Effects of Leaving Amputated Ovaries Intra-Abdominally during Elective Bilateral Standing Laparoscopic Ovariectomy in Equids

There is risk of dropping an amputated ovary within the abdomen during standing laparoscopic ovariectomies in mares. If the ovary can no longer be directly visualized with the laparoscope, the procedure is then converted to a flank laparotomy for manual retrieval of the ovary which negates the minimally invasive nature of the laparoscopic procedure. The objective was to identify if ovaries left in the abdomen after amputation would atrophy or if they re-vascularize. Standing bilateral ovariectomies were performed in mature mares, but after transection of the ovarian pedicle, the ovaries were intentionally dropped and left within the abdomen. Post-operative endocrine values were at basal levels and an improvement in all mare’s behavior and general herd dynamics was observed. While this study does not encourage to leave ovaries in the abdomen after amputation, we report no complication related to their voluntary release into the abdomen.

Comparison of Intraoperative Nociception and Postoperative Acute Pain After Traditional or Minimally Invasive Ovariohysterectomy in Dogs

Background: Many variations of ovariohysterectomy techniques have been described, including the traditional one and minimally invasive procedures. Non-laparoscopic Snook hook technique is an alternative for performing minimally invasive ovariohysterectomy. Few studies have been carried out in order to assess pain in animals submitted to minimally invasive surgeries, especially involving one of the most performed surgical procedures in veterinary practice. The aim of this study was to evaluate surgical duration, intraoperative nociception and acute postoperative pain after traditional ovariohysterectomy or minimally invasive non-laparoscopic technique in dogs using Snook hook. The hypothesis is that non-laparoscopic minimally invasive ovariohysterectomy would be faster and less painful than the conventional technique.Material, Methods & Results: Thirty dogs were divided into Traditional Group (TG = 15) and Minimally Invasive Group (MIG = 15). Heart rate, respiratory rate, systolic blood pressure, body temperature, oxyhemoglobin saturation, end-tidal carbon dioxide concentration (ETCO2) and end-tidal isoflurane concentration were evaluated before the surgery to start (M0), during incision (M1), clamping of the first ovarian pedicle (M2), second ovarian pedicle (M3), uterine cervix (M4), abdominal suture (M5) and at the end of surgery (M6). The modified Glasgow Pain Scale was used for acute postoperative pain assessment and Visual Analogue Scale (VAS) was used to assess the sensitivity of surgical wound. The level of significance established for all statistical analyzes was 5%. Statistical differences were not observed between groups considering total surgical time and postoperative acute pain intensity (P > 0.05), in spite of MIG having shorter duration of surgery. There was no statistical difference between groups considering all intraoperative parameters except respiratory rate (TG < MIG; P < 0.05) and ETCO2 (MIG < TG; P < 0.05) at the moment of traction of the first ovarian pedicle (M2). Pain assessment by VAS showed statistical difference 24h after the end of surgery (TG < MIG) (P < 0.05). Discussion: Both procedures were similar regarding intraoperative nociception and acute postoperative pain. It is possible that the sensation of pain in both procedures was blocked by the effectiveness of analgesics, once they might cause an inhibition of painful behaviors limiting a possible difference in pain identification. Higher respiratory stress observed in MIG at M2 and higher pain score by VAS noted in MIG 24 h after the end of surgery can be justified by greater traction of ovarian pedicle, due to limited surgical access of minimally invasive technique. Minimally invasive ovariohysterectomy non-laparoscopic seems to be potentially faster, probably due to the smaller size of the abdominal incision, which takes less time to be closed. In the present study, both techniques were performed by an experienced surgeon, providing safe procedures, nevertheless it is important to emphasize that iatrogenic injury can be caused by surgeons not proficient in the Snook hook technique, considering the limited visualization of anatomical abdominal structures. Data obtained indicate that traditional ovariohysterectomy and non-laparoscopic Snook hook technique promote similar intraoperative nociception and acute postoperative pain, however minimally invasive procedure is potentially faster and with less surgical trauma.

