Postado por:
Pedro Paulo Maia Teixeira
Veterinarian
Master Veterinary Surgery
PhD Obstetrics and Animal Reproduction - FCAV / UNESP
PhD Obstetrics and Animal Reproduction - FCAV / UNESP
Clinic, Veterinary Surgery and Obstetrics
p_paulomt@yahoo.com.br
Postado por:
ABSTRACT
Background:
Ventricular foreign bodies are common in some species of birds. Depending on
the type of the material ingested, the bird can develop ventricular impactions.
Diagnosis is made by radiography, palpation (in larger species), endoscopy and
exploratory laparotomy. Treatment depends on the nature of the foreign body,
and if there is impaction. Endoscopy is a less invasive treatment that can be
used in some situations. This paper reports a case of a foreign body in a
toucan’s ventriculus, removed by endoscopy.
Case: A young Toco
Toucan (Ramphastos toco) was referred to the Veterinary Hospital “Governador
Laudo Natel" of the School of
Agricultural and Veterinary Sciences “Júlio de Mesquita Filho”, São Paulo State
University (HV/FCAV/UNESP) by the Environmental Police. Survey radiographs
indicated a foreign body in the ventriculus. Based on the size of the foreign
body, the endoscope removal was the determinate treatment. The patient was fasted
for 6 hours and was anesthetized with isoflurane. The endoscope was carefully
passed through the esophagus, than the proventriculus and ventriculus. This
view was hampered by the large amount of fibrin in gastroesophageal mucus,
making it necessary to wash it during the procedure, with 0.9% saline through
the operating channel. Was observed hyperemic mucosa throughout the digestive
tract and a marked hyperemia on the ventriculus surface. The foreign body was
seized using Babcock forceps and gently the whole set was removed, preventing
further injury to the gastrointestinal mucosa.
The foreign body was visualized and collected out of the use of the
Babcock atraumatic forceps. The overall surgical time was 24 minutes. The
patient recovered with no complications of anesthesia and early postoperative
period, the surgical recovery was considered excellent.
Discussion: The access
allowed visualizes the oral cavity, esophagus (the most difficult access, right
of the midline)
proventriculus and ventriculus, demonstrating the feasibility of endoscopy in
these birds. Nevertheless, the use of the technique in toucans to date, only have
been described for sex determination. This report demonstrates the
effectiveness of endoscopy and significantly reduced risk of death due to a
surgical procedure. Foreign body ingestion is a common indication for
endoscopy. If the foreign body is present in the crop, it is easily removed
with the help of an endoscope and graspers or by means of an ingluviotomy. If
the foreign body has already traveled to the proventriculus or ventriculus,
depending on the bird’s length, rigid endoscopy may still be a viable option,
even if the access requires more heed and sensibility. The 30 to 45 º incline
profess by [4] was conclusive to the success of the procedure, not only to
avoid the risk of aspiration of gastric contents, but mostly for better access
to the ventriculus, identified by the yellow greenish color of the koilin layer.
The use of optics with working channel allowed safer handling of foods and
foreign body seized within the gastric chamber.
Foreign
body ingestion is a common indication for endoscopy. Orally approach allowed excellent
visualization of the ventriculus site, demonstrating the feasibility of the
endoscopy in this specie and reducing the death risk due to a surgical
procedure to remove the foreign body. The external position at 30 to 45º
incline was imperative for procedure success due to the aspiration risk of
gastric fluids and the best access to the ventriculus. The use of the endoscope
equipment with an operating channel allowed safer manipulation of the foods and
the foreign body seized in the gastric chamber.
Keywords: endoscopic,
removal, Aglandular stomach, toucan.
Postado por:
Pedro Paulo Maia Teixeira
Veterinarian
Master Veterinary Surgery
PhD Obstetrics and Animal Reproduction - FCAV / UNESP
PhD Obstetrics and Animal Reproduction - FCAV / UNESP
Clinic, Veterinary Surgery and Obstetrics
p_paulomt@yahoo.com.br
Pedro Paulo Maia Teixeira
Veterinarian
Master of Veterinary Surgery
PhD in Obstetrics and Animal Reproduction - FCAV / UNESP
Clinic, Veterinary Surgery and Obstetrics
p_paulomt@yahoo.com.br
ABSTRACT
Background: Intraperitoneal adhesions in equines, especially following
exploratory celiotomy. Adhesiolysis is the treatment of choice for patients presenting
postsurgical adhesions. Laparoscopic approach for adhesiolysis presents several
advantageous aspects in human patients. The aim of the current study was to report
a case of successful laparoscopic adhesiolysis in a mini pony horse.
Case: A male Shetland Pony, weighing 140 kg , was admitted under
complaint of right hind limb trauma and treated surgically for metatarsal
fracture reduction. The patient has also had intermittent episodes of colic and
was always treated clinically without major complications. The pony had no
history of previous abdominal surgery and no episodes of acute abdomen were
seen during hospital stay. Three months following ostheosynthesis, an exploratory
laparoscopic approach was carried out to assess the possible cause or
consequences of the episodes of acute abdomen. The patient was submitted to
general anesthesia, positioned in dorsal recumbency and the abdomen was clipped
and aseptically prepared for surgery. During the laparoscopic inspection, there
were adhesions involving the ventral abdominal wall and a ventral mesogastric
segment of duodenum. Laparoscopic adhesiolysis was performed using a two-port approach,
by gently breaking the adhesion bands using meticulous traction with a 10-mm
laparoscopic atraumatic Babcock forceps. Afterwards, the intestinal loop was rinsed
with heparin sodium solution diluted in normal saline. Total surgical time was
58 min. the patient was able to recover without complications. In the early postoperative
period, the surgical recovery was considered excellent. No apparent adhesion involving
the previously affected intestinal loop was found during the ultrasound exam
following 15 days of surgery. Furthermore, the surgical wounds had healed
completely, with no complications.
Discussion: In the current case report, the primary cause of the acute abdomen episodes
was not determined since the patient had never undergone abdominal surgery. It was
hypothesized that an acute inflammation of the duodenal loop that was involved
by the adhesion bands may have triggered the adhesiogenesis. Laparoscopy was efficient and presented a short operative time, due to
magnification of image and adequate observation of structures surrounded by
adhesion bands. Although the use of Babcock forceps is not usually recommended
for adhesiolysis in the current literature, it was both effective in
manipulating the bowel and performing the adhesiolysis. The heparin solution diluted in normal saline was
effective in preventing the recurrence of new adhesions, which was evidenced by
ultrasonography following 15 days. The laparoscopic approach usually minimizes
the new formation of adhesions as trauma to the peritoneal surfaces is
minimized by the use of delicate instruments, as observed in the current study.
