Pararectal Cystotomy for Urolith Removal in Nine Horses

Objective: To report outcome of horses after standing pararectal cystotomy for removal of uroliths. Study Design: Case series. Animals: Horses (n=9) with cystic calculi. Methods: Medical records (December 1998–May 2007) of horses with cystic calculi that had standing pararectal cystotomy were reviewed. Signalment; urolith number, size, and type; surgical technique; sedation and analgesia protocols; intra‐ and postoperative complications and outcome were analyzed. Results: Uroliths (mean diameter, 6.37 cm; median, 6 cm; range, 3–10 cm) were removed intact without need for fragmentation. Eight (89%) horses had no complications and 1 horse (11%) developed persistent drainage from the perineal incision and incisional healing was prolonged. The complications resolved after wound revision, and although cystoscopy showed absence of uroliths, the clinical signs associated with cystitis recurred. Conclusions: Cystic calculi can be removed safely in standing horses using a pararectal approach. The procedure was well tolerated and no serious complications were encountered. Clinical Relevance: Pararectal cystotomy allows removal of cystic calculi in standing sedated horses. The technique may offer an economic advantage over approaches that require general anesthesia.     

Laparoscopic-assisted cystotomy for urolith removal in geldings

OBJECTIVE: To describe a technique for laparoscopic-assisted removal of cystic calculi in geldings and report outcome. STUDY DESIGN: Clinical report. ANIMALS: Four geldings with cystic calculi. METHODS: Laparoscopic-assisted cystotomy and urolith retrieval was performed in 4 anesthetized geldings positioned in dorsal recumbency. With a laparoscope portal located at the umbilicus, the abdomen was insufflated and then the surgical table was tilted (30 degrees head-down position) before an instrumental portal was created parallel and 2-3 cm medial to the left external inguinal ring. Laparoscopic grasping forceps were inserted to grasp the cranial aspect of the bladder and elevate it to the ventral abdominal wall. With the instrumental portal as mid-point, the parainguinal skin incision was longitudinally extended cranial and caudal (approximately 8-10 cm) to accommodate the size of the urolith. The apex of the bladder was exteriorized and sharply incised, the urolith extracted, and after cystotomy closure, the bladder was repositioned. The mini-laparotomy and trocar incisions were closed in layers. RESULTS: There were no intra- or post-operative complications. All horses had minor incisional swelling for 3-4 days. No signs of abdominal or incisional pain were observed. Hematuria and slight stranguria occurred until the 3rd or 4th day. Surgical time (skin incision to skin closure) was 35-40 minutes. On long-term follow-up (up to 12 months) no recurrence of clinical signs associated with cystic calculi occurred. CONCLUSION: Uroliths (6-8 cm diameter) can be removed by laparoscopic-assisted cystotomy in geldings. CLINICAL RELEVANCE: Laparoscopic-assisted cystotomy combines the advantages of the parainguinal laparocystotomy with laparoscopic technique for removal of cystic calculi while avoiding their disadvantages.     

The use of pneumatic impact lithotripsy and a retrieval pouch to create a closed system for removal of cystic calculi in standing male horses

Multiple techniques exist for removal of cystic calculi in the male horse, some of which use a perineal urethrotomy (PU) to facilitate access to the urinary bladder for removal of small uroliths in the standing, sedated horse. These techniques have limited efficacy in the removal of uroliths that have a diameter larger than the PU site, typically 4–5 cm. Pneumatic lithotripsy as reported in this article provides a novel way to fragment these larger uroliths while containing the fragments and protecting the urethra and urinary bladder. Ten geldings and one stallion underwent a lithotripsy procedure to remove one (n = 10) or several (n = 1) uroliths ranging in diameter from 4 to 9 cm. A PU was performed and a laparoscopic retrieval bag was inserted into the urinary bladder through the PU site. The urolith was manipulated into the bag using blind transrectal manipulation or endoscopic guidance and the opening of the bag was exteriorised out of the PU site. A pneumatic lithotrite was used to fragment the stone. When the urolith was adequately fragmented, the fragments were removed by the use of sponge forceps and by flushing the fragments from the bag with obstetrical lube. This was continued until the bag could smoothly be withdrawn from the urinary bladder. All uroliths were successfully removed. The PU sites healed without complication and none of the horses had recurrence of presenting clinical signs. This article also discusses the difference between two types of laparoscopic retrieval bags. Pneumatic impact lithotripsy in combination with a retrieval pouch offers a safe alternative to other methods for removal of cystic calculi in the horse.     

