Successful surgical removal of a pheochromocytoma in a mare via trans-costal approach.

BACKGROUND: Pheochromocytomas have been previously reported in horses, but successful antemortem diagnosis and surgical removal without recurrence of clinical signs have not been described. OBJECTIVE: To report the clinical presentation, diagnostic evaluation, surgical technique, anaesthetic management and post-operative care of a mare diagnosed with pheochromocytoma. STUDY DESIGN: Clinical case report. METHODS: An 18-year-old Quarter Horse mare presented for recurrent episodes of colic, profuse sweating, muscle fasciculations and agitation over a 2-month period. Clinical, clinicopathologic and ultrasonographic (transcutaneous, transrectal) abnormalities were consistent with a unilateral left-sided adrenal mass. Surgical removal of the mass was performed via a trans-costal approach with removal of the 18th rib and retraction of the left kidney to improve exposure. Associated vasculature was ligated, and the adrenal mass was removed and submitted for histopathology and immunohistochemistry. RESULTS: A trans-costal surgical approach provided excellent visualisation of the adrenal mass and allowed for identification and ligation of associated vessels. Total surgical and anaesthesia time were 86 and 114 min, respectively. Several intraoperative (hypertension, tachycardia) and post-operative (colic with tachycardia, tachypnea, large colon pelvic flexure impaction and nasogastric reflux) complications were encountered and managed successfully. Immunohistochemistry demonstrated positive labelling for synaptophysin and chromogranin A, confirming diagnosis of pheochromocytoma. The mare had recovered well at 6-week recheck post-operatively and returned to training at 6 months post-operatively. No further clinical signs consistent with pheochromocytoma have been observed following removal. CONCLUSIONS: The trans-costal approach allowed for surgical removal of a pheochromocytoma in a mare. Surgical removal of adrenal masses in horses may be associated with complications yet was successfully performed without subsequent recurrence of clinical signs associated with tumour presence and return to athletic use in this mare.

Phylogenetic relationships of the North American catfishes (Ictaluridae, Siluriformes): Investigating the origins and parallel evolution of the troglobitic species.

Insular habitats have played an important role in developing evolutionary theory, including natural selection and island biogeography. Caves are insular habitats that place extreme selective pressures on organisms due to the absence of light and food scarcity. Therefore, cave organisms present an excellent opportunity for studying colonization and speciation in response to the unique abiotic conditions that require extreme adaptations. One vertebrate family, the North American catfishes (Ictaluridae), includes four troglobitic species that inhabit the karst region bordering the western Gulf of Mexico. The phylogenetic relationships of these species have been contentious, and conflicting hypotheses have been proposed to explain their origins. The purpose of our study was to construct a time-calibrated phylogeny of Ictaluridae using first-occurrence fossil data and the largest molecular dataset on the group to date. We test the hypothesis that troglobitic ictalurids have evolved in parallel, thus resulting from repeated cave colonization events. We found that Prietella lundbergi is sister to surface-dwelling Ictalurus and that Prietella phreatophila + Trogloglanis pattersoni are sister to surface-dwelling Ameiurus, suggesting that ictalurids colonized subterranean habitats at least twice in evolutionary history. The sister relationship between Prietella phreatophila and Trogloglanis pattersoni may indicate that these two species diverged from a common ancestor following a subterranean dispersal event between Texas and Coahuila aquifers. We recovered Prietella as a polyphyletic genus and recommend P. lundbergi be removed from this genus. With respect to Ameiurus, we found evidence for a potentially undescribed species sister to A. platycephalus, which warrants further investigation of Atlantic and Gulf slope Ameiurus species. In Ictalurus, we identified shallow divergence between I. dugesii and I. ochoterenai, I. australis and I. mexicanus, and I. furcatus and I. meridionalis, indicating a need to reexamine the validity of each species. Lastly, we propose minor revisions to the intrageneric classification of Noturus including the restriction of subgenus Schilbeodes to N. gyrinus (type species), N. lachneri, N. leptacanthus, and N. nocturnus.

Liposomal bupivacaine is both safe and effective when administered via local infiltration at surgical site and mesovarium for laparoscopic ovariectomy in mares.

