Surgery Department Services

Arthroscopy
Arthroscopic surgery is indicated for the removal of bone lesions from joints that could affect future performance. Equine carpal joints (knees) are the most frequently performed arthroscopies and have set the standard for the procedure in equine surgery. Advantages of arthroscopic surgery can be seen in less soft tissue trauma, obvious cosmetic results and possibly quicker return to work depending on the lesion. It is also believed by many to offer better visualization of lesions, improved racing performance post operatively and significant reduction of post-op care costs.

The procedure is performed under general anesthesia with the horse in dorsal recumbency. The immediate surgery site will be shaved, then aseptically scrubbed and draped prior to surgery. Special equipment and instruments are required for arthroscopic surgery which generally includes: scope, camera, monitor, a variety of bone rongeurs, curettes, grasping forceps, cannulas, and the fluid pump, to name a few.

Small incisions are made to insert the arthroscope into the joint capsule to allow for visualization of the joint as well as to utilize the necessary instruments needed to remove the lesions. The camera projects the image inside the joint onto a monitor for more convenient evaluation of the site by the surgeon. A steady stream of fluid is pumped through the joint during the procedure to aid in the removal of debris and to keep the surgery field clear. Generally only a minimal number of sutures are required to close the small surgical incisions and a protective bandage is applied to the area for the horse’s recovery from anesthesia.

The usual hospital stay is three days. Horses are admitted to the hospital one day prior to surgery and released one day after. Hand walking can begin seven to ten days post surgery and horses with simple chips can be back to work within 6 weeks. Many horses return to work earlier, under the direction of their veterinarian, without complication.

These notes are offered only as a general guideline of what is involved with a horse and owner experiencing arthroscopy surgery and are not intended to be a substitute for the communication necessary between client and veterinarian.

Upper respiratory surgery
Laryngoplasty
Laryngeal hemiplegia is a condition caused by damage or degeneration of the laryngeal nerve. Hemi is a Greek word element meaning half. Plegia is another Greek word element, meaning paralysis. Therefore, the combined term literally means paralysis of half of the larynx. The left side is most frequently involved. Affected horses usually present with exercise intolerance and an inspiratory noise that is best described as a hollow whistle.

Laryngoplasty is a procedure utilized to restore the upper airway to a more normal aperture in a horse with laryngeal hemiplegia. An ancillary procedure performed is a vocal cordectomy. The cordectomy is performed first. The horse is sedated and restrained in standing stocks. An endoscope (scope) is passed up the horse’s nostril and positioned in front of the larynx. The area is desensitized with the topical application of carbocaine through a scope portal. The laser fiber is then passed through the scope and used to perform the procedure. Subsequently, the horse is anesthetized and placed in lateral recumbency. The surgical site is prepared and draped. An incision is made over the affected side of the throat latch. This is followed by blunt dissection until the larynx is exposed. Two sutures are placed in such a fashion as to maintain full abduction of the paralyzed half of the larynx. The sutures replace the function of a muscle that has atrophied as a result of the laryngeal nerve damage. Antibiotics are placed over the implant and the surgery site is closed in three layers. Staples are used for the skin. The surgery site is covered with a sterile drape for protection while the horse recovers from anesthesia.

The average hospital stay for this procedure is three days. After this, the horse will be confined to a stall with hand walking for 8 weeks. Training can resume after this period of time.

Cryptorchidism
Cryptorchidism is a common developmental defect of the horse and occurs when one or both testicles fail to descend. Testicles begin development behind the kidney in the fetus. As fetal growth progresses, the testis slowly descend from the abdomen into the scrotum. In the horse, descent begins between 8-9 months of gestation and is complete 10-14 days before or after birth. Yet, a testicle that has reached the inguinal area may descend into the scrotum as late as 4 years of age.

The cryptorchid testis can be located in the abdomen or inguinal area. It can result in stallion-like behavior if left behind. This testicle also has an increased incidence of cancer. The genetic mechanism has yet to be determined.

The retained testicle cannot be removed by routine castration. Removal requires that the abdominal cavity be opened which increases the risk for infection. This is why the surgery must be performed in a facility under sterile conditions. There are numerous surgical approaches for removal of retained testicles. The approach utilized depends on location of the testicle and surgeon preference. Most of the approaches require general anesthesia with the patient in dorsal recumbency.

