Left- and right-sided laparoscopic-assisted nephrectomy in standing horses with unilateral renal disease.

The research describes a technique used to perform left- or right-sided laparoscopic-assisted nephrectomy (surgical removal of a diseased kidney) in standing horses impacted by unilateral renal disease, using sedation and local anesthesia, and also includes the postoperative results.

Methodology

• The study focused on horses (n=3) diagnosed with unilateral renal disease.
• Each horse was sedated using detomidine and levomethadone, injected intravenously.
• Paravertebral and infiltration anesthesia using 2% lidocaine were established around the surgical field, which encompassed the 17th intercostal space and paralumbar fossa.
• Two ipsilateral portals and a small incision (mini-laparotomy) were created for the procedure.
• Endoscissors were used to make a horizontal incision of about 10-15 cm into the perirenal peritoneum, this incision was then manually enlarged for the subsequent dissection of perirenal fat and kidney mobilization.
• The kidney’s vessels and ureter were individually dissected, tied up, and cut under laparoscopic observation. After this, the kidney was surgically removed.
• Neither the perirenal nor the laparotomy peritoneal defects were closed, however, the wounding from the mini-laparotomy was secured in multiple layers.
• The closing of the transverse abdominal muscle was performed with a continuous stitching pattern using 1 polyglactin 910, the subcutaneous tissue was joined back together with a simple, uninterrupted pattern stitch, with the skin stitched together in a simple, interrupted pattern using 2-0 polyglactin 910.

Results

• Nephrectomies (1 due to nephrolithiasis, 2 due to hydronephrosis) were successfully performed on two left kidneys and one right kidney of the selected horses.
• Sedation and local anesthesia proved to be sufficient for keeping the horses immobilized and pain-free during the procedure.
• No intraoperative complications were reported.
• However, one horse developed a seroma (a collection of fluid) at the incision site and developed a fever on the 3rd and 4th post-op days – symptoms that later subsided following a medical intervention.

Conclusions

• The conducted research indicates that laparoscopic-assisted nephrectomy can effectively be performed on a standing horse suffering from unilateral kidney disease.
• Performing the procedure on a standing, sedated horse can potentially mitigate risks linked to general anesthesia and also reduce surgical trauma.
• Utilizing a two-portal technique and a mini-laparotomy for the procedure proves to be effective.