BACKGROUND: Liposomal local anaesthetic solutions may provide extended-duration analgesia postoperatively but have not been assessed following intra-peritoneal local infiltration in any species. OBJECTIVES: To evaluate two doses of 1.33% liposomal bupivacaine (LB) versus 0.75% bupivacaine HCL (BHCl) for analgesia following laparoscopic ovariectomy in mares. STUDY DESIGN: Prospective cohort study. METHODS: Fifteen healthy Quarter Horse mares (age 2-20 years) with normal bilateral ovarian palpation and appearance were enrolled. Horses were restrained in standing stocks and administered an α-2 agonist, butorphanol, and flunixin meglumine, followed by a variable rate infusion of sedation with α-2 agonists. Bilateral paralumbar fossa ovariectomies were performed. Treatment with either 30 ml 0.75% BHCl followed by 20 or 40 ml LB 13.3% (LB20 and LB40) volume expanded with saline to 80 ml total (n = 6/group) or 80 ml BHCl alone (n = 3, BCHL) was infused around incision sites and each mesovarium (LB or BHCl) prior to ovariectomy. Horses were monitored for 72 h by physical examination, algometry, and pain scoring (composite pain scale by Bussieres et al., Horse Grimace Scale). Abdominocentesis with peritoneal fluid analysis was performed at 72 h. RESULTS: Analgesia achieved with all treatment protocols allowed completion of ovariectomy procedures. Pressure algometry scores were lower in BHCl-treated horses versus both LB groups overall. Pain scores were improved with LB-treated horses in a dose-dependent fashion (Horse Grimace Scale scores LB40 < LB20 < BHCL; composite pain scale scores LB40 < BHCL, LB20 < BHCL, BHCL, and LB20 did not differ). Peritoneal fluid total protein was lower in LB40 versus LB20 and BHCL horses. No complications from LB administration were appreciated. MAIN LIMITATIONS: Small patient sample size, lack of follow-up past 72 h or histopathology. CONCLUSIONS: Analgesia duration was extended and pain scores improved postoperatively with LB versus BHCl in a dose-dependent fashion. Further clinical evaluation of extended-duration local anaesthetics in horses for improved postoperative pain management is warranted.

Evaluation of factors associated with surgical site infection in equine proximal interphalangeal joint arthrodesis: 54 cases (2010-2019).

BACKGROUND: The frequency of surgical site infection (SSI) following orthopaedic implant placement in horses has been reported but not compared with respect to specific antibiotic protocols administered. OBJECTIVES: To determine factors associated with SSI in horses undergoing proximal interphalangeal joint (PIPJ) arthrodesis including perioperative antibiotic protocols. METHODS: Records were evaluated (2010-2019), and horses undergoing PIPJ arthrodesis were identified. Patient signalment, supervising surgeon, reason for surgery, limb, implants placed, anaesthetic time, duration casting/coaptation postoperatively, antibiotic regimen and incidence/onset SSI were recorded. Bayesian and frequentist logistic regressions were used to estimate the contribution of covariates to infection occurrence. RESULTS: Fifty-four PIPJ arthrodeses were performed. SSI occurred in 2/54 (3.7%) on day 15,30. Arthrodesis was performed most commonly for osteoarthritis (33/54, 61.1%), fracture (11/54, 20.4%), and subluxation (5/54, 9.3%). Perioperative systemic antibiotics were administered 1-3 days (15/54, 27.8%) or > 3 days (39/54, 72.2%). Antibiotic protocols included cefazolin/gentamicin (20/54, 37%), cefazolin/gentamicin/doxycycline (14/54, 25.9%) and potassium penicillin/gentamicin (10/54, 18.5%). Regional limb perfusion was performed preoperatively 31/54 (57.4%) and postoperatively 7/54 (13%). Survival to dismissal was 98.1% (53/54 horses) with one horse euthanized due to support limb laminitis. No association was identified between antibiotic selection or duration (1-3 vs. > 3 days), pre-operative regional antibiotic perfusion, intraoperative antibiotic lavage or anaesthetic time (< or > 3 h) and SSI; however, modelling was complicated by quasi-complete or complete separation of the data. Bayesian analysis (but not frequentist analysis) indicated an association between post-operative regional antibiotic perfusion and SSI. Limitations include the retrospective nature of data collection and the low rate of infection overall. CONCLUSIONS: The prevalence of SSI in this population was lower than that in previous reports of equine orthopaedic internal fixation. There was no difference in SSI rate in cases administered systemic antibiotics for 1-3 days or >3 days, or for those horses that did or did not receive preoperative regional antibiotic perfusion.

Comparison of sedation quality and safety of detomidine and romifidine as a continuous rate infusion for standing elective laparoscopic ovariectomy in mares.

OBJECTIVE: To compare efficacy and safety of a continuous rate infusion of detomidine hydrochloride and romifidine hydrochloride for standing elective bilateral laparoscopic ovariectomy in mares. STUDY DESIGN: Blinded, randomized prospective clinical study. ANIMALS: Eighteen healthy mares presenting for elective bilateral ovariectomy METHODS: Mares were randomly assigned to one of two sedation protocols. Prior to surgery, baseline head height, heart rate, respiratory rate, and postural sway were recorded. An IV loading dose of α2-agonist (46 µg/kg romifidine or 13.9 µg/kg detomidine) was administered. Standing sedation was maintained with a continuous rate infusion of the respective α2-agonist (126 µg/kg/h romifidine or 37.8 µg/kg/h detomidine). Intraoperative measurements included respiratory rate, heart rate, head height, postural sway, and response to surgical stimulus. Postoperatively, fecal output was recorded, and pain scoring was performed using composite pain score and visual analog scales. RESULTS: Three of 18 horses required additional α-2 agonists: one detomidine and two romifidine and butorphanol. Head height during surgery was lower (p < .001) in mares receiving detomidine. Postural sway around the vertical axis was greater in mares sedated with detomidine rather than romifidine (p = .013). No differences were detected in intraoperative heart rate, postoperative pain scores or postoperative fecal output between sedation techniques. CONCLUSION: Comparable scores for surgical stimulation and sedation were measured in both sedation groups. No differences in postoperative analgesia or manure production were identified. CLINICAL SIGNIFICANCE: Romifidine appears suitable as an alternative to detomidine and may limit ataxia and head drop in sedated horses.

Retrospective evaluation of association between perioperative antimicrobial protocol and complications following elective equine synovial endoscopy.

BACKGROUND: Prophylactic perioperative antimicrobial protocols in equine synovial endoscopy have been described but not compared with respect to post-operative outcomes and complications. Increasing antimicrobial resistance in equine practice and interest in promoting judicious use of antimicrobials has prompted reevaluation of drug selection and dosing strategies. OBJECTIVES: To determine the frequency of and compare post-operative complications following elective synovial endoscopy between horses receiving different perioperative antimicrobial protocols. METHODS: Records from the Colorado State University Veterinary Teaching Hospital were evaluated (2014-2018) and equine patients undergoing elective synovial endoscopy were identified. Patients undergoing endoscopy for sepsis or internal fixation were excluded. Patient signalment, clinician, joint and limb involved, perioperative antimicrobial regimen, number endoscopic portals and closure technique, and post-operative complications including incidence of joint infection were recorded. Generalized linear models were used to estimate the odds of post-operative complications. RESULTS: Elective synovial endoscopies of 516 horses in 537 procedures evaluating 761 synovial structures were performed. No horses developed post-operative septic synovitis. Administration of post-operative antimicrobials, type used and patient sex were all significantly associated with increased risk of complications, which were predominantly gastrointestinal-related. Complication rates in horses receiving a single preoperative dose of cefazolin were lower than in horses receiving potassium penicillin, gentamicin or multiple doses. Complication rates were lower in females compared to castrated or intact males. Other factors evaluated (breed, age, surgeon, anaesthesia duration or hospitalization, joint/limb operated, number endoscopic portals) were not associated with increased risk of complications post-operatively in this case population. CONCLUSIONS: Prophylactic perioperative antimicrobial protocols in equine practice deserve periodic reconsideration due to increased antimicrobial resistance. Prolonged antimicrobial usage beyond the time of surgery was unnecessary to prevent septic synovitis following synovial endoscopy in this case population and was furthermore associated with an increased risk of gastrointestinal complications.

Ovarian histopathology, pre- and post-operative endocrinological analysis and behavior alterations in 27 mares undergoing bilateral standing laparoscopic ovariectomy.

