Laparoscopic Ovariectomy on the Standing Horse (Granulosa Cell Tumour)

Several reports can be found in recent literature on laparoscopic ovariectomy. The procedure can be performed on the standing horse or in dorsal recumbency. We perform all the ovariectomies including all sizes of granulosa cell tumours on the standing horse and until now we never had to convert to a general anaesthesia.

Horses are without food for 36 hours, only water is allowed.
Horse are sedated with Detomidine and morphine IV followed by a Detomidine IV drip on effect. Local infiltration with scandicaine is used before making the laparoscopy portals. We do not use epidural anaesthesia.
The scope portal is located between the 17th and 18th rib. The instrument portals are located in the paralumbar fossae halfway between last rib and tuber coxae.
Good local anaesthesia of the mesosalpinx and mesovarium is necessary. A 10 mm diameter and > 40 cm long claw forceps is needed to have a strong grasp of the ovary. Mesosalpinx and oviduct are generally cut with (bipolar) scissors, which sometimes results in a minor bleeding. The mesovarium contains a number of large vascular structures, they can be very important especially in large size granulosa cell tumours.

There are several ways to ligate the ovarian pedicle. Intracorporeal or extracorporeal ligation, endoloop ligatures, stapling devices (endo-GIA), bipolar vessel-sealing device, polyamide tie-rap and laser techniques have been successfully used to seal the blood vessels in the ovarian pedicle.

We use a bipolar electrosurgical vessel sealing devices (LigaSure- Valleylab/Tyco) for both normal ovaries and granulosa cell tumours. This makes ligation of the pedicle unnecessary and it reduces surgical time considerably.
If a bilateral ovariectomy is performed the left ovary will be passed, after dissection and cutting the pedicle, from the left to the right side of the abdomen. This allows removal of both ovaries from the abdomen from one side (right side) and thus creating only 1 enlarged endoscopy portal. It reduces surgical time and cosmetic outcome.

If a large size tumoral ovary needs to be exteriorized from the abdomen both instrument portals are connected to create one larger single skin incision and the abdominal muscle are bluntly separated along the axis of their fibers (grid technique). Abdominal muscles should not be sharply dissected if possible, to avoid complications in healing. [...]