Parainguinal laparocystotomy for urolith removal in geldings

OBJECTIVE: To describe parainguinal laparocystotomy for urolith removal and to report outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Ten geldings with uroliths. METHODS: Signalment, number, size, type of uroliths, surgical technique, and complications were recorded. Long-term follow-up was obtained by telephone interviews with the client and/or examination by the referring veterinarian. RESULTS: Cystic calculi, 3-9 cm in diameter, were removed by parainguinal laparocystotomy. Mean surgical time was 59 minutes (range, 40-100 minutes). With this approach, ligation of the pudendal or superficial epigastric vessels was not needed. Serous incisional drainage resolved without treatment in 3 horses and 2 horses developed moderate-to-severe incisional swelling. On long-term follow-up (mean, 52 months; range, 11-82 months) for 9 horses, owners reported no recurrence of clinical signs associated with cystic calculi. CONCLUSIONS: Parainguinal laparotomy represents a satisfactory alternative approach to the apex of the bladder for urolith removal. CLINICAL RELEVANCE: Parainguinal laparocystotomy avoids the pudendal and superficial epigastric blood vessels that are encountered when performing median or paramedian laparocystotomy in geldings. This approach minimizes dead space by avoiding the reflection of the prepuce in paramedian or median approaches.     

Urethral Calculi in Five Horses

Urinary calculi are not uncommon in many domestic animals and man. Urethral calculi, however, occur infrequently in horses relative to other domestic species. Of 14 cases of urinary calculi in horses admitted to the Colorado State University Veterinary Teaching Hospital during the past eight years, nine had cystic calculi, one had a ureteral calculus, and five had urethral calculi. One case had a cystic and a urethral calculus. The clinical findings, medical and surgical management, and postoperative results in five cases of urethral calculi are reviewed in this article.     

Urolithiasis in 68 Horses

Medical records of 68 horses with urolithiasis were examined. Calculi were in the bladder in 47 horses, urethra in 11 horses, kidneys in 15 horses, and ureter in two horses. They occurred at several sites in six horses. Common clinical signs included hematuria, altered micturition (pollakiuria, dysuria, urinary incontinence), and tenesmus. Weight loss, possibly attributable to chronic renal failure and colic, was associated more commonly with renal and ureteral calculi. Weight loss also occurred in 13% of horses with cystic calculi only. In male horses, most cystic calculi were removed by perineal (ischial) urethrotomy under epidural anesthesia. Although there were few surgical complications with urethrotomy, seven of 15 horses with follow-up suffered recurrent urolithiasis.     

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

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

Endoscopic-assisted disruption of urinary calculi using a holmium:YAG laser in standing horses

OBJECTIVE: To describe a technique for endoscope-assisted disruption and removal of urinary calculi using a holmium:YAG laser in sedated, standing horses. STUDY DESIGN: Retrospective study. ANIMALS: Six horses with urinary calculi. METHODS: A holmium:YAG laser was used to disrupt naturally occurring urinary calculi in horses (4 geldings, 1 stallion, 1 mare). Ischial urethrotomy was performed in male horses to provide a portal for the endoscope and laser fiber. Calculus fragments were removed by a combination of lavage, transendoscopic basket snare removal, forceps, and digital manipulation. Ischial urethrotomies healed by second intention. Follow-up was obtained by recheck examination and telephone interview of owners. RESULTS: No major operative or postoperative complications occurred. Two calculi (1 stallion and 1 mare) were fragmented by a combination of laser ablation and manual disruption with a lithotrite. Postoperative dysuria occurred in the mare, but resolved after 1 month. Mean (+/- SD) follow-up was 306 +/- 149 days; no other complications were reported. CONCLUSIONS: Calcium carbonate urinary calculi (up to 15 cm in diameter) in horses can be effectively fragmented with a holmium:YAG laser. It is not known if this technique would be completely effective for larger calculi or extremely dense calculi. CLINICAL RELEVANCE: Calculus disruption by an endoscopically assisted holmium:YAG laser offers a minimally invasive method that can be performed in standing horses and that minimizes patient risk.     

