Reproductive Endoscopy PDF 2021-2022

Chapter (7) Reproductive Endoscopy Beni-Suef University Faculty of Veterinary Medicine Theriogenology Department Practical Notes in Reproductive Ultrasonography & Reproductive Endoscopy...

Chapter (7) Reproductive Endoscopy Beni-Suef University Faculty of Veterinary Medicine Theriogenology Department Practical Notes in Reproductive Ultrasonography & Reproductive Endoscopy For Fifth Year Students By Theriogenology Staff Members 2021-2022 1 Contents Contents Topic Page Chapter (1): 3 Ultrasonographic Examination of Non-Pregnant Cow Chapter (2): 6 Ultrasonographic Examination of Pregnant Cow Chapter (3): 9 Reproductive tract pathology Chapter (4): 12 Ultrasonographic Examination of Non-Pregnant Mare Chapter (5): 19 Ultrasonographic Examination of Pregnant Mare Chapter (6): 22 Ultrasonographic Examination of Small Animals Chapter (7): 30 Reproductive Endoscopy Chapter (8): 35 Endoscopic Surgery in the Field of Animal Reproduction Chapter (9): 41 Endoscopy in small animal Theriogenology Chapter (10): 46 Endoscopy in pet animal theriogenology 2 Chapter (7) Reproductive Endoscopy Chapter (1) Ultrasonographic Examination of Non-Pregnant Cow Cyclic ovary 1- Ovarian Follicles Cyclic ovary is including follicles and/ or corpora lutea have differ echogenicity and appear with varying degrees of shades of grey on ultrasound examination. Ovarian follicles appear as anechoic regions. Follicles do not always appear round due to transferred pressure from the transducer on the surrounding ovarian tissue. 2- Ovarian Corpus luteum Luteal tissue appears as distinctly echogenic areas within the ovarian stroma. A central lacuna (fluid-filled cavity) may be seen within a normal CL and should not be confused with the presence of a luteal cyst. 3 Chapter (1) Ultrasonographic Examination of Non-Pregnant Cow The CL may be recognized upon ultrasound examination at fourth days after ovulation. If fertilization of the ovum does not occur, the CL reaches peak size 14 days post-ovulation and then begins to regress. So, repeated examination of the ovaries can provide an idea regarding stage of the cycle through monitoring of changes to the CL. Presence of the CL may assist in the determination of early pregnancy diagnosis. Sonogram of the ovary with corpus luteum (1), Follicle (2) and pelvic bone (3) Ultrasound examination of non-pregnant uterus: The uterus has different echogenic appearances depending on the stage of the estrous cycle. In cross section, the uterus is circular in appearance may 4 Chapter (1) Ultrasonographic Examination of Non-Pregnant Cow enable the endometrium, myometrium and uterine lumen and its contents to be identified. When the cow is in estrus, the endometrium becomes edematous and the endometrial folds become more prominent. In the peri-ovulatory period, the uterine lumen appears anechoic due to accumulation of mucus. You must differentiate between the accumulation of mucus in the uterus and early pregnancy. This can be done through examination of the ovaries for the presence of follicles and corpus luteum in addition to the presence and or absence of a fetus, fetal membranes and placentomes. Longitudinal and transverse section of non-pregnant uterine horn: (1) endometrium, (2) myometrium and (3) is vascular portion of the uterus. 5 Chapter (2) Ultrasonographic Examination of Pregnant Cow Chapter (2) Ultrasonographic Examination of Pregnant Cow Early identification of the non-pregnant cow is essential to improve the reproductive efficiency of the dairy herd. The experienced veterinarian able to detect a pregnancy as early as day 18 post- insemination. Diagnosis of pregnancy during stage should be considered with caution to avoid incidence of early embryonic loss. 30- day pregnancy in cow (embryo and amniotic vesicle) Most veterinarians able to diagnose pregnancy under field conditions easily and accurately by day 30 post AI by using of transrectal ultrasonography Pregnant cow at 40-day pregnancy 6 Chapter (2) Ultrasonographic Examination of Pregnant Cow Pregnant cow at 60-day pregnancy Twinning Ultrasound is an effective tool as twin pregnancies can be accurately identified using transrectal ultrasonography by 40– 70 days post -AI. It is important to evaluate the ovaries at the time of pregnancy diagnosis as the presence of two or more CL gives an indication of cows which may develop a twin pregnancy. 1- heterogenous twinning. 2- monozyguos twinning at Fetus in each horn the two foeti at the same horn Fetal sex determination by ultrasonography 7 Chapter (2) Ultrasonographic Examination of Pregnant Cow Transrectal ultrasonography is useful for determining fetal sex by evaluating the location of the genital tubercle (precursor to the penis and clitoris). