Standing hand-assisted laparoscopic ovariohysterectomy to treat chronic pyometra in a mare.

OBJECTIVE: To describe a standing hand-assisted laparoscopic ovariohysterectomy in a mare. ANIMAL: A 15-year-old maiden Oldenburg mare. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The mare was presented for evaluation of bucking under saddle and uncharacteristic aggressive behavior. Evaluation of a 24-hour video of the mare in a stall showed behavior consistent with caudal visceral abdominal discomfort. Reproductive evaluation revealed a pyometra secondary to complete transluminal cervical adhesions. The mare was initially managed medically with disruption of the adhesions and uterine lavage, but the adhesions reformed within 6 weeks and could not be manually disrupted. TREATMENT AND OUTCOME: To eliminate the recurrence of pyometra, the mare underwent standing hand-assisted laparoscopic ovariohysterectomy through bilateral flank incisions. The only complication was a seroma at 1 flank incision that resolved after drainage. CLINICAL RELEVANCE: Complete ovariohysterectomy in the mare is a challenging procedure and has previously been performed under general anesthesia. This is the first report of the procedure being performed completely in the standing mare without inversion of the uterus through the cervix.

Hand-assisted laparoscopic cystotomy for cystic calculus removal in male horses (3 cases).

A technique for hand-assisted laparoscopic removal of cystic calculi in male horses is described. Three cystic calculi ranging from 5 to 10 cm in diameter were removed successfully using bilateral para-inguinal laparoscopic portals assisted by a human hand within the abdomen, effectively sealing the midline incision. Long-term follow-up information obtained from referring veterinarians and owners indicated that the patients returned to their previous activity level and had no recurrence of clinical signs in the following 6 to 12 months. Key clinical message: Hand-assisted recumbent laparoscopy is a satisfactory surgical technique for removal of cystic calculi in horses which cannot be operated on standing or whose body condition would make the parainguinal approach difficult.

Cystotomie laparoscopique aidée de mains pour le retrait de calculs cystiques chez des chevaux mâles (3 cas). Une technique pour le retrait de calculs cystiques par laparoscopie aidée de mains chez des chevaux mâles est décrite. Trois calculs cystiques variant de 5 à 10 cm de diamètre furent retirés avec succès en utilisant des entrées laparoscopiques bilatérales para-inguinales aidées d'une main humaine à l'intérieur de l'abdomen, scellant avec succès l'incision sur la ligne médiane. Les informations sur le suivi à long terme obtenues des vétérinaires référant et des propriétaires indiquaient que les patients étaient retournés à leur niveau d'activité antérieur et qu'aucune récurrence des signes cliniques ne fut notée dans les 6 à 12 mois suivants.Message clinique clé:La laparoscopie couchée aidée de mains est une technique chirurgicale satisfaisante pour le retrait de calculs cystiques chez des chevaux qui ne peuvent être opérés debout ou dont la condition corporelle rendrait l'approche parainguinale difficile.(Traduit par Dr Serge Messier).

Standing Hand-Assisted Laparoscopic Diagnosis and Treatment of a Rare Case of Uterine Adenocarcinoma in an 18-Year-Old Mare.

An 18-year-old French Trotter mare was presented to the Clinique Equine, Ecole Nationale Vétérinaire d'Alfort, for exploration of a 3-month-duration vaginal bleeding. A transrectal ultrasound examination identified a mass within the right uterine horn wall, which had been suspected during transrectal palpation. It was described as a firm heterogeneous intramural mass (7 × 12 cm) in the right uterine horn, located few centimeters cranially to the bifurcation. Hysteroscopy confirmed the ulcerated and irregular shape of the mass. A standing hand-assisted flank laparoscopy was performed to carry out a partial ovariohysterectomy. Two days after surgery, the mare presented with acute and severe signs of colic and was euthanized. Postmortem examination revealed a 720° small intestine volvulus at the mesenteric root, a left dorsal displacement of the large colon, and iliac and tracheobronchial lymph node hypertrophy. Histopathological examination of the removed uterine mass revealed a well-differentiated and infiltrating uterine adenocarcinoma, with lymph node metastasis. Uterine neoplasia, especially adenocarcinoma, is uncommon in the mare and can be successfully removed using a standing hand-assisted laparoscopic technique, which avoids the risks associated with general anesthesia and allows a histologic diagnosis of malignancy. In such cases, though, initial staging and identification of metastasis remain a challenge that will influence the treatment strategy.

Evidence of Spontaneous Recovery of Granulosa-Theca Cell Tumour in a Heifer: A Retrospective Report.