Determining if ovariectomy will abolish unwanted behaviors can be challenging in mares without ultrasonographic ovarian abnormalities and/or endocrine values not consistent with a granulosa cell tumor. The objective of the study was to identify mares that have a positive improvement in unwanted behaviors after elective standing laparoscopic ovariectomy and to determine if the change is associated with any pre- and post-operative endocrine profiles and/or with ovarian histological findings. During the study period 27 mares underwent a bilateral standing laparoscopic ovariectomy. Pre- and post-operative questionnaires and endocrine profiles, along with ovarian histopathology were performed and data were analyzed. Eighty-nine percent of clients were satisfied with the change in behavior after surgery. There were no significant associations between specific elevated hormones or absent luteal tissue with any specific unwanted behaviors. Pre-operative endocrine values were not predictive of post-operative owner satisfaction but bilateral ovariectomy for the treatment of unwanted behaviors in mares had a high likelihood of achieving owner satisfaction.

Histopathologie ovarienne, analyse endocrinienne pré- et post-opération et modifications du comportement chez 27 juments soumises à une ovariectomie bilatérale laparoscopique en position debout. Déterminer si une ovariectomie éliminera les comportements non-désirés peut représenter un défi chez les juments sans anomalie ovarienne détectable par échographie et/ou ayant des valeurs endocrines non cohérentes avec une tumeur des cellules de la granulosa. L'objectif de la présente étude était d'identifier les juments avec une amélioration positive des comportements non-désirés à la suite d'une ovariectomie élective par laparoscopie en position debout et de déterminer si le changement était associé avec un quelconque profil endocrinien pré- et post-opération et/ou avec des trouvailles histologiques dans les ovaires. Durant la période d'étude 27 juments ont été soumises à une ovariectomie laparoscopique bilatérale en position debout. Des questionnaires pré- et post-opération ainsi que des profils endocriniens et des analyses histopathologiques des ovaires furent réalisés et les données analysées. Quatre-vingt-neuf pourcents des clients étaient satisfaits avec le changement dans le comportement après la chirurgie. Il n'y avait pas d'association significative entre des niveaux élevés d'hormones spécifiques ou l'absence de tissu lutéal et des comportements non-désirés spécifiques. Les valeurs endocrines pré-opération n'étaient pas prédictives de la satisfaction post-opération des propriétaires mais l'ovariectomie bilatérale pour le traitement de comportements non-désirés chez les juments avait un grand potentiel d'obtenir la satisfaction du propriétaire.(Traduit par Dr Serge Messier).

In vitro evaluation and in vivo use of a novel surgical stent to minimize suture pressure necrosis.

OBJECTIVE: To evaluate the efficacy of stents to distribute pressure when incorporated into tension-relieving sutures. STUDY DESIGN: An in vitro study and case report. ANIMAL: One common bottlenose dolphin (Tursiops truncates). METHODS: Three novel silicone stents, a traditional stent, and a control were tested in vitro by using a suture simulator. Stent surface area was measured by using a pressure mapping sensor. Pressure was derived from the measured surface area and the downward force of the suture simulator. Novel silicone stents were also used in the closure of an incision in a bottlenose dolphin. RESULTS: No difference was found in surface area or pressure among the three silicone stents (adjusted P > .05). Silicone stents yielded an average, 2.69 cm2 more surface area and 842.37 kPa less pressure compared with the control as well as 1.67 cm2 more surface area and 110.67 kPa less pressure compared with the traditional stent. The traditional stent yielded 1.02 cm2 more surface area and 731.7 kPa less pressure compared with the control. Incision site and silicone stent assessment performed postoperatively revealed no obvious pressure necrosis. CONCLUSION: Stents improved distribution of suture pressure, and novel silicone stents were more effective compared with traditional stents. Novel silicone stents appear to have preliminary clinical success in vivo. CLINICAL SIGNIFICANCE: Our study provides evidence that stents effectively help distribute suture pressure, and their incorporation might minimize the risk of suture pressure necrosis. Novel silicone stents should be integrated into tension-relieving suture patterns when closing wounds and incisions, particularly in aquatic animals.

A Competency-Guided Veterinary Curriculum Review Process.

