Evaluation of a Transvaginal Laparoscopic NOTES (Natural Orifice Transluminal Endoscopic Surgery) Approach to the Abdomen of Mares

Abstract

The objectives of this study were to describe a natural orifice transluminal endoscopic surgery (NOTES) using laparoscopic and endoscopic instrumentation transvaginally into the standing mare’s abdomen and identify structures that are visualized using this approach. With the horse under sedation, a standing transvaginal approach was made in the cranial vaginal vault lateral to the cervix in each mare. A single approach through the vaginal wall was made on the left or on the right side of the cervix. The abdomen was explored and the abdominal viscera evaluated using a flexible endoscope followed by a rigid laparoscope. Incisional healing was monitored clinically by vaginoscopy post-operatively. Exploration of the abdomen was sufficiently performed in all mares through a transvaginal approach using either a left or right sided approach. The endoscope allowed consistent visualization of the left kidney, spleen, nephrosplenic space, stomach, cecum, duodenum, left and right ovaries, diaphragm, and caudal peritoneal reflection. The liver was observed with somewhat less consistency on either the left or right side. The laparoscope provided similar views of the caudal abdomen but was limited in both the cranial advancement and in its lateral mobility due to the confines of the pelvis. Healing of the vaginal incision occurred rapidly with apparent closure of the incision by 3 days. NOTES techniques through a transvaginal approach may be a useful tool in the diagnosis of intra-abdominal disorders encountered in the mare.