Evaluation of a transvaginal laparoscopic natural orifice transluminal endoscopic surgery approach to the abdomen of mares.
Authors: Alford Christopher, Hanson Reid
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Transvaginal NOTES in Equine Abdominal Exploration Minimally invasive diagnostic approaches to the equine abdomen remain limited, prompting investigation of natural orifice transluminal endoscopic surgery (NOTES) as an alternative to conventional laparoscopy. Alford and Hanson (2010) evaluated transvaginal access to the abdominal cavity in eight standing mares, positioning endoscopic instruments at the 1 or 11 o'clock position within the cranial vaginal vault to explore visceral structures. Using both a 2 m flexible endoscope and 62 cm laparoscope, they consistently visualised the left kidney, spleen, nephrosplenic space, stomach, caecum, duodenum, ovaries, diaphragm and caudal peritoneal reflection, with the liver visible only inconsistently; the laparoscope proved superior for caudal abdominal views but was limited in cranial and lateral mobility compared to the flexible endoscope. Incisional closure occurred within three days with minimal morbidity (one mare exhibited mild, self-resolving colic), supporting the safety and tolerability of this approach in standing animals. Whilst the transvaginal NOTES technique shows promise for diagnosing dorsal caudal abdominal pathology in mares—potentially offering reduced invasiveness compared to conventional laparoscopy—clinicians should recognise its current limitations in visualising cranial structures and understand that instrument selection (endoscope versus laparoscope) will influence diagnostic capability for different anatomical regions.
Read the full abstract on PubMed
Practical Takeaways
- •NOTES transvaginal approach offers a minimally invasive diagnostic option for evaluating dorsal caudal abdominal structures in mares without general anesthesia or major surgical incisions
- •The procedure requires minimal recovery time with incisions healing by day 3, making it potentially valuable for field or clinic-based diagnostic work
- •Visualization is limited to structures on the side of insertion and cranial to the nephrosplenic space; consider this limitation when planning diagnostic approach
Key Findings
- •Transvaginal NOTES approach successfully visualized left kidney, spleen, nephrosplenic space, stomach, cecum, duodenum, ovaries, diaphragm, and caudal peritoneal reflection in all 8 mares
- •Incisional closure was evident by day 3 post-procedure with only 1 mare experiencing mild colic that resolved with conservative treatment
- •Endoscope provided better cranial visualization than laparoscope, but laparoscope had limited lateral mobility
- •Transvaginal approach was well-tolerated and safe for diagnostic abdominal exploration in standing mares