Equine Reproductive Procedures. Группа авторов

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СКАЧАТЬ under general anesthesia.

       The mare is fasted for 24 hours prior to surgery.

       Antibiotics and flunixin meglumine (1.1 mg/kg, IV, s.i.d.) are administered prior to surgery and after surgery as needed.

       The mare is placed under general anesthesia and in dorsal recumbency.

       The ventral abdomen is clipped free of hair.

       A standard surgical prep is made over the ventral abdomen.

       Two paramedian incisions are made in the caudal ventral abdomen through the skin and blunt dissection is used to pass through the external and internal abdominal oblique muscles.

       A hand is passed into the abdomen and the adjacent ovary and uterine horn tip are exteriorized.

       A small incision is made near the uterine horn tip and the uterus is everted to expose the papilla of the UTJ.

       The papilla is cannulated with the blunt‐ended catheter.

       The oviduct is flushed retrograde with sterile saline containing fluorescein dye.

       The infundibulum end of the oviduct is observed for the presence of colored saline which may contain masses.

       The procedures are repeated on the contralateral oviduct.

       The uterus and abdomen are closed in a routine manner.

      Comments

      Cannulation of the papilla of the UTJ is technically difficult to perform. The original paper (Zent et al. 1993) indicated that the flush procedure was successful in five of eight mares, with oviductal masses observed in the flush fluid from both oviducts in all five mares. Three of the mares eventually had live foals. Note that the retrograde oviductal flush is also possible via a hysteroscopic approach in the standing mare.

       Equipment and Supplies

      Antibiotics, non‐steroidal anti‐inflammatory drugs, sedation, local anesthetic, and general anesthesia use vary with each procedure.

      Retrograde oviductal flush, laparotomy approach

      Surgical scrub, examination gloves, clippers, standard surgical supplies for abdominal surgery, sterile saline, 1.3 cm (0.5 inch) 24 gauge blunt‐ended catheter, fluorescein dye (add one fluorescein ophthalmic strip to 10 ml of sterile saline), 12 ml syringe.

      Normograde oviductal flush, laparotomy approach

      Surgical scrub, examination gloves, clippers, standard surgical supplies for abdominal surgery, Doyen intestinal forceps, 8.0 Fr Foley catheter 30 cm (12 inch) with 5.0 ml balloon cuff (no. V‐PFC8‐30; Cook Veterinary Products, Inc., Bloomington, IN, USA), sterile saline, new methylene blue dye, 20 ml syringe.

      Normograde oviductal flush, laparoscopic approach

      Standard equipment and supplies for a standing laparoscopic surgery: detomidine hydrochloride, butorphanol tartrate, laparoscopic Babcock forceps or oviductal forceps (×2), 7 Fr balloon catheter (Willy Rűsch GmbH, Kernen i.R., Germany), sterile saline, methylene blue dye, 20 ml syringe, videoendoscope to evaluate the uterine lumen after the flush procedure.

      Retrograde oviductal flush, hysteroscopic approach

      Examination gloves, tail wrap, tail rope, non‐irritant soap, bucket, disposable bucket liner, roll cotton, sterile surgical gloves, long sterile sleeves, indigo carmine solution (5 ml, 4 mg/ml indigo carmoine injection), oviduct catheter: 200 cm (79 inch) polyethylene tube (1.7 mm OD) with a 22 gauge 4.45 cm (1.75 inch) injection catheter attached at one end and a 20 gauge 3.8 cm (1.5 inch) needle connected to a 5 ml syringe (filled with dye) at the opposite end, guidewire for human angiography (0.46 mm diameter, 220 cm (87 inches) long, RF‐GA18263; Terumo, Surrey, UK), standard supplies for abdominocentesis, spectrophotometer, sterile flexible videoendoscope, videoprocessor, light source.

      Optional (vaginotomy)

      Scalpel, second sterile flexible endoscope.

Normograde Oviductal Flush (Laparotomy Approach) Technique

      Performed under general anesthesia.

       The mare is fasted for 24 hours prior to surgery.

       Antibiotics and flunixin meglumine (1.1 mg/kg IV, s.i.d.) are administered prior to surgery and for 3 days after surgery.

       The mare is placed under general anesthesia and in dorsal recumbency and a pelvic tilt apparatus applied to gain better access to the reproductive tract.

       The ventral abdomen is clipped free of hair.

       A standard surgical prep is made over the ventral abdomen.

       A 10 cm incision is made along the ventral midline just cranial to the udder.

       One ovary and uterine horn are exteriorized and examined for gross pathology.

       Doyen intestinal forceps are placed on the uterine horn 5 cm from the cranial tip to occlude the uterine horn.

       An 8.0 Fr balloon‐tipped catheter is passed into the infundibulum of the oviduct and down to the ampulla region and the cuff inflated with approximately 1.0–1.5 ml of air.

       20 ml of sterile saline with new methylene blue dye is slowly injected through the catheter as the catheter is held in the oviduct by the application of manual pressure proximal to the balloon.

       Patency of the oviduct may be confirmed by the techniques below:Injection and aspiration of 10–20 ml of sterile saline into the occluded cranial uterine horn to detect the presence of dye.Injection of 20 ml of air through the catheterized oviduct and listening for the sound of air “gurgling” through the UTJ into the uterine lumen.The advantage of performing these confirmation procedures is that additional flushing could be performed if the oviduct is not yet patent.Alternatively, an endoscopic examination of the uterine lumen could be used to visualize the dye. This could be accomplished by a second set of personnel during surgery while the horse is under general anesthesia.

       The procedures are repeated on the contralateral oviduct.

       The abdomen is closed in a routine manner.

      Comments

      Oviductal lavage may cause dislodgment of oviductal blockages and may therefore be therapeutic. Caution should be used to not overly dilate the oviduct or exert excessive pressure. Severely occluded oviducts may rupture during the flush procedure. A unilateral ovariectomy may be performed in the event СКАЧАТЬ