In addition, laparoscopy reduces the possibility of contact among the
peritoneal surfaces and foreign bodies, such as gauze, glove powder and room
air particles. Moreover, it maintains the abdominal surfaces in adequate humidity
environment.
Keywords:
endosurgery,
equines, intraperitoneal adhesions.
Descritores:
videocirurgia, equinos, aderências intraperitoneais.
INTRODUCTION
Peritoneal adhesions are common complications in
horses following exploratory laparotomy, especially regarding small intestine secondary
disorders [4,5,7]. Adhesiolysis is the treatment of choice. Moreover, the laparoscopic
approach has been reported to present several beneficial effects over the conventional
approaches for adhesiolysis in human patients [6]. However, little information is
known about the use of minimally invasive endoscopic techniques for adhesiolysis
in equine species so far.
Within such context, the aim
of this case report was to describe a successful case of minimally invasive
laparoscopic adhesiolysis in a mini pony horse.
CASE REPORT
The patient, a male Shetland Pony, weighing 140 kg , was admitted at the Large Animal
Surgery Division of the Veterinary Teaching Hospital “Governador Laudo
Natel" of the School of Agricultural
and Veterinary Sciences “Júlio de Mesquita Filho”, São Paulo State University
(HV/FCAV/UNESP), under complaint of right hind limb trauma, and submitted to metatarsal
fracture ostheosynthesis. During the anamnesis, it was reported that the patient
had been presenting intermittent episodes of acute abdomen and had always been treated
clinically without complications. Additionally, there was no record of previous
abdominal surgery and no episodes of acute abdominal pain were observed during
the hospitalization period.
A diagnostic laparoscopic approach was suggested in
order to aid in the diagnosis of the recurrent acute abdomen episodes and
possible surgical treatment. The patient was fasted for 12 hours and premedicated
using xylazine hydrochloride1 (0.8 mg/kg, IM). Following a 15-min
interval, anesthesia was induced using guaifenesin2 (100 mg/kg, IV) and
ketamine chloride3 (1 mg/kg, IV) and maintained using halothane4
vaporized in oxygen (100%), to 2 CAM, following tracheal intubation. The
abdomens was ventrally clipped and aseptically prepared for surgery. Local
anesthetic was injected on the desired laparoscopic portal sites, using 4 mL of
lidocaine hydrochloride5.
Patient was placed under supine simple position,
without head-down tilt. Two 12-mm trocars were used for abdominal access of a 10-mm,
30º angled laparoscope and a 10-mm atraumatic laparoscopic Babcock forceps. The
first port was inserted through the umbilical scar using the open mini-laparotomy
technique, which was used for the insertion of the laparoscope. Subsequently,
the pneumoperitoneum with sterilized CO2 was created, using
intraperitoneal pressure of 8 mmHg and 5 L /min of insufflation flow rate. The second
trocar was introduced in the midline, 10 cm caudally to the first port, under
laparoscopic assistance.
During general laparoscopic inspection, broad fibrous
bands were observed on the ventral mesogastric area, connecting a segment of
the duodenum to the ventral abdominal wall (Figure 1A). Adhesiolysis was then performed
employing a slight and gentle traction of the adhesion bands proximally to the
abdominal wall, using the atraumatic Babcock forceps (Figure 1B). Extreme care
was taken not to traumatize the intestinal loop and its mesenteric vessels. No
intestinal petechial or bleeding were noted following adhesiolysis (Figure 2). The
intestinal loop was finally rinsed using sodium heparin in normal saline (5 IU/mL),
in order to prevent adhesion recurrence.
Figure 1. (A) Laparoscopic view of fibrous adhesions involving the abdominal wall
(ab) and a loop of the duodenum (du). (B) Blunt adhesiolysis being carried out
with a 10-mm atraumatic Babcock forceps.
Figure 2. (A) Laparoscopic view of the abdominal wall (arrow) following
adhesiolysis. (B) Duodenum (arrow) free from adhesion bands following blunt
dissection. No bleeding was noted.
The pneumoperitoneum was completely drained and the
trocars sequentially withdrawn from the abdominal wall. The synthesis of the
muscular layer was carried out using an interrupted cross mattress pattern (Sultan
pattern), followed by synthesis of the skin with an interrupted cushion pattern
(Wolf pattern).
The overall surgical time was 58 minutes. The patient
recovered with no complications of anesthesia. In the early postoperative
period, the surgical recovery was considered excellent, as only mild pain (<
30) was diagnosed using the visual analogue scale (VAS) for pain assessment
(ranging from 0, no pain, to 100, worst pain possible). The patient received
flunixin meglumine7 (1.1 mg/kg), ceftiofur8 (2.2 mg/kg) and
benzilpenicillin9 (40,000 IU) on the surgery day. The antibiotics
were continued for 6 days of coverage.
No adhesion recurrence was noted during the following
15 days after the procedure during the ultrasound scanning. Furthermore, the
surgical wounds healed completely, with no complications at any time point.
DISCUSSION
Intraperitoneal adhesions may involve
any intestinal segment. Although intestinal anastomosis or enterotomy sites are
the main adhesiogenic sites, the hole intestine can be affected [4]. In the
current case report, the primary cause was not determined preoperatively since
patient had never undergone abdominal surgical procedures. It is believed that
an acute inflammation of the intestinal loop involved may have resulted in the
formation of adhesions. The formation of adhesions without prior surgical
trauma is common in women with uterine inflammatory or degenerative diseases,
such as endometriosis [2]. In the current clinical case, the heparin solution diluted
in normal saline was effective in preventing the formation of new adhesions
following adhesiolysis, as shown during the ultrasonography [1,4,8].
Laparoscopic approach was
efficient for the accomplishment of adhesiolysis in a short surgical time. Although
Metzenbaum scissors, monopolar dissectors, bipolar coagulation forceps, lasers
and ultrasonic shears have been both indicated and used for adhesiolysis in
human patients and animals, gentle traction of the adhesion bands using an atraumatic
Babcock forceps was effective in both handling the intestinal loop and performing
adhesiolysis. This kind of meticulous approach minimizes the formation of new
adhesions and the trauma to peritoneal surfaces compared to open surgery. In
addition, the contact of intraperitoneal surfaces with foreign bodies is
reduced and the tissues are maintained in a closely physiologic humidity and
atmosphere-free environment [3]. In the current case report, there was no
recurrence of adhesions, no considerable painful and excellent postoperative recovery.
