Standing female equine urogenital endoscopic surgery.

Standing female urogenital endoscopic surgery is facilitated by the more dorsal location of the organs of the female reproduction tract. The most common reason for laparoscopic surgery on the female urogenital system is ovariectomy; however, the technique has been used to diagnose periparturient or reproductive diseases and to perform surgical embryo transfer. Standing surgical approaches avoid the risk and expense of general anesthesia, but these techniques are limited by the temperament and size of the patient and the availability of facilities for restraint. Owner acceptance of laparoscopic procedures is excellent. It is anticipated that standing endoscopic surgery may become the preferred technique for applicable procedures.     

Uterine torsion and uterine tear in a mare.

A 15-year-old Standard-bred mare was examined because of signs of abdominal discomfort in late gestation. Palpation per rectum revealed tight broad ligaments above and below the uterus, with the right broad ligament running across the top of the uterine body down toward the left, ventral side of the abdomen. A diagnosis of counterclockwise uterine torsion was made and surgical correction was approached via a left, flank laparotomy with the horse standing. The uterus was repositioned and a uterine tear encompassing 180 degrees of the uterine surface was found in the lateral, uterine body just cranial to the cervix. A live colt was delivered vaginally after uterine repositioning and the laparotomy incision was closed. The uterine tear was then repaired via a blind, vaginal approach. The mare was discharged 10 days after surgery. Repair per vaginum of a uterine tear is presented as an alternative treatment in cases for which the tear is recent, abdominal contamination is minimal, and the tear is easily accessible from the vaginal approach.     

Prevention and treatment of complications of bovine gastrointestinal surgery

Abdominal surgery is the most common major surgical procedure performed by bovine practitioners. Most cattle, particularly dairy cattle, are sufficiently placid that major abdominal procedures are routinely completed with the animal standing, using local anesthesia and minimal physical and chemical restraint. An experienced bovine surgeon who exercises good judgment will infrequently encounter complications associated with this surgery. The purpose of this article is to describe the potential complications related to bovine abdominal surgery, how to avoid them, and how to treat them when they arise.     

Chemical restraint for surgery in the standing horse.

Chemical restraint can be a useful pharmacologic tool to assist the veterinarian performing surgery in the standing horse. The agents discussed impose minimal adverse side effects and are considered relatively safe when administered in the doses described. Acetylpromazine, the most widely used tranquilizer, produces mild sedation but no analgesia. The use of tranquilizers for surgical procedures requires the combined use of either a local anesthetic technique or a sedative-hypnotic or opiate to provide analgesia. Sedative-hypnotics such as xylazine and detomidine or opiates such as morphine and butorphanol are commonly used. The sedative-hypnotics also can induce deep CNS depression and may be sufficient alone for many procedures. Opiates may be used to supplement the analgesia produced by sedative-hypnotics or provide analgesia to the tranquilized horse. Opiates are not useful alone because of their potential to cause CNS excitement in the horse. The combination of detomidine and butorphanol is probably the most effective drug combination to facilitate painful surgery in the standing horse.     

Successful outcome after surgical correction of large colon atresia in a colt foal

This report describes successful surgical correction and long-term survival of a case of large colon atresia in a 24-h-old Warmblood colt, referred with signs of unrelenting abdominal pain and a suspicion of meconium impaction. Radiographic and ultrasonographic examination was indicative of large colon meconium impaction with secondary ileus. Due to deterioration of the foal, surgery was recommended. An atretic segment was found between the left ventral and dorsal large (ascending) colon. A band of fibrous tissue with no identifiable lumen connected the segments. Surgical correction was done by performing a stapled side-to-side anastomosis. Twelve days after surgery, the foal was discharged. Twenty-two months after discharge, the owner reported the foal developing as expected compared with its peers, but had a mild, self-limiting episode of colic at 20 months of age.     

