Standing ovariectomy in mares using a transvaginal natural orifice transluminal endoscopic surgery (NOTES®) approach.

The study revolves around testing and evaluating the feasibility of a standing transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES®) ovariectomy in horses (mares). Their findings suggest that the procedure, when performed with specialized equipment, offers a viable approach with mostly excellent postoperative recovery results, although there are potential challenges and complications that need further research.

Understanding Transvaginal NOTES® Ovariectomy

• The study aims to design and evaluate the standing transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES®) ovariectomy in mares or female horses – a novel medical procedure where the ovaries are removed through the vagina using an endoscopic technique.
• The method was first developed on six mares and then further assessed in a short-term study involving four mares, to determine the potential complications and impacts of the surgery.
• The procedure involves inserting a vaginal cannula under endoscopic guidance to gain abdominal access, after which the ovarian pedicles are cut and sealed with a special bipolar vessel-sealing device, then the ovaries are retrieved, and the surgical opening sutured.

Results and Observations

• Once the technique and the instruments were assembled, the researchers successfully performed the transvaginal NOTES® ovariectomy.
• During the procedure, the flexible endoscope provided satisfactory visibility, and the experiment ensured proper analgesia or pain relief in all cases.
• During the operation, the team encountered certain complications like viewing difficulties that increased the operating time and the failure to remove the second ovary in one of the mares.
• In terms of postoperative recovery, the results were largely excellent.
• One major post-mortem concern was the confirmed microbial culture, increased cell counts in the abdominal fluid, and adhesion formation, which raise significant questions for future studies.

Conclusion

• In conclusion, the research suggests that transvaginal NOTES® ovariectomy can be technically possible in mares when using specialized instruments.
• The results indicate several benefits of the NOTES procedure, such as minor surgical invasiveness and good postoperative recovery, but also highlight complications and potential risks that need further studies to analyze and mitigate.