Competencies can guide outcomes assessment in veterinary medical education by providing a core set of specific abilities expected of new veterinary graduates. A competency-guided evaluation of Colorado State University's (CSU) equine veterinary curriculum was undertaken via an alumni survey. Published competencies for equine veterinary graduates were used to develop the survey, which was distributed to large animal alumni from CSU's Doctor of Veterinary Medicine program. The results of the survey indicated areas for improvement, specifically in equine business, surgery, dentistry, and radiology. The desire for more hands-on experiences in their training was repeatedly mentioned by alumni, with the largest discrepancies between didactic knowledge and hands-on skills in the areas of business and equine surgery. Alumni surveys allow graduates to voice their perceived levels of preparation by the veterinary program and should be used to inform curriculum revisions. It is proposed that the definition and utilization of competencies in each phase of a curricular review process (outcomes assessment, curriculum mapping, and curricular modifications), in addition to faculty experience and internal review, is warranted.

Prospective randomized investigation of topical anesthesia during unilateral laparoscopic ovariectomy in horses.

OBJECTIVE: To compare pain-related responses in mares receiving topical or injected anesthesia of the ovarian pedicle prior to standing unilateral laparoscopic ovariectomy. STUDY DESIGN: Prospective randomized, blinded, placebo-controlled study. ANIMALS: Fifteen healthy research mares. METHODS: Mares were restrained in stocks and administered sedation. A right or left paralumbar ovariectomy was performed by using a laparoscopic portal and two instrument portals. Mares were divided into two treatment groups, and equal volumes of mepivacaine anesthesia were administered either topically (n = 8) or by injection into the ovarian pedicle (n = 7). Saline controls were simultaneously administered topically (n = 7) or by injection (n = 8), and surgeons were blinded to the treatment group. Ovarian removal was performed with traumatic forceps and a blunt tip vessel sealer and divider. Pain responses were measured by operative visual analog scale (VAS) scoring and perioperative serum cortisol response. Visual analog scale and serum cortisol were compared between groups by using Mann-Whitney testing. Serum cortisol concentrations were evaluated using repeated-measures one-way analysis of variance. RESULTS: Ovaries were removed in all mares by using the described technique without operative complications. Quantity of sedation required to complete the procedure, operative VAS scores, and perioperative cortisol concentrations did not differ between treatment groups. CONCLUSION: Application of topical mepivacaine to the ovary provided intraoperative analgesia similar to injection of the ovarian pedicle when performing unilateral standing laparoscopic ovariectomy in mares. CLINICAL SIGNIFICANCE: Topical anesthesia application to the ovary could provide an alternative to laparoscopic needle use, reducing the risk of inadvertent trauma to the pedicle or other visceral organs during laparoscopic ovariectomy.

Left paralumbar fossa approach combined with mesocolon fenestration for bilateral equine ovariectomy.

OBJECTIVE: To describe a standing left paralumbar fossa approach combined with mesocolon fenestration for bilateral equine ovariectomy. STUDY DESIGN: Prospective experimental clinical study. ANIMALS: Four healthy client-owned mares and 1 client-owned Molly mule. METHODS: Mares were restrained in standing stocks and sedated with an α2 -agonist continuous infusion to effect. The abdominal cavity was approached via a left paralumbar fossa approach, and the contralateral right ovary was accessed through an incision in the mesocolon. The location of the window was adjusted to allow triangulation, adequate visualization, and manipulation of the contralateral right ovary. Each ovarian pedicle was ligated with extracorporeal ligatures prior to sharp transection. The ovaries were dropped and left within the abdomen as part of another study. The incision in the mesocolon was closed with laparoscopic staples. Mares were monitored hourly while hospitalized, and a questionnaire was completed by the owners 90 days after surgery. RESULTS: Both ovarian pedicles were successfully ligated and transected in all mares through the left paralumbar fossa approach and mesocolon fenestration. The only complications consisted of mild incisional emphysema in 2 of 5 equids, with all resolving spontaneously. All equids returned to intended use at 90 days. CONCLUSION: The left paralumbar fossa approach combined with mesocolon fenestration provided adequate access to both ovaries with minimal morbidity in this small population. CLINICAL SIGNIFICANCE: A unilateral left paralumbar fossa approach and fenestration of the mesocolon should be considered as an alternative to traditional approaches for bilateral laparoscopic ovariectomies in equids.

