Hand-assisted laparoscopic technique for removal of ovarian tumors in standing mares.
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ABSTRACT: To develop a minimally invasive, hand-assisted laparoscopic ovariohysterectomy (HALS-OHE) technique in the mare and to evaluate safety and any associated complications. Experimental study. Eight, 11-24-year-old mares with anatomically normal urogenital tracts. The surgical technique was developed in 2 non-survival mares and subsequently evaluated in 6 survival procedures. Food was withheld for 48 hours, then mares were anesthetized and positioned in dorsal recumbency for laparoscopic surgery. A hand access device (Omniport) was placed followed by 4 laparoscopic portals. Transection of the ovarian pedicles and broad ligaments was achieved using a combination of a laparoscopic stapling instrument (Endo GIA II), an ultrasonically activated instrument (Harmonic Scalpel), and endoscopic clips (Endo Clip II ML). The genital tract was exteriorized through the laparotomy, and the uterus transected and sutured in a conventional pattern. Horses were evaluated through postoperative day 14 when a necropsy was performed. Four mares recuperated well after surgery, 1 mare was euthanatized because of bilateral femur fracture during anesthetic recovery, and another developed severe pleuropneumonia. At necropsy all but 1 abdominal incision was healing routinely. One mare had abscessed along the celiotomy incision and developed visceral adhesions. Uncomplicated healing of transected mesovarial, mesometrial, and uterine remnants was observed. Ovariohysterectomy in horses can be accomplished using HALS technique. HALS-OHE technique represents a minimally invasive and technically feasible alternative for conventional OHE. Careful patient selection and preparation may reduce the complications observed. The HALS technique may be useful in other laparoscopic surgical procedures.Veterinary Surgery 08/2004; 33(5):487-94. DOI:10.1111/j.1532-950x.2004.04063.x · 0.99 Impact Factor
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ABSTRACT: Diagnostic and surgical laparoscopy has become a routine procedure in human and veterinary medicine and has similar potential uses in zoological medicine. Surgical telescopes and fiberoptic cables allow the veterinarian to look inside body cavities of the patient and specialized instruments provide the ability to perform a wide variety of diagnostic and surgical procedures. Rigid laparoscopy is considered minimally invasive surgery and is associated with a more rapid post-operative recovery rate and an improved prognosis as compared to conventional surgical techniques. 3 Laparoscopic surgery is commonly being utilized in horses and other zoo animals for a variety of abdominal surgical procedures including tubal ligation and ovariectomy. 7,8,12 Recent advances in technology now provide the ability to perform laparoscopy in the largest mammalian species maintained in zoological collections. 11 A variety of disease problems and reproductive disorders have been documented in the rhinoceros and elephant. Due to their size and anatomy, many of the standard diagnostic tests available in human and veterinary medicine are not routine in these animals (radiography, advanced imaging techniques, liver biopsy, abdominal tap, etc.) at this time. Although conventional abdominal surgery has been performed in rhinoceros and elephants 1,5,10 survival rates have been extremely low. Laparoscopy can provide a variety of additional diagnostic options, and may also provide an avenue for performing surgical procedures that would otherwise be impossible in these animals.
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ABSTRACT: To describe a hand-assisted, laparoscopic technique to remove the left kidney in standing horses. Prospective evaluation. Eight horses. Food was withheld for a minimum of 12 hours. Horses were sedated with detomidine hydrochloride (0.01-0.02 mg/kg, intravenously) and restrained in standing stocks. The left paralumbar fossa was prepared for surgery, and the surgical site was infiltrated with 2% mepivacaine. Hand-assisted, laparoscopic removal of the left kidney was performed through an incision in the center of the paralumbar fossa; the surgeon's hand was used to isolate the left kidney and associated vasculature. The renal artery and vein were isolated and individually ligated. After vessel transection distal to the ligatures, the left kidney was exteriorized, the ureter ligated and transected, and the incision closed. Laparoscopic removal of the left kidney was successfully performed in all horses. Retroperitoneal infiltration of local anesthesia provided adequate anesthesia. Intraoperative hemorrhage occurred in 3 horses. Surgical duration (initial skin incision to transection of the left kidney) ranged from 20 to 90 minutes. In 2 horses, no signs of pain were noted for 48 hours postoperatively. Hand-assisted laparoscopic surgery can be used for removal of the left kidney in horses. Clinical Relevance-Hand-assisted laparoscopic nephrectomy can be safely performed in standing horses; however, care should be taken to identify accessory branches of the renal artery to limit potential complications with hemorrhage.Veterinary Surgery 01/2003; 32(3):206-12. DOI:10.1053/jvet.2003.50028 · 0.99 Impact Factor