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.     

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.     

Retrospective study of 350 cases of equine cryptorchidism.

Equine cryptorchidism was examined by a review of the literature and a retrospective study of 350 horses over a 14-year period. The incidence of left vs right testis retention was nearly equal. On the left side, 75.2% of the retained testes were retained abdominally and 24.8% inguinally; on the right side, 41.8% of the retained testes were retained abdominally and 58.2% inguinally. Preoperative diagnosis by rectal palpation of the vaginal rings was considered a valuable technique, with 87.9% accuracy in 190 horses. Invasive and nonivasive surgical techniques for abdominal cryptorchidectomy and associated complications were compared. The results supported the technique of traction on gonadal structures outside the abdominal cavity (noninvasive) as superior to techniques requiring intraabdominal manipulation (invasive).     

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.     

A Modified Technique for Extensive Large Colon Resection and Anastomosis in Horses

Objective —To describe an alternative technique for large colon resection and anastomosis in horses.
Study Design —Retrospective study of clinical patients.
Animal Population —37 horses that had ventral midline celiotomies between July 1, 1990, and July 1, 1994.
Methods —Large colon resection and anastomosis was performed using a modification of previously described techniques. Modifications include mesocolon ligation with a stapling device and an end-to-end apposition of the right ventral and right dorsal colon.
Results —Twenty-one of the 37 horses were discharged from the hospital without complications. Two horses were euthanatized immediately after recovery from anesthesia because of hindlimb fracture. Fourteen horses were euthanatized in the initial postoperative period because of persistent endotoxemia and abdominal pain.
Conclusions —The described technique is a safe, reliable method for large colon resection and anastomosis in horses.
Clinical Relevance —The described technique is fairly simple to perform and requires less surgical time compared with other techniques.     

Inguinal percutaneous ultrasound to locate cryptorchid testes

Standing laparoscopic removal of abdominally retained cryptorchid testes may reduce patient morbidity and speed recovery compared with traditional laparotomy because anaesthesia is avoided and skin incisions are smaller. Reliably locating the testis preoperatively is therefore optimal to avoid unnecessary surgical morbidity and expense. We describe and review the results of a simple method of location using ultrasound scanning of the inguinal region, with a negative result indicating abdominal retention. One hundred and twenty‐seven horses with 141 cryptorchid testes were identified. Eighty‐five testes were identified inguinally: 56 abdominal. Two inguinally retained testes were not observed on ultrasound (false negatives) and 2 testes were considered inguinal but subsequently had to be removed from the abdomen (false positives). Sensitivity of inguinal ultrasound to predict the location of cryptorchid testes was therefore 98% and specificity 97%. The technique described herein proved a reliable technique to locate cryptorchid testes prior to surgery, minimising morbidity and cost. Suspect cryptorchids with no external evidence of testes should undergo a screening blood test prior to this ultrasound method of diagnosis.     

Abdominal cryptorchidectomy in the horse, using inguinal extension of the gubernaculum testis.

Removal of abdominal testes was accomplished in 32 horses ranging in age from 6 to 72 months. Twenty were unilateral and 12 were bilateral abdominal cryptorchids. An incision was made over the superficial inguinal ring, and the extension of the gubernaculum testis was identified and grasped with forceps. Traction was applied to this structure until the vaginal process was everted beyond the superficial inguinal ring. The vaginal process was incised and the protruding structure, usually the epididymis, was grasped. The testis was drawn out by gentle traction on the epididymis, and castration was performed in the routine manner.     

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.     

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.     

Cryptorchidism and monorchism in cats: 25 cases (1980-1989).

Of 1,345 cats admitted for orchiectomy during a 10-year period, 23 (1.7%) were cryptorchid and 2 (0.1%) were monorchid. Persian cats were over-represented in the cryptorchid population (P = 0.01). Cats were more likely to be unilaterally than bilaterally cryptorchid (P = 0.01). A predisposition for location of undescended testes (abdominal vs inguinal or right vs left side) was not identified in unilateral cryptorchids. All bilateral cryptorchids had abdominally located testes. The most common surgical approaches used for orchiectomy of cryptorchid cats were a caudal ventral midline incision for inguinal testes and a caudal ventral midline celiotomy for abdominal testes.     

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.     

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.     

Laparoscopic cryptorchidectomy in horses.

Laparoscopic cryptorchidectomy was successfully performed in 15 standing or recumbent horses. In 3 horses, owners believed that castrations had been performed, but the horses had retained stallion-like behavior. Successful removal of undescended testes in these horses stopped this behavior. Laparoscopy offered excellent visualization of the structures of the vaginal ring and facilitated removal of the abdominally located testis. The internal and external inguinal rings were not invaded, thus the chance of serious complications that may result during open cryptorchidectomy procedures was minimized.     

