Complete vaginectomy via a ventral approach with pelvic osteotomy in a cat.

A 6-year-old, intact female, domestic short-hair cat had a 3-month history of obstipation. On physical examination and diagnostic imaging, megacolon secondary to a large, intrapelvic vaginal mass was diagnosed. An ovariohysterectomy and a complete vaginectomy via a ventral midline celiotomy and bilateral pubic and ischial osteotomies were performed. This approach allowed excellent exposure of the entire genital tract necessary to excise the large vaginal mass. The mass was histologically diagnosed as a vaginal fibrous stromal polyp. Obstipation resolved 12 h after surgery. On radiographic recheck 11 d after surgery, the colon had returned to normal size. No major surgical complications were observed. This is the first case report of a complete vaginectomy via the ventral approach with a pelvic osteotomy in a cat. Furthermore, this report describes the different surgical techniques used in animals affected by a large vaginal mass and provides evidence that an aggressive surgical approach and en-bloc excision can be considered for the management of extensive intrapelvic vaginal masses in cats.

Vaginectomie complète par voie ventrale avec ostéotomie pelvienne chez une chatte. Une chatte domestique à poils courts, intacte, âgée de 6 ans, présentait des antécédents d'obstipation depuis 3 mois. À l'examen physique et à l'imagerie diagnostique, un mégacôlon secondaire à une grosse masse vaginale intra-pelvienne a été diagnostiqué. Une ovario-hystérectomie et une vaginectomie complète via une céliotomie médiane ventrale et des ostéotomies pubiennes et ischiatiques bilatérales ont été réalisées. Cette approche a permis une excellente exposition de l'ensemble du tractus génital nécessaire pour exciser la grosse masse vaginale. La masse a été histologiquement diagnostiquée comme étant un polype stromal fibreux vaginal. L'obstipation a été résolue 12 h après la chirurgie. Lors d'une nouvelle vérification radiographique 11 jours après la chirurgie, le côlon avait retrouvé sa taille normale. Aucune complication chirurgicale majeure n'a été observée. Il s'agit du premier rapport de cas d'une vaginectomie complète par voie ventrale avec ostéotomie pelvienne chez une chatte. En outre, ce rapport décrit les différentes techniques chirurgicales utilisées chez les animaux atteints d'un gros polype vaginal et fournit des preuves qu'une approche chirurgicale agressive et une excision en bloc peuvent être envisagées pour la prise en charge des masses vaginales intra-pelviennes étendues chez les chats.(Traduit par Dr Serge Messier).

Hybrid natural orifice transluminal endoscopy surgery (NOTES) to perform bilateral ovariectomy in mares.

OBJECTIVES: To combine laparoscopic techniques with natural orifice transluminal endoscopic surgery (hybrid NOTES) to minimize number and enlargement of paralumbar laparoscopic portals for bilateral ovariectomy in standing, sedated mares. STUDY DESIGN: Case series. ANIMALS: Six horses. MATERIALS AND METHODS: Six mares with palpably normal ovaries were restrained in stocks, sedated, and had caudal epidural anesthesia performed. A 7.5 MHz ultrasound probe was used transvaginally to select placement of vaginotomy. An attempt was made to remove both ovaries with 70 cm esophageal forceps through the vaginotomy, while visualized and transected via ipsilateral paralumbar fossa laparoscopic portals. Surgical time, intraoperative, and postoperative complications were recorded. Vaginoscopy was performed at days 0, 3, 7, and 14 postoperatively. After 14 days, mares were euthanized and necropsied. RESULTS: Hybrid NOTES allowed successful bilateral ovariectomy in all six mares, with a mean surgical time of 70 ± 25 min. In two mares, one ovary was dislodged from the forceps during vaginotomy extraction. Abdominal retrieval of the ovary was successful with reapplication of forceps or a surgeon's hand via vaginotomy. At necropsy, five mares had no adhesions within the abdominal cavity or at the vaginotomy site. One mare in which hand retrieval of the ovary was necessary, developed an adhesion between the bladder and the vaginotomy. CONCLUSIONS: This technique appears to offer a safe alternative for bilateral ovariectomy with minimal postoperative complications. CLINICAL SIGNIFICANCE: Decreased number and size of paralumbar laparoscopic incisions could decrease complications associated with exteriorization of ovaries through the flank.

Use of Tubo-Ovarian Ligation Via Colpotomy as A Potential Method for Sterilization in Mares.

