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Standing Surgery A Non-Traditional Option For Severe Colic Cases

Colic is a very real concern to horse owners. An overarching term applied to any abdominal pain, over 80 percent of colic cases can be resolved without surgical intervention.

The standard colic surgery needed for horses which do require medical intervention involves putting the horse under general anesthesia, laying him down and opening the horse along his ventral midline. This type of surgery carries additional risk to the horse and adds significantly to the cost of treatment.

A new study has found that a flank incision, made while the horse is standing, may be a good option for specific types of colic. This type of surgery is less risky to the horse and less of a financial strain for the owner.

Dr. Marco Lopes and a study team reviewed records of 26 horses and ponies and one donkey which underwent a standing flank laparotomy between 2003 and 2020. The main reason for the decision to utilize this particular surgery was financial.

Though seven animals were euthanized due to an untreatable condition or a poor chance of survival, 20 of the 30 horses with treatable conditions survived. The surviving horses suffered from small intestine impaction or inflammation, large colon displacement (specifically nephrosplenic ligament entrapment), and sand impaction.

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Small colon impaction has already been found to respond well to the standing-flank incision method of treatment.

Study authors found that there are limitations to the surgery. These include:

The horse must remain still during the operation; one in intense pain from severe colic may not be able to have his pain controlled well enough to complete the surgery
Peritoneal cavity and abdominal organ access is not as good as with a typical ventral midline incision
A second incision on the opposite flank may be necessary

The team concluded that a standing flank laparotomy may be a viable approach for abdominopelvic exploration in horses with colic related to the small intestine, cecum, large colon, and peritoneum.

AAEP Convention: Standing Arthroscopy Can Be Used On More Than Stifles

When traditional diagnostic tools such as X-ray and ultrasound provide no definitive diagnosis for an equine lameness, a vet may perform an arthroscopy. While this procedure typically requires putting the horse under general anesthesia, a needle arthroscopy can be done while the horse is under standing sedation, Dr. Alvaro Bonilla said at the virtual 2020 American Association of Equine Practitioners Convention and Trade Show.

A safe, reliable procedure, needle arthroscopy is less risky and less costly to the owner; putting a horse under general anesthesia for surgery has its own risks, including recovery. While typically used for diagnostics, a standing arthroscopy can also be used therapeutically for septic joints and small osteochondral fragments, specifically for dorsal fragments of the first phalanx in the fetlock, Alvaro says. However, the procedure does still have limitations.

Previously, needle arthroscopy was used only in the stifle joint; Alvaro reports that now it can be used successfully to evaluate multiple synovial structures, including shoulders, fetlocks, hocks, radiocarpal and middle carpal joints, and carpal sheaths.

When using this diagnostic tool, it's important that the horse is sedated, but not overly so, which could make him unsteady and make the procedure not only difficult, but dangerous. Additionally, the surgical site must be sterile, which can be difficult as debris can fall onto the joint or the horse can urinate. Potential for both complications can be decreased by using blankets and inserting a urinary catheter.

An adjustable, lightweight splint made from stainless steel and aluminum is used during the procedure; to ensure as successful an outcome as possible, horses should be acclimated to wearing the brace before being sedated for the surgery.

The surgical area should be bandaged for four to five days following the procedure; horses that had the procedure for diagnostic reasons can go back to work as soon as the bandages are removed.

Prisma Partners With B.W. Furlong & Associates, Company To Receive Inaugural Imaging System

Prisma has come to mutually agreeable terms with B.W. Furlong & Associates to be the recipient of Prisma's first robotic imaging system. This agreement represents a significant milestone that validates the equine veterinary community's demand for Prisma's novel technology that produces full-body imaging of a conscious and standing horse.

“Our strategy in establishing relationships with some of the country's largest and most prestigious practices was twofold,” said Michael Silver, Prisma's founder and CEO.

“Firstly, these practices were an invaluable resource during the early development process that ensured that the system would work well for the equine patient. Secondly, as we approach commercial readiness, we want to have a few early systems out in the field to ensure they will function perfectly prior to scalable operations. Meeting or exceeding our customer's expectations is of paramount importance.”

Prisma and B.W. Furlong have been in discussions for nearly a year, during which time the advancement of the system's development and functionality were able to be demonstrated and documented.

“It's undeniable that Prisma's system's capability to perform distal limb and head C.T. imaging of a conscious horse, plus image the axial skeleton and abdomen represents a material advancement for equine diagnostics and their health and welfare,” said B.W. Furlong's founder Brandan Furlong, MVB MRCVS. “We've been able to monitor and vet the progress of the system's development and are excited by the prospect of getting their inaugural system. We're equally enthusiastic about having this technology to perform more comprehensive diagnostics and deliver exceptional patient care.”

Silver estimates that the system will be ready for installation by late 2021. Prisma is in discussions with several other top veterinary practices as additional potential candidates to receive one of its early systems.

Learn more about Prisma here.

Learn more about B.W. Furlong here.

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Diagnostic Tool Offers Medical-Grade Imaging In Standing Equines

Prisma Imaging has successfully developed a new system for equine diagnostic imaging that addresses the shortcomings of current technology. Founded in 2016, Prisma developed a system that captures CT and radiographic images of the entire anatomy of a standing, weight-bearing and conscious horse. The advanced imaging capabilities established through Prisma's research and development is different from anything available in the marketplace. The resulting system represents a game-changer for the overall effect on equine diagnostics and horse health care.

Other ventures have attempted to build equine CT systems but have been unable to provide a comprehensive solution to image the horse's entire anatomy. Other devices are repurposed human medical CT systems. Most systems require that the horse be under anesthesia, representing a risk to their health and safety. In 2015, another venture's attempt employed the use of robotics, but never developed a working system.

“Miscues in the industry demonstrate a strong demand for better equine CT imaging,” said Michael Silver, Prisma's founder and chief operating officer. “Building next-generation imaging to benefit the veterinary industry and horse health is the core of Prisma's mission.”

Prisma's system is distinctly different and was developed to ensure every component meets high-performance specifications. Fully documented, thorough testing by third-party experts have been performed on every aspect of the system.

Authorities on imaging have taken notice of the groundbreaking work of the Prisma team.

“The testing done with Prisma's system demonstrates image quality which has eliminated the risks to achieve commercial readiness,” said Josh Star-Lack, principal scientist at Varex Imaging, author of over 100 papers and co-inventor of 27 patents.

According to Silver, their unique solution is facilitated by three major innovations:

1) Robotics

2) Using two types of radiographic technologies

3) A motion correction system to compensate for the movement of a conscious horse

Prisma's system has successfully performed in vivo imaging of live horse subjects and has demonstrated the efficacy of the system's multiple technologies. Prisma's CT image quality has proven to be on par with the top medical-grade CT systems.

The CT images taken with Prisma's system revealed all of the relevant anatomy and was virtually indistinguishable from those taken with medical-grade CT systems.” said Kurt Selberg, DVM, MS, DACVR, associate professor veterinary diagnostic imaging, Colorado State University and lead imaging practitioner at the 2018 FEI World Equestrian Games in Tryon.

Silver projects that commercial installations of the system will begin in mid-2021. “Prior to purchase, Prisma will require the customer's inspection and full satisfaction that all its capabilities are fully functional and meet or exceed the highest standards,” Silver said.

Learn more about Prisma here.

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