Keyhole Surgery: Conventional and Advanced Laparoscopic Procedures for Horses

The fulminant growth in minimally invasive surgery in people has paid dividends for the horse.

“Not only are laparoscopic procedures in horses less invasive and associated with less postoperative pain and inflammation, in some instances they provide a better alternative to conventional open surgery.” said Dr. John Caron, an equine orthopedic and soft tissue surgeon with an avid interest in the area of minimally invasive surgery.

“A good example of the usefulness of laparoscopy is the surgical management of a “gelding” with no visible testicles that acts like a stallion and has an elevated blood testosterone level.”

Affected horses often have an abdominal testicle and can undergo a thorough exploratory examination and removal of the testicle (cryptorchidectomy) through a set of 3 incisions totaling an inch and a half or less in length.

“Regardless of whether it is located on the left or right side, any remaining testicular tissue is safely and easily removed with hemorrhage control assured by direct visualization without the trauma to the regional anatomical structures that accompanies traditional cryptorchidectomy. It is effective, reliable and no more expensive than conventional open cryptorchid surgery.”

“Like many other disciplines, laparoscopic surgical principles differ somewhat from those of conventional surgery and the technical skills entail considerable time and effort to develop, however, once mastered, one is able to conduct surgical procedures rather more elegantly than in the past. Perhaps more important than that, we are seeing fewer complications than we did in the past using traditional open surgical techniques.” Caron said.

In addition to introducing a number of established laparoscopic procedures to MSU, Caron has developed a number of innovative techniques. Recently, he has adapted a laparoscopic technique for incisional hernia repair in people to horses.

“Unfortunately, from time to time, horses develop a hernia after colic or other abdominal surgical procedure. Conventional open repair with the insertion of a prosthetic mesh has been associated with disappointingly frequent complications such as fluid accumulation, persistent drainage, infection and even failure of the repair. By placing and securing the hernia patch laparoscopically, the extensive soft tissue dissection that used to be required is avoided and complications appear correspondingly reduced. To date, our results with a minimally invasive approach to hernia repair have been very encouraging. This may well become the standard method for repair of these hernias in the future.”

The list of conditions of the chest and abdomen that can be managed by minimally invasive techniques in horses is growing. Indications and applications for laparoscopic and thoracoscopic surgery in horses include:

* Abdominal or thoracic exploration

* Biopsies of organs (e.g. lung, liver, intestine)

* Ovariectomy (Removal both ovaries for colic or behavioral problems)

* Ovarian tumor removal

* Cryptorchidectomy (Removal of abdominal testicle(s))

* Adhesiolysis (Management of adhesions after abdominal surgery)

* Inguinal hernia repair

* Incisional hernia repair

* Nephrectomy (Removal of a diseased kidney)

* Colopexy and nephrosplenic space ablation (Prevention of displacement of the large colon)

* Ruptured bladder repair

* Closure of mesenteric defects