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Topic:Minimally Invasive Surgery
Minimally invasive surgery (MIS) in horses refers to surgical techniques that limit the size and number of incisions needed to perform procedures. These techniques often involve the use of specialized equipment such as endoscopes, cameras, and instruments designed for precision. MIS aims to reduce tissue trauma, potentially leading to shorter recovery times and decreased post-operative discomfort compared to traditional surgical methods. Common minimally invasive procedures in equine medicine include arthroscopy, laparoscopy, and thoracoscopy, which are used for diagnostic and therapeutic purposes. This page compiles peer-reviewed research studies and scholarly articles that explore the methodologies, applications, and outcomes of minimally invasive surgery in equine practice.
Evaluation of the non-calibrated pulse contour cardiac output monitor FloTrac/Vigileo against thermodilution in standing horses. To evaluate the non-calibrated, minimally invasive cardiac output (CO) monitor FloTrac/Vigileo (FloTrac) against thermodilution (TD) CO in standing horses. Methods: Prospective, experimental trial. Methods: Nine adult horses weighing a median (range) of 535 (470-602) kg. Methods: Catheters were placed in the right atrium, pulmonary artery and carotid artery under local anaesthesia. CO was measured 147 times by TD and FloTrac and indexed to body weight. Changes in CO were achieved with romifidine or xylazine and dobutamine constant rate infusions. Bland-Altman analysis, concordance and polar pl...
Design of an endovascular morcellator for the surgical treatment of equine Cushing’s disease. A new paradigm of surgical treatment of equine Cushing's disease has been developed using the vascular system combined with a flexible morcellation instrument to reach the pituitary gland. Objective: The goal was twofold: (1) to design, prototype, and test an instrument that can reach the pituitary gland using the vascular system unique to equids and (2) to test the feasibility of the endovascular approach. Methods: The morcellator consists of a radial rotating cutting blade for tissue resection, a flexible shaft incorporating a cable drive for flexible actuation, and central morcellated tissu...
Development of a technique for standing hand-assisted laparoscopic splenectomy in five horses. To develop an experimental standing hand-assisted laparoscopic splenectomy (HALS) technique, report the associated peri-operative complications and document the short-term surgical outcomes. Results: Five healthy 300-470 kg horses that underwent standing HALS. Spleens of different weights (2.25-7.0 kg) were removed using this technique. The main complication during surgery was difficulty sectioning the gastrosplenic ligament. The postoperative complications included adhesions of the colon to the nephrosplenic ligament stump and incisional discharge in two horses. Conclusions: Standing HALS...
Medial patellar ligament splitting in horses with upward fixation of the patella: A long-term follow-up. Medial patellar ligament splitting (MPLS) has been shown to be a highly effective and minimally invasive treatment for upward fixation of the patella (UFP) in horses. However, long-term follow-up results of this procedure have not previously been reported. Objective: To evaluate the long-term resolution of UFP following MPLS and provide information on complications and recurrence. Methods: Retrospective case series. Methods: Data were collected from horses that underwent MPLS between 1999 and 2013. All cases had a confirmed diagnosis of UFP that had not responded to conservative therapy. Data ...
Neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking: A safe procedure resulting in medium-term remission in five of seven horses. There are no consistently safe and effective methods for the treatment of trigeminal-mediated headshaking in horses. In affected horses, the trigeminal nerve is sensitised, appearing to result in neuropathic pain. Percutaneous electrical nerve stimulation (PENS) therapy is a minimally invasive neuromodulatory treatment used in people to manage neuropathic pain. Objective: To determine whether PENS therapy is safe, tolerated and effective for the management of trigeminal-mediated headshaking in horses. Methods: Descriptive case series. Methods: Seven horses diagnosed with trigeminal-mediated he...
Update on disorders and treatment of the guttural pouch. The most common disorders of the equine guttural pouches are empyema, tympany, mycosis, and temporohyoid osteoarthropathy. Diagnosis of these conditions is made primarily by imaging with endoscopy, radiographs, computed tomography, and/or MRI. Medical treatment with anti-inflammatories, antimicrobials, and/or antifungals may be successful in some cases, but many of these disorders necessitate surgical intervention. Direct surgical approaches to the guttural pouch are difficult because of their complex anatomy and relationship with important structures, thus precipitating a move toward minimall...