Effect of Short- Versus Long-Term Video Game Playing on Basic Laparoscopic Skills Acquisition of Veterinary Medicine Students.

The objective of this study was to investigate the effect of playing video games on the performance of basic laparoscopic skills. The study was an experimental pre-test-post-test comparison group design. Fifty-two students (31 from the Western University of Health Sciences College of Veterinary Medicine and 21 from the Colorado State University College of Veterinary Medicine) completing their first or second year of the veterinary curriculum were randomized into two intervention groups. The intervention consisted of playing the video game Marble Mania on a Nintendo Wii. group L (long) played 18 hours over 6 weeks and group S (short) played 3 hours during the last week of the 6-week intervention period. Before and after the intervention, basic laparoscopic skills for both groups were assessed using a modified McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) instrument. Participants performed two laparoscopic tasks. Results showed that the performance of students improved in both group S and L (p < .05) on both laparoscopic tasks. Both groups showed statistically significant improvement in their post-intervention scores (group L, N = 25, z = -3.711, p < .001, r = 0.742; group S, N = 27, z = -3.016, p < .003, r = 0.580). There was no significant difference in the degree of improvement between group S and group L. The results suggest that playing Marble Mania on a Wii for any time duration could be an effective method for veterinary medicine students to improve basic laparoscopic skills, and indicate the needs for additional studies.

Evaluation of post-operative pain after active desufflation at completion of laparoscopy in mares undergoing ovariectomy.

The cause of transient post-operative pain in a subset of horses undergoing laparoscopy is unclear. The objective of this study was to evaluate if residual pneumoperitoneum is associated with transient post-operative pain in mares undergoing ovariectomy. Thirty-eight mares undergoing routine standing laparoscopic ovariectomy were randomly allocated into 2 groups. At the completion of laparoscopy, either the abdominal cavity was actively desufflated or the cannulas were opened to achieve ambient pressure before incisional closure. Assessments were performed for 18 hours after surgery using a validated visceral/somatic pain scale for horses. Overall, pain was minimal in both groups (median score 2/39) post-surgery. Active desufflation of the pneumoperitoneum at the completion of laparoscopy approached statistical significance (P = 0.07) in decreasing pain at 12 hours after laparoscopy. However, effects of active desuffation were not significant throughout the monitored 18-hour post-surgery period. We conclude that the decision to actively desufflate at the completion of laparoscopy should be based on surgeon's preference.

Évaluation de la douleur postopératoire après un désoufflement actif à l'achèvement d'une laparoscopie chez les juments subissant une ovariectomie. La cause d'une douleur postopératoire transitoire dans un sous-groupe de chevaux subissant une laparoscopie est indéterminée. Cette étude avait pour objectif d'évaluer si le pneumopéritoine résiduel est associé à de la douleur postopératoire chez les juments subissant une ovariectomie. Trente-huit juments subissant une ovariectomie laparascopique debout de routine ont été réparties au hasard dans deux groupes. À l'achèvement de la laparoscopie, soit la cavité abdominale a été activement désoufflée ou les canules ont été ouvertes pour obtenir une pression ambiante avant la fermeture de l'incision. Des évaluations ont été réalisées pendant 18 heures après la chirurgie en utilisant une échelle de douleur viscérale/somatique validée pour les chevaux. Dans l'ensemble, la douleur a été minimale dans les deux groupes (note médiane de 2/39) après la chirurgie. La désoufflement actif du pneumopéritoine à l'achèvement de la laparoscopie s'approchait de l'importance statistique (valeur de P = 0,07) en réduisant la douleur à 12 heures après la laparoscopie. Cependant, les effets du désoufflement actif n'étaient pas significatifs pendant la période de surveillance 18 heures après la chirurgie. La décision de désouffler activement à l'achèvement de la laparoscopie est toujours sujette à la préférence du chirurgien.(Traduit par Isabelle Vallières).

Vessel sealer and divider instrument temperature during laparoscopic ovariectomy in horses.

