How to perform ovariectomy through a colpotomy

Loco-Regional Anaesthesia during Standing Laparoscopic Ovariectomy in Equids: A Systematic Review (2003-2023) of the Literature

Laparoscopic ovariectomy is generally performed with equids in the standing position, with the animals heavily sedated and restrained in stocks. This procedure may be quite painful, and it is essential first to manage intraoperative pain to complete the surgery, respecting the animal's welfare and, at the same time, ensuring the safety of the operators. Laparoscopy requires multiple small incisions to introduce the instruments, with one to two incisions enlarged sufficiently to remove the ovary. The surgical procedure must be associated with effective pain control, usually obtained with loco-regional anaesthesia, mesovarian injection, mesovaric or ovarian topical anaesthesia, and epidural anaesthesia. This systematic review aims to discuss articles published from 2003 to 2023 on treating loco-regional anaesthesia in standing laparoscopic ovariectomy in association with an evaluation of pain. The literature review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on three databases (NCBI-PubMed, Web of Science, and SciVerse Scopus). Despite the collected papers numbering 36, we identified only five eligible papers, demonstrating that few studies are performed in order to evaluate the quality of analgesia with loco-regional anaesthesia in standing laparoscopic ovariectomy in equids. The authors of this systematic review agree that the association of injectable and epidural anaesthesia is the best solution to manage intraoperative pain in standing laparoscopic ovariectomy in equids.

Hybrid natural orifice transluminal endoscopy surgery (NOTES) to perform bilateral ovariectomy in mares

OBJECTIVES

To combine laparoscopic techniques with natural orifice transluminal endoscopic surgery (hybrid NOTES) to minimize number and enlargement of paralumbar laparoscopic portals for bilateral ovariectomy in standing, sedated mares.

STUDY DESIGN

Case series.

ANIMALS

Six horses.

MATERIALS AND METHODS

Six mares with palpably normal ovaries were restrained in stocks, sedated, and had caudal epidural anesthesia performed. A 7.5 MHz ultrasound probe was used transvaginally to select placement of vaginotomy. An attempt was made to remove both ovaries with 70 cm esophageal forceps through the vaginotomy, while visualized and transected via ipsilateral paralumbar fossa laparoscopic portals. Surgical time, intraoperative, and postoperative complications were recorded. Vaginoscopy was performed at days 0, 3, 7, and 14 postoperatively. After 14 days, mares were euthanized and necropsied.

RESULTS

Hybrid NOTES allowed successful bilateral ovariectomy in all six mares, with a mean surgical time of 70 ± 25 min. In two mares, one ovary was dislodged from the forceps during vaginotomy extraction. Abdominal retrieval of the ovary was successful with reapplication of forceps or a surgeon's hand via vaginotomy. At necropsy, five mares had no adhesions within the abdominal cavity or at the vaginotomy site. One mare in which hand retrieval of the ovary was necessary, developed an adhesion between the bladder and the vaginotomy.

CONCLUSIONS

This technique appears to offer a safe alternative for bilateral ovariectomy with minimal postoperative complications.

CLINICAL SIGNIFICANCE

Decreased number and size of paralumbar laparoscopic incisions could decrease complications associated with exteriorization of ovaries through the flank.