Transoral snare removal of subepiglottic cysts.

Overview

• This study presents a minimally invasive surgical technique for the removal of subepiglottic cysts in horses using a transoral, endoscopy-guided approach.
• The procedure was demonstrated both clinically and through simulation on a cadaver model to aid in surgical training and education.

Introduction to Subepiglottic Cysts and Surgical Need

• Subepiglottic cysts are fluid-filled sacs located under the epiglottis in horses, which can impair respiratory function or cause other complications.
• Traditional removal methods might be more invasive, potentially causing more tissue trauma and requiring longer recovery times.
• The motivation of the study was to develop and demonstrate a minimally invasive method that can be performed via the oral cavity under endoscopic guidance, improving outcomes and reducing surgical risks.

Methodology

• Two clinical cases from the Washington State University Teaching Hospital were used as real-world examples to demonstrate the technique.
• A third horse head, euthanized for unrelated causes, was prepared for simulation by freezing and transversely transecting it.
• An artificial cyst was created and implanted under the mucosa using a glove fingertip filled with carboxymethyl cellulose gel to mimic a cyst’s characteristics.
• The cyst was sutured in place to allow realistic manipulation during the procedure.
• Surgical instruments used included bronchoesophageal grasping forceps and a cautery snare to simulate clinical handling and cyst removal.
• The procedure was performed by one of the authors and recorded to create an educational video resource.

Procedure Description

• The horse was positioned in dorsal recumbency (lying on its back) to allow access through the oral cavity.
• Under endoscopic visualization, the subepiglottic cyst was identified.
• The cautery snare was guided orally and positioned around the cyst to excise it safely with minimal damage to surrounding tissues.
• The grasping forceps helped manipulate and stabilize the cyst during removal.
• The endoscopic view facilitated precise control and visualization throughout the procedure.

Results and Validation

• The cyst was successfully removed in both real clinical cases and the cadaver simulation.
• Video analysis confirmed that the procedure is reproducible and feasible under real clinical conditions.
• The simulation provided a controlled environment to practice and visualize the technique without patient risk.

Conclusions and Implications

• The transoral snare technique represents a minimally invasive, safe, and effective approach to removing subepiglottic cysts in horses.
• Its minimally invasive nature potentially offers reduced recovery times and fewer complications compared to open surgical methods.
• Recording and sharing the procedure in video format supports surgeon education and training, improving clinical skills in a risk-free setting.
• Simulation models, such as the cadaver setup with artificial cysts, are valuable tools for preparing surgeons for live cases.