Such facts highlight the suitability of the laparoscopic approach in the equine
surgical routine.
SOURCES
AND MANUFACTURERS
1Rompun®
Bayer. SP, Brazil.
2Guaifenesin®,
Henrifarma. SP, Brazil.
3Dopalen®,
Vetbrands. SP, Brazil.
4Halothane®,
Cristalia. SP, Brazil.
5Lidovet®,
Bravet, RJ, Brazil.
6Xcel®
Ethicon, SP, Brazil.
7Banamine®
Injection, Schering-Plough. SP, Brazil.
8Bioxell,
Vallé. MG, Brazil.
9Benzapen®.
Teuto. SP, Brazil.
Declaration of interest. The authors report no conflicts of interest. The
authors alone are responsible for the content and writing of the paper.
REFERENCES
1
Hillyer M.H. & Wright C.J. 1997. Peritonitis in the horse. Equine
Veterinary Education. 9(3): 136-142.
2 Howard
F.M. 2011. Surgical
treatment of endometriosis. Obstetics and
Gynecology Clinics of North America, 38(4): 677-686.
3 Kavic
S.M., Kavic S.M.2002.
Adhesions and Adhesiolysis: The Role of Laparoscopy. Journal of the Society of Laparoendscopic
Surgeons, (6) 99-109.
4 Kelmer G. 2009. Update on recent advances in equine abdominal surgery.
The Veterinary Clinics, Equine Practice,
25:271-282.
5
Leira
P.A.T., Martins P., Dércoli T.E., Furini T.F., Berlingieri M.A. 2012. Adesiólise
peritoneal trans-cirúrgica seguida de lavagem peritoneal e infusão de solução
de carboximetilcelulose 1% (SCMC 1%) através de tubo de silicone implantado na
cavidade abdominal. In: XIII
Conferência Anual da ABRAVEQ – 2012. (Campinas, SP). p. 984.
6 Li
M.Z, Lian L., Xiao L., Wu W., He Y., Song X. 2012. Laparoscopic versus open adhesiolysis in patients
with adhesive small bowel obstruction: a systematic review and meta-analysis. American Journal of Surgery. [in Press]
7 Pagliosa G.M., Alves G.E.S. 2004. Fatorespredisponentes das complicaçõesincisionais
de laparotomiasmedianasemequinos. Ciência
Rural,
34(5):1655-1659.
8 Parsak
C.K., SatarS., Akcam T., SatarD., Sunguret I. 2007. Effectiveness of treatment to prevent adhesions after
abdominal surgery: an experimental evaluation in rats. Advances in Therapy, 24(4):796-802.
Pedro Paulo Maia Teixeira
Veterinarian
Master of Veterinary Surgery
PhD in Obstetrics and Animal Reproduction - FCAV / UNESP
Clinic, Veterinary Surgery and Obstetrics
Teixeira et al., 2011 - p_paulomt@yahoo.com.br
aUniversidade
Estadual Paulista (FCAV/UNESP), Jaboticabal – São Paulo – Brazil.
bUniversidade
Federal Rural da Amazônia (CPCOP/ISPA/UFRA), Belém – Pará – Brazil.
* Corresponding author at: Departamento de Medicina Veterinária Preventiva e Reprodução Animal. Universidade Estadual Paulista (FCAV/UNESP), Via de acesso Prof. Paulo Donato Castellane - Vila Industrial CEP: 14884900. Jaboticabal – São Paulo – Brazil.
E-mail address: p_paulomt@yahoo.com.br (P.P.M. Teixeira)
ABSTRACT
Gross
and microscopic evaluations of the ovaries of sheep subjected to successive
ovum pick-up were performed with the objective of identifying if there was interference
in oocyte production and morphology of gonads. Gross evaluation of the internal
genital tract was also performed. Eighteen ewes of the Santa Inês breed were
randomly distributed into three experimental groups of six animals each; G0, G1
and G9 with 0, 1 and 9 repetitions, respectively. Estrus synchronization was
achieved with a short protocol using MAP followed by single dose stimulation
with 80 mg of FSHp and 300 IU of eCG (IM). Laparoscopic ovum pick-up was
performed 36 hours later, with 7-day intervals. The number of visualized
follicles, aspirated follicles and oocytes recovery was recorded. After the
last intervention, ovariectomy was performed for evaluation of gross and
microscopical appearance and existence of lesions caused by follicular puncture,
which were classified as absent (0), mild (1), moderate (2) and severe (3). The
number of visualized follicles, aspirated follicles and oocytes recovery were
13.24±2.0, 11.27±3.03 and 5.79±2.3, respectively, with a recovery rate of
51.69%. No statistical difference was found between the nine sessions
(p>0.05). We concluded that nine sessions of superovulation and ovum pick-up
procedures did not cause ovarian lesions and did not interfere with the
production of follicles in ewes of the Santa Inês breed.
Keywords: follicular aspiration, histology,
ovary, ewes, laparoscopy.
1. Introduction
The sheep industry has been experiencing a
cycle of global growth, especially in developing countries as Brazil (Fonseca,
2005; Simplício et al., 2007). In this context, reproduction biotechnologies are
highlighted since they are strong allies in improvement of reproductive
efficiency and productivity of herds, ensuring economical viability to be more
attractive (Traldi, 2006).
Ovum pick-up, together with the in vitro production
of embryos (IVP), a technique of great relevance which was initially used in
production of descendents of high genetic value from animals with acquired
problems involving reproductive capacity (Bols et al., 1996; Schernthaner et
al., 1999) or that would not respond to conventional superovulation treatments
(Looney et al., 1994). However, this technique has an embryo production
potential and number of gestations over a period of time inferior to that
obtained by other techniques (Bousquet et al, 1999). Its application can be
extended to prepubertal females (Fry et al., 1998, Majerus et al., 1999),
acyclic or in seasonal anestrus, gestating and also, submitted or not to
previous hyperstimulation treatments (Berrnardi, 2005), as well as to animals with temporary or
irreversible infertility (Baldassare
et al., 1996; Kühholzer et al., 1997).
This technique can also be applied to other biotechnologies as cloning and
transgenic techniques (Basso et al., 2008).
The high efficiency of this technique is
related to the possibility of its repeated use with short intervals. It is
noteworthy that the majority of studies on identification of viability of
repeated ovum pick-up, considering number of oocytes harvested and ovarian
lesions promoted by the technique, have been restricted to bovines (Viana et
al., 2003; Pieterse et al., 1991; Becker et al., 1996 and Santl et al., 1998).
