Hybrid natural orifice transluminal endoscopy surgery (NOTES) to perform bilateral ovariectomy in mares.
Authors: Velloso Alvarez A, Boone Lindsey, Horzmann Katharine, Hanson R Reid
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Hybrid NOTES for Equine Ovariectomy Bilateral ovariectomy in mares typically requires multiple flank incisions to exteriorize and remove ovarian tissue, which can compromise the integrity of the body wall and increase postoperative morbidity. Velloso Alvarez and colleagues combined laparoscopic visualisation with natural orifice transluminal endoscopic surgery (hybrid NOTES), using a transvaginal approach to remove both ovaries whilst minimising paralumbar portal trauma in six standing, sedated mares. The technique proved successful across all animals with a mean operative time of 70 minutes; whilst two mares experienced temporary ovarian prolapse during vaginal extraction, both were successfully retrieved either with forceps reapplication or manual reduction, with only one mare subsequently developing a bladder–vaginotomy adhesion at necropsy. The reduction in flank incision number and size potentially mitigates the soft tissue trauma, infection risk, and body wall complications traditionally associated with standard laparoscopic ovariectomy, though the small case series warrants further investigation into long-term complications such as adhesion formation and reproductive tract integrity. For practitioners seeking to refine surgical technique and enhance mare welfare, this hybrid approach merits consideration as part of the expanding toolkit for minimally invasive ovariectomy.
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Practical Takeaways
- •Hybrid NOTES is a feasible alternative to traditional laparoscopic ovariectomy that reduces flank incision size and number, potentially lowering flank-related complications
- •The vaginotomy approach allows for rapid ovary retrieval, though contingency for abdominal retrieval via hand or forceps reapplication must be available if ovaries slip during extraction
- •Careful surgical technique is critical—hand retrieval may increase adhesion risk, so gentle forceps handling during vaginotomy passage is preferred
Key Findings
- •Hybrid NOTES successfully performed bilateral ovariectomy in all 6 mares with mean surgical time of 70±25 minutes
- •Two mares experienced ovary dislodgement during vaginotomy extraction, both successfully retrieved via abdominal approach
- •Five of six mares had no adhesions at necropsy; one mare with hand retrieval developed bladder-vaginotomy adhesion
- •Technique minimized number and size of paralumbar laparoscopic portals compared to conventional ovariectomy