Significantly delayed polyglactin 910 suture-related pseudoinfection in a Yucatan pig

Background Polyglactin 910 is a synthetic braided, absorbable suture commonly used in surgery. Though polyglactin 910 suture-related pseudoinfection is well documented in the human literature, it has not been previously reported in the veterinary literature. Case description A 3-year-old female, ovariectomized but otherwise experimentally naïve Yucatan pig was evaluated for a several week history of bilateral multifocal abscesses in the area of the paralumbar fossa, which continued to worsen despite oral antibiotics and non-steroidal anti-inflammatory medications. The multi-focal abscesses continued to worsen and additional diagnostics were pursued including cytology, culture (aerobic, anaerobic and fungal), and bloodwork. All supported a non-infectious etiology. Biopsy results indicated a suture-related pseudoinfection. Despite treatment including parenteral antibiotics, pain medications and superficial surgical debridement, the dermatologic lesions worsened. Euthanasia was elected. Post-mortem necropsy demonstrated a suture-related pseudoinfection with extrusion of suture material from the ovarian pedicle ligatures through the body wall and skin leading to numerous sterile abscesses in the bilateral paralumbar fossa. Conclusions This is the first published report of a significantly delayed polyglactin 910 suture-related pseudoinfection in a Yucatan pig. While likely an isolated incident, it supports further research into this area. Additionally for critical research studies using Yucatan pigs, pre-surgical assessment with hypersensitivity patch testing may be appropriate.

Laparoscopic Ovariectomy in a Domestic Yak

Owners of a juvenile domestic yak elected bilateral ovariectomy to prevent future reproduction. The yak was noted to be healthy at presentation. Both ovaries were removed using a laparoscopic approach as follows: after induction and maintenance of general inhalant anesthesia, 15 degrees Trendelenburg positioning was required to view the ovaries. Ovariectomy was conducted within a surgical time of 50 minutes. Due to the small ovarian size, portal enlargement was not necessary for removal. Mild hemorrhage from the left ovarian pedicle was controlled with application of a vessel-sealing device. Postoperative complications were not encountered during hospitalization. At 12 months following surgery, the yak was healthy, and the owner was highly satisfied with the procedure. The described approach was successful for performing laparoscopic ovariectomy in a juvenile yak. Positioning for surgery was similar to other small ruminant species. Further case enrollment is needed to optimize the surgical approach and better describe clinical outcomes.

A rare case report of ovarian torsion with sigmoid volvulus

Ovarian torsion results from twisting of the ovary about the suspensory ligament, which contains the ovarian artery and vein, lymphatic’s, and nerves. Volvulus is a torsion of a segment of the alimentary tract, that often leads to intestinal obstruction. Ovarian torsion leading to sigmoid volvulus is the rarest complication which authors found in this case. Hence the case was presented. A 28-year-old women presented with acute pain in abdomen since 14 hours, followed by 2 episodes of vomiting, abdominal distension since 10 hours. Plain X-ray Abdomen erect was done which showed ‘Coffee bean’ sign with multiple air fluid levels suggestive of sigmoid volvulus. On laparotomy, after opening the peritoneum, large right ovarian cyst around 12×11×10 cm with solid and haemorrhagic content with long pedicle around 8 cm with 3 turns of torsion was noted. Abutting the ovarian mass, sigmoid colon was seen twisted around its mesentery including the twisted ovarian pedicle. Hence, the twisted component included the twisted ovarian pedicle and twisted sigmoid mesentery. Stepwise detorsion of ovarian pedicle followed by oophorectomy was done. For sigmoid volvulus, resection of vascular compromised sigmoid colon and descending colon stoma was done. Reanastomosis was done later after 3 months post operatively.