Nevertheless, it is imperative to obtain information on occurrence of
histological ovarian alterations and oocyte recovery rate after successive ovum
pick-up procedures by laparoscopy in ewes.
Thus, the objective of this study was to
perform gross and microscopic evaluations of the ovaries of ewes subjected to
successive ovum pick-up procedures and evaluate if there was interference with
oocyte production and morphology of gonads, as well as to perform macroscopic
observation of the internal genital tract.
2. Material and
methods
2.1. Location and characterization of the area
The study was performed
at Faculdade de Ciências Agrárias e Veterinárias of Universidade Estadual
Paulista “Julio de Mesquita Filho”, located in the municipality of Jaboticabal
(Latitude 21º15'17"S and longitude 48º19'20" W of Greenwich, at an
altitude of 605 meters), São Paulo state - Brazil.
The present study was
conducted following the approval of the Animal Ethics and Welfare Committee of
the School of Agrarian and Veterinary Sciences of the São Paulo State
University (protocol No 025922-08). The principles of Ethics of the European
Commission for experiments involving animals (Directive 83/609EEC) were followed
also.
2.2. Animals and treatments
Eighteen adult pluripara
ewes of the Santa Ines breed with an average age of 2 years, mean body
condition score of 2.9±0.2 (score 1-5, from Jefferies, 1961) and considered eligible
after clinical examination (hemogram, total protein, fibrinogen and parasitic
control) and ultrasound evaluation of the organs of the reproductive system,
were selected for this study. They were kept under intensive system of
management, receiving corn silage and balanced feed twice a day, and had access
to water and mineral salt ad libitum.
Animals were randomly
distributed into three experimental groups (n=6): control (G0), not subjected
to the ovum pick-up process; group 1 (G1), subjected to one ovum pick-up
session; group 9 (G9), subjected to nine ovum pick-up sessions with 7-day
intervals.
For estrus
synchronization, animals were treated with intravaginal sponges impregnated
with 60 mg of medroxyprogesterone acetate (MAP - Progespon®, Schering-Plough. Brazil) starting at a random day of
the estrus cycle (Day 0) and for a total of six days. On Day 5, 37.5 µg of
D-cloprostenol (Sincrocio® Orofino S.A, Brazil) and 300 IU of eCG (Novormon®,
Schering-Plough, Brazil) were administered intramuscularly.
The ovarian stimulation
was performed 12 hours after detection of estrus (confirmed with teaser) and
consisted of administration of 80 mg of FSHp (Folltropinâ, Schering-Plough, Brazil) and 300
IU of eCG, and after 36 hours the ovum pick-up procedures were performed by
laparoscopy. For the subsequent aspirations, only the ovary stimulation was
performed.
2.3. Animal preparation and anesthesia protocol
After 36 hours of food
and water fasting, animals were subjected to anesthesia, which was obtained by
administration of 0.5 mg/kg of diazepam (IM, Diazepamâ Cristalia., Brazil) and 2 mg/kg of
tramadol (IM, Tramal® Cristalia. Brazil) as premedication; subsequently,
induction was performed using propofol (IV, Propofol® Cristalia. Brazil) in a
dose of 6 mg/kg and anesthesia was maintained with continuous infusion of propofol
at a rate of 0.5 mg/kg/min (IV) as well as 1mg/kg bolus and 1mg/kg/min infusion
of lidocaine hydrochloride (IV, Lidovetâ, Bravet, Brasil).
Animals underwent
tracheal intubation using 8 mm endotracheal tubes with inflatable cuffs. This
procedure had the objective of avoiding aspiration of ruminal content and allowing
the supply of humidified medical oxygen, under assisted ventilation.
In the surgical field,
hair clipping and skin antisepsis with iodine were performed on the abdominal
region cranial to the udder, and subsequently, local infiltration anesthesia
was performed with 0.4 mL of lidocaine hydrochloride, being 0.2 mL for a
subcutaneous administration and 0.2 mL for intramuscular administration.
2.4. Laparoscopy for ovum pick-up
Females were placed in Trendelenburg position.
The cutaneous incision was performed with a scalpel, 10 to 15 cm cranial to the
udder and 5 cm to the right of the midline to facilitate the introduction of a
trocar with insufflation valves (5 mm). Pneumoperinoneum was established with
CO2, maintaining intra-abdominal pressure (IAP) at a range of 5 to 8
mmHg and a flow rate of 5 L/min. Subsequently, with video-assisted guidance,
the second trocar of 10 mm in diameter was inserted symmetrically to the first
and the third of 5 mm was placed on the midline, 20 cm cranial to the udder.
Next, the laparoscope was transferred to the
third trocar, obtaining visual field. Afterwards, the atraumatic forceps
(Babcock) were introduced through the first and second trocars, which allowed
individualization and fixation of ovaries on the mesovarium, always avoiding
injuries to any structure (Figure 1A).
Number of follicles measuring 2 to 8 mm was
recorded. Next, the aspiration needle was introduced into the cavity, close to
the ovary. Puncture was performed by moving the ovaries in different positions
with the manipulation atraumatic forceps. The needle was initially placed in
parallel position to the ovarian surface, which allowed perforation of the
follicles in the extremities, and when that was not possible, the puncture was
performed perpendicularly (Figure 1).
Figure 1: Image of
the abdominal cavity of a sheep with 10x magnification, note: fixation of the ovary (circle) with atraumatic
forceps (1), and presence of follicles (arrow) (A); needle position (2) for
ovum pick-up (B), and aspiration of the follicles (C and D).
Once inserted in the follicle, the needle was
carefully moved to ensure that all the content was aspirated. Vacuum pressure
was adjusted for a maximum of 50 mmHg.
A single lumen (same internal diameter)
aspiration system was used, which was composed of a 16 G needle with a short
bevel connected to a 50 cm length cannula, connected to a silicone cork (Handle
Cook®, Ribeirão Preto-SP, Brazil) which were connected to the collection tube
(50 mL). Vacuum was produced by an aspiration pump (Nevoni, Brazil) connected
to a silicone hose also connected to the collection tube. Previous to the
oocytes aspiration, a washout was performed with the harvesting medium, with approximately
2 mL of the medium left for the end of the procedure to receive the oocytes.
Ovaries were washed with 10 mL of 0.9% NaCl
solution to remove surface clots, minimizing formation of adherences. Skin
suture was performed using horizontal "U-shaped" suture pattern. Next,
the surgical wound was cleaned with povidone iodine and a repellent/healing
ointment was used around the wound.
