Laparoscopic removal of a large abdominal testicular teratoma in a standing horse.

This research article shares a successful case study of using laparoscopic surgery to remove a large testicular teratoma from an 11-month-old horse. It highlights the benefits of this method, particularly its minimally invasive nature and the improved visibility it offers.

Understanding the Case

• The study revolves around an 11-month-old Thoroughbred horse carrying a large, fluid-filled testicular mass. This mass is later confirmed to be a testicular teratoma, a type of tumor made up of several different tissue types.
• The horse had a condition called cryptorchidism, where one or both of the testes do not descend. The large size of the hanging testicle had made it impossible for it to be removed through an inguinal approach (through the groin area) under general anesthesia.
• Post-recovery from the anesthesia, an ultrasound evaluation revealed the teratoma’s size to be as large as 24 x 19 cm.

Methodology of Laparoscopic Removal

• The horse undergone paralumbar fossa laparoscopy – a minimally invasive surgical procedure done through small incisions in the abdominal wall for observation and operations within the abdomen. The procedure was done while the horse was in a standing position.
• First, the fluid from the teratoma was drawn out (known as aspiration) to reduce its size as well as to ease manipulation and retrieval.
• The mesorchium and ductus deferens, which are part of the horse’s reproductive system, were tied off with knots tied outside the body (extracorporeal knots).
• The teratoma was then relocated into a special laparoscopic specimen pouch to prevent the loss of abdominal insufflation (the process to establish a pneumoperitoneum for laparoscopic surgery), minimize fluid leakage, and avoid the dispersal of cancerous cells (termed as ‘seeding’).

Key Takeaways and Conclusions

• The study demonstrates that laparoscopy is an effective method for removing cryptorchid testicles that are cancerous. It is minimally invasive and provides excellent visibility, thus ensuring increased safety during surgery.
• Aspiration of fluid from the teratoma prior to surgery made manipulation and retrieval more manageable.
• Use of a laparoscopic specimen pouch was beneficial in maintaining abdominal insufflation, reducing fluid leakage, and preventing the spread of possibly neoplastic cells.
• The authors recommend consideration of standing laparoscopic surgery for removal of testicular neoplasms in horses.