A chondrocyte infiltrated collagen type I/III membrane (MACI® implant) improves cartilage healing in the equine patellofemoral joint model. Autologous chondrocyte implantation (ACI) has improved outcome in long-term studies of joint repair in man. However, ACI requires sutured periosteal flaps to secure the cells, which precludes minimally-invasive implantation, and introduces complications with arthrofibrosis and graft hypertrophy. This study evaluated ACI on a collagen type I/III scaffold (matrix-induced autologous chondrocyte implantation; MACI(®)) in critical sized defects in the equine model. Methods: Chondrocytes were isolated from horses, expanded and seeded onto a collagen I/III membrane (ACI-Maix™) and implanted into o...
Minimally invasive proximal interphalangeal joint arthrodesis using a locking compression plate and tissue engineering in horses: a pilot study. This pilot study assessed the efficacy of 2 minimally invasive techniques for proximal interphalangeal (PIP) joint arthrodesis in horses. The PIP joints of both forelimbs (n = 6) were stabilized with locking compression plates (LCP) using a minimally invasive technique (LCP technique). Subsequently, for 1 randomly selected PIP joint of each horse, surgical drilling (SurD) was performed and tissue engineering (TE) was applied (LCP/SurD/TE technique). Minimally invasive PIP joint arthrodesis with LCP demonstrated low postoperative infection rates. Gross and histological evaluations revealed cons...
Endoscopic, transoral, reduction of epiglottic entrapment via wire snare technique. To describe the use of a wire snare technique for epiglottic entrapment. Methods: Case series. Methods: Eight adult horses. Methods: Under general anesthesia, a modified mouth gag was placed in the oropharynx. An endoscope was passed through the gag until there was adequate visualization of the entrapped epiglottis. The entrapping mucosa was grasped with bronchoesophageal forceps and pulled rostrally, releasing the epiglottis. A custom snare was passed down the bronchoesophageal forceps to encircle the redundant subepiglottic mucosa. Tension was applied to the entrapping mucosa via the forceps...
Laparoscopic-guided compared to skilled instructor support for student rectal examination training using live horses in the veterinary curriculum. To evaluate the veterinary student learning outcome of 2 methods of equine rectal examination training. Methods: Randomized prospective study. Methods: Veterinary students (3rd and 4th year; n = 40) and practicing equine veterinarians (n = 10). Methods: Year 1: Group 1 (n = 11) and Group 2 students (n = 10) received skilled instructor (SI) and laparoscopic-guidance (LG), respectively, during rectal exam instruction. All students were tested on rectal identification of 4 abdominal organs. Year 2: One group of students (n = 19) was trained and subsequently tested using each technique, first SI, ...
A comparison of peritoneal fluid values in mares following bilateral laparoscopic ovariectomy using a vessel sealing and dividing device versus placement of two ligating loops. The objective of this study was to determine the effect of bilateral laparoscopic ovariectomy on peritoneal fluid values in mares and compare how this effect was modified by the method of ovarian vessel hemostasis used. Ten mares undergoing standing bilateral laparoscopic ovariectomy were used in a randomized clinical study. During surgery, blood vessels within the mesovarium were either: (1) sealed and transected with a vessel sealing and dividing device (VSDD), or (2) ligated using two loops placed proximal to each ovary and then the mesovarium transected using laparoscopic scissors. The ova...
Endoscopic-assisted resection of a pedunculated uterine leiomyoma with maximal tissue preservation in a cow and a mare. To report successful minimally invasive treatment of a uterine leiomyoma in a cow and a mare. Methods: Clinical report. Methods: Limousine cow (n = 1), Thoroughbred mare (n = 1). Methods: A 10-year-old cow and an 18-year-old mare were presented for difficulties in breeding and infertility, respectively. Examination of the reproductive tract revealed the presence of a large mass attached to the uterine wall via a wide and short peduncle in both cases. The mass expanded into the uterine lumen in the mare and into the abdomen in the cow. Both masses were removed using a minimally invasive...
Two-step surgery combining standing laparoscopy with recumbent ventral median celiotomy for removal of enlarged pathologic ovaries in 20 mares. To report a combination of standing laparoscopic technique for intra-abdominal dissection of the mesovarial pedicle followed by a limited ventral median celiotomy under general anesthesia for removal of enlarged ovaries in mares. Methods: Case series. Methods: Mares (n = 20) aged 3-22 years with unilateral enlarged ovaries. Methods: Enlarged ovaries were confirmed by transrectal palpation and ultrasonography. After sedation, 3 laparoscopic portals were made in the paralumbar fossa. The mesovarium was desensitized and dissected using a vessel sealing device, and the ovary was left free in t...
