Elevating the uterus (uteropexy) of five mares by laparoscopically imbricating the mesometrium

Broad uterine ligament plication by toggle use during laparoscopic surgery

ABSTRACT The aim of the present study is to describe the surgical technique and complications of uterine elevation by laparoscopic surgery, using the broad uterine ligament plication with toogles. Five mares of different breeds, weight and age were selected, presenting poor perineal conformation and pendulous uterus. The surgical technique was performed with a toogle applicator, 0.6mm sterile nylon thread and toogles, using three portals on each side of the flank. After one month, a new laparoscopy was performed, with only one portal on each side, to observe uterine positioning and healing. The average surgical time reached in this study was 82 minutes per procedure, and the uterus of all mares was successfully raised, remaining in a more horizontal orientation and presenting satisfactory healing. There are only two articles published with uteropexy in mares, where the proposed techniques take longer, which consequently increases the surgical risk.

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).

Looking beyond the ovary for oncofertility care in women: uterine injury as a potential target for fertility-preserving treatments

Treatment for cancer has the potential to significantly diminish fertility and, further, to negatively impact the obstetrical outcomes of pregnancies that do occur. Cancer survivors have decreased rates of fertility and increased rates of pregnancy complications, such as preterm birth and low birth weight, after exposure to chemotherapy. To date, research on the impact of chemotherapy and radiotherapy on fertility and pregnancy outcomes has focused largely on the gonadotoxic effect of cancer treatments on ovaries, while the uterus and endometrium have not been extensively studied. It is intuitive, however, that decreased fertility and poorer obstetrical outcomes may be substantially mediated through injury to a highly mitotic tissue like the endometrium, which is also central to embryo implantation and utero-placental exchange. Pregnancy complications in cancer survivors might be due to compromised blood supply to the endometrium and myometrium affecting placentation or altered remodeling of the pregnant uterus secondary to radiation fibrosis. Alterations in endometrial receptivity at the molecular level could affect pregnancy implantation and early pregnancy loss, but later complications also can occur. This review focuses on understanding the unintended effects of chemotherapy and radiotherapy on uterine function in female cancer survivors and the impact on pregnancy, and summarizes mechanisms to protect and treat the uterus before and after cancer chemotherapy and radiotherapy.

Small intestinal herniation through the broad ligament in a mare outside of the gestation period – a case report

A Furioso-North Star mare, aged 8 years, was examined for colic signs. The mare had a history of dystocia and post partum vaginal lacerations, acute endometritis and laminitis approximately one year before the admission for colic. Signs of persistent abdominal pain, moderate distended abdomen, non-passage of manure, fever, tachycardia, tachypnoea, congested mucus membranes, and “toxic line” were recorded. No intestinal borborygmi were present in the four quarters of the abdomen. On rectal examination, the colon, the ventral band of the caecum, the right ovary and the uterine horn were palpated on the right side of the abdomen. The spleen, the nephrosplenic ligament, the left ovary and a firm, distended and painful small intestine (SI) loop were palpated on the left side. The left uterine horn and the adjacent broad ligament were not detectable. Percutaneous abdominal ultrasound evaluation revealed a large amount of fluid in the abdominal cavity, SI distention and absence of peristalsis. Abdominocentesis yielded approximately 20 ml of red-tinged peritoneal fluid with increased mean protein concentration (5.2 mg/dl), white blood cell count (12,550 cells/μl), and lactate (14 mmol/dl). A presumptive diagnosis of SI strangulation was made. Surgical resection of the affected intestinal loops was recommended. Due to poor prognosis and financial limitations, the mare was euthanized. Post mortem macroscopic diagnosis was a herniation of 3 metres of the mid-jejunum through the left mesometrium, resulting in a complete and complicated strangulation. To prevent this type of SI strangulation, we recommend transrectal palpation of the urogenital tract (including the broad ligament) after foaling. If a defect is identified, we recommend flank laparoscopy for correction.

Endometritis: Managing Persistent Post-Breeding Endometritis

Endometritis was rated as the third most common medical problem encountered in adult horses in North America. It is the leading cause of subfertility in broodmares and is a major contributor to economic loss in the horse breeding industry, with pregnancy rates reported to be as low as 21% in mares with severe endometritis. Endometritis may be categorized as: endometrosis (chronic degenerative endometritis), acute, chronic, active, dormant, subclinical, clinical, and persistent post-breeding. These classifications are not mutually exclusive, and mares may change categories within breeding seasons or estrous cycles or may fit in multiple classifications. This chapter will focus on discussing etiology and management strategies for mares affected by persistent post-breeding endometritis. Overall, these mares are considered subfertile but acceptable pregnancy and foaling rates can be achieved with appropriate breeding management.

A review of equine laparoscopy

Minimally invasive surgery in the human was first identified in mid 900's. The procedure as is more commonly practiced now was first reported in 1912. There have been many advances and new techniques developed in the past 100 years. Equine laparoscopy, was first reported in the 1970's, and similarly has undergone much transformation in the last 40 years. It is now considered the standard of care in many surgical techniques such as cryptorchidectomy, ovariectomy, nephrosplenic space ablation, standing abdominal exploratory, and many other reproductive surgeries. This manuscript describes the history of minimally invasive surgery, and highlights many of the techniques that are currently performed in equine surgery. Special attention is given to instrumentation, ligating techniques, and the surgical principles of equine minimally invasive surgery.