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EQUINE MATTERS
One of the most significant advances in
the field of surgery is the introduction of
minimally invasive surgical techniques.
Although laparoscopy in horses was first
reported in the 1970's it has undergone
much transformation in the past 40 years
and has not until recently become the
standard of care for the surgical treatment
of a number of conditions. Although there
are applications within thoracic, abdominal
and joint surgery we shall focus solely on
abdominal surgery and specifically
laparoscopy.
Laparoscopy (also known as 'keyhole surgery')
is a type of surgical procedure that allows
a surgeon to access the inside of the
abdomen without having to make large
incisions within the skin. Laparoscopy is
a minimally invasive procedure that has
applications as a diagnostic, prognostic
and therapeutic technique.
The procedure involves placement of a long
rigid camera called a laparoscope through a
small incision to view inside the body. The
image from the camera is viewed on a large
monitor. Further small incisions are made and
cannulae (tubular portals) are placed in these
incisions to allow passage of long-handled
surgical instruments to assist in the surgery.
In some cases, instruments may not be able
to completely perform the surgery. In these
instances, in combination with laparoscopy,
a larger incision is made that the surgeon
can put their hand through. This is called
hand-assisted laparoscopy.
Laparoscopy is a skilled and technically
challenging surgical procedure as it relies
on triangulation. Triangulation occurs when
two or more instruments are placed through
the body wall and move towards the area
of interest. When instruments are too close
to each other or too far away from one
another it makes surgical manipulation
difficult. The procedure relies on a skilled
and experienced surgeon.
Not only is it important to have an
experienced surgeon but investment in
specialised equipment is required to perform
laparoscopic surgery; a 57cm laparoscope,
digital camera, light source and carbon
dioxide gas insufflator are required as well
as an array of laparoscopic specific
operating instruments.
Common laparoscopic procedures performed
on horses include ovariectomy (surgical
removal of the ovaries), cryptorchidectomy
(removal of a retained testicle), adhesiolysis
(removal of bands of scar tissue that form
between organs), repair of rectal tears,
bladder stone removal, nephrectomy (removal
of a kidney) and herniorrhaphy (hernia repair).
Laparoscopy can be performed standing,
under sedation and local anaesthetic, or under
general anaesthetic in horses; the decision is
made based on surgeon preference, patient
status or the procedure being performed.
LAPAROSCOPY
Laparoscopy allows access to the abdomen
through small incisons and can be
performed on the standing patient
Laparoscopic ovariectomy
Minimally invasive surgery -
laparoscopy
Recent advances
in equine surgery
