Diagnostic endoscopy of the navicular bursa using a needle endoscope by direct or transthecal approach: A comparative cadaver study.
Authors: Mählmann Kathrin, Koch Christoph, Bodó Gábor
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Navicular Bursa Endoscopy — Direct versus Transthecal Access Diagnostic imaging of the navicular bursa remains challenging in lameness investigations, particularly when conventional radiography and ultrasound fail to identify pathology. Mählmann and colleagues used 30 equine cadaver forelimbs to evaluate two needle endoscopic approaches—direct insertion and transthecal (through the digital flexor tendon sheath)—comparing their practicality, visualisation capability, and potential for iatrogenic damage. Both techniques required similar numbers of insertion attempts and examination time, but the direct approach demonstrated significantly superior visualisation of the ipsilateral abaxial and proximal navicular bone margins and the ipsilateral collateral sesamoidean ligament. Importantly, iatrogenic lesions were minor and superficial regardless of technique or trocar design, suggesting needle endoscopy poses minimal risk to surrounding soft tissue structures. For practitioners managing horses with navicular-region lameness, these findings support needle endoscopy as a viable diagnostic tool that could complement or potentially replace traditional imaging modalities, though the direct approach should be favoured when improved visualisation of specific anatomical structures is diagnostically necessary.
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Practical Takeaways
- •Needle endoscopy is a viable diagnostic technique for investigating navicular bursa pathology in lame horses, with the direct approach offering better visualization of key anatomical structures
- •Both direct and transthecal approaches are similarly efficient in terms of access time and attempt number, allowing choice based on clinical circumstances and operator preference
- •Risk of significant iatrogenic damage from needle endoscopy is minimal with either approach, making this a relatively safe complementary diagnostic tool for navicular region lameness
Key Findings
- •Direct and transthecal needle endoscopic approaches showed no significant difference in number of attempts or time to access the navicular bursa
- •Direct approach provided significantly superior visualization of ipsilateral abaxial and proximal navicular bone margins and collateral sesamoidean ligament compared to transthecal approach
- •Iatrogenic lesions from needle endoscopy were superficial and focal regardless of approach or trocar type used