Hand-assisted laparoscopic left nephrectomy in standing horses.
Authors: Keoughan Curry G, Rodgerson Dwayne H, Brown Murray P
Journal: Veterinary surgery : VS
Summary
# Hand-Assisted Laparoscopic Nephrectomy in Standing Horses Equine nephrectomy has traditionally required general anaesthesia and extensive surgical access, but this 2003 study evaluated whether minimally invasive laparoscopic techniques could be safely performed in standing, sedated horses. Eight horses underwent hand-assisted laparoscopic removal of the left kidney through a single paralumbar fossa incision, with the surgeon's hand used to isolate renal vasculature under direct visualisation; retroperitoneal infiltration with mepivacaine provided analgesia without general anaesthesia. All procedures were completed successfully, with operative times ranging from 20–90 minutes and notably, two horses demonstrated no pain responses in the first 48 hours post-operatively, though intraoperative haemorrhage occurred in three cases. The technique's key advantage lies in reduced trauma and faster recovery compared to open approaches, though the authors emphasise the critical importance of careful identification and individual ligation of accessory renal arterial branches to prevent potentially life-threatening bleeding complications. For practitioners managing horses with renal pathology requiring nephrectomy, this work demonstrates that standing laparoscopic surgery is a viable option that warrants consideration, particularly where minimising systemic anaesthetic risk or expediting recovery is clinically important.
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Practical Takeaways
- •Hand-assisted laparoscopic nephrectomy is a viable surgical option for kidney removal in standing horses under sedation and local anesthesia, avoiding general anesthesia risks.
- •Careful identification and ligation of all renal artery branches is critical to minimize hemorrhage complications during the procedure.
- •Surgical duration is variable (20-90 minutes); surgeon experience and anatomy variations should inform case planning and client communication.
Key Findings
- •Hand-assisted laparoscopic left nephrectomy was successfully completed in all 8 standing horses with surgical duration ranging from 20 to 90 minutes.
- •Retroperitoneal infiltration of local anesthetic (2% mepivacaine) provided adequate anesthesia in standing sedated horses.
- •Intraoperative hemorrhage occurred in 3 of 8 horses, highlighting the importance of identifying accessory renal artery branches.
- •Two horses demonstrated no signs of pain for 48 hours postoperatively following the procedure.