Gastration of the stallion: Preferably in the standing horse by

Astrid B. M. Riikenhuizenund G. C. M. Grinwis
Pferdeheilkunde16 (1999) 5 (September/Oktober)425-429
Gastrationof the stallion:Preferablyin the standinghorse
by laparoscopictechniques?
Astrid B. M. Rijkenhuizenund G. C. M. Grinwis*
Faculty
of Veterinary
Medicine,
Equine
Sciences,
Utrecht
Unversity
' Dept.of Pathology
Summary
Progressin the laparoscopic
techniques
hasmadeit possibleto removean abdominal
testiclein the standinghorse.As abdominal
cryptorchidism
is usuallyunilateral,
the descended
testicleis removedusinga classicstandingcastration
technique.
However,
thislattertechnique is not considered
idealas it is difiicultto guarantee
asepsis,andcanbe dangerous
for the surgeon.
Therefore,
a studywasinitiated
to
castratedescended
testiclesin the standinghorssusinga laparoscopic
technique.
In sixWelshponystallions,
2 yearsof age,eachwith2
descended
testicles,
the mesorchium,
including
thetesticular
arteryandvein,areligatedintraabdominally
andthetesticles
areleftin place.
Themeasurements
of plasmatestosteron
levels,theclinicalexamination
andthe resultsof the necropsy
of the ponies5 monthspostoperativelyrevealed,
thatthe testiclesatrophyandwereno longerfunctional.
Also,the resultsof the surgeryon I unilateral
inguinal
cryptorchids,
one bilateral
inguinalcryptorchid,
(otwhich5 werecastratedunjlateralJy),
17 unilatetal
abdominal
cryptorchids
2 bihteralabdominal
cryptorchidsand12 .normal" stallions
aredescribed.
In conclusion,
the surgicaltechnique
described
in thisreponis a safeandefficient
methodof castrating
descended
testiclesin the standing
patient.Advantages
includereducedtissuetrauma,no riskbecauseof generalanaesthesia,
a quickerreturnto normalworkand reduced
hospitalization
time.
Keywords:
horse,equine,laparoscopy,castration
Kastrationdes Hengstesin laparoskopischer
Technikam stehendenpferd
DerFortschritt
der laparoskopischen
Techniken
bdm Pferdhat es ermöglicht,
abdominale
Hodenam stehenden
Tierzu entfernen.
Da der
abdominale
Kryptorchismus
üblicherweise
einseitig
auftritt,wird der zweite,abgestiegene
Hodenmeistdurchdie klassische
lvlethode
am
stehenden
Pferdenlfernt.DieseTechnikkanniedochnichtals idealbezeichnet
werden,weileinaseptisches
Vorgehen
kaummöglichund
der Eingrififür denChirurgen
nichtungefährlich
ist.AusdiesemGrundewurdeim RahmeneinererstenStudieversucht,
denabgestiegenen
Hodenebenfalls
dorchlaparoskpische
Technikzu kastrieren.
Bei6 zweiiährigen
Welsh'Pony-Hengsten
mitjeweils2 abgesliegenen
Hoden
wurdedas Mesorchium
samtAnerieundVeneintraabdominal
ligiertund die Hodenim Skrotumbelassen.
Messungen
der Plasma-Testosteronspiegel,
klinische
Untersuchung
unddieErgebnisse
der pathologischen
Untersuchung
ergaben,
dassdieHodenatrophieren
undnicht
längerfunktionstüchtig
bleiben.lm RahmendieserArbeitwerdendieErgebnisse
deraufdieseWeisedurchgeführten
Kastrationen
vong einseitiginguinalen
Kryptorchiden,
elnembeidseitig
inguinalen
Kryptorchiden,
17 einseitig
abdominalen
Kryptorchiden,
von denen5 einseitig
vorkastriert
waren,2 beidseitig
abdominalen
Kryptorchiden
und 12 ,,normalen"
Hengsten
beschrieben.