Laparoscopic Anatomy of the Abdomen and Laparoscopic Ligating Loops,Electrocoagulation, and a Novel Modified Electroligation Ovariectomy in Standing Mare

The purpose of this study was to provide a detailed laparoscopic anatomy of the caudal abdominal region of mare in a standing position and to evaluate and modify a technique for standing laparoscopic ovariectomy using combination between hand-tied ligating loop and electrocoagulation techniques, as the ligating loops, electrocoagulation, and modified electroligation laparoscopic ovariectomy were applied using nine adult mares. Laparoscopy was practical and effective for direct visual examination of internal abdominal organs in the mare. Ventral dislocation of abdominal viscera after pneumoperitoneum was established with the mare in standing position, which provided an excellent inspection of the dorsal and ventral structures in the peritoneal cavity on the right and left sides. Standing laparoscopic ovariectomy using an electroligation modified method was considered a safe and effective method for hemostasis of the mesovarium, technically easy, time saving, and economical. The mean surgical time for bilateral ovariectomy was 40 ± 7.63, 60 ± 5.25, and 85 ± 6.43 minutes for electroligation-modified technique, ligating loops technique, and electrocoagulation technique, respectively.     

Torsion of the uterus--a cause of colic in the mare.

A case of uterine torsion in a mare with colic is described in which an early diagnosis was made and the torsion successfully reduced through a standing laparotomy with survival of both the mare and the foal. This case is used to stress the importance of thorough examination of all pregnant mares with colic in order to differentiate uterine torsion from other causes of abdominal pain, thereby avoiding delay in surgical correction and reducing the risk of fetal and/or maternal death. The advantages of the standing laparotomy are presented in support of this method of treatment of torsion of the gravid uterus.     

Torsion of the Uterus — A Cause of Colic in the Mare

A case of uterine torsion in a mare with colic is described in which an early diagnosis was made and the torsion successfully reduced through a standing laparotomy with survival of both the mare and the foal. This case is used to stress the importance of thorough examination of all pregnant mares with colic in order to differentiate uterine torsion from other causes of abdominal pain, thereby avoiding delay in surgical correction and reducing the risk of fetal and/or maternal death. The advantages of the standing laparotomy are presented in support of this method of treatment of torsion of the gravid uterus.     

Abomasal volvulus in cattle following correction of left displacement by casting and rolling

Seven adult cows developed abomasal volvulus immediately following correction of left displacement by casting and rolling. Three cows were rolled to provide temporary relief from left displaced abomasum because of concurrent disease and 4 were rolled as the principal therapy for left displacement. In each animal surgical correction of abomasal volvulus was accomplished via right paralumbar fossa celiotomy and inclusion of an omentopexy during abdominal closure. Surgery was performed within 24 hours of casting and rolling. All 7 cows recovered after surgery and were reported to have satisfactory milk production and appetite 6 weeks later.     

Recent advances in equine abdominal surgery

Laparoscopy is a minimally invasive procedure that has applications as a diagnostic, therapeutic and prognostic technique. Specialized equipment is necessary to perform equine laparoscopy, and there is a large range of instruments, both disposable and non-disposable available. Laparoscopic procedures described include ovariectomy, cryptorchidectomy, adhesiolysis and herniorrhaphy. Laparoscopy can be performed in a standing or dorsally recumbent position, depending on surgeon preference, patient status and the procedure to be performed. Stapling equipment is frequently used in gastrointestinal surgery in horses. Advantages include decreased surgical time and a decrease in the risk of contamination. Stapling equipment is often used in creating anastomoses, both in the large and small intestines, as well as in vessel ligation. New surgical techniques intended to decrease adhesion formation include the use of carboxymethylcellulose and bioresorbable patches. Indwelling abdominal drains can be used for peritoneal lavage following surgery and also appear to decrease the risk of adhesion formation. Improvements in post-operative care, including the treatment of post-operative ileus and endotoxaemia can significantly improve the outcome of horses that have undergone surgery for abdominal disorders. Recommendations for the use of prokinetic agents in horses with ileus vary widely. Prokinetic agents include local anaesthetics, macrolide antimicrobials, cholinergic agonists and dopamine antagonists. Endotoxaemia is common in horses following surgery for gastrointestinal disorders. The antibiotic polymyxin B binds to the circulating endotoxin molecule, decreasing its half-life in the intra-vascular space and reducing associated inflammation. This drug appears to be an effective and affordable treatment option for horses with endotoxaemia. The use of specific cyclooxygenase inhibitors in veterinary medicine have been studied recently. Selective cyclooxygenase-2 inhibitors may provide comparable anti-inflammatory and analgesic properties to the non-selective non-steroidal anti-inflammatory drugs. These drugs appear to have similar clinical effectiveness and will hopefully minimize deleterious side effects. The optimal healing of ventral midline incisions in horses is related to many factors including appropriate suture patterns and bite size, in addition to appropriate post-operative exercise recommendations. Recent advances in surgical techniques and post-operative care should decrease the morbidity and mortality associated with abdominal surgery. This article provides an overview of some of these advances.     

