Equine thoracoscopy: normal anatomy and surgical technique.
Authors: Peroni J F, Horner N T, Robinson N E, Stick J A
Journal: Equine veterinary journal
Summary
# Editorial Summary: Equine Thoracoscopy — Normal Anatomy and Surgical Technique Thoracoscopic examination of the equine thorax remained poorly characterised in the early 2000s, prompting Peroni and colleagues to map the normal anatomical landmarks and optimise the surgical approach for clinical application. Six healthy horses underwent bilateral thoracoscopic exploration using rigid 30-degree telescopes inserted through the 8th, 10th and 12th intercostal spaces during controlled pneumothorax periods, with procedures captured digitally to document visualised structures. Major mediastinal and cardiopulmonary structures including the aorta, oesophagus, diaphragm, pulmonary veins and thoracic duct were consistently identified regardless of approach, though the 10th and 12th intercostal spaces proved superior to the 8th due to reduced rib rigidity and muscular obstruction that limited instrument manoeuvrability. Whilst horses tolerated the procedure well overall, discomfort manifested through increased respiratory rate, coughing and reduced sedation response, particularly when using the more cranial intercostal approach and during pneumothorax periods. For practitioners considering thoracoscopic intervention, this work establishes that the 10th and 12th intercostal spaces offer optimal visualisation with minimal complications, providing a foundation for safe exploration of pleural, pulmonary and mediastinal pathology in standing sedated horses.
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Practical Takeaways
- •Thoracoscopy is a viable diagnostic and surgical technique in horses; use 10th or 12th intercostal spaces to avoid access limitations encountered with the 8th space
- •Adequate sedation (continuous detomidine), local/regional anaesthesia, and controlled pneumothorax periods (15 minutes) are essential for animal welfare and successful visualization
- •Clinicians performing equine thoracoscopy should expect to visualize major cardiopulmonary structures and plan surgical approaches accordingly, avoiding cranial intercostal spaces when possible
Key Findings
- •Six healthy horses (3-10 years) tolerated left and right thoracoscopic examination via rigid 10mm telescope inserted through 8th, 10th, and 12th intercostal spaces
- •Major thoracic structures (collapsed lung, aorta, oesophagus, diaphragm, azygos vein, thoracic duct, pulmonary veins) were readily identified during bilateral examination
- •Use of 8th intercostal space resulted in hindered surgical access due to rib rigidity, greater musculature, and limited telescope mobility
- •Discomfort signs (increased respiratory rate, coughing, reduced sedation) were associated with lung collapse, pneumothorax, and 8th intercostal space approach