Equine lamellar energy metabolism studied using tissue microdialysis. Failure of lamellar energy metabolism may contribute to the pathophysiology of equine laminitis. Tissue microdialysis has the potential to dynamically monitor lamellar energy balance over time. The objectives of this study were to develop a minimally invasive lamellar microdialysis technique and use it to measure normal lamellar energy metabolite concentrations over 24 h. Microdialysis probes were placed (through the white line) into either the lamellar dermis (LAM) (n = 6) or the sublamellar dermis (SUBLAM) (n = 6) and perfused continuously over a 24 h study period. Probes were pl...
Use of a motorized morcellator for elective bilateral laparoscopic ovariectomy in standing equids: 30 cases (2007-2013). To describe the use of a motorized morcellator for elective bilateral laparoscopic ovariectomy in standing equids and to evaluate long-term outcome. Methods: Retrospective case series. Methods: 30 equids (20 horses, 9 mules, and 1 pony). Methods: 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...
Standing diagnostic and therapeutic equine abdominal surgery. The widespread use of laparoscopy in equine surgery has increased interest in the standing approach to a wide range of procedures typically regarded as feasible only through a ventral midline incision. Although a commonly cited benefit of standing surgery relates to avoiding costs of general anesthesia and risks associated with it, some procedures and horses are not suitable candidates for standing abdominal procedures. Some procedures, such as nephrectomy, colostomy, and closure of the nephrosplenic space, are not only suitable for standing surgery but are performed more easily and more safel...
Standing ophthalmic surgeries in horses. Standing ophthalmic surgery without general anesthesia allows for several routine ophthalmic procedures including eyelid lacerations and enucleations to be performed in the horse, but does contain increased risk of causing tissue damage arising from the inability to eliminate eye and head movements. Heavy sedation and local nerve blocks of the involved motor and sensory nerves are essential in achieving a good outcome from ophthalmic surgery in the nonanesthetized horse. The inability to use an operating microscope in standing surgery in horses prevents performing precise corneal and intraocul...
Surgical technique and short-term outcome for experimental laparoscopic closure of the epiploic foramen in 6 horses. To describe a laparoscopic technique for, and short-term outcome after, closure of the epiploic foramen (EF) in horses. Methods: Descriptive, experimental study. Methods: Healthy, adult horses (n = 6). Methods: Laparoscopic portals to approach the EF were identified in standing horses. Under laparoscopic observation, the gastropancreatic fold and right lobe of the pancreas were grasped with Babcock forceps and secured to the caudate hepatic lobe using helical titanium coils to obliterate the EF. Surgical procedure time and intra- and postoperative complications were recorded. Serial analys...
Diagnostic and therapeutic arthroscopy in the standing horse. This article describes diagnostic arthroscopy and arthroscopic management of selected lesions in the standing equine patient. Details on case selection, patient and operating room preparation, and surgical technique are presented. This information will add techniques that avoid general anesthesia to the equine surgeon's armamentarium.
Standing equine sinus surgery. Trephination of the equine sinuses is a common surgical procedure in sedated standing horses. Standing sinus flap surgery has become increasingly popular in equine referral hospitals and offers several advantages over sinusotomy performed under general anesthesia, including reduced patient-associated risks and costs; less intraoperative hemorrhage, allowing better visualization of the operative site; and allows surgeons to take their time. Other minimally invasive surgical procedures include sinoscopic surgery, balloon sinuplasty, and transnasal laser sinonasal fenestration. Despite the proced...
Urogenital surgery performed with the mare standing. Many urogenital procedures of the mare are commonly performed with the mare standing. Ovariectomy via colpotomy was described as early as 1903, and the Caslick vulvoplasty was first described in 1937. As knowledge expands and instruments become more specialized, techniques will improve. With the introduction of laparoscopy, clinicians have not only been able to improve the previously described urogenital procedures but also to devise new procedures. This article describes multiple surgeries of the female urogenital tract, all of which can be performed with the mare standing, and describes a va...