Zusammenfassend
wirdfestgestellt,
dasdie beschriebene
Methodeeinesichereund wirksame
Technikzur Kastration
des stehenden
Hengstes
darstellt.DieVorteileliegenin
reduziertem
Gewebstrauma,
keinerInkaufnahme
einesNarkoserisikos,
kürzerer
Rekonvalseszenz
undküzeremKlinikaufenthalt.
Schlüsselwörtsr: Pferd,Laparoskopie,
Kastration
Introduction
Progressin the laparoscopictechniqueshas made it possible to removean abdominaltesticlein the standinghorse.
Variousauthors describe how the testicleis grasped and
exteriorizedthrough the abdominalwall; the ligationand
transectionof the abdominaltesticleoccur extracorporally
(Fischer and Vachon 1992, Davis 1997). As abdominal
cryptorchidismis usuallyunilateral,the descendedtesticle
is removed using a classic standing castrationtechnique.
However,this lattertechniqueis not consideredidealas it
is difficultto guaranteeasepsis,and can be dangerousto
the surgeon, An alternativewould be to castrate in a recumbent position, but then one of the main advantagesof
the used laparoscopictechniqueis lost. Thereforea study
was started to castrate descendedtesticlesin the standing
horse using a laparoscopictechnique.The mesorchiuminPferdeheilkunde
15
cludingthe testiculararteryand vein are ligatedintraabdominallyand the testiclesare left in place, From eadierstudies (Ensrnkand Klein 1996, Wilsonet al 1996), performed
in horses in recumbency under general anesthesia,it is
known that the testiclewill atrophy.
In this paper the surgicalprocedure,the post-operativeperiod and the histologicalconsequencesfor the testicleare
described,
Materials and methods
Six Welsh pony stallions,2 years of age, each with 2 normally descended testicles,were used. The ponies were
held of feed for 2 days. The ponies were restrained in
425
Castrationof the stallion:Preferably
in the standingHorseby laparoscopic
techniques?
stocks and sedated with detomidine ([email protected]
mg/100 kg Bvtrl-)together with butorphanol (Nubaine@
0.1mg/kg B\Afl-).Local infiltrationanesthesia(Lidocainehydrochloride)was provided at the sites of the laparoscope
and instrumentportals in the paralumbarregion. Preparations for aseptic surgery were carried out using routine
te ch n i oue.
The portal for the laparoscope(diameter10mm, length57
cm, straightforward 0 angle, Storz@)was locatedjust dorsal to the internalobliqueabdominalmuscle and 2 cm caudal to the last rib. After introductionof the laparoscopethe
abdomen was distendedusing a carbon dioxide (COr)-insufflator(Storz@,flowrate 7-B Umin) to a maximalintra-abdominalpressureof 6 mm Hg. The second trocar (guarded
disposablewith a reducer)was insertedunder laparoscopic
supervision,approximately4 cm caudaland B-10 cm distal
to the laparoscopicportal,directedcaudalventrally.
This instrumentportal was used for the introductionof the ligature. The laparoscopewas directedcaudallyand the vaginal
ring was visualised.The mesorchiumwas perforatedusing
a graspingforcepsjust proximalto the vaginalring and lateral to the bloodvessels(Fig.1)and a ligature(polyglactin
910, Vicryl@USP2, Ethicon)was insertedthroughthis perforation.The ligaturewas picked up with the forcepson the
mediocaudal side of the spermatic cord and retracted
extracorporally(Fig. 2). A modified Roeders knot was tred
extracorporally and the slipknot was advanced with a
p u sh ro d,whilepullingth e l o n g ta i l o f th e l i g a tu rea, n d ti ghtened. The suture was cut adjacent to the knot. The mesorchium, including the ductus deferens and spermatic
cord, was ligatedtwice and the testicleremainedin place.