Laparoscopic techniques for investigating the equine oviduct

Reasons for performing study: The diagnostic and therapeutic options for oviduct disorders in the mare are limited. The current best techniques require exploratory surgery under general anaesthesia or flank laparotomy. Hypothesis: The orthograde flushing of the oviduct for diagnostic or therapeutic options is possible using laparoscopic techniques in the standing sedated mare. Methods: Development of a laparoscopic technique for catheterisation of the infundibulum and flushing of the oviduct (sterile methylene blue solution) in the standing sedated mare was examined in 2 experiments. The first involved a transvaginal laparoscopic approach, the second a laparoscopic flank approach. Passage of fluid into the uterus was assessed by post operative hysteroscopy. Results: In Experiment I, visualisation of the infundibulum was possible (left side 7/8 cases, right side in 6/8 cases). The beginning of the oviductal ampulla could be seen in 3 of 8 cases on the left side. An adequate opening of the infundibulum and visualisation or catheterisation of the abdominal ostium were not possible. In Experiment II, catheterisation of the ampulla was successful in 7 of 11 cases, and in 5 of these 7 cases the injected fluid could be identified in the uterus by post operative hysteroscopy. Conclusion: A transvaginal laparoscopic approach to the oviduct is not appropriate for oviductal flushing in the mare. However, a laparoscopic flank‐approach permits investigation and flushing of the oviduct. Potential relevance: Laparoscopic flushing could become a practical method for diagnosis and therapy of oviduct disorders and a minimally invasive technique for collection of young embryos or the transfer of gametes (GIFT).     

Method for obtaining bovine zygotes produced in vivo

A superovulatory and surgical protocol was developed for recovery of bovine zygotes. Holstein cows and heifers were given follicle-stimulating hormone and cloprostenol to induce superovulation. Surgical cannulation and lavage of the uterine tube was performed 40 to 48 hours after the start of standing estrus. In general, cows had more corpora hemorrhagica than did heifers, but a higher percentage (P less than 0.05) of ova recovered from cows were infertile. Several heifers were subjected to the procedure twice, and embryo recovery rates were equivalent both times.     

Nonsurgical treatment of uterine torsion in seven mares

Nonsurgical correction of uterine torsion was performed in 7 mares, and 6 foals were subsequently born alive. Uterine rupture necessitated euthanasia in 1 mare. Correction was achieved by rolling of the mares after general anesthesia had been induced. Previously, this technique was believed to be associated with a high prevalence of fetal and maternal mortality. Nonsurgical correction may be a satisfactory alternative to abdominal surgery in treating uterine torsion in mares.     

Clinical signs and treatment of chronic uterine torsion in two mares

Two mares were evaluated because of chronic uterine torsions of 2 and 4 weeks' duration; both were pyrectic, anemic, tachycardic, and anorectic, had signs of depression, and had an abnormal uterus and contents on transrectal examination. Both mares underwent cesarean section for lysis of adhesions from the uterus to the peritoneum, correction of the torsion, and ovariohysterectomy Both mares recovered with only minor complications and returned to be used as riding horses. Chronic uterine torsion should be considered in mares in late stages of gestation that have vague clinical signs and transrectal palpation findings that are unlike those described in typical cases of uterine torsion. Prognosis for life can be good after treatment by ventral midline celiotomy, cesarean section, correction of the torsion, and ovariohysterectomy.     