The goal of this study was to develop a safe, effective, and economical method for permanent sterilization of mares based upon tubo-ovarian ligation performed via colpotomy. In this study, we evaluated the application of a nylon cable tie (zip-tie) to the ovarian pedicle and oviduct of mares to induce ovarian ischemia and tubal ligation without removal of ovaries. Initially, efficiency of zip-ties on the ovarian pedicle was tested in vitro and in vivo. Based on the absence of leakage through the zip-tie ligated vessels in anatomic specimens, we confirmed the potential efficacy of the technique. Next, ligation of the ovarian pedicle via a standing colpotomy was conducted in five mares. Although the surgical procedure in these mares appeared to be quick and efficient, all five mares were noted to develop ovarian adhesions to surrounding abdominal viscera in either one or both ovaries postoperatively. Ovarian ischemia led to loss of ovarian activity based upon ultrasound examination, which was confirmed by a low plasma progesterone concentration in four of the five mares. During the postoperative period, four mares demonstrated clinical signs related to the ovarian adhesions and were euthanized. The postoperative complications associated with ovarian adhesions to abdominal viscera presented significant challenges, limiting the success of this study. While this technique resulted in ovarian ischemia and atrophy in four out of the five mares, we were unable to assess long-term effects on the health and reproduction of the mares due to the ovarian adhesions to the surrounding tissues and the potential for secondary complications. Although technically feasible, tubo-ovarian ligation via colpotomy does not appear to be a viable option for sterilization of mares using the described technique due to ovarian adhesions post procedure.

Outcomes associated with vaginectomy and vulvovaginectomy in 21 dogs.

OBJECTIVE: To report the outcomes of dogs with lesions of the genitourinary tract treated by vaginectomy or vulvovaginectomy. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Female dogs that underwent vulvovaginectomy, complete vaginectomy, or subtotal vaginectomy from 2003 to 2018 with complete medical records and a minimum of 60 days follow-up. METHODS: Data collected from medical records included preoperative, intraoperative, and postoperative data, such as the occurrence of urinary incontinence (UIC), disease recurrence, and death/euthanasia. RESULTS: This study included 21 dogs. Four dogs had vulvovaginectomy, six had complete vaginectomy, and 11 had a subtotal vaginectomy performed. The mean age at surgery was 9.2 years (SD, 3.3). Thirteen dogs were intact at presentation. Smooth muscle tumors were diagnosed most commonly (10 leiomyomata, three leiomyosarcomas, two leiomyofibromas). The median duration of follow-up was 520 days (range, 71-1955). Major complications requiring revision surgery were recorded in two dogs. Postoperative UIC occurred in six of 21 dogs, resolving spontaneously within 60 days in three dogs. Dogs with malignant tumors (n = 6) survived at least 71 days (median, 626; 95% CI, 71-1245), and recurrence of disease occurred in two dogs. In dogs with benign tumors (n = 15), the median survival time was not reached. These dogs survived at least 104 days and had no recurrence of the disease. CONCLUSION: Vaginectomy and vulvovaginectomy resulted in prolonged survival and low rates of major complications and UIC. CLINICAL SIGNIFICANCE: This study provides evidence to recommend that the risks of this procedure and expectations should be discussed with clients.

Influence of caudal epidural analgesia on cortisol concentrations and pain-related behavioral responses in mares during and after ovariectomy via colpotomy.

OBJECTIVE: To determine the influence of epidural detomidine and morphine on serum corticosteroid concentrations and pain-related behavioral responses in mares during and after ovariectomy via colpotomy. STUDY DESIGN: Blinded prospective study. ANIMALS: Nine university-owned mares. METHODS: Five of 9 horses received caudal epidural detomidine hydrochloride (0.01 mg/kg) and morphine sulfate (0.1 mg/kg) prior to surgery. All horses received local anesthetic around the ovarian pedicle, 0.02 mg/kg butorphanol IV at the start of the procedure and after first ovary removal, were sedated as required throughout the procedure, and were monitored for leg lifting, grunting, and abdominal tensing. Horses were monitored hourly for pain postoperatively. Heart rate was recorded every 4 hours, and photographs were taken to assess pain according to the horse grimace scale (HGS). Control group horses (n = 4) were treated with butorphanol (0.02 mg/kg IV) every 4 hours for 24 hours postoperatively. All horses received oral phenylbutazone 18 hours postoperatively. Serum cortisol was measured prior to the procedure, after first and second ovary removal, and 8 and 24 hours postoperatively. RESULTS: No differences were detected between horses receiving caudal epidural detomidine and morphine and those that received systemic opioids. A decrease in HGS score occurred after phenylbutazone administration. CONCLUSION: Administration of caudal epidural detomidine and morphine resulted in similar pain-related behavior and corticosteroid concentrations as did administration of systemic butorphanol every 4 hours for 24 hours postoperatively. CLINICAL SIGNIFICANCE: Caudal epidural detomidine and morphine may mitigate the requirement for frequent systemic opioid administration after a potentially painful procedure.

