Abstract
A sexually mature intact female Grey Seal was diagnosed with hyperestrogenism that resulted in bone marrow suppression and a severe non-regenerative anemia. The suspected source of the hyperestrogenism was diagnosed by ultrasound examination as polycystic ovaries. The referring veterinarian (Lacave) elected to have the ovariectomy performed laparoscopically.
The animal was anesthetized using midazolam and isoflurane and placed in dorsal recumbency. The abdomen was prepared in the same manner as for open laparotomy including shaving and sterile scrub. A 1 cm skin and subcutaneous incision was made just caudal to the umbilicus, followed by insertion of a 10 cm long veress needle into the peritoneal cavity. Insufflation to 14 mm Hg was achieved using sterile carbon dioxide through the veress needle attached to an electronic insufflator. The needle was replaced with a 11 mm x 10.5 cm Ternamian EndoTIP cannula and the ovaries were examined laparoscopically using a 10 mm x 31 cm, 30 degree HOPKINS II telescope attached to an endoscopic camera and a 175 watt xenon light source (Karl Storz GmbH & Co. KG, Tuttlingen, Germany). Both ovaries appeared to be enlarged and polycystic and were highly vascularized by a plexus of vessels in addition to the ovarian artery and vein. Two 6 mm x 8.5 cm cannulas were inserted under direct visualization 5 cm caudal and 10 cm lateral to the umbilicus to be used for instrumentation.
The ovarian pedicle was bluntly dissected to isolate the ovarian artery and vein using 5 mm x 34 cm laparoscopic Metzenbaum scissors, Kelly forceps and Babcock forceps. Vessels less than 2 mm in diameter were cauterized using bipolar and monopolar cautery (Autocon 250 Electrosurgical Generator, Karl Storz GmbH & Co. KG, Tuttlingen, Germany). Three size 0 PDS loop ligatures were placed on the ovarian pedicle and the ovary was excised. After repeating the procedure on the remaining ovary, both ovaries were removed by slightly enlarging one of the incisions for the instrument cannula and removing them with a Babcock forceps. Liver biopsies were then performed using a cup biopsy forceps. Five samples were collected from multiple liver lobes. The fascia, subcutaneous tissue and skin incisions were closed in two layers, using absorbable and nylon suture in a single cruciate pattern and then sealed with surgical glue. Recovery from anesthesia was uneventful and the animal returned to normal attitude and appetite the following day.
Acknowledgements
The authors would like to thank the staff and management of Zoomarine for their assistance and opportunity to perform this procedure. We are especially grateful to Sr. Eduardo Sequiera Neves and Sr. Santiago Marcos Del Rincon from Karl Storz Endoscopia Iberica S.A. for donating their time, the use of equipment and their technical assistance.