Females were placed in a clean and calm
environment and were observed until standing in all four legs. On the
subsequent interventions, incisions were made laterally to the first.
2.5. Postoperative evaluation
All animals were weighed
weekly and after the aspirations, were evaluated on the first 24 hours for pain
manifestation taking into account the curvature of the back, difficulty moving
and decreased appetite (Mellor and Stafford, 2004). Grades were established
using these parameters allowing for classification of this symptom, and for
each of them a score of 0 to 2 was determined (0 – absent; 1 – moderate; 2 –
intense) characterizing the intensity of painful discomfort. The sum of the
values referring to each of the parameters was used as indicative of
manifestation of pain, which could reach a maximum grade of 6 (0 to 2 – absent
to mild; 2 to 4 – mild to moderate and 4 to 6 – moderate to intense).
2.6. Analysis
of visualized follicles, aspirated follicles and oocytes recovery
The number of visualized follicles, aspirated
follicles and oocytes recovery was recorded and the averages of these values
were analyzed comparatively between sessions.
In a laboratory, the
aspirated liquid was carefully deposited in petri dishes and taken for
observation in stereomicroscope with 40X magnification. Once located, oocytes
were transferred to another dish containing 300 to 500 mL of washing medium and were
classified according to their quality in agreement with Hewitt and England
(1997).
2.7. Gross evaluation of the ovaries, oviducts
and uterus
These structures were observed by laparoscopy
and evaluated macroscopically to confirm the presence or absence of adherences and
fibrosis, especially on the ovaries and other abdominal structures.
Seven days after the last aspiration,
ovariectomy was performed by laparoscopy for gross and microscopic evaluation
of the ovaries. Macroscopically, the presence of scarring lesions and consistency
of the gonad were evaluated and quantified in a score of 0 to 2 (0 -
characteristic consistency; 1 - moderate hardening and 2 - fibrous tissue
consistency).
2.8. Histological processing and evaluation of
ovaries
Histological sections of
7 mm thickness were obtained from four fragments
per ovary. Slides were mounted and stained with hematoxylin-eosin and Masson’s
trichrome.
The injury severity was
analyzed from the formation of scar tissue, inflammatory cell infiltration and
presence of luteal tissue scattered in the ovarian stroma, according to Viana
et al. (2003), and hemorrhagic follicles or partially luteinized according to
Gibbons et al. (1994).
Slides were analyzed per
fields and a score of the inflammatory process was established and classified
as: negative (0), absent or low occurrence (1), medium occurrence (2) and high
occurrence (3).
2.9. Statistical analysis
Data obtained from
visualized follicles, aspirated follicles, quantity and quality of oocytes
harvested per session, data referring to gross analysis, and weekly body weight
were expressed in averages ± standard deviation and were submitted to analysis
of variance (ANOVA) and Tukey’s test (P<0.05). Histological analysis and
score of pain were submitted to analysis of chi-square, using GraphPad Prisma 4
statistics program.
3. Results
3.1. Trans and
postoperative evaluations
The 36h fasting, besides avoiding reflux of
ruminal contents, facilitated, together with a pneumoperitoneum of 5 mmHg and
5L/min, an adequate visualization of the abdominal cavity which had its image
transmitted to video with 10X magnification, allowing for a surgical time of
26.75 ± 9.6 min.
The bleeding
observed from follicular punctures was incipient and the washout of the ovaries
promoted removal of clots, avoiding formation of adherences in all animals.
The weight of the animals did not vary along evaluations
(p>0.05), the ewes exhibited good anesthetic recovery and they would stand
in four legs without difficulties in average within 20 minutes. At painful
discomfort evaluation 90%
of animals presented score zero and 10% score 1.
.
3.2.
Ovarian stimulation and oocyte production
Most ewes (72,2%) showed estrus 36 hours after removal
of progestogens (5,5% at 12 hours, 11,1% at 24 hours, 72,2% at 36 hours and
11,1% at 42 hours). For the others sessions of G9 there was no necessity of
estrus observation, although follicular waves were estimulated, which were
observed through laparoscopic view at ovarian aspiration moment.
The average number of visualized follicles,
aspirated follicles and oocytes recovery was 13.24±2.0, 11.27±3.03 and
5.79±2.3, respectively, with a recovery rate of 51.69% (aspirated follicles/oocytes
recovery), and no variation was observed between the sessions (p>0.05), as
seen in figure 2. In some sessions, animals exhibited corpora lutea (CL), with
0.46±0.84 CL/animal/session.
Figure 2: Graphical representation of number of visualized follicles
(VF), aspirated follicles (AF) and recovered oocytes (RO) over time in weeks. No
significant difference was found between sessions (p>0.05).
There was also no difference in oocyte quality
along the observations (p>0.05) and the frequency distribution of grade
classification of oocytes can be seen in figure 3.
Figure
3: Graphical representation of qualitative classification of oocytes during the
nine weeks of the study. No significant difference was found between sessions
(p>0.05).
3.3. Gross and microscopic evaluation of the ovaries
At laparoscopy, no lesions were observed on the
internal reproductive system (uterine body, horns and oviduct) and similarly,
no lesions were seen in the ovaries during the surgical procedures and after
ovariectomy (score zero).
No significant lesions were found in the
histological evaluation comparing G0, G1 and G9 (p>0.05). Only two animals
of G1 exhibited small areas of scarring tissue and mononuclear infiltrate,
possibly on the locations of follicular punctures (score zero for all groups
(G0 (control), G1 and G9), can be seen in figure 4.
Figure 4: Photomicrograph of ovary sections of sheep subjected to ovum
pick-up, stained with hematoxylin and eosin (HE) and Masson's trichrome (MT). Tissue integrity can be seen in all
images; images A, B, C and D correspond to G1, images E, F, G and H to G9. Note
unaltered germinal epithelium on the cortical region (arrows) and ovarian
follicles in various stages of development, primordial follicles (1), primary
(2), secondary (3) and tertiary (4) preovulatory follicles.
4. Discussion
A surgical time was similar to the 35 minutes described
by Cordeiro (2006) and 18 to 20 minutes by Wieczorek et al. (2010) in ovum
pick-up procedures in goats and sheep, respectively. Duarte et al. (2009)
described 23 minutes for liver biopsies in rams and Bleul et al. (2005)
described 120 to 150 minutes for ovariectomies in bovines. With these citations
we can suggest that the laparoscopic technique favors the execution of
different procedures with very convenient operative time, particularly in small
ruminants. However, it should be noted that the surgeon skills are important
for obtainment of this result, fact that was also described by those authors.