Usefulness of computed tomography for cryptorchidism in bulls

Cryptorchidism is defined as the failure of the testis to descend into the scrotal position. Bulls with cryptorchidism have problems in both meat quality and husbandry management; thus, it is greatly important to accurately identify the retained testis and remove it during the early stage. Abdominal computed tomography (CT) was performed under general anesthesia in 34 bulls aged 3–9 months with cryptorchidism. All bulls underwent laparoscopic or incision approach for cryptorchidectomy, and 40 testes were dissected. The detection rates of retained testes were 64.5% in the abdominal cavity and 100% in the subcutaneous inguinal region, and the total detection rate was 72.5%. Furthermore, all cases in this study were suspected to have intra-abdominal cryptorchidism in primary care, but CT revealed that 22.5% of cases had cryptorchidism in the subcutaneous inguinal region. The CT value (mean ± standard deviation) of the retained testes was 20.96 ± 7.54 Hounsfield Unit, and the CT value and size of the retained testes showed a positive weak correlation with bovine age. Therefore, there is the demerit that general anesthesia and a huge device are necessary; nevertheless, CT is suggested to be useful in identifying the location of retained testes and selecting an appropriate surgical approach in bulls with cryptorchidism. Moreover, CT findings suggested that the maturation of the retained testes might depend not on the descending process but on age.     

Laparoscopic cryptorchidectomy in dogs --report of 15 cases

The study aimed at determining the usability of laparoscopic cryptorchidectomy in treating cases of simple cryptorchidism and neoplastic testes in dogs. The presence of one or both testes inside the peritoneal cavity was confirmed in this study by an ultrasonographic examination employing the use of a 6.5 MHz convex head. The surgeries were conducted on a group of 15 dogs. In 12 subjects a one-sided cryptorchidism was found, 9 of which had right-sided cryptorchidism. In 3 dogs, both-sided cryptorchidism was observed. In 3 cases, an increase in the size of the abdominal testes with the symptoms of hyperestrogenism and feminisation raised a suspicion of neoplastic changes (SCT) taking place, which was confirmed by a histopathological examination. A laparoscopic cryptorchidectomy with intracorporal ligation was performed in all the subjects. The spermatic cord and ductus deferens were occluded with a ligature of an absorbable material, and a manually applied knot.     

Ventral Abdominal Approach for Laparoscopic Ovariectomy in Llamas

Objective —To evaluate a technique for laparoscopic ovariectomy by a ventral abdominal approach in the llama.
Study Design —Prospective evaluation.
Animal Population —Six healthy adult female llamas, aged 2 to 6 years.
Methods —Laparoscopic ovariectomy was performed with the llamas in a 30-degree Trendelenburg position. The mesovarium and proper ligament of the ovary were isolated, and two Hulka clips were placed in opposite directions across each mesovarium and proper ligament of the ovary. Ovaries were removed through either the instrument cannula or instrument portal.
Results —The ovaries, mesovarium, and proper ligaments of the ovaries were easily identified using laparoscopy by a ventral abdominal approach. The Hulka Clip Applicator was easy to use, and the Hulka Clips provided secure hemostasis of the vessels within the mesovarium. Mean duration of surgery was 35 minutes (range, 17 to 85 minutes). Two llamas were depressed after surgery but improved within 24 hours. No other complications occurred during an 18-month follow-up period.
Conclusions —Laparoscopic ovariectomy in the llama was facilitated by the use of Hulka Clips placed across the mesovarium and proper ligament of the ovary.
Clinical Relevance —Laparoscopic ovariectomy in the llama can be accomplished easily with few complications.     

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.     

Comparison of intraoperative pain responses following intratesticular or mesorchial injection of lidocaine in standing horses undergoing laparoscopic cryptorchidectomy

OBJECTIVE: To compare pain responses in stallions undergoing standing laparoscopic cryptorchidectomy following intratesticular or mesorchial infiltration of lidocaine. DESIGN: Clinical trial. ANIMALS: 20 stallions with 1 or 2 undescended testes. PROCEDURES: Standing horses were administered a nonsteroidal anti-inflammatory drug and a caudal epidural injection of detomidine hydrochloride and underwent laparoscopic cryptorchidectomy. The undescended testis (1/horse) was grasped to determine the preoperative pain response (present vs absent) and assess severity of pain (by use of a visual analog scale [VAS]). The undescended testis or its mesorchium was injected with 2% lidocaine (10 mL); saline (0.9% NaCl) solution (10 mL) was injected in the untreated structure. Presence and severity of pain was determined by 2 individuals as the testis was grasped following infiltration and at the times of ligature placement and transection of the spermatic cord. Serum cortisol concentration was analyzed preoperatively, after ligation, and after transection. Presence or absence of signs of pain, severity of pain, and serum cortisol concentrations were compared within and between treatment groups. RESULTS: Detection of signs of pain and VAS pain scores did not differ between observers at any time point. Perceived pain responses associated with ligature placement differed significantly from preoperative responses. Pain responses and serum cortisol concentrations after intratesticular and mesorchial infiltration of lidocaine did not differ. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that intratesticular or mesorchial infiltration of lidocaine combined with administration of a nonsteroidal anti-inflammatory drug and caudal epidural injection of detomidine provides adequate analgesia in standing stallions undergoing laparoscopic cryptorchidectomy.     

Evaluation of Postoperative Peritoneal Lavage in Standing Horses for Prevention of Experimentally Induced Abdominal Adhesions

Objective —To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses.
Study Design —Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery.
Animals or Sample Population—12 horses.
Methods —Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions.
Results —All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less ( P <.0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain.
Conclusions —Peritoneal lavage reduced the frequency of intraabdominal adhesions.
Clinical Relevance —When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.