Hand-assisted laparoscopic ovariectomy and colpotomy in standing mares.

OBJECTIVE: To determine the feasibility of hand-assisted laparoscopic ovariectomy via colpotomy for bilateral ovariectomy in standing mares. STUDY DESIGN: Case series. ANIMALS: Mares (n = 21) aged 2-21 years, weighing 312-582 kg. METHODS: After a pilot study in 6 mares, the technique was used in 15 mares. Ovaries were identified and manipulated using 2 laparoscopic portals in the left paralumbar fossa. Transection and hemostasis of the ovarian pedicle was achieved using a LigaSure Atlas™ or chain écraseur. Ovaries were removed through a colpotomy by an assistant. RESULTS: In 19 mares, both ovaries were successfully identified from the left portals whereas in 2 mares, laparoscopic portals in the right flank were needed to access the right ovary because the working length of the equipment was insufficient to reach the right side from the left portals. CONCLUSIONS: Bilateral laparoscopic ovariectomy by means of 2 same-sided portals in combination with hand assistance via colpotomy is a technically feasible, safe, and effective technique in small- to average-sized mares.

Laparoscopic-assisted colpotomy for ovariectomy in the mare.

OBJECTIVE: To describe a technique for ovariectomy through a colpotomy using a chain écraseur with laparoscopic guidance and report outcome in 4 mares. STUDY DESIGN: Case series. METHOD: After insertion of a laparoscope into the abdomen through the left flank, colpotomy was performed to allow introduction of an écraseur into the caudal aspect of the abdomen. Grasping and removal of the ovary and evaluation of the pedicle was observed via the laparoscope. The laparoscope was then inserted in the right flank for right ovariectomy. The colpotomy was closed in a continuous suture pattern using laparoscopic or long needle holders. RESULTS: Insertion of a laparoscope allowed ready identification of the ovaries and capture within an écraseur, including assurance that no other tissues were contained within écraseur chain. The mesovarial pedicles were easily be examined for hemorrhage. Surgical time for ovariectomy was 10-15 minutes with no postsurgical complications. Closure of the colpotomy healed without complications. CONCLUSION: Laparoscopic-assisted écraseur ovariectomy is inexpensive, rapid, and a safe alternative to other methods of open and laparoscopic ovariectomy.

[Surgical and conservative methods for removing mummified fetuses in cattle]. / Chirurgische und konservative Methode zur Entfernung von abgestorbenen Feten beim Rind.

The purpose of this study was to describe the findings and therapy in 4 cows and 1 heifer with mummified fetus. All animals were admitted at the clinic after several unsuccessful therapies with prostaglandin F2alpha and local uterine infusions. All animals were in good condition. In case 1, diagnosis of mummified fetus could not be confirmed after manual rectal palpation and ultrasonography whereas cases 2, 4, 5 all had mummified fetus. In case 3, the fetus was in maceration. Initial therapy consisted of administration of prostaglandin F2alpha and prostaglandin E2 followed by repeated administration of prostaglandin E2. Mummies (length from apex to rump 13-32 cm) could be taken out within 3 to 6 days per vias naturales in cases 2, 4, 5 and in case 3, bones (maximal length 4 cm) could be unhinged. The structure in the uterus of case 1 could not be mobilised and was consequently removed under sight control using colpotomy followed by hysterotomy. Animals 2, 3, 4 and 5 were pregnant on the occasion of telephone inquiry. On the basis of our results, we recommend the conservative medical therapy with PGE2 for cases of mummified fetus. Colpotomy and hysterotomy are reserved as therapy feasible if the use of prostaglandin E2 is not successful.

Hysterotomy by a colpotomy approach for treatment of foetal mummification in a cow.

A 7-year-old Brahman cow was diagnosed as suffering from chronic foetal mummification of unknown aetiology, concurrent cystic ovarian disease, prolapse of the 2nd cervical ring and chronic cervicitis. Repeated treatment with prostaglandin F2alpha and oestrogen failed to resolve the mummification. A hysterotomy was performed via an incision in the dorsolateral vaginal wall. Good exposure of the uterine horn was achieved and mild post-operative complications were observed. Colpotomy can be regarded as an alternative surgical approach to the moderately enlarged bovine uterus.