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Home / Equine Research Bank / Equine Vet J / Retroperitoneoscopy of the presacral space in horses: Surgic...
Equine veterinary journal2023; doi: 10.1111/evj.13994

Retroperitoneoscopy of the presacral space in horses: Surgical access and anatomy.

Abstract: Surgical approaches to the equine rectum and perirectal area are described in the literature. However, surgeries in this region can be challenging. Objective: To describe the surgical anatomy of the presacral space and to evaluate its access using a retroperitoneoscopic approach. Methods: Ex vivo experiment. Methods: Preliminary dissections were performed in two cadavers to define the boundaries of the presacral space and to determine portal locations for the surgical approach. After that, nine cadavers were used for experimental presacral retroperitoneoscopic procedure in a standing position. Following retroperitoneoscopy, cadavers were dissected to confirm the anatomical structures observed during the endoscopic procedures, to control the location of each portal and to record iatrogenic trauma. Results: The presacral space was bordered by the vertebral column from the ventral aspect of lumbosacral promontorium to the first coccygeal vertebra dorsally and by the presacral fascia and peritoneum ventrally. Lateral limits were composed of the sacrosciatic ligament and transversalis fascia. Cranial and caudal borders were composed of the peritoneum and coccygeal and levator ani muscles respectively. Retroperitoneoscopic portals were placed between the external anal sphincter and semimembranosus muscles and between the base of the tail and the external anal sphincter muscle through the anococcygeal fascia to enter the space by its caudal border. The retroperitoneal space was reached in all cases and the dorsal and lateral aspects of the rectum were visualised after creation of a working space. Conclusions: Use of cadaver specimens do not permit to evaluate the tolerance in living animals and the surgical complications such as rectal damage, haemorrhage and infection. Conclusions: This study provides an anatomical description and surgical access of the presacral space with a minimal invasive approach. Retroperitoneoscopy allows access to the rectum and the dorsal aspect of the pelvis. Unassigned: In der Literatur werden chirurgische Zugänge zum Rektum und zum perirektalen Bereich des Pferdes beschrieben. Operationen in dieser Region können jedoch eine Herausforderung darstellen. Unassigned: Beschreibung der chirurgischen Anatomie des präsakralen Raums und Bewertung seines Zugangs mittels retroperitoneoskopischem Ansatz. Methods: Ex-vivo-Experimentelle Studie. Methods: Vorab wurden an zwei Kadavern Sektionen durchgeführt, um die Grenzen des präsakralen Raums zu definieren und die Portalstandorte für den chirurgischen Zugang zu bestimmen. Anschließend wurden neun Kadaver für den experimentellen retroperitoneoskopischen Eingriff in stehender Position verwendet. Nach der Retroperitoneoskopie wurden die Kadaver seziert, um die während der endoskopischen Verfahren beobachteten anatomischen Strukturen zu bestätigen, die Lage jedes Portals zu kontrollieren und iatrogene Verletzungen zu dokumentieren. Results: Der präsakrale Raum war dorsal begrenzt von der Wirbelsäule (ventraler Aspekt des lumbosakralen Promotoriums bis zum ersten coccygealen Wirbelkörper) und ventral von der präsakralen Faszie und des Peritoneums. Die lateralen Grenzen bestanden aus dem sakrosciatischen Ligament und der transversalen Faszie. Die kranialen und kaudalen Begrenzungen waren durch das Peritoneum sowie durch die Steißbein- und Levator-ani-Muskeln gebildet. Die retroperitoneoskopischen Portale wurden zwischen dem äußeren Schließmuskel des Afters und den Semimembranosus-Muskeln sowie zwischen der Basis des Schweifes und dem äußeren Schließmuskel des Afters durch die anococcygeale Faszie platziert, um den Raum durch seine kaudale Grenze zu erreichen. Der retroperitoneale Raum wurde in allen Fällen erreicht, und die dorsalen und lateralen Aspekte des Rektums wurden nach Schaffung eines Arbeitsraums visualisiert. WICHTIGSTE EINSCHRÄNKUNGEN: Die Verwendung von Kadaverpräparaten erlaubt keine Bewertung der Verträglichkeit bei lebenden Tieren sowie chirurgischer Komplikationen wie Rektumschäden, Blutungen und Infektionen. Unassigned: Diese Studie liefert eine anatomische Beschreibung und chirurgischen Zugang zum präsakralen Raum mittels minimal-invasivem Ansatz. Die Retroperitoneoskopie ermöglicht den Zugang zum Rektum und zum dorsalen Aspekt des Beckens.
© 2023 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2023-09-01 PubMed ID: 37654189DOI: 10.1111/evj.13994Google Scholar: Lookup
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Summary

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The research explores the anatomy of the presacral space in horses and assesses surgical access to this area using a retroperitoneoscopic approach, providing an important resource for vets performing surgery in this challenging area.

Research Methodology

  • The researchers began by conducting preliminary dissections on two horse cadavers. This allowed them to define the boundaries of the presacral space, as well as determine the best locations for the surgical approach portals.
  • Next, they performed experimental presacral retroperitoneoscopic procedures on nine additional cadavers. These were carried out with the horse in a standing position.
  • Following the retroperitoneoscopy, detailed dissection was performed on the cadavers. This was to verify the anatomical structures observed during the endoscopic procedures, evaluate the portal locations, and catalog any incidences of iatrogenic trauma, or harm caused by the medical intervention.

Research Findings

  • The study revealed that the presacral space was bordered by the vertebral column on its dorsal side, and by the presacral fascia and peritoneum ventrally. The sacrosciatic ligament and transversalis fascia made up the lateral limits, while cranial and caudal borders consisted of the peritoneum and coccygeal and levator ani muscles.
  • The researchers successfully placed the retroperitoneoscopic portals between the external anal sphincter and the semimembranosus muscles, and between the base of the tail and the external anal sphincter muscle. This allowed them to enter the space by its caudal border.
  • In all cases, they were able to reach the retroperitoneal space and visualize the dorsal and lateral aspects of the rectum.

Conclusions

  • The use of cadaver specimens meant that the researchers could not evaluate how live animals would tolerate this procedure, or potential surgical complications such as rectal damage, bleeding, and infection.
  • Despite these limitations, the study provides an important anatomical description and suggests a minimally invasive surgical approach to the presacral space. Retroperitoneoscopy, according to the research, can provide access to the rectum and the dorsal aspect of the pelvis.

Cite This Article

APA
Meurice A, Pujol R, De Fourmestraux C, Coquillon M, Tessier C. (2023). Retroperitoneoscopy of the presacral space in horses: Surgical access and anatomy. Equine Vet J. https://doi.org/10.1111/evj.13994

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Meurice, Antoine
  • Department of Surgery, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France.
Pujol, Raymond
  • Clinique Equine de Provence, Saint Cannat, France.
De Fourmestraux, Claire
  • Department of Surgery, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France.
Coquillon, Morgane
  • Department of Surgery, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France.
Tessier, Caroline
  • Department of Surgery, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France.

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