The surgical technique used allowed for
excellent postoperative recovery of animals, which corroborates with the fact
that no painful discomfort was observed, which was evaluated by loss of
appetite, difficulty moving and curvature of the back, as described by Mellor
& Stafford (2004). Curiously, this type of observation considered important
was not mentioned as a specific criterion by any of the authors reported above;
probably due to obtainment of favorable recovery. Therefore, this condition
allows one to infer about the superiority of this surgical procedure over
conventional ovum pick-up methods.
The interval of seven days used between
surgical interventions in animals of G9 was adequate and sufficient, which
allowed the obtainment of oocytes without compromising the clinical condition
of the animals; which was evidenced by maintenance of body condition score and
behavior of animals. Stangl et al. (1999) did not perform clinical and
behavioral observations, but reported that the weekly interval was sufficient
and no alteration was seen in oocyte production in 10 repetitions of laparoscopic
ovum pick-up in sheep.
The synchronization and ovarian stimulation protocols
were correct for most of the animals showed estrus 36 hours after removal of
MAP implants. Thereby, ovarian stimulation using eCG and FSHp induced a new
follicular wave, exhibiting a satisfactory number of follicles/sheep. Even though in some cases corpora lutea were
seen, which result from follicles that ovulated before the aspiration, these
losses were not significant (p>0.05).
The average number of follicles/sheep founded
in this study was close to the values found by Baldassare and Karatzas (2004)
of 13.4 follicles/sheep and Basso et al. (2008) of 14.3 follicles/sheep. The oocyte
recovery rate is within the interval of 40 to 90% (Cognié et al.,
2004; Morton et al., 2005; Rodriguez et al., 2006; Cox e Alfaro, 2007; Gibbons
et al., 2007).
However, Abdullah et
al. (2008), when comparing the best time for ovarian stimulation in goats, observed
that ovum pick-up was
performed 60 and 72 hours after stimulation using FSH and hCG, showed superior results than performed
36 hours after stimulation, both in
quantity and quality of oocytes recovery.
In several sessions
of the present study, follicles were close to the minimum size required for
aspiration (2 mm); therefore, we could establish a hypothesis that such losses
can be resolved by studying other hormonal protocols with the aim of promoting
better ovarian stimulation, which will result in more viable follicles (from 2
to 8 mm) at the moment of ovum pick-up.
The absence of
variation in quantity and quality of aspirated oocytes throughout the
successive sessions of ovum pick-up is a favorable factor for animal production
because the animals will have a higher reproductive performance when using LOPU
for IVP. Cordeiro (2006) reported reduction in oocytes production, both
quantitative and qualitatively, along consecutive sessions when studying LOPU
in goats. Even though it was not the object of this study, authors as Roy et
al. (1999), Drion et al. (2001)
and De Ruigh et al. (2000) mentioned
the hypothesis of formation of antibodies, such as anti-eCG and anti-FSH, after
prolonged use of exogenous hormones, which would compromise the obtainment of
oocytes. However, our results stand in contrast to those mentioned by
these authors, which allows the questioning of these reports and we propose the
development of further research to clarify this fact.
The absence of gross lesions (adherences,
fibroses, and others) was probably due to the fact that laparoscopy is a
minimally invasive procedure, not perforating the other organs of the reproductive
system, as happens when using ultrasound-guided ovum pick-up in bovines (Viana
et al, 2003). Histological evaluation similarly did not reveal presence of
lesions in the ovaries and we consider this is due to punctures being performed
in specific locations, since ovarian follicles are located on the surface of
the ovary, on the cortical region.
In ultrasound-guided ovum pick-up there is a
relation between number of aspirated follicles and the occurrence of ovary
adherences; however, there was no reduction in number of oocytes recovery
(Viana et al., 2003). Neither formation of fibrous cords around the organ, nor
the presence of hemorrhagic or partially luteinized follicles were seen, differently
than what has been described for cows aspirated by ultrasound-guided (Gibbons
et al., 1994).
None of those findings were found in the
present study, which is justified by the fact that ultrasound-guided OPU is a
more traumatic procedure since there is no way of puncturing only the surface
of the ovarian follicle, as well as due to manual manipulation of the ovary
which can cause lesions on the surface of the gonad.
There is no information regarding ovarian
lesions caused by follicle aspirations in small ruminants. However, Cordeiro
(2006) reported the occurrence of adherences in reproductive organs of 15% of
the goats which underwent ovum pick-up, even with the use of heparinized
solution, and Stangl et al. (1999) reported unilateral and bilateral adherences
on ovaries of sheep subjected to ten sessions of ovum pick-up with weekly
intervals.
Such consequences did not occur in this study
even without the use of substances such as heparinized solutions, used by
Cordeiro (2006) and Baldassare and Karatzas (2004), and carboxymethilcellulose
used by Ewoldt etal. (2004). This can be justified by the care taken on genital
tract manipulation and the removal of clots from the ovarian surface using 0.9%
NaCl solution.
It is possible that the absence of histological
alterations in the ovaries results from punctures being performed only on the
surface of the ovarian follicle as well as from the physiological recovery
capacity of the ovary. Physiologically, the corpus hemorrhagicum, porterior
corpus luteum from the ovulated follicle, is totally eliminated by apoptosis
(Silva et al., 2010). This mechanism occurs by action of immunological cells
(macrophages and T lymphocytes) which produce cytokines such as
interferon-gamma (IFN-γ), tumor necrosis factor (TNF-α) and interleukin- β
(ILβ-1), which can modify the syntheses of progesterone and prostaglandins by
luteum cells, causing direct cytotoxic effects in which the dead luteum cells
are phagocyted by macrophages (Miyamoto, 1996; Pate, 1996). This phenomenum can
also occur in the punctured follicles, so there is no scarring tissue seven
days after the ovum pick-up procedure.
5. Conclusions
The repetition process of ovum pick-up did not
cause painful discomfort to the animals which could limit the technique; the
interval between ovum pick-up sessions allowed adequate recovery time for the
animals.
Also, the repetition of ovum pick-up sessions
did not alter the number of visualized and aspirated follicles, or the quantity
of oocytes recovery. Probably the quality of oocytes was not affected.
Besides, the surgical sequences for the ovum
pick-up procedures did not cause macro or microscopic lesions in any of the
structures evaluated, particularly the ovaries. Therefore, consecutive ovum
pick-up procedures in nine weekly sessions were feasible and show that the
technique has a great potential for assisted reproduction optimization in this
animal species.