The average hospital stay for this procedure is three to four days. Horses are admitted the day before surgery for preparation purposes and are released after 24-hour monitoring post-surgery. After release, exercise will depend on the location of the testicle/invasiveness of the surgery. If the testicle is in the inguinal area, the horse can resume training upon release. If the testicle is in the abdomen, necessitating a more invasive surgery, the horse will be confined to a stall with hand walking for two weeks before training can resume. Prognosis is generally excellent.

Colic Surgery
Abdominal surgery is most commonly performed for the treatment of colic. Most cases of colic are due to intestinal disease, but disease of an abdominal organ can cause the manifestation of pain known as colic. There are numerous causes of abdominal pain or colic in horses, and most can be managed medically. It is important to approximate the site of the lesion and to determine if surgical intervention is necessary. When making the decision for surgery, the following must be considered and interpreted: 1) pain level, 2) cardiovascular status, 3) physical / rectal exam findings, and 4) laboratory findings. It is important to understand that the previous parameters do not usually give us an exact diagnosis and therefore the surgery begins as an exploratory.

Once it is determined that surgery is necessary to determine and correct the cause of colic, the horse is prepared. Broad spectrum antibiotics and anti-inflammatories are administered. The horse is then taken to the induction stall and given a sedative. This is followed by induction of anesthesia and placement in dorsal recumbency (on its back). The ventral abdomen is clipped and prepped routinely for an exploratory surgery and the surgeon and their assistant prepare for surgery.

An incision is made on midline and the abdomen is entered. The surgeon then begins exploration. The lesion is localized and manually corrected if possible. Sometimes a piece of intestine may need to be opened to remove contents or the intestine may need to be removed. The rest of the abdomen is then explored to check for any additional abnormalities. The abdomen is then lavaged with sterile saline solution and closed in a routine 3-layer closure. After surgery is completed, the horse is taken to the recovery stall and monitored. Once recovery is complete, the horse is placed in a stall for further treatment and monitoring.

The average hospital stay for this procedure is approximately one week. Twelve to fourteen days after surgery the skin sutures should be removed. The horse will be confined to a stall with hand walking for 2 weeks after release, followed by 2 weeks turn out in a round pen. One month after surgery, the horse can have free choice turnout. Riding can resume two months after surgery. Prognosis is related to the surgical lesion and invasiveness of the procedure, but most horses return to their previous activity.

Surgery residency program
Peterson and Smith offers a three year ACVS residency program in equine surgery to qualified veterinarians interested in gaining experience and confidence while developing and improving their knowledge and practical skills. The program provides residents with extensive exposure to all aspects of both equine surgery and medicine. One emphasis of the Peterson and Smith residency is to provide broad clinical experiences supported by ACVS and ACVIM boarded doctors. Good judgment and surgical and medical expertise are developed through hard work and mentorship preparing residents for a career in academia or a specialty practice.

Arrangements with the University of Florida Veterinary Teaching Hospital in Gainesville enable residents to fulfill the required ACVS special rotations in radiology, pathology, anesthesiology and medicine. Residents travel to Gainesville one day a week until the rotations are completed, usually by the beginning of the second year. This time spent at the University provides quality time with peers and Diplomates of all specialty colleges and access to University of Florida libraries.

By the time residents have progressed to their second year, they have begun to accept and manage surgical and medical cases with direct support from all hospital doctors and technical staff. The first year of the program prepares the second and third year residents for this responsibility through many hours of training by both observation and practical experience gained from an excellent elective and emergency caseload.

The primary aim of the Peterson and Smith surgical residency is to produce a highly competent veterinarian with refined surgical skills who is also capable of practicing quality medicine.

Pharmacy The Surgery Department is supported by the practice pharmacy. The Pharmacy, run by Cheryl Hurn, Pharmacy technician, can provide any prescribed medication from stock or by special order. The pharmacy stocks over 95% of the medications used by the practice, and special orders can usually be filled within 24-hours. Click on Photo for a larger view