OBJECTIVE: To determine the temperature of a vessel sealer and divider device during unilateral paralumbar laparoscopic ovariectomy in standing, sedated mares. STUDY DESIGN: Prospective study. ANIMALS: Fifteen healthy research mares. METHODS: Healthy mares with normal ovarian palpation and ultrasonographic appearance were enrolled. Horses were restrained in standing stocks and sedated. A right or left paralumbar ovariectomy was performed with a laparoscopic portal and 2 instrument portals. Ovaries were excised with traumatic forceps and a blunt tip vessel sealer and divider. Temperatures of the vessel sealer and divider were recorded with a thermocouple device adhered to the tip of the instrument. Variables were reported as median and interquartile range (IQR). RESULTS: Surgical time was 30 minutes (IQR, 25-32) including use of the vessel sealer and the divider for 4.1 minutes (IQR, 3.2-5.8). The tip of the instrument reached temperatures of 77°C (IQR, 72-85) during activation and 64°C (IQR, 61-67) at end cycle. The median increase in end-cycle instrument tip temperature per activation cycle was 2°C (IQR, -1-6). All mares returned to their intended use. CONCLUSION: Despite the instrument temperatures observed during unilateral laparoscopic ovariectomy, surgical complications were minimal. The clinical relevance of the increase in instrument tip temperature of the vessel sealer and divider is presently unclear, but surgeons should use the instrument with caution, especially in close proximity to viscera. The increase in temperature observed at the tip of the vessel sealer and divider during unilateral ovariectomy could be associated with morbidity. The clinical relevance of instrument tip heating during other procedures, such as adhesiolysis and intestinal resection, is unknown and should be evaluated.

EMERGENCY ANESTHESIA AND EXPLORATORY LAPAROTOMY IN A COMPROMISED PACIFIC WHITE-SIDED DOLPHIN (LAGENORHYNCHUS OBLIQUIDENS).

Anesthesia and surgery in cetaceans have inherent risks and have rarely been utilized as viable treatment options. This report represents the first known multidisciplinary team approach to emergency laparotomy in a compromised, 22-yr-old, female Pacific white-sided dolphin ( Lagenorhynchus obliquidens ). The inciting clinical signs and ancillary diagnostics were consistent with a mechanical ileus. Although no torsion or obstruction was apparent during surgery, severe enteritis and peritonitis were noted. Postoperatively, the animal was maintained on aggressive medical management with continuous supportive care until succumbing 3 days later with clinical pathology indicative of terminal sepsis and profound inflammation. Postmortem findings included generalized vascular stasis and segmental intestinal volvulus with infarction. To the authors' knowledge, this is one of the most-complex surgical and anesthetic procedures performed in a cetacean. Though the outcome was unsuccessful, this case represents the aquatic veterinary community's collective advances in the ability to treat cetaceans under human care.

Left paralumbar laparoscopic bilateral ovariectomy in mares.

OBJECTIVE: To develop a novel technique for left paralumbar laparoscopic bilateral ovariectomy in standing, sedated mares. STUDY DESIGN: Prospective descriptive clinical study. ANIMALS: Twelve client-owned mares. METHODS: Healthy mares with normal ovarian palpation and ultrasonographic appearance were enrolled. Horses were restrained in standing stocks and administered a variable rate infusion of sedation. A left paralumbar bilateral ovariectomy was performed with 1 laparoscopic and 3 instrument portals. Access to the right ovary was facilitated by retracting the descending colon and associated mesentery with a fan retractor. Ovaries were removed with traumatic forceps, and a blunt tip vessel sealing device. A laparoscopic portal within the 17th intercostal space provided good visualization of the right ovary and reduced interference between instrumentation. Complications were recorded during hospitalization. In addition, an owner follow-up questionnaire was used to determine complications after discharge from the hospital. RESULTS: Left paralumbar bilateral ovariectomy was successful in all 12 mares, with a mean surgical time of 76 ± 8 minutes. Postoperative complications occurred in 4/12 (33%) mares and included fever, mild colic, incisional swelling, and azotemia. Complications resolved and mares returned to full activity, with complete owner satisfaction. CONCLUSIONS: Bilateral ovariectomy can be successfully achieved with minimal morbidity in standing mares with normal ovarian ultrasonographic appearance via left paralumbar laparoscopy.

Laparoscopic Closure of the Nephrosplenic Space in Horses with Nephrosplenic Colonic Entrapment: Factors Associated with Survival and Colic Recurrence.