Standing male equine urogenital surgery. The advantages of performing standing male urogenital surgeries are numerous when compared with performing the same surgery in the anesthetized animal. Some traditional standing male urogenital surgeries, such as castrations, may be faster and cheaper to perform. Laparoscopic standing male urogenital surgeries may allow for improved visualization of the surgical field, decreased hemorrhage, and decreased morbidity and convalescence. Limitations of standing procedures may include increased danger to the surgeon because of fractious behavior of the patient, and increased expense and training ass...
Standing equine dental surgery. Dental surgeries refer to procedures that affect the dental tissues or their supporting structures. With the development of specific, efficacious, and conservative treatments, morbidity risks have been lowered and chances of benefiting the health of equids improved. Advances in quality of sedation, analgesia, and locoregional anesthesia allow a majority of dental surgeries to be performed in the standing patient. This update focuses on an orthograde endodontic technique, a minimally invasive buccotomy technique, with the potential to combine it with a transbuccal screw extraction technique, an...
Advances in laparoscopic techniques and instrumentation in standing equine surgery. Equine standing surgery and laparoscopy are becoming increasingly important aspects of equine surgery. Laparoscopic advancements lag behind the human medical field, mainly due to decreased access to appropriate training and instrumentation. It is nearly impossible to cover the topic of equine standing surgery without discussing advances in laparoscopy, because without such advances, equine standing surgery lacks potential for forward progress. Although novel standing techniques continue to be published, the addition of minimally invasive laparoscopic techniques adds an entirely new dimension a...
Incisional hernia repair in horses: a cadaveric study of endoscopic component separation. To report a technique for endoscopic component separation in horses and quantify the amount of body wall advancement obtained. Methods: Descriptive study. Methods: Fresh cadaveric horses (n = 14). Methods: After a preliminary anatomic study, 7 horses had unilateral endoscopic component separation involving transection of the external abdominal oblique fascia lateral to the rectus abdominis muscle. A laparoscope, placed using a balloon dissector, was used to create an intermuscular working space between the external abdominal oblique fascia and internal abdominal oblique muscle. A single instru...
Standing laparoscopic inguinal hernioplasty using cyanoacrylate for preventing recurrence of acquired strangulated inguinal herniation in 10 stallions. To describe a technique for standing inguinal hernioplasty in horses using cyanoacrylate glue, and to evaluate its effect on prevention of recurrent inguinal herniation in stallions that had previous acquired strangulated inguinal hernia (SIH). Methods: Case series. Methods: Stallions (n = 10) with a history of SIH. Methods: Hernioplasty was performed in standing horses using 4 laparoscopic portals. The mesorchium was retracted caudomedially using Babcock forceps. A flexible polyethylene extension tube was introduced through the sheath of a laparoscopic needle and n-butyl-2-cyanoacrylate (2 mL...
Diagnostic stifle joint arthroscopy using a needle arthroscope in standing horses. To assess use of an 18 g arthroscope for diagnostic stifle joint examination in the standing horse. Methods: Phase 1 used cadaver limbs and simultaneous ultrasonographic assessment. Phase 2 used 6 normal horses where stifles were assessed in both a standing and flexed position. Phase 3 used horses with suspected stifle injury or disease. Methods: Normal horses (n = 6) to assess ability to perform diagnostic procedure (phase 2) and 3 clinical cases (phase 3). Methods: Five cadaver limbs were used in phase 1 to assess all stifle joints. Phase 2 used standing sedated and locally anesthetized hors...
Laparoscopic removal of a bladder urolith in a standing horse. An 11-year-old Arabian gelding was evaluated for hematuria, stranguria, and pollakiuria that had been observed for 1 week. Results: Transrectal palpation revealed a 5-cm firm round mass in the urinary bladder. Cystoscopy and transrectal ultrasonography confirmed the diagnosis of urinary bladder urolithiasis. Results: 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 nor...
Mandibular corrective osteotomy using novel locking compression plate 3.5/4.5/5.0 mm metaphyseal plates. To describe a technique and the outcome of using 3.5/4.5/5.0 Metaphyseal Locking Compression Plate for corrective osteotomy of mandibular brachygnathia. Methods: Clinical report. Methods: Eight-month Thoroughbred horse. Methods: Severe mandibular brachygnathia was surgically treated by corrective osteotomy and fixation with 2 LCP 3.5/4.5/5.0 Metaphyseal plates inserted using minimally invasive technique. Results: Severe mandibular brachygnathia was treated successfully with minor complications and stable fixation after 3 months. Cosmetic outcome and owner satisfaction was excellent. Conclusion...