The same procedurewas performedon the other side.The
insertionportalswere closed in two layers(polyglactinUSP
2-O\.
man et al. 1983).Plasmafor WBC and serum fibrinogen
determinationwas collectedon day 0, day 1, day 4 and
day 7 postoperatively.In two ponies peritonealfluid was
obtained24 hours post operatively.
Fig2:
Laparoscopic
viewof the mesorchium,
including
the testiculararteryand vein,withthe ligaturein place,but not
yettightened.
Laparoskopische
Sichtauf das Mesorchium
samtArterie
Ligatur
undVene,mitdervorgelegten
The ponieswere kept at pastureand examinedclinicallyon
a daily basis for the first week and then weekly for 5
months. The testicleswere palpated to determineconsistencyand measuredwith slidingcalliperson day O, day 7,
day 28, and just before euthanasia.
One pony was euthanised 1 week postoperatively,the
other 5 at 5-O months postoperatively.The testicles were
examinedhistologically
for the presenceof spermatogenesis and the abdomen examinedfor adhesionsor anv other
complicationsdue to surgery,
Futhermore,the same laparoscopicsurgerytechniquewas
per-formed
on 9 unilateralinguinalcryptorchids,one bilateral
inguinalcryptorchid,17 unilateralabdominal cryptorchids
(of which 5 were castrated unilaterally),
2 bilateralabdominal cryptorchidsand 12 ,,normal"stallions.(14 Warmblood
horses, 12 Friesian,12 Ponys, 1 Trotter, 1 Quarterhorse
und 1 Arabian;2-12 year;average3,3 years).The only difference, was that before surgical manipulationthe mesorchiumwas anaesthetisedby injectionof 4 ml 2% Lidocain through a 36-mm aspiratingNeedle (Storz)to reduce
the reactionduringthe tigtheningof the ligature.
Results
Fig 1:
Laparoscopicview of the vaginal ring and the mesorchium on the right side of the pony. The forcepswith the
ligaturepoints to the mesorchiumat the place where it
will be perforated.
LaparoskopischeSicht auf Vaginalringund Mesorchium
rechtsseitig.Die Klemme mit der Ligaturdeutet auf die
Stelledes Mesorchium,die perforiertwerden wird.
lmmediately preoperatively, 7 days later and just before
euthanasia plasma testosteron levels were determined (radioimmunoassay as described by Verjans et al 1973, Diele-
426
Laparoscopywas performed without complicationsin all
ponies.Visualisation
of the vaginalring was excellent.Perforationof the mesorchiumdid not resultin a painfulreaction from the pony. Some reaction was seen when the
mesorchium,includingthe testiculararteryand vein,was ligated, Postoperativerecoverywas rapid. Some oedema of
the scrotal skin was noted in 2 ponies between day 2 and
day 5. The testicleswere not painfulon palpation,nor did
the ponies show any lamenessor manifestany abdominal
discomfoft.Woundhealingwas by first intention.
15
Pferdeheilkunde
AstridB. M. Rijkenhuizen
undG.C.M. Grinwis
During the first postoperativeweek the size (length and
width)of the testicleincreasedin all poniesat an averageof
3 mm ffable 1). Then the testicledecreasedin size and 5
months postoperativelythey were not palpableanymore.
lmmediatelypostoperativelythe testiclesbecame firm on
palpationand remainedso as long as they were palpable.
The mean testosteron level before surgery was 322 (range
150-560) pg/ml fl-able 2). By day 7 the testosteron level
had dropped to below the detection levelof the assay (<25
pg/ml) in all poniesand was the same leveljust beforeeuthanasia.
Tab 1: Averagesize in mm of both testiclesduringthe time
spanof theexperiment.
n.p.= not palpable.
Durchschnittliche
Größein mm beiderHodenwährend
der DauerdesExperiments.
N.p. = nichtpalpierbar.
pony
1
4
5
Mean
Tab 2:
Day
0
week
1
week
4
week
8
week
12
week
20
oz
65
65
50
40
64
67
55
25
25
4B
n .p .
