Study Compares Laparoscopic, Conventional Cryptorchidectomy

Your veterinarian says your horse needs surgery, and there are two options to choose from—a tried-and-true but somewhat invasive procedure or a newer, less invasive method that lets them return to function quicker. While the latter option seems enticing, you might want to stick to tradition, depending on the procedure: Researchers recently learned that conventional tactics appear to reign supreme over newer methods when it comes to equine cryptorchidectomies.

At the 2013 American Association of Equine Practitioners' Convention, held Dec. 7-11 in Nashville, Tenn., Nicola Cribb, MA, VetMB, DVSc, Dipl. ACVS, described a recent study that showed conventional cryptorchidectomies (in which veterinarians use an incision either in the inguinal area, near the prepuce, or in the flank to gain access to and remove a retained testicle) appeared to have better outcomes than those performed via laparoscopy (making a small incision, using a laparoscope to view within the peritoneal cavity, and removing the testicle through this incision).

Cribb, an assistant professor of large animal surgery at the University of Guelph's Ontario Veterinary College, said that, in general, practitioners believe laparoscopy has some advantages over conventional surgical procedures, such as superior visualization of the lesion, less surgical morbidity, and quicker return to work for the horse. However, "to our knowledge, no previous study has compared intra-operative and postoperative surgical parameters between conventional surgery and its laparoscopic equivalent in horses," Cribb added.

Thus, she and colleagues set out to evaluate differences in intra- and postoperative complications between conventional methods and laparoscopy when used in a common procedure: a cryptorchidectomy.

Cribb and her coworkers matched 30 horses that underwent a laparoscopic cryptorchidectomy with 30 that had a conventional cryptorchidectomy procedure; she said the team matched horses based on previous surgical history, testicle location, and type of close after testicle removal. The team also compared the length of surgery time, anesthesia time, length of hospital stay, and complication rates.

They found that:

  • Of the 30 matched pairs, 14 were in for routine cryptorchidectomies and 16 were in for a second attempt; of the latter group, veterinarians weren't sure where the testicle was located in seven pairs.
  • Horses that had the laparoscopic procedure had significantly more postoperative complications and a tendency for more intraoperative complications than horses treated with the conventional procedure. However, she noted, "The intraoperative complications in the horses undergoing laparoscopy were relatively minor and unlikely to be a deterrent to selecting laparoscopy as a surgical option."
  • Laparoscopically treated horses had significantly longer anesthesia durations and surgical times than their conventionally treated counterparts.
  • There was no statistical difference in the length of hospital stay between the two groups.

"The advantages of laparoscopy may not always outweigh the disadvantages in horses requiring surgery for cryptorchidism," Cribb concluded, but noted that there are two scenarios in which laparoscopy might be the way to go.

"First, if the horse has already had one surgical attempt for removal of the cryptorchid testicle, but it could not be found," she said. "The superior visualization afforded by laparoscopy in this situation allowed in our study a surgical time on par with that of a conventional surgery."

The other scenario in which laparoscopy could be beneficial is in cases where it's not known prior to surgery where in the horse's body the cryptorchid testicle is located, she said: "That is, whether it is on the left or right side, abdominal or inguinal, located within the abdomen, or indeed whether there is one cryptorchid testicle to be removed or two," Cribb explained. "This situation can arise in a horse that has been purchased with the owner believing it to be a gelding, but stallionlike behavior leading the owner to believe that it is not, and hormonal testing conducted by a veterinarian confirming it to have testicular tissue present. Such testing can tell us that a testicle is present but of course not where it is present. "

In such a situation, Cribb said, laparoscopy offers superior visualization compared to conventional surgery; thus, surgical times between the two were similar, she said.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.