Acknowledgements
The authors gratefully thank FAPESP for support in the study.
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Postado por:
Pedro Paulo Maia Teixeira
Médico Veterinário
Mestre em Cirurgia Veterinária
Doutorando em Medicina Veterinária (Reprodução Animal)
email: p_paulomt@yahoo.com.br
Abstract
The aim of the study was to compare the use of open ovariectomy, to the video-assisted laparoscopic approach or total laparoscopic ovariectomy in Santa Ines ewes. Surgical time and body weight gain/loss were recorded and post-surgical pain assessed using a behavioral scale. Laparotomy involved a longer surgical time (75±29.5 min.), than the video-assisted (37.5±13.04 min.; p<0.05) or total laparoscopic approach (27.5±2.89; p<0.01). Behavioral pain recorded score was higher for the laparotomy ovariectomy (5.6±0.5), compared to the video-assisted (0.3±0.5) and laparoscopic approaches (0.3±0.5) (p<0.0001). No significant differences were recorded regarding body weight gain/loss during the first 30 days post-surgery, between the techniques. The video-assisted laparoscopic and total laparoscopic techniques of ovariectomy showed a tendency to have more advantages than the use of laparotomy as such. Less surgical trauma, a shorter surgical time, minimal post-surgical stress and better surgical recovery being highlighted as the main advantages of the endoscopic approaches in sheep.
Keywords: Sheep, ovariectomy, video-assisted, laparoscopy, laparotomy.
1. Introduction
Laparoscopy is a minimal invasive surgical technique and with the use of a trans-abdominal endoscope, it is possible to visually observe the organs within the abdominal cavity (Bouré, 2005). The laparoscopic approach also provides a better success rate in small ruminants, and can be performed several times in the same recipient if necessary, with minimal surgical trauma (Graff et al., 1999; Baldassarre et al., 2002; Cordeiro, 2006). Many different laparoscopic techniques have thus been applied in livestock for e.g. liver biopsy (Chiesa et al., 2009; Duarte et al., 2009), cistotomy (Franz et al., 2006), ruminoscopy (Franz et al., 2009) and ovariectomy (Bleul et al., 2006).
Ovariectomy (removal of the ovaries) results in many advantages for livestock, such as easier handling, the suppression of heat behavior in beef animals for the maintenance of male and female cattle in the same environment (Garber et al, 1990), faster weight gain and the production of a high quality carcass (Silva et al., 2006). This technique has then also been employed for the recovery of the gonads from animals of high genetic and productive performance, and for other reproductive techniques (Padula et al., 2002).
In the modern livestock breeding industry, surgical procedures are generally aimed at providing minimal stress. Painful procedures may decrease the productive performance and thus impair the body weight gain, while animal welfare remains a major concern in surgical procedures, especially in the beef industry (Fitzpatrick, et al., 2006; Luna, 2008).
The aim of the present study was to compare the surgical techniques, post-operative pain and complications of ovariectomy performed by laparotomy, the video-assisted approach and a total laparoscopic approach in Santa Ines ewes.
2. Material and Methods
2.1. Animals and experimental design
The present study was conducted following the approval of the Animal Ethics and Welfare Committee of the School of Agrarian and Veterinary Sciences of the São Paulo State University (protocol No. 025988-08). The Principles of Ethics of the European Commission for experiments involving animals (Directive 86/609EEC) were followed also. Eighteen adult female Santa Ines ewes were randomly allocated to one out of the three surgical techniques of ovariectomy. Ovariectomy was either performed by laparotomy (n=6), the video-assisted laparoscopic approach (n=6) or the full laparoscopic approach (n=6).
2.2. Anesthetic protocol and pre-operative care
All ewes were fasted for 36h prior to each surgical procedure. The animals were premedicated using diazepam (0.5mg/kg, IM - Diazepamâ Cristalia., Brazil), and tramadol (2mg/kg, IM - Tramal® Cristalia. Brazil) and anesthesia was induced using a mixture of propofol (6 mg/kg, IV - Proporfol® Cristalia. Brazil) and lidocaine chloride (1mg/kg, IV).
Anesthesia was maintained with propofol (0.5mg/kg/min., IV) and lidocaine-chloride (1 mg/kg/min, iv) at a constant rate of infusion. After induction, the animals were intubated using a cuffed 8 mm tracheal tubes, to provide 100% oxygen. The sheep were positioned and kept in dorsal recumbency for laparotomy and in the Trendelenburg position for video-assisted and normal laparoscopic ovariectomy. Local anesthesia with lidocaine chloride (2 ml) was administered at the portal sites prior to skin incision in the laparoscopic procedures.
2.3. Laparotomic ovariectomy
The ovariectomy was accomplished following a 10 cm prepubic median incision laparotomic for adequate exposure of the uterus and ovaries. Due to the difficulty in finding the internal genital tract, assisted vaginal palpation was required in some cases. Once the ovaries had been exposed, a transfixation ligature around each ovarian pedicle was performed and the ovary excised. Following final abdominal inspection, the muscular layer was sutured with continuous simple pattern interspersed with simple interrupted knots. The skin was sutured in a simple interrupted pattern.
2.4. Video-assisted laparoscopic ovariectomy
The video-assisted ovariectomy was performed using three portals. Firstly, a 6 mm trocar was introduced into the linea alba, 30 cm cranial to the udder, using the Hasson technique, for insertion of a 5 mm rigid endoscope (Vilos et al., 2007). The pneumoperitoneum was established under 5 L/min. CO2 flow rate and the intra-abdominal pressure maintained between 5 and 8 mmHg. One 6 mm and one 11 mm instrument port was positioned bilaterally using the laparoscopic-assisted technique, 10 cm cranial to the udder and 5 cm lateral to the linea alba. A 10 mm Babcock atraumatic forceps and a 5 mm atraumatic grasping forceps was then introduced through the 11 mm and 6 mm instrument ports, respectively. The uterus, fallopian tubes and ovaries were manipulated and the ovaries then grasped and exteriorized from the abdominal cavity, via the 11 mm trocar. The ligature of the ovarian pedicle was carried out in the same manner as for the laparotomy technique. The same technique was used for the opposite ovary. After resection of both ovaries, the CO2 pneumoperitoneum was adequately drained. Skin sutures were performed at the portal sites, using the Wolf interrupted pattern with 2-0 nylon. The muscular layer was not sutured.