20
28
n .p.
ol
63
63
63
66
50
45
ÖU
65
55
A1
al
28
66
50
37
n .p.
n .p.
n . p.
n. p .
valuesindicatethat there was no acute inflammationor oeritonitispresentat any time. The abdominalfluid analyses
revealedno changespointingtowardsa peritonitis.
At necropsyno adhesionsat the portalsites or the inguinal
ringswere noted in any of the ponies.
Gross examinationof the testiclesof the pony euthanised1
week postoperativelyrevealed congestion of the plexus
pampiniformis.The cut surface was swollen and reddish.
Histologyshowed coagulationnecrosisof testiculartissue
and no functionaltissuecould be found.
The sizeof the testiclesof the remaining5 ponieswas 2 x 2
x 1 cm on average.ln 2 casesone of the testicleswas attached to the vaginaltunic; more proximallyno adhesions
were found on the spermaticcord. The remainingcases
showed no adhesionsof the testiclesto the vaginaltunic.
The cut sur-faceof the testicleswas yellowishgreen at the
peripherywith a dull reddishbrown colourin the centre(Fig.
3). Histologyof the testiclesshowedfibrosisand in one pony
(both testicles)coagulationnecrosis. In 3 ponies locally
intactseminiferous
tubulesand Leydigcellswere found,
n. p .
Averagetestosteronlevelin pg/ml at day 0 and day 7.
DurchschnittlicherTestosteron-Blutspiegel
in pg/ml a
Tag 0 und Tag 7
Pony
Testosteron
pg/ml day 0
Testosteron
pg/ml day 7
1
150
<25
560
< 25
< 25
4
420
290
5
1 90
< 25
mean
322
< 25
Fig 3:
< 25
MakroskopischerLänqsschnittdurch einen nekrotischen
Hoden.
The mean WBC count of all ponies was 9.2 G/L on D0,
1 1 .4 G/ L on D1, 10, 3 G /L o n D 4 , 8 .9 G/L o n D 1 4 (ta bl e3).
The mean differentialcell counts were 27o/oneutrophilson
DO, 5 2% on D1, 36% o n D 4 a n d 4 1 o /oo t1 D 1 4 . These
Tab 3:
Macroscopicview of the incisednecrotictesticle.
All patientsunderwentthe surgeryquietly.Postoperatively,
in most horses mild oedema in the scrotum was noticed
between the second and fifth day, which graduallyresolved. On the second day, in 5 horses a slight increasein
temperature(until39.5 C) occurred which lasted 2 days.
Blood parameterson Day 0, 1, 4 and 14 afterthe surgicalintervention.
Blutwertean den TagenO, 1, 4 und 14 nach dem chirurgischen
Eingriff.
Day 0
wbc g/l
pmn's %o
1
o .ö
zl
2
8.9
TI
ö
12.6
4
8.6
6
9. 2
9. 2
Mean
wbc = whitebloodcells
Pferdeheilkunde
15
/1
1a
tt
29
27
27
Day 1
fibr g/l
wbc g/l
Day 4
pmn's o/o wbc g/l
pmn's 7o
Day 14
fibr g/l
2 .4
2 .5
2 .4
8. 8
25
7.3
\)/
2.4
12.2
to
11.9
35
z.o
14. 4
37
13.7
17
2,5
1. 7
9. 1
qq
| 1.ö
69
8.3
10.3
10.3
2 .1
2 .2
g/l = grams/ liter
11. 4
52
O4
36
wbc g/l
2.2
2.5
pmn's 7o
-7 I
t.l
z4
7.7
56
34
8.3
49
\Jk)
42
8.9
41
fibr g/l
|.t
2. 2
2. 6
2. 8
2. 4
2. 4
pmn's= polymorphonuclear
neutrophils fibr= 1;5p1non"n
427
techniques?
in the standingHorseby laparoscopic
Castrationof the staliion:Preferably
The mean WBC count (Day0, 1 und 7) and fibrogendeterminationof the blood (DayO and 1) revealedno elevations.
