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An equine surgeon developed a successful method of castration of cryptorchidism by entering and removing the remaining testicles through the belly button.

Published by Christa Lesté-Lasserre, Massachusetts | October 16, 2021 | Breeding and reproduction, castration and castration, horse care

The horse's belly button can play a key surgical role, literally acting as a gateway between the inside and outside of the animal. This is the way California researchers have been using them recently, specifically to remove the retained testicles from the body with minimal complications.

“We think it’s safer to close along the midline, perhaps because it’s a thicker area to close, and it’s a cleaner technique than taking (testicles) through the paragroin area (closer to the scrotum),” Andrew T. Fisher said, DVM, diploma. ACVS, Chino Valley Horse Hospital in Chino Hills, California.

Male horses with testicles on the abdomen, from just above the scrotum-where they should be-all the way to any place near the kidney, are called cryptorchidism. In the past 30 years, many veterinarians have inserted instruments (a technique called laparoscopy) through keyhole incisions in the lower abdomen to find and clamp the testicles and cauterize or ligate blood supply and other attachment structures.

But the newly loosened testicle is wider than the surgical instrument—the surgical instrument also includes a small camera and a cannula that pumps carbon dioxide into the abdomen for better observation—so it cannot pass through those keyhole incisions. Surgeons usually expand the incision closest to the testicle in the groin area near the scrotum to remove the testicle. Although this technique is usually successful, it carries the risk of severe bleeding because there are many major blood vessels in the area, including the superficial abdominal artery. Fischer said the accidental severance of that artery caused some horses to bleed to death during or after the operation.

So in the past 15 years, Fischer has been trying different methods: pass the testicle through the entrance of the umbilical cord-a hole in the horse's belly button. The horse was lying on his back under general anesthesia, and Fischer inserted the instrument through a small incision in the groin area to expand the abdomen and find the testicles. After cutting the testicles, he used forceps to pass it to the second set of forceps, through the umbilical cord entrance into the abdomen. He clamped the testicle with a second set of forceps and pulled it out of the larger opening without having to make a small groin incision that was already larger than the instrument.

"What I really like is that you will eventually make two 5 mm incisions for your...device, and then maybe a 2 or 3 cm incision through the umbilicus (for tissue removal), and that's all. ," Fischer said of the horse.

Between 2006 and 2016, Fischer used this laparoscopic method to perform 90 cryptorchiectomy on 79 horses, removing the testes through the umbilical cord entrance. He said the complications were mild and rare (except for a horse that had to be euthanized during recovery due to neurological problems that may be related to anesthesia). Cauterizing the blood vessels leading to the testicles seems to limit the chance of bleeding from the stump.

"Laparoscopy is good for the horse and its owner, because we (surgeons) can always see the bleeding, so we can try to correct it immediately," he said. "So this means there are fewer bleeding problems after surgery."

By the way, Fischer also noticed that compared with other cryptorchidism laparoscopic surgeries, his team had a much lower rate of colic after cryptorchidectomy. He suspects that this may be related to the shorter preoperative fasting period, rather than the use of the umbilical cord entrance. He said that he only banned patients from eating 12 to 18 hours before the operation (instead of up to 48 hours), which may help reduce digestive discomfort, he said. In addition, his team tried to expel the abdomen as much as possible from the inhaled carbon dioxide before stitching the horse together. They pointed out in a peer-reviewed paper that this may release stress on the digestive system.

On June 10, 2021, Equine Veterinary Journal published the paper "After intra-abdominal laparoscopic castration, the removal of equine cryptorchidism through the umbilical cord entrance of an enlarged dorsal horse".

Christa Lesté-Lasserre has been passionate about horses and science since she rode her first Shetland pony in Texas, and she has written scientific research that helps to better understand all equine animals. After completing her undergraduate studies in science, journalism and literature, she received a master's degree in creative writing. She lives in France and aims to showcase the most fascinating aspect of equine science: the stories it creates. Follow Lesté-Lasserre on Twitter @christalestelas.

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