Objective—To describe the use of a motorized morcellator for elective bilateral laparoscopic ovariectomy in standing equids and to evaluate long-term outcome.
Design—Retrospective case series.
Animals—30 equids (20 horses, 9 mules, and 1 pony).
Procedures—Medical records of equids undergoing elective bilateral laparoscopic ovariectomy from 2007 to 2013 were evaluated. Cases were selected on the basis of use of a motorized morcellator for ovary extraction. Data collected included age, breed, reason for surgery, surgery date, surgical approach, intraoperative complications, surgery and morcellation times, postoperative complications, and duration of hospitalization. Long-term follow-up was obtained by telephone interview with owners, and included effectiveness at resolving original reason for surgery, time to return to usual activity, incision site appearance, signs of estrus after surgery, and overall owner satisfaction.
Results—30 equids underwent laparoscopic bilateral ovariectomy with the morcellator technique. Median surgery time was 102 minutes (range, 47 to 150 minutes). Median single ovary morcellation time was 3.5 minutes (range, 2 to 8 minutes). Intraoperative complications occurred in 2 of 30 cases and included iatrogenic organ damage (uterus; 1) and persistent hemorrhage (1). Nineteen of 20 mares for which long-term follow-up was available returned to their previous use at a median of 60 days after surgery (range, 21 to 180 days).
Conclusions and Clinical Relevance—Results of the present study indicated that use of a mechanical morcellator with a 2-portal technique for bilateral laparoscopic ovariectomy in clinically normal equids eliminated the need for a larger laparotomy incision as well as a third portal. Few complications occurred, and clients were satisfied with the procedure. The morcellator technique may offer advantages over other techniques but should only be used by experienced laparoscopic surgeons following adequate training.
Case Description—An 11-year-old Arabian gelding was evaluated for hematuria, stranguria, and pollakiuria that had been observed for 1 week.
Clinical Findings—Transrectal palpation revealed a 5-cm firm round mass in the urinary bladder. Cystoscopy and transrectal ultrasonography confirmed the diagnosis of urinary bladder urolithiasis.
Treatment and Outcome—A multiportal transparalumbar fossa laparoscopic approach was selected for cystotomy and urolith removal. Cystotomy and urolith removal was performed with sedation and local anesthesia with the horse standing. No perioperative complications were observed. Urination returned to normal 5 days after surgery. The horse returned to its previous level of activity at 3 weeks after surgery.
Clinical Relevance—Findings suggested that minimally invasive transparalumbar fossa laparoscopic approach can be successfully used for cystotomy and urolith extraction in standing horses; this avoids the disadvantages of conventional laparocystotomy for removal of large uroliths in male equids and the potential complications of general anesthesia and recovery. The technique provided excellent viewing and access to the bladder, permitting extraction of the urolith and secure closure of the cystotomy with minimal tension and tissue trauma to the bladder.
A 12-year-old Friesian stallion was examined because of a 1-year history of preputial injury and urination through a urethrocutaneous fistula located at the midbody of the ventral aspect of the penis.
Physical examination revealed an opening with a clearly apparent mucocutaneous junction 12 cm from the distal opening of the urethra on the ventral left side of the penis. Endoscopic examination of the distal portion of the urethra confirmed a blind pouch with no communication with the fistula or proximal portion of the urethra.
TREATMENT AND OUTCOME
A temporary perineal urethrostomy was performed with sedation and local anesthesia, with the stallion standing, to divert urine from the urethral reconstruction site. Fistulectomy and urethral resection and anastomosis were performed under general anesthesia with the stallion in dorsal recumbency. At 15 days after surgery, endoscopic examination of the urethra revealed distortion of the urethral lumen at the fistulectomy site. Under sedation, the urethra was dilated for 5 minutes every 12 hours for 3 days. At 22 days after surgery, endoscopic examination of the urethra revealed a healed anastomosis site and a large urethral luminal diameter. At 36 months after surgery, the owner reported that the stallion had normal micturition and had sired multiple foals by live cover matings.
Severe preputial or penile trauma in horses is most commonly treated with amputation because of concerns of postoperative urethral stricture and occlusion. To the authors' knowledge, this case represented the first time that a successful end-to-end anastomosis of the distal portion of the urethra has been performed in a stallion.