Surgical removal of a seminoma from a black sea bass

An adult black sea bass was examined because of abdominal distention and decreased appetite. A large abdominal swelling was evident and was firm on palpation. Differential diagnoses included neoplasia, abscess or granuloma, hematoma, or swim bladder abnormality. Diagnostic tests included survey radiography, positive-contrast radiography, and computed tomography. The sea bass was anesthetized with tricaine methanesulfonate. A ventral midline abdominal incision was made, and adhesions to the mass were gently dissected. The fish recovered without complications. Radiography was repeated 8 weeks after surgery, and there was no evidence of mass regrowth. To the authors' knowledge, this is the first report of a barium enema being performed in a fish. Although surgical procedures are performed more commonly on fish for research, a few reports of clinical surgical cases have been described. Our experience supports the conclusions of other reports that certain surgical procedures can be performed safely in fish.     

Standing musculoskeletal surgery.

Indications for performing orthopedic surgery on the standing horse include inability to tolerate general anesthesia, risk of worsening an injury during recovery from anesthesia, and cost. The surgeon should be aware that performing surgery in the standing horse can be more demanding and require more experience than the same procedures when the time and convenience of general anesthesia are available. Improved sedatives and analgesics have allowed more latitude because the horses now are more tolerant than when older agents were used. Common sense should be applied to each situation before the decision is made to do a procedure, because every horse and problem is unique.     

Technical note: transfer of ovine embryos through a simplified mini-laparotomy technique

The aim of this experiment was to examine whether a simplified mini-laparotomy technique is suitable for embryo transfer in ewes. In vitro produced blastocysts were transferred to the uterine horns of synchronous recipient ewes. Each recipient received 1 embryo by conventional laparotomy (n = 36), laparoscopy (n = 21), or by simplified mini-laparotomy (n = 33). Pregnancy rates for these 3 transfer techniques were 38.9, 47.6, 45.5%, respectively (P = 0.58). Of these techniques, the simplified mini-laparotomy was preferred because of benefits it provided in terms of savings in time and expense as well as reductions in surgical trauma and elimination of exteriorization of most of the reproductive system along with only one suture. It is likely that this technique will play a substantial role in adoption of embryo transfer by the sheep industry.     

Laparoscopic repair of a small intestinal mesenteric rent in a broodmare

OBJECTIVES : To describe standing laparoscopic repair of mesoduodenal rent inaccessible by ventral median celiotomy. STUDY DESIGN : Clinical case report. SAMPLE POPULATION : A 6-year-old Thoroughbred broodmare with a right displacement of the dorsal colon and small intestinal incarceration in a mesoduodenal rent. METHODS : Two days after correction of a right dorsal displacement of the ascending colon, small intestinal incarceration, and partial closure of mesoduodenal rent, standing left and right flank laparoscopy was used to explore the abdomen to identify the mesoduodenal defect. The mesenteric rent was repaired from right flank portals by approximation with hemostatic clips. RESULTS : Approximation of the mesoduodenal rent was achieved with laparoscopic clips. No further complications or signs of abdominal pain occurred over the following year. CONCLUSIONS : Mesenteric rents in the mesoduodenum can be repaired by laparoscopic techniques in the standing horse. CLINICAL RELEVANCE : Use of laparoscopic techniques in the standing horse should be considered for mesoduodenal rents that are not accessible form a ventral median celiotomy.     

How to perform ovariectomy through a colpotomy

Bilateral ovariectomy of mares is performed most commonly to eliminate or diminish unwanted behaviour, create a teaser mare, sterilise a mare so that it can be registered in its breed association, or produce a recipient mare for embryo transfer. A practical technique of bilateral ovariectomy that can be easily performed without the mare sedated and without a surgical facility is ovariectomy through a colpotomy. Ovariectomy through a colpotomy is less expensive than ovariectomy using other approaches because it is performed with the mare standing, can be performed quickly and the only specialised instrument required is a chain écraseur. Complications of ovariectomy performed through a colpotomy are uncommon when the mare is correctly prepared for the procedure and when proper precautions are taken during and after the procedure.     

Natural orifice transluminal endoscopic surgery (NOTES) in animals

Natural orifice transluminal endoscopic surgery (NOTES) is a modern technique of performing surgical procedures developed worldwide. In the last few years, series of NOTES operations were performed in animals and humans. This article describes some surgical procedures performed in animals with use of this new technique.