title: Hand-assisted laparoscopic left nephrectomy in standing horses.
abstract: OBJECTIVE
  To describe a hand-assisted, laparoscopic technique to remove the left kidney in standing horses.
  
  
  METHODS
  Prospective evaluation.
  
  
  METHODS
  Eight horses.
  
  
  METHODS
  Food was withheld for a minimum of 12 hours. Horses were sedated with detomidine hydrochloride (0.01-0.02 mg/kg, intravenously) and restrained in standing stocks. The left paralumbar fossa was prepared for surgery, and the surgical site was infiltrated with 2% mepivacaine. Hand-assisted, laparoscopic removal of the left kidney was performed through an incision in the center of the paralumbar fossa; the surgeon's hand was used to isolate the left kidney and associated vasculature. The renal artery and vein were isolated and individually ligated. After vessel transection distal to the ligatures, the left kidney was exteriorized, the ureter ligated and transected, and the incision closed.
  
  
  RESULTS
  Laparoscopic removal of the left kidney was successfully performed in all horses. Retroperitoneal infiltration of local anesthesia provided adequate anesthesia. Intraoperative hemorrhage occurred in 3 horses. Surgical duration (initial skin incision to transection of the left kidney) ranged from 20 to 90 minutes. In 2 horses, no signs of pain were noted for 48 hours postoperatively.
  
  
  CONCLUSIONS
  Hand-assisted laparoscopic surgery can be used for removal of the left kidney in horses. Clinical Relevance-Hand-assisted laparoscopic nephrectomy can be safely performed in standing horses; however, care should be taken to identify accessory branches of the renal artery to limit potential complications with hemorrhage.
authors.affiliation: Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Gainesville, FL 32610-0136, USA.
authors.forename: Curry G
authors.initials: CG
authors.lastname: Keoughan
authors.forename: Dwayne H
authors.initials: DH
authors.lastname: Rodgerson
authors.forename: Murray P
authors.initials: MP
authors.lastname: Brown
mesh_terms: D000818:Animals; D005260:Female; D006734:Horse Diseases / Q000601:surgery; D006736:Horses / Q000601:surgery*; D007674:Kidney Diseases / Q000601:surgery / Q000662:veterinary; D010535:Laparoscopy / Q000379:methods / Q000662:veterinary*; D008297:Male; D009392:Nephrectomy / Q000379:methods / Q000662:veterinary*; D011187:Posture; D011446:Prospective Studies