Use of a motorized morcellator for elective bilateral laparoscopic ovariectomy in standing equids: 30 cases (2007–2013)

• Autores: C. M. Lund
• Localización: JAVMA: Journal of the American Veterinary Medical Association, ISSN-e 0003-1488, Vol. 244, Nº. 10, 2014, págs. 1191-1197
• Idioma: inglés
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• Resumen

  • Objective—To describe the use of a motorized morcellator for elective bilateral laparoscopic ovariectomy in standing equids and to evaluate long-term outcome.

    Design—Retrospective case series.

    Animals—30 equids (20 horses, 9 mules, and 1 pony).

    Procedures—Medical records of equids undergoing elective bilateral laparoscopic ovariectomy from 2007 to 2013 were evaluated. Cases were selected on the basis of use of a motorized morcellator for ovary extraction. Data collected included age, breed, reason for surgery, surgery date, surgical approach, intraoperative complications, surgery and morcellation times, postoperative complications, and duration of hospitalization. Long-term follow-up was obtained by telephone interview with owners, and included effectiveness at resolving original reason for surgery, time to return to usual activity, incision site appearance, signs of estrus after surgery, and overall owner satisfaction.

    Results—30 equids underwent laparoscopic bilateral ovariectomy with the morcellator technique. Median surgery time was 102 minutes (range, 47 to 150 minutes). Median single ovary morcellation time was 3.5 minutes (range, 2 to 8 minutes). Intraoperative complications occurred in 2 of 30 cases and included iatrogenic organ damage (uterus; 1) and persistent hemorrhage (1). Nineteen of 20 mares for which long-term follow-up was available returned to their previous use at a median of 60 days after surgery (range, 21 to 180 days).

    Conclusions and Clinical Relevance—Results of the present study indicated that use of a mechanical morcellator with a 2-portal technique for bilateral laparoscopic ovariectomy in clinically normal equids eliminated the need for a larger laparotomy incision as well as a third portal. Few complications occurred, and clients were satisfied with the procedure. The morcellator technique may offer advantages over other techniques but should only be used by experienced laparoscopic surgeons following adequate training.

    Unilateral and bilateral ovariectomies are performed in mares for a variety of reasons. Unilateral ovariectomy is most commonly performed for treatment of ovarian neoplasia.1,2 Bilateral ovariectomy is an elective procedure prescribed for behavioral modification, estrus behavior suppression, sterilization for registration, preparation of jump mares for collecting semen, and elimination of chronic visceral pain occurring during estrus.3,4 Historically, ovariectomy in mares has been performed via colpotomy, celiotomy, or laparotomy surgical approaches. Serious complications have been reported with open approaches and include exsanguination, shock, adhesion formation, abdominal pain, peritonitis, dehiscence, and evisceration.5–8 Laparoscopic ovariectomy was first reported in the 1990s.9,10 The use of laparoscopy has reduced the morbidity and mortality rates historically associated with ovariectomy.11,12 Advantages of laparoscopy in standing mares include direct visualization of less accessible abdominal viscera, the ability for local anesthesia to be delivered in adequate volume under direct observation, tension-free manipulation of ovaries, and smaller flank incisions.9,10,12 These advantages have reduced complication rates and decreased convalescent times associated with ovariectomy in adult equids.12,13 The advent of feedback-controlled bipolar vessel sealing instruments has further simplified ovarian dissection and hemostasis.14,15 Ultimately, the specific surgical technique used is dictated by surgeon preference, patient tractability, laparoscopic training, and availability of equipment.

    After transection, extraction of normal ovaries from the abdominal cavity requires conversion of a laparoscopic portal incision to a 5- to 8-cm paralumbar laparotomy.16 Larger paralumbar incisions have been associated with increased complication rates as incision size increases.12,17 Incisional site defects and hernias can also remain visible.12 Morbidity associated with larger incisions could be avoided by use of a less invasive extraction technique. Technology has been developed to extract large tissue masses without enlarging abdominal incisions and has been described in human18–20 and equine surgery21 and used in our practice since 2007. Mechanized morcellators have conical blades designed to core, peel, and cut masses for piecemeal extraction, thus avoiding large incisions for tissue extraction. In human surgery, the first mechanized morcellator was used by Steiner et al18 for extraction of masses from the abdomen. Use of commercially available mechanical morcellators in human laparoscopy is most common in obstetrics and gynecology.20,22–24 The first peer-reviewed report of use in horses, for extraction of large ovarian tumors with a mechanical morcellator, was by Kummer et al21 in 2010.

    The purpose of the study reported here was to describe use of a mechanical morcellator for elective bilateral laparoscopic ovariectomy in equids. The objective was to evaluate a mechanical morcellator technique that facilitates ovarian removal via an existing laparoscopic portal and to evaluate use of 2 portals (ie, eliminating the third standard portal). An additional goal was to critically evaluate possible intra- and postoperative complications and the long-term outcome of the procedure in this group of patients.