Also, leaving the abdominaltesticle inside the abdomen
resultedin no clinicalproblemsIn 2 horsesthe testosteron
leveldid not drop to below the detectionlevelof the assay.
These horses were castratedthe conventionalwav under
generalanesthesia.
The tunica vaginalrswas adhered for 3-4 cm2 to the testicle.The cut surface of these testicles(both the normal
descendedtesticle)showed necrosisfor 3/4 of the testicle.
to be ligated increases.Tighteningof the ligatureis then
harderto performand the risk of insufficientligationincreases.This might have been a cause of the failurein the 2 pati ents.
When the testicleis left in situ no additionaldisruotionof
the abdominalwall for the exteriorisation
of the testicleis
necessary.Additionally,this procedurereducesthe risk of
excessivepost operativeswellingor infectionand there rs
no risk of post operativeherniationwith evisceration.By
avoidingsharp divisionof the spermaticcord another advantage towards the method described by (Wilson et al
1996)is reachedwith the castrationmethod in this article.
No bleedingsurface is present inside the abdomen, thus
Discussion
creating a lower risk for the formation of adhesions.
may occur is a subject for disCastration of descended testicles by double ligation Whether revascularisation
cussion,but in these ponies no signs of revascularisation
through laparoscopicintervention,without removal of the
were found.
testicle,can be performedsuccessfullyand may turn out to
be an importantstep forwardin the use of the laparoscopic The initialincreasein size of the testicleis the resultof congestion caused by the ligationof the vessels in the mete ch n i quein equinem e d i c i n el.t i s te c h n i c a l lsyi m p l eto perform and very usefulfor the castrationof the normallydessorchium.This congestionresolveswithin one week. No
adversereactionswere noticedbecauseof the fact that the
cended testicles in case of unilateralabdominal cryptorchism.This testiclewill atrophy in the scrotum. General testiclewas left in place. Only small,hardly palpable,remnants are presentat 5 months post operatively.
These remanaesthesiaand positioningin dorsalrecumbencyare avoinantswill presentno problemswith ownershipchanges,
ded by operatrngon the standinghorse.The reportedinciIn this study the testicularartery and vein are neitherdisdence of post-anestheticmyopathy ranges from 0.75 to
6.4% of equine anesthetic cases (Klein 1978, McCarville sected nor transectedas described by Wilson et al (1996);
and Blais 1986, Richeyet al 1990, Peek 1993; Rijkenhuizen the mesorchi um,i ncl udi ngthe arteryand vei n,i s only ligated, thus reduci ngthe ri skof i ntra-abdomi nal
and van Dijk 1998).By usinga surgicaltechniquein a stanbl eedi ng,
Failureof the castrationtechniqueoccurred in 2 patients,
ding horse, a lot of post-operativecomplicationsare preprobablybecauseof an ineffectiveligationof the mesorchivented and thereforea real drfferenceto the other laoarosum and ductus deferens,as the result of a loose knot or
copic castrationmethodsdescribedin literature.
Other possible indicationsfor laparoscopiccastrationin the standing ligationof insufficienttissue, meaningnot includingall the
is very unlikelyto occur within 7
horse includeall forms of cryptorchismand the castration vessels,Revascularisation
Also it is important to include the
of horseswith normallydescendedtesticles.
days postoperatively.
For the castrationtwo oortalsare needed on each side of
ductus deferensin the ligature,becausethe artery beside
for
the ductus is able to vascularisethe testiclesuffictentlv
the horse:one for the laparoscopeand one instrumentporproducingtestosteron.
tal. When only two instrumentsare used to manipulate,there is no need for an assistantsurgeon.