Laparoscopic Splenectomy for Treatment of Splenic Hemangiosarcoma in a Dog

Objective: To report laparoscopic splenectomy in a dog. Study Design: Clinical report. Animals: Mixed breed dog (n=1). Methods: Hemangiosarcoma was diagnosed by ultrasound‐guided fine‐needle aspiration of a splenic mass in an 11‐year‐old, 30 kg, mixed breed dog. No metastatic disease was identified during complete staging (chest radiographs, echocardiogram, and abdominal ultrasonography); however, cystic calculi were identified. Laparoscopic splenectomy using Ligasure V was performed through 3 portals and the calculi were removed by laparoscopic‐assisted cystoscopy. Results: Total surgical time was 2 hours and for laparoscopic splenectomy, 65 minutes. The celiotomy incision for splenic removal was 7 cm. The dog recovered uneventfully and was ambulatory 2 hours postoperatively. Conclusion: Laparoscopy with Ligasure V facilitated successful removal of a spleen with a 3 cm mass. Clinical Relevance: Laparoscopic splenectomy in dogs is feasible for removal of a normal‐sized spleen with a moderate‐sized mass.     

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.     

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.     

Removal of 11 Incompletely Erupted,Impacted Cheek Teeth in 10 Horses using a Dental Alveolar Transcortical Osteotomy and Buccotomy Approach

Objective: To describe surgical technique and outcome in 10 horses with impacted cheek teeth that were removed by a transcortical osteotomy and buccotomy technique. Study Design: Case series. Animals: Horses (n=10) with impacted cheek teeth. Methods: Medical records (2002–2008) of horses with impacted cheek teeth requiring removal were reviewed; surgical technique and outcome were determined. Results: Exodontia of 11 cheek teeth was performed surgically in 10 horses; 3 horses had complications (residual swelling of the mandible) that resolved and all horses returned to their previous use. Conclusions: Transcortical buccotomy technique is effective for removal of incompletely erupted impacted cheek teeth in horses and has a good long‐term prognosis for remission of clinical signs. Clinical Relevance: Transcortical buccotomy approach is an effective technique for removal of unerupted impacted equine cheek teeth.     

Removal of cystic calculi using a transinguinal laparoscopic‐assisted technique in two stallions

A 12‐year‐old donkey and a 6‐year‐old Connemara pony, both sexually intact males, were admitted for surgical removal of urinary calculi. Both underwent a laparoscopic‐assisted cystotomy technique to exteriorise the bladder and remove uroliths via the inguinal canal after hemi‐castration. Both surgeries were successful and no complications occurred. This modified technique, which is minimally invasive, may be a safe and efficient way to remove bladder stones from adult stallions.     

Urolithiasis in the horse — A review of 13 cases

The presenting signs, treatment and postoperative progress of 13 horses with vesical and urethral calculi are reviewed. Single, discrete stones were present in 10 animals in which the results of treatment were generally good. In three horses with sabulous cystic deposits, urolithiasis was associated with bladder paralysis and the response to treatment was poor.     

Laparoscopic Mesh Incisional Hernioplasty in Five Horses

Objective— To report a technique for incisional hernioplasty in horses using laparoscopic placement of a prosthetic mesh.
Study Design— Case series.
Animals— Horses (n=5) with ventral median abdominal incisional hernia.
Methods— A telescope and 2 instrument portals were established bilaterally, lateral to and distant from the hernia margins. After exposure of the internal rectus sheath by removal of retroperitoneal fat with endoscopic scissors and monopolar cautery, a prosthetic mesh was introduced into the abdomen and secured intraperitoneally using transfascial sutures with or without supplemental endoscopic hernia fixation devices.
Results— Successful placement of the prostheses was achieved without major intra- or postoperative complications. Repairs were intact in all horses (follow-up range: 6–23 months) without evidence of adhesion formation. Cosmetic results compared favorably with those typically achieved using conventional, open hernioplasty techniques.
Conclusion— Incisional hernia repair in horses can be successfully achieved with a laparoscopic intraperitoneal mesh onlay technique.
Clinical Relevance— Laparoscopic mesh hernioplasty has promise as a safe and effective method for repair of incisional hernias in horses.     

