Complications in Laparoscopic Access in Standing Horses Using Cannula and Trocar Units Developed for Human Medicine

Abstract

First cannulation is a critical manoeuvre in equine laparoscopy. This retrospective study aimed at the comparison of the frequency and type of complications detected when using different human laparoscopy devices for laparoscopic access in standing horses, and the influence of body condition in such complications. Forty-four procedures were included, and retrieved data comprised cannula insertion technique, body condition, and type and frequency of complications. Laparoscopic access techniques were classified into five groups: P: pneumoperitoneum created using Veress needle prior to cannulation; T: sharp trocar; D: direct access via surgical incision; V: Visiport optical trocar and H: optical helical cannula (OHC). In groups T, D, V and H, access was achieved without prior induction of pneumoperitoneum. Complications were registered in 13/44 procedures, of which retroperitoneal insufflation was the most common (6/13). Statistically significant association was found between the complication incidence and the type of access, with group D showing the highest complication frequency (80%) and group H the lowest frequency (0%). The majority of complications (9/13) were observed in overweight horses. We conclude that devices designed for human patients can be used for laparoscopic access in standing horses, with the use of OHC minimizing the appearance of complications, especially in overweight horses with OW.

Keywords: body condition; complications; endotip cannula; horse; laparoscopic access; laparoscopy; minimally invasive surgery.

Figure 1

Device used in Group P after the induction of pneumoperitoneum: laparoscopic disposable cannula (12 mm diameter, 11 cm length). The cannula had a shielded sharp trocar of 13 cm.

Figure 2

Device used in Group T. Laparoscopic cannula (12.5 mm diameter, 15 cm length) with a pyramidal tip trocar of 17 cm.

Figure 3

Device used in Group D. Single-port access system was used for one of the two methods included in group D: conformable device (blue foam) that adapts to the incision and seals it, presenting three orifices, one to insert a cannula (12 mm diameter, 11 cm length) for the endoscope and two for 5 mm instruments (at the top of the picture, not inserted in the foam).

Figure 4

Device used in Group V. Disposable optic Visiport™ device inserted through a laparoscopic cannula (12 mm diameter, 11 cm length).

Figure 5

Device used in Group H. Optical helical cannula (12 mm, 15 cm length).