Disadvantagesof this technique are the size of the area
The procedurewas performedwhilethe ponieswere sedathat has to be clipped,the cost of the equipmentand the
ted and restrainedin a stock to minimrzethe riskto the animanoower needed to connect the tubes and cables and
ma l s, th e per s onnelan d th e e q u i p me n t.W i th h o l d i n gfeed
the care of the equipment includingthe surgical instrufor 2 days allowsfor a good view in the abdomenand reduments, the postoperativemeasurementof the testosteron
perforating
inserlion
leveland the need for trainrngof the surgeon.
risk
the
viscera
of
the
ces the
of
during
In concl usi on,the surgi caltechni quedescri bedi n this r etrocar.To furtherreducethis risk,the administration
of hyoport is safe and representsan efficientmethod of castrating
sin butylbromide(Buscopan@)might be considered.The
spleenis situatedon the left and with the chosen sedation, descendedtesticlesin the standingpatient.Advantagesinwhich oreventsan increasein the soleen size, the risk of
clude reduced tissue trauma, no risk because of general
punctureof the spleenis reduced,
anaesthesia,a quicker returnto normalwork and reduced
pressureof 6 mmHg did not give riseto
The rntra-abdominal
hosoi tal i zati on
ti me.
any signsof abdominaldiscomfort.The poniesand patients
tolerated the surgical interventionwithout needing adLiterature
ditionalrestraint.The only moment some discomfortwas
Laparoscopic
in standing
horDavisE.W. (1997):
cryptorchidectomy
shown, was the moment when the first ligaturewas tighte26,326-331
ses,Vet.Surgery
ned in the oonies,Howeverthis was limitedto some uneasinessand an occasionalkick. In the oatientsthe mesorchi- DielemanS.J., Th.A N. Kruip,P. Fonteyne,W.H.R. de Jong and
progesterone
(1983):
in oestradiol,
G.C.vander Weyden
Changes
um was anaesthetisedwhich reduces this reaction,but if
in follicular
fluidand in the micriconcentrations
andtestosterone
the volumeof analgesicsis largeor if it is injectedexactlyat
relative
to the peakof
morphology
of preovulatory
bovinefollicles
the place of the ligature,the volume of the tissuethat has
luteinizing
hormone.
71, 31-42
J Endocrinol
428
P ferdehei l k unde15
Astrid B. M. Riikenhuizenund G. C. M. Grinwis
FischerA.T. and A.M. Vachon(1992).Laparoscopiccryptorchidectomy in horses.J Am Vet Med Assoc 200, 1705-'1708
EnsinkJ. M. and W.R. Klein(1996):Castrationof horsesand ponies
by ligationof the spermaticcord. Proc. ScientificMeetingECVS5,
142
myopathyin
KleinL. (1978):A reviewof 50 cases of post-operative
the horse- intrinsicand managementfactorsaffectingrisk. Proc.
Am. Assoc.EquinePracI24,89-94
McCarvilleE. and D. Blais(1986)Myopathyaftergeneralanesthesiain
the horse:literaturereviewand a retrospective
study of thirteenclinicalcases.Med Vet Quebec16,17-2O
Peek M. L. (1993):A case of post-anesthetic
myopathy.EquineVet
E duc5, 1 83 -18 6
RicheyM. T., M. S. Holland,C.J. McGrath,N. H. Dodman,D. B. Marshall, M.H, Courl, W.M. Normanand D.C. See/er(1990):Equine
study. Vet Surg, 19,
Post-anesthetic
Lameness.A retrospective
392-397
VerjansH. L., B. A. Cooke,F. H. de Jong, C. M. M. de Jong and H. J.
for testovan der Molen (1973):Evaluationof radioimmunoassay
steroneestimation.
J SteroidBiochem4, 665-676
Wilson D.G., D.A, Hendrickson,A.J. Cooley and E. Degrave-Madigan (1996):Laparoscopicmethodsfor castrationof equids.J Am
Vet Med Assoc209,112-114
Prof. Astrid B. M.Rijkenhuizen
Facultyof VeterinaryMedicine
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429