Cystic calculi in two horses

The use of real-time ultrasound for examination of the bladder was a useful diagnostic aid in 2 cases of cystic calculi. The ultrasound procedure revealed that a firm mass palpated per rectum in the bladder of one horse was a calculus. In the other horse, ultrasound revealed additional small uroliths. To remove the uroliths in both horses, laparocystidotomy via a ventral paramedian approach was chosen because it provided the best access to the bladder lumen. The calculi were analyzed by qualitative chemical analysis and quantitative crystallography. Results differed between analysis methods. Crystallography revealed that the mineral composition of both calculi was pure calcium carbonate. Chemical analysis erroneously indicated that the calculi contained phosphate, magnesium, and oxalate.     

Standing laparoscopic abdominal lavage using a suction-irrigation device in 2 horses with primary suppurative peritonitis

The use of a laparoscopic suction-irrigation device in 2 standing horses for lavage of the abdomen for the treatment of primary suppurative peritonitis is reported. Two horses were presented with a 1- to 2-week history of weight loss. Abdominocentesis revealed highly elevated total nucleated cell count. Peritoneal lavage systems were placed in both horses, but complications prevented adequate lavage. Both horses underwent standing laparoscopy; the dorsal abdomen was explored and the abdomen was profusely lavaged, using a suction-irrigation device. The procedure was efficient and allowed adequate visualization of the dorsal abdomen and lavage. A successful outcome was achieved in both cases.Key clinical message:Lavage of the abdomen of horses with peritonitis can be achieved under standing sedation, using a laparoscopic technique. In appropriately selected cases, this allows for adequate visualization of the dorsal abdomen and efficacious abdominal lavage.     

Evaluation of success rate of laparoscopic castration without orchidectomy in 32 mature horses

The surgical success of laparoscopic castration without orchidectomy results from avascular necrosis of the testes. However, failures and subsequent production of testosterone and stallion‐like behaviour have been previously identified. Laparoscopic castration without removal of the testes was performed in 32 horses with 2 normal descended scrotal testes between July 2006 and October 2012. The objectives of our study were to evaluate the success rate of laparoscopic castration without orchidectomy on descended testes in our population and assess complications and recovery time. Endocrine tests were performed after surgery and owners also asked to report on their horse's behaviour and ability to resume exercise. Castration was deemed successful if endocrine test results were in accordance with gelding values. Failed horses were castrated using a conventional technique and histology performed when possible. Basal testosterone levels decreased below 3 nmol/l after surgery in 30/32 cases. However, in 2 horses, stallion behaviour persisted and histological evaluation after inguinal castration showed residual viable tissue. Two horses maintained high testosterone levels after surgery associated with stallion‐like behaviour. Based on these results, 12.5% of horses (4/32 horses) failed to be considered a gelding based on either endocrine tests and/or histology. All horses, with one exception, were able to resume exercise less than a week after the procedure. Laparoscopic castration without orchidectomy appears to be a safe procedure. When assessing the success of laparoscopic castration, our total failure rate was 12.5% (4/32 horses) which is significantly higher than previously reported.     

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.     

Laparoscopic Cryptorchidectomy in Standing Horses

Objective — The purpose of this study was to determine the feasibility of using laparoscopy to remove cryptorchid testes from standing horses.
Study Design — Prospective clinical study.
Animals or Sample Population — Eleven client-owned horses ranging in age from 4 months to 2 years.
Methods — Abdominal insufflation was initiated and maintained using a 20 F insufflation tube, attached via a stopcock, to the low pressure regulator on a standard carbon dioxide pressure tank. After trocar and laparoscope placement in the ipsilateral flank the testes were identified. Local anesthesia of the structures to be manipulated was administered through the instrument channel on the operative laparoscope, using a catheter with a needle attached. Testes were grasped with large laparoscopic forceps and exteriorized through the abdominal wall. Ligation and transection of the mesorchium was extracorporeal. The descended testes were removed using a standard standing technique.
Results — Complications were minor, including mild colic in one horse. The mean surgical time for standing laparoscopic cryptorchidectomy and castration of these colts was 58.9 ±24.3 minutes.
Conclusions and Clinical Relevance — Standing laparoscopic cryptorchidectomy, using the instrumentation described, is a safe and practical technique in young horses.