Complications associated with cannula insertion techniques used for laparoscopy in standing horses.
Authors: Desmaizières Louis-Marie, Martinot Stephane, Lepage Olivier M, Bareiss Emmanuel, Cadoré Jean-Luc
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Cannula Insertion Techniques for Standing Laparoscopy in Horses Standing laparoscopy has become an established diagnostic and surgical tool in equine practice, yet the safest method for initial trocar placement remains incompletely defined. This retrospective analysis of 40 horses compared five different cannula insertion techniques for laparoscopy performed via the left flank, examining the incidence of inadvertent organ perforation and peritoneal complications during the critical first-access phase. Blind insertion techniques—whether using a Veress needle, catheter-directed insufflation, or direct cannula insertion without visualisation—resulted in 11 of 12 total complications (six peritoneal detachments, four splenic punctures, and two descending colon punctures), whereas visually-guided techniques using either an operating laparoscope or an optical trocar (Visiport device) produced only one complication across 14 horses combined. The optical trocar system proved particularly practical, achieving reliable entry even when horses were fasted for only 12 hours and enabling direct right-flank cannulation without initial left-flank insufflation. For practitioners, these findings suggest that investment in optical trocar technology substantially reduces serious complications associated with the initial access phase of standing laparoscopy, making it a worthwhile consideration for horses requiring diagnostic or therapeutic endoscopic procedures.
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Practical Takeaways
- •If performing standing laparoscopy, prioritize optical trocar or visual guidance techniques—blind Veress needle and catheter methods carry unacceptably high complication rates (nearly 50%) including organ puncture
- •The Visiport optical trocar system is the preferred technique, reducing complications to <6% and allowing direct right-flank insertion in properly fasted horses
- •Standard 12-hour feed withholding is sufficient preparation for optical trocar techniques; ensure proper positioning and physical examination before attempting any flank approach
Key Findings
- •Blind cannula insertion techniques (groups 1-3) resulted in 11 complications out of 23 horses (47.8%), including peritoneal detachment, splenic puncture, and colon puncture
- •Visual control techniques (groups 4-5) using laparoscope or Visiport optical trocar resulted in only 1 complication out of 17 horses (5.9%)
- •Visiport optical trocar technique was effective and safe in horses fasted for 12 hours, allowing direct right flank cannula insertion
- •Complications decreased by over 8-fold when using optical cannula insertion compared to blind techniques