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a)
b)
have shown it to be a source of bacteria and other undesirable contaminants. Using a filter method, Ott (1997) cultured multiple strains of bacteria including: Staphylococcus spp. from 12 of 60 gas tanks, Streptococcus spp. 9/60, Listeria monocytogenes 3/60, Enterobacteria spp. 6/60 and Escherichia coli 5/60. Numbers rose counting insufflators, inward and outward connectors and tubing, whilst similar results were obtained by Couper et al. (1997) who also found metallic dust in 100% of the 10 insufflators they tested. Frankel et al. (1998) was unable to replicate these results but were unable to conclude whether their negative results were because their filters failed to trap contaminants, or whether none were present to start. Whether or not there is a clinically relevant difference between the contamination obtained by passive air aspiration from a regular operating room, versus a commercial gas tank and insufflator, is debatable. Having the means to supply positive pressure insufflation with carbon dioxide is a wise precaution in case of limited working space. Routinely using it in standing horses is not a necessity. The accompanying article illustrates well the need for
quick thinking and improvisation of surgical technique, even when rigorous workup regimes are followed. Although testicular teratomas are rare, with sufficient volume they occur with regularity and little warning. Having a technique available to remove an abdominal cryptorchid testicle much larger than its descended counterpart should be available. The potential for viscous or solid contents ill-suited to needle aspiration or morcellation should be anticipated.
Author’s declaration of interests No conflicts of interest have been declared.
Fig 4: This teratoma was predominantly bone, weighing 22 kg and measuring 50 cm in diameter (a) by the time recurrent colic prompted exploratory laparotomy (b). Extensive and multiple adhesions had developed, including both large and small intestine. The size of the laparotomy wound and grave internal damage sustained in removing it proved fatal.
The use of insufflation during standing laparoscopy, as it
was in both cryptorchid horses in the accompanying article, warrants discussion. Carbon dioxide is preferred over oxygen, nitrous oxide and room air thanks to not supporting combustion and its rapid blood solubility allowing clearance through the lungs (Safran and Orlando 1994). Peritoneal acidosis induced by CO2 absorption also causes mild inflammatory peritonitis (Latimer et al. 2003) that may be associated with increased early post-operative pain. In a 2013 Cochrane review (Cheng et al. 2013) post-operative pain scores were higher in elective human laparoscopy patients undergoing insufflation with carbon dioxide compared to nitrous oxide. Many surgeons including the author do not use it routinely in standing horses for laparoscopy (e.g. Lloyd et al. 2007; Lund et al. 2014). With adequate starvation to reduce gut fill, the potential space achieved by passive aspiration of room air gives good visibility and working area, whilst the use of modern vessel sealing devices minimises the risk of combustion. The need for a ‘sterile operating medium’, as opposed to passive room air with its attendant dust particles, may be a concern for some, but carbon dioxide is made industrially and various studies
References
Bergin, W.C., Gier, H.T., Marion, G.B. and Coffman, J.R. (1970) A developmental concept of equine cryptorchidism. Biol. Reprod. 3,82-92.
Bont, M.N., Wilderjans, H. and Simon, O. (2010) Standing laparoscopic ovariectomy technique with intraabdominal dissection for removal of large pathologic ovaries in mares. Vet. Surg. 39, 731-741.
Brendemuehl, J.P. (2006) Effects of repeated hCG administration on serum testosterone and testicular descent in prepubertal thoroughbred colts with cryptorchid testicles. Proc. Am. Assoc. Equine Pract. 52, 381.
Brommer, H., Grinwis, G.C.M., van Loon, V. and Ensink, J.M. (2011) Laparoscopic-assisted diagnosis of anomalous unilateral abdominal cryptorchidism. Equine Vet. Educ. 23, 391-395.
Cheng, Y., Lu, J., Xiong, X., Wu, S., Lin, Y., Wu, T. and Cheng, N. (2013) Gasses for establishing pneumoperitoneum during laparoscopic abdominal surgery. Cochrane Database Syst. Rev. 31(1), CD009569.
Coomer, R.P.C., Gorvy, D.A., McKane, S.A. and Wilderjans, H. (2016) Inguinal percutaneous ultrasound to locate cryptorchid testes. Equine Vet. Educ. 28, 150-154.
Couper, G.W., Ewen, S.W. and Krukowski, Z.H. (1997) Risk of contamination from laparoscopic carbon dioxide insufflators. J. R. Coll. Surg. Edinb. 42, 231-232.
© 2019 EVJ Ltd
Ethical animal research Not applicable.
Source of funding None.
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