2.5. Laparoscopic ovariectomy
The laparoscopic ovariectomy was carried out using a two-port technique. One 11 mm port was placed on the midline, 10 cm cranial to the udder, using the Hasson technique (Bouré, 2005). A 10 mm rigid endoscope with a working channel for instruments of up to 5.5 mm was inserted and the initial visual abdominal inspections performed. The pneumoperitoneum was located in the same fashion as in the video-assisted technique. A second 6 mm trocar was placed on the left side, using the laparoscopic-assisted technique, 5 cm from the linea alba and 5 cm from the 11 mm port. A 42 cm in length Babcock forceps was introduced through the working channel of the endoscope. A second 33 cm in length Babcock forceps was inserted through the 6 mm trocar, in order to manipulate the ovaries. The second forceps was used to expose the ovarian pedicle. Following adequate ovarian pedicle exposure, the first forceps was replaced by a bipolar forceps with a simultaneously coagulation and cutting function (Lina Tripol PowerBlade® – WEM & VIVAMED – Ribeirão Preto – SP – Brazil). The left pedicle was cauterized and the ovary was excised and exteriorized through the 11 mm port, along with the trocar. The 11 mm trocar was then reinserted through the abdominal incision. The same procedure was performed for the opposite ovary. The trocars were withdrawn from the abdominal cavity and the pneumoperitoneum drained. The incisions were closed in the same fashion as for the video-assisted technique.
During the early post-operative period, all animals received a single dose of a long acting oxytetracycline (20 mg/Kg, IM).
2.6. Trans and post-surgical assessment
Surgical time and trans-surgical complications were recorded for the groups and post surgical pain also assessed , using a behavioral scale proposed in the present study. This consisted of a kyphosis score for difficulty in movement and spontaneous feed intake score. The score ranged from 0 to 3 for each variable evaluated and the final score was then the sum of the scores of each variable. The maximum pain score ranged from 0 to 9. All animals were weighed weekly, for a 30 day post treatment period and the weight loss/gain compared between the groups.
2.7. Statistical analysis
Surgical time, post-surgical pain score and body weight loss/gain were recorded as the mean (±SD). An analysis of variance (ANOVA) was used and the comparison between the groups were performed using the Tukey test. A confidence level of P<0.05 was considered to be significant. Trans and post-operative complications were assessed descriptively.
3. Results
The ovaries were generally difficult to locate during laparotomy. Exposure of the genital tract was poor and intense traction was required to withdraw the ovaries from the abdominal cavity. However, visualization and manipulation of the genital tract were usually easy to perform during the two endoscopic techniques.
Surgical time was longer for laparotomy (75.8 ± 29.5 min; mean ± SD) than following laparoscopy (27.5 ± 2.9 min; P<0.01) and video-assisted laparoscopy (40.0 ± 13.0 min; P<0.05). The difference in surgical time between laparoscopy and video-assisted laparoscopy was not significant (Fig. 1). Behavioral pain score (Fig. 2) was significantly higher for laparotomy (5.6 ± 0.5; P<0.001), than following laparoscopy (0.3 ± 0.5) or video-assisted laparoscopy (0.3 ± 0.5). No significant differences were recorded in live body weight changes between the treatments during the first 30 day post-operative period.
4. Discussion
The approach to the ovaries was found to be difficult during the laparotomic procedure, due to the presence of extensive gastrointestinal viscera and the caudal topography of the genital tract of the ewe. Vaginal palpation performed may be useful during this surgical step in laparotomic ovariectomy. In the video-assisted and laparoscopic ovariectomy no difficulties were experienced in locating the ovaries. The Trendelenburg position, pneumoperitoneum and amplification of the field of view with the aid of a rigid endoscope and camera system played a crucial role during the endoscopic procedures. This thus resulted in shorter surgical times when the endoscopic approaches were used. Several studies have indicated that laparoscopic surgical procedures usually imply short surgical times in livestock e.g. ovariectomy in cows (Bleul et al., 2005), liver biopsies in sheep (Duarte et al., 2009) and ovarian follicular aspiration in goats (Cordeiro, 2006) and sheep (Teixeira et al., 2010b).
In the present study for endoscopic evaluations, an intra-abdominal CO2 pressure of 5 mmHg provided a satisfactory surgical field. Furthermore, no visceral injury was observed during trocar insertion and surgical handling. However, other studies have indicated that a higher intra-abdominal pressure is required to obtain a good visual surgical field and to avoid visceral injury during trocar insertion (Tabet et al., 2005; Cordeiro, 2006; Duarte et al., 2009, Teixeira et al., 2010a). It is strongly believed that higher intra-peritoneal pressure is not necessary to access the reproductive tract of sheep when the Trendelenburg position is used. High intra-abdominal pressure may lead to respiratory depression, acidosis and an increase in EtCO2 in animals under spontaneous breathing (Uemura et al., 2004).
Generally both laparoscopic techniques were less invasive than the open surgical procedure, and resulted in lower pain scores. The performance of the laparotomy technique plays an important role in post-operative pain. While this technique required a 10 cm-long median incision, the video-assisted required two punctures of 6 mm and one of 11 mm, and the general laparoscopic assisted ovariectomy required one puncture of 6 mm and one of 11 mm. This fact was also observed when conventional and laparoscopic approaches for cistotomy (Franz et al., 2009) and ovariectomy (Bleul et al., 2005) were compared in cows.
The endoscopic approaches proved to be less painful than laparotomy. Even though no changes regarding body weight gain/loss were recorded between the groups during the 30 days of post-operative assessment, the sheep subjected to the video-assisted and laparoscopic techniques generally showed better post-surgical recovery, compared to those submitted to the open procedure. Moreover, the behavioral pain score used in the present study identified variations in post-surgical pain between the groups, satisfactorily. Furthermore, this study recorded physiologic changes similar to those stated in other studies regarding the pain and welfare of ruminants (Mellor & Stafford, 2004).
Regarding the body weight loss/gain, all ovariectomy techniques assessed in the present study may be acceptable for use in sheep, with no difference being detected between the groups. Meirelles et al. (2007) observed a negative effect on body weight gain in cows submitted to a vaginal accessed colpotomy. Although Silva et al. (2006) did not observe any body weight gain changes, a better carcass quality was reported to be obtained with ovariectomy accessed through the flank in Nelore heifers.
5. Conclusion
The endoscopic techniques showed advantages above the laparotomy procedure of ovariectomy in sheep, which resulted in minimal invasiveness, less post-operative pain, a shorter surgical time and a faster recovery time.
Acknowledgements
The authors gratefully thank FAPESP for financial support in the study.
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