kg. METHODS: Standing laparoscopic bilateral ovariectomy was performed in 8 mares with normal reproductive tract anatomy. The Harmonic Scalpel (an ultrasonically activated instrument) was used to simultaneously transect and obtain hemostasis of the ovarian pedicle. Necropsy was performed on 4 mares 3 days after surgery and 4 mares 30 days after surgery. Gross and histopathologic evaluation of the ovarian pedicles was performed to characterize tissue reaction. RESULTS: Complete hemostasis of the ovarian pedicles was obtained in all mares. Median transection time for the ovarian pedicle was 28 minutes. Postoperative complications included transient fever, moderate subcutaneous emphysema, and incisional seroma formation. On necropsy examination, there were no signs of generalized peritonitis, postoperative hemorrhage, or adhesion formation. Mild to moderate acute inflammation and scar formation with moderate chronic inflammation at the ovarian pedicle was found at 3 and 30 days. Median depth of coagulation necrosis at 3 days was 2.87 mm. CONCLUSIONS: The Harmonic Scalpel appears to provide reliable hemostasis of the ovarian pedicle during elective laparoscopic ovariectomy in horses. Clinical Relevance-The Harmonic Scalpel represents a safe alternative to other methods of hemostasis during elective laparoscopic ovariectomy in horses.     

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.     

Luteoma in two mares treated by ovariectomy

A 15-year-old Paint mare (Case 1) and a 15-year-old Arabian mare (Case 2) were presented for aggressive and undesired behaviour. Reproductive evaluation revealed, initially, an enlarged ovary with a smaller/normal sized contralateral ovary in each case. Granulosa cell tumour (GCT) panel testing revealed elevated inhibin B in both cases and elevated anti-Mullerian hormone (AMH) levels only in Case 1 determined from currently established reference ranges. Based on a presumptive diagnosis of GCT, bilateral standing ovariectomy was elected for both mares. In each case neoplastic tissue consistent with luteoma was detected only on histological examination in the smaller/normal sized left ovary; the right ovary appearing normal. Long-term follow-up was performed 1 year and 5 years post-operatively by telephone. The owners were satisfied with the outcome and each patient demonstrated resolution of aggressive stallion-like behaviour. Each case returned to the owners' intended use. In conclusion, luteoma should be considered as a differential diagnosis for ovarian neoplasms in horses related to behavioural abnormalities, even in normal-sized ovaries.     

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.     

Laparoscopic ovariectomy in the standing mare

An eleven year old warmblood mare was referred to Dierenkliniek Emmeloord because of recurrent cyclic behavioral problems. A standing bilateral laparoscopic ovariectomy was performed. Due to this minimal invasive technique a quick return to training was possible.     

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.     

Instrument associated complication of a laparoscopic ovariectomy

The case reported here describes the retrieval of the end of a pair of laparoscopic forceps that became separated from the instrument shaft during a laparoscopic ovariectomy. This case details the procedures used to locate and remove the foreign body from the abdominal cavity. No complications associated with the intra‐abdominal foreign body occurred and the mare was discharged the following day.