Autoamputation of the ovary: a rare consequence of torsion in a mature cystic teratoma

Autoamputation of the ovary may be a result of longstanding infarction resulting from torsion of the ovarian pedicle. This entity may be confused with an ectopic or supernumerary ovary. A proper detailed history taking is important to provide clues for diagnosis. We report a case of a young female patient diagnosed with autoamputation of unilateral ovary on laparoscopy, with histopathology confirmation of ovary with dermoid cyst.

Continuous Intravenous Anesthesia by Dextroketamine and Detomidine in Bitches Subjected to Ovariohysterectomy and Premedicated with Midazolam and Morphine

Background:The use of injectable anesthetics to induce and maintain anesthesia has been the subject of extensive research. Ketamine induces dissociative anesthesia, which is characterized by sensory loss, analgesia and amnesia without loss of consciousness. The levorotatory isomer of ketamine is dextroketamine. Detomidine, a potent myorelaxant that acts as a sedative and analgesic, is commonly used on horses but rarely tested in dogs. The purpose of this study was to evaluate the cardiorespiratory and anesthetic effects promoted by a combination of detomidine and dextroketamine applied via continuous intravenous infusion in bitches premedicated with midazolam and morphine.Materials, Methods & Results:Eight bitches treated at the veterinary hospital of the Federal University of Campina Grande were referred for elective ovariohysterectomy (OHE). The animals were premedicated with 0.3mg/kg of midazolam and 0.1mg/kg ofmorphine intramuscular (IM) followed, after 15 min, with 0.02mg/kg of detomidine IM. Fifteen min after the administration of detomidine, 3.5 mg/kg of dextroketamine was administered intravenously (IV), followed by continuous IV infusion of 14 mg/kg/h of dextroketamine and 30 μg/kg/h of detomidine. Heart rate (HR), respiratory rate (RR), body temperature (BT), mean arterial pressure (MAP), myorelaxation and electrocardiogram were recorded before and 15 min after the administration of midazolam and morphine (M0 and M1), 15 min after detomidine (M2), immediately after starting the infusion (M3), at 10 min intervals up to 60 min (M4, M5, M6, M7, M8 and M9) and 30 min after the end of the infusion (M10). Blood gas variables were analyzed at M0, M1, M2, M6, M9 and M10. Analgesia was evaluated by measuring cortisol and glucose levels at M0, three min after dermotomy, three min after clamping the ovarian pedicle, and three min after dermorrhaphy. The quality and duration of recovery were evaluated. HR dropped significantly from M2 to M4 (P <0.05), with bradycardia recorded at M2; at RR, with bradypnea starting at M2; and at BT from M6 to M10 (P<0.05), without severe hypothermia. Mean arterial pressure (MAP) increased significantly from M3 to M7 (P<0.01). Hypotension was observed at M1. The following were also observed: high amplitude T wave, elevated ST segment, atrioventricular blocks, sinus arrest and premature ventricular complexes. The blood gas variables suggested the presence of respiratory acidosis with hypoxemia. Cortisol levels were significantly higher (P<0.01) after clamping the ovarian pedicle (6.23 ± 3.07μg/dL) and after dermorrhaphy (6.03 ± 2.24μg/dL) than the levels at M0 (1.74 ± 1.08μg/dL). Glucose levels three min after dermorrhaphy (129.46 ± 29.61mg/dL) were substantially increased (P<0.05) in comparison to M0 (89.66 ± 7.92mg/dL). Myorelaxation was significantly higher from M3 to M9 (P<0.05) than at M0 and M1. The recovery period lasted 302.1 ± 64.9 min. The quality of recovery was considered excellent in two animals, good in four animals and poor in two animals, which showed signs of agitation, vocalization and hypersalivation.Discussion:Continuous intravenous anesthesia with dextroketamine and detomidine causes cardiorespiratory depression, promoting good muscle relaxation. Based on the findings of serum cortisol, blood glucose, blood pressure and augmented infusion rate, it can be stated that the protocol used here cannot eliminate the pain caused by OHE in bitches.