Current Use of Equine Laparoscopy in Urogenital Disorders: A Scoping Review of the Literature from 2000 to 2021

(1) Background: Laparoscopic surgery replaced traditional invasive techniques for the treatment of common urogenital disorders in equids. The aim of this review is to evaluate applications and the development of urogenital laparoscopy from 2001 to 2021. (2) Methods: A scoping review of literature was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for scoping reviews on three databases (NCBI-PubMed, Web of Science-Thompson Reuters, and SciVerse Scopus). (3) Results: A total of 452 papers were identified. After duplicate removal and title screening, 181 papers underwent abstract screening. Of these, 160 + 10 papers (cited by others) were assessed for eligibility according to the PICOs. A total of 132 papers were considered eligible. Most of the research was focused on ovaries and testes, followed by urinary bladder and general articles about laparoscopy in horses. We identified 43 original studies (33%, RCT, NoRCT, and experimental trials), 39 case series/retrospective studies (29%), 37 case reports (28%), and 13 reviews (10%, narrative or systematic). (4) Conclusions: Gonadal disorders were the most investigated. Hand-Assisted Laparoscopic Surgery (HALS) and laparoscopic-assisted surgery represent valuable options for more challenging conditions (uterine and urinary bladder disorders).

Outcome of bilateral equid laparoscopic ovariectomies

OBJECTIVE

To assess outcomes and behavior changes associated with bilateral laparoscopic ovariectomies.

STUDY DESIGN

Retrospective study.

SAMPLE POPULATION

Fifty-one equids.

METHODS

Medical records were evaluated from equid bilateral laparoscopic ovariectomies from January 2012 to October 2018 with a potential of 6 months follow-up. Follow-up information obtained by telephone interviews included behavior before and after surgery. Likelihood ratio chi-square tests and odds ratios (OR) with 95% CI were calculated where applicable, with statistical significance at p < .05.

RESULTS

Bilateral ovariectomy was performed in 51 cases, with elective (no pathologic ovaries) ovariectomies performed in 41/51 cases. Occasional estrus-like behavior was observed postoperatively in 14/51 (27%) mares, but the behavior was mild and manageable in all cases. There was no age effect on outcome in all bilateral (p = .56) or elective only (p = .36) cases. In 37/41 (90%) elective cases, improvement was observed in the reason for presentation. Some response to altrenogest administration for behavior modification was observed preoperatively in 12/18 (67%) elective cases. Response to altrenogest was not associated with (p = .31) or able to predict a beneficial response to surgery (OR = 5.5; 95% CI = 0.38-78.57; p = .21).

CONCLUSION

Response to altrenogest in elective cases may not predict behavioral outcome with ovariectomy. Occasional estrus-like behavior in mares postoperatively was not problematic for any owners. Bilateral ovariectomy is a viable treatment option for owners seeking to alleviate undesirable behavior in mares.

CLINICAL SIGNIFICANCE

This study should aid veterinarians and horse owners in case selection for bilateral ovariectomy.

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.

Laparoscopic Ovariectomy in Standing Mule Mares

Mules are hybrids bred from the mating of a jack donkey and a horse mare, known for their strength and resistance and still used to work in agriculture. Although they have been for long considered sterile, evidence of estrus cycle has been demonstrated together with abnormal behavior related to ovarian activity. In this study, a bilateral standing laparoscopic ovariectomy technique using the LigaSure technology was applied in 10 mare mules for treating unwanted behavioral patterns. The technique was effectively performed on these animals avoiding the risk of general anesthesia, and the use of the LigaSure technology allowed good hemostasis and reduced surgical time. Owners declared to be satisfied with the resolution of the behavior.

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.

Laparoscopic evaluation of the small intestine in the standing horse: Technique and effects

OBJECTIVE

To evaluate the feasibility and clinical outcomes after laparoscopic evaluation of the small intestines via laparoscopy.

STUDY DESIGN

Prospective pilot study.

ANIMALS

Healthy adult horses (n = 5).

METHODS

Horses were restrained in standing stocks and received an infusion of detomidine. One port was placed in the left last intercostal space and 3 ports were placed in the right paralumbar fossa. The small intestine was run with atraumatic laparoscopic grasping forceps, from the duodenocolic plica to the ileocecal plica. Postoperative pain was scored every 4 hours for the first 48 hours. Horses were monitored via physical examinations for 2 weeks. Second look laparoscopy was repeated at 2 weeks, to run the small intestine and assess iatrogenic changes. An exploratory celiotomy was performed in 2 horses, 2 months later and long-term follow-up was recorded in 3 horses.

RESULTS

Laparoscopic evaluation of the entire small intestine was successfully completed twice in every horse. This evaluation lasted 39 ± 21.2 minutes (mean ± SD), while total surgery time was 73 ± 34.1 minutes. Postoperative physical examinations remained normal in all horses, and pain scores were scored as mild. The only abnormalities at second look laparoscopy consisted of multifocal petechiae and ecchymoses in all horses, resolved by 2 months in the 2 horses explored via celiotomy. Three horses with long-term follow-up were healthy 8 months after the study.

CONCLUSION

Running the small intestine laparoscopically is a feasible procedure in standing normal horses, and does not cause significant discomfort nor complications.