OBJECTIVES: 1) To identify factors associated with short-term survival and time to death after hospital discharge in horses with nephrosplenic entrapment (NSE). 2) To compare the frequency of recurrent colic episodes in horses with and without laparoscopic closure of the nephrosplenic space. STUDY DESIGN: Historical cohort with a nested case control. ANIMALS: Client-owned horses. METHODS: Medical records of horses treated for NSE from January 1, 2002 to June 1, 2014 were reviewed. Data collected included signalment, physical examination parameters, laboratory results, diagnostic findings, and treatments. Factors associated with short-term survival to discharge were analyzed with a multivariable logistic regression model and time to death after hospital discharge was analyzed with a Cox proportional hazards model. RESULTS: During the study period, 211 horses had 231 NSE events and 192/211 (91%) horses survived to discharge. A positive difference in packed cell volume (PCV at admission - PCV after treatment) was associated with reduced odds of nonsurvival with each increment (OR: 0.899, 95% CI 0.816-0.991, P=.03) while the presence of concurrent alimentary lesions (OR: 8.47, 95% CI 1.42-50.4, P=.02) were significantly associated with increased odds of nonsurvival in the short term. Of 156 horses that survived to discharge for which follow-up was available, 152 (97%) were alive for ≥1 year. Increasing age (incremental years) at hospital admission was significantly associated with death after discharge (hazard ratio 1.078, 95% CI 1.002-1.16, P=.049). Recurrence of NSE was documented in 49/211 (23%) horses. The overall change in colic score indicated a reduction in colic in horses following laparoscopic closure of the nephrosplenic space compared with horses that did not have closure of the nephrosplenic space (P<0.001). CONCLUSION: An increase in PCV from admission to after treatment and concurrent abdominal lesions were associated with increased odds of nonsurvival to discharge in horses with NSE. Horses that underwent laparoscopic closure had reduced colic episodes compared with horses without laparoscopic closure.

A comparison of peritoneal fluid values in mares following bilateral laparoscopic ovariectomy using a vessel sealing and dividing device versus placement of two ligating loops.

The objective of this study was to determine the effect of bilateral laparoscopic ovariectomy on peritoneal fluid values in mares and compare how this effect was modified by the method of ovarian vessel hemostasis used. Ten mares undergoing standing bilateral laparoscopic ovariectomy were used in a randomized clinical study. During surgery, blood vessels within the mesovarium were either: (1) sealed and transected with a vessel sealing and dividing device (VSDD), or (2) ligated using two loops placed proximal to each ovary and then the mesovarium transected using laparoscopic scissors. The ovaries were removed through the ipsilateral body wall. Abdominocentesis was performed before surgery and 24 h and 72 h after surgery. Markers of peritoneal inflammation, as measured by total nucleated cell count, total protein (TP) and red blood cell count via abdominocentesis, were consistently increased for all groups compared to pre-operative values. The mean (range) of TP for the VSDD group was 4.14 (3.9-4.5) g/dL, and that for the ligating loop group was 3.18 (2.7-3.5) g/dL. Use of the VSDD resulted in significantly greater TP concentrations in the abdominal fluid at 24 h and 72 h post-operatively when compared to a ligating loop (P <0.001 and 0.04, respectively).

Advances in laparoscopic techniques and instrumentation in standing equine surgery.

Equine standing surgery and laparoscopy are becoming increasingly important aspects of equine surgery. Laparoscopic advancements lag behind the human medical field, mainly due to decreased access to appropriate training and instrumentation. It is nearly impossible to cover the topic of equine standing surgery without discussing advances in laparoscopy, because without such advances, equine standing surgery lacks potential for forward progress. Although novel standing techniques continue to be published, the addition of minimally invasive laparoscopic techniques adds an entirely new dimension and provides a plethora of procedures to surgeons practicing equine standing surgery.

Standing male equine urogenital surgery.

The advantages of performing standing male urogenital surgeries are numerous when compared with performing the same surgery in the anesthetized animal. Some traditional standing male urogenital surgeries, such as castrations, may be faster and cheaper to perform. Laparoscopic standing male urogenital surgeries may allow for improved visualization of the surgical field, decreased hemorrhage, and decreased morbidity and convalescence. Limitations of standing procedures may include increased danger to the surgeon because of fractious behavior of the patient, and increased expense and training associated with instrumentation for specialized procedures such as laparoscopy.