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Laparoscopic Uteropexy Surgery at Scone Equine Hospital Scone Equine Hospital recently brought Danish surgeon, Dr Palle Brink to Australia to undertake the surgical technique of Laparoscopic Uteropexy. Dr Brink recently reported the technique in the EVJ and has performed another 12 cases since this paper was written. I have included a copy of this EVJ manuscript for your interest. His success rate for pregnancies is approximately 75%, which is a very exciting result for mares with long-term infertility. Having now done approximately 100 laparoscopic procedures I felt I had the skills to tackle this technically difficult procedure with the guidance of Dr Brink. The Scone Equine Hospital has recently purchased the additional laparoscopic equipment needed to perform this procedure well. We tackled three mares and successfully performed the technique on two. On examination of the third mare, both rectally and laparoscopically the chance of future pregnancies for this mare was very poor and surgery was not attempted. Briefly, the procedure is done standing in specially designed stocks, under sedation and local anaesthesia. The procedure basically aims to shorten the mesometrium by the placement of an absorbable suture through the uterus and mesometria, which when tightened, lifts the uterus and aids the gravitational drainage of fluid. The uterus must be sutured in a certain way to ensure this gravitational drainage. The procedure is performed from both sides of the abdomen. We have suggested the mares that recently underwent the procedure can be served within 4 weeks. However, the procedure is ideally done in the autumn to prepare the mare for service at the beginning of the following stud season. We believe the best candidates for the procedure are mares that have infertility associated with chronic uterine fluid retention, largely due to the conformation of the uterus, rather than fluid from chronic infection or urine pooling. I believe it would be beneficial to perform a uterine biopsy and culture of the mare prior to surgery to help give a more informed prognosis and guide post-surgical treatment. Having performed the surgery with Dr Brink and received guidance on the tricks and techniques of the procedure I am very pleased to offer this surgical option to our clients. Please contact me at the SEH if you would like to discuss this technique in more detail or if you have a mare that you consider a candidate. Following are some images of the procedure being performed for your interest:

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This is an image of the procedure being performed. Dr Brink is the bigger bloke, being a Viking. The horse is covered with a sterile drape and restrained in specially designed stocks. These stocks do not have upright bars at the back and can be dismantled within seconds if the mare “goes-down”. An indwelling urinary catheter (white) can be seen positioned over the back door. This prevents the bladder filling to avoid it restricting visualisation and causing pain.

The image on the left shows instruction from Palle, which was vital for success and the image on the right shows a needle being placed through the mesometria.

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The image on the left is an intra-operative image showing the beginning of the procedure with three strands of suture being visible. The image on the right shows the procedure half way through. The left uterine horn is indicated by the white arrows.

This intra-operative image shows the final result on the left side. The uterus is indicated by the white arrows. The uterus is sutured to allow optimal gravitational drainage. The ovary is not visible but positioned just to the left of the knot in the foreground. I also placed PGE2 gel on the oviduct during surgery to ensure oviduct patency. The gel can be seen as the yellow substance on the tissue in the top left of the image.

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Regards

Dr Angus R Adkins BVSc FACVSc Fellow and Specialist in Equine Surgery VPB Registration: 6162