A 14-month-old Japanese Black heifer was evaluated on Day 0 (D 0) for enlargement of the right ovary (RO). Transrectal ultrasonography (TRUS) revealed that the RO was markedly enlarged and multicystic, while the left ovary (LO) was small and inactive. The presumptive diagnosis was granulosa-theca cell tumour (GTCT), which was confirmed by markedly elevated plasma anti-Müllerian hormone (AMH) of 4.42 ng/ml. Therefore, ovariectomy of the RO was the treatment of choice. The heifer was checked by TRUS and blood sampling on D 42, D 63 and immediately before ovariectomy on D 85. On D 42, TRUS did not show marked changes in either ovary in comparison with D 0. However, on D 63, the RO had transformed into a single cyst, and on D 85, the LO had resumed cyclic activity. The RO was extracted on D 85 by hand-assisted laparoscopic ovariectomy to allow better control. Unexpectedly, histopathology revealed the lesion to be a fluid-filled cystic structure, with no neoplastic proliferation of follicular epithelium that would indicate GTCT. The wall of the cystic structure consisted of collagen fibres and a few degenerated granulosa cells. The retrospective hormonal analysis revealed that the AMH concentrations had markedly dropped on D 63 and 85, which coincided with resumption of cyclicity in the LO. These findings suggest that the GTCT had self-cured and transformed into a cyst-like structure. The heifer then received an oestrous synchronization regime on D 105, was artificially inseminated on D 115 and became pregnant.

Surgical time and complications of total transvaginal (total-NOTES), single-port laparoscopic-assisted and conventional ovariohysterectomy in bitches / Tempo cirúrgico e das complicações entre as técnicas de ovário-histerectomia totalmente transvaginal (total-NOTES), videoassistida com único portal e convencional em cadelas

The recently developed minimally invasive techniques of ovariohysterectomy (OVH) have been studied in dogs in order to optimize their benefits and decrease risks to the patients. The purpose of this study was to compare surgical time, complications and technical difficulties of transvaginal total-NOTES, single-port laparoscopic-assisted and conventional OVH in bitches. Twelve bitches were submitted to total-NOTES (NOTES group), while 13 underwent single-port laparoscopic-assisted (SPLA group) and 15 were submitted to conventional OVH (OPEN group). Intra-operative period was divided into 7 stages: (1) access to abdominal cavity; (2) pneumoperitoneum; approach to the right (3) and left (4) ovarian pedicle and uterine body (5); (6) abdominal or vaginal synthesis, performed in 6 out of 12 patients of NOTES; (7) inoperative time. Overall and stages operative times, intra and postoperative complications and technical difficulties were compared among groups. Mean overall surgical time in NOTES (25.7±6.8 minutes) and SPLA (23.1±4.0 minutes) groups were shorter than in the OPEN group (34.0±6.4 minutes) (P<0.05). The intraoperative stage that required the longest time was the approach to the uterine body in the NOTES group and abdominal and cutaneous sutures in the OPEN group. There was no difference regarding the rates of complications. Major complications included postoperative bleeding requiring reoperation in a bitch in the OPEN group, while minor complications included mild vaginal discharge in four patients in the NOTES group and seroma in three bitches in the SPLA group. In conclusion, total-NOTES and SPLA OVH were less time-consuming then conventional OVH in bitches. All techniques presented complications, which were properly managed.

O emprego de novas técnicas minimamente invasivas de ovário-histerectomia (OHE) vem sendo estudado em cães com o intuito de otimizar seus benefícios e reduzir os riscos aos pacientes. O presente estudo objetivou comparar o tempo cirúrgico, as complicações e dificuldades técnicas entre as abordagens por total-NOTES transvaginal, videoassistida com único portal e por celiotomia para ovário-histerectomia (OVH) em cadelas. Foram operados 12 animais por total-NOTES (grupo NOTES), 13 pela técnica videoassistida (grupo SPLA) e 15 pela técnica convencional (grupo OPEN). O período intraoperatório foi dividido em sete etapas: (1) acesso à cavidade abdominal; (2) criação do pneumoperitônio; abordagem ao pedículo ovariano direito (3), esquerdo (4) e ao corpo uterino (5); (6) síntese abdominal ou vaginal, realizado em seis de 12 pacientes do grupo NOTES; (7) tempo inoperante. Os parâmetros avaliados foram o tempo cirúrgico total e de cada etapa intraoperatória, a frequência de complicações intra e pós-operatórias e dificuldades técnicas. O tempo cirúrgico total médio dos grupos NOTES (25,7±6,8 minutos) e SPVA (23,1±4,0 minutos) foram menores que o do grupo OPEN (34,0±6,4 minutos) (P<0.05). A etapa intraoperatória que demandou maior tempo de execução foi a abordagem ao corpo uterino para o grupo NOTES, e síntese abdominal e cutânea para o grupo OPEN. Uma cadela do grupo OPEN necessitou de reintervenção para controle de hemorragia como complicação maior, e três cadelas do grupo SPVA apresentaram seroma de ferida cirúrgica como complicações menores. Concluiu-se que as técnicas de total-NOTES e SPLA apresentaram menor tempo cirúrgico que a abordagem convencional de OVH em cadelas. Todas as técnicas apresentaram complicações que foram adequadamente manejadas.

Development of a technique for standing hand-assisted laparoscopic splenectomy in five horses.

OBJECTIVES: To develop an experimental standing hand-assisted laparoscopic splenectomy (HALS) technique, report the associated peri-operative complications and document the short-term surgical outcomes. METHODS AND RESULTS: Five healthy 300-470 kg horses that underwent standing HALS. Spleens of different weights (2.25-7.0 kg) were removed using this technique. The main complication during surgery was difficulty sectioning the gastrosplenic ligament. The postoperative complications included adhesions of the colon to the nephrosplenic ligament stump and incisional discharge in two horses. CONCLUSIONS: Standing HALS is a feasible experimental procedure for medium-sized horses, which avoids rib excision and general anaesthesia, but requires further development.

Hand-assisted laparoscopic repair of a grade IV rectal tear in a postparturient mare.

CASE DESCRIPTION: An 8-year-old multiparous Thoroughbred broodmare was admitted for evaluation of a rectal tear sustained during parturition. CLINICAL FINDINGS: On initial evaluation, the mare had mild signs of abdominal discomfort. A full-thickness rectal tear located 30 cm cranial to the anus and extending approximately 15 cm longitudinally along the surface of the small colon between the 4 and 6 o'clock positions, when viewed from behind, was diagnosed on examination per rectum. TREATMENT AND OUTCOME: Laparoscopic evaluation of the abdomen was performed to assess the tear and extent of peritoneal contamination. A hand-assisted repair via a flank incision was performed. The tear was closed in a single-layer, simple continuous pattern with size-0 polydioxanone with a handheld needle holder. Subsequently, a ventral midline celiotomy was performed, and intestinal contents were evacuated via a pelvic flexure enterotomy and a typhlotomy. Following surgery, the mare was managed with IV fluid therapy, partial parenteral nutrition, antimicrobials, and NSAIDs for 5 to 7 days before being gradually reintroduced to a complete pelleted feed and alfalfa hay. Prior to discharge, examination per rectum revealed no stricture formation associated with repair. The mare was discharged from the hospital and performed successfully as a broodmare, with the delivery of a live foal 1 year after surgery. CLINICAL RELEVANCE: Successful repair with an excellent outcome was achieved in this mare. Hand-assisted laparoscopic repair should be considered as a possible treatment option in horses with grade IV rectal tears.

Use of a hand-assisted laparoscopic surgical technique for closure of an extensive mesojejunal rent in a horse.

CASE DESCRIPTION: A 7-year-old 573-kg (1,261 -lb) Swiss Warmblood gelding was evaluated because of signs of acute abdominal pain. CLINICAL FINDINGS: Physical examination revealed a markedly distended abdomen with subjectively reduced borborygmi in all abdominal quadrants. A large, gas-distended viscus was present at the pelvic brim preventing complete palpation of the abdomen per rectum. Ultrasonographic evaluation could not be safely performed in the initial evaluation because of severe signs of abdominal pain. TREATMENT AND OUTCOME: Ventral midline celiotomy was performed, and right dorsal displacement of the ascending colon was corrected. Progressive signs of abdominal pain after surgery prompted repeat ventral midline celiotomy, and small intestinal incarceration in a large, radial mesojejunal rent was detected. The incarceration was reduced, but the defect was not fully accessible for repair via the celiotomy. Repair of the mesenteric defect was not attempted, and conservative management was planned after surgery; however, signs of colic returned. A standard laparoscopic approach was attempted from both flanks in the standing patient, but the small intestine could not be adequately mobilized for full evaluation of the rent. Hand-assisted laparoscopic surgery (HALS) allowed identification and reduction of jejunal incarceration and repair of the mesenteric rent. Although minor ventral midline incisional complications were encountered, the horse recovered fully. CLINICAL RELEVANCE: HALS techniques should be considered for repair of mesenteric rents in horses. In the horse of this report, HALS facilitated identification, evaluation, and repair of a large radial mesenteric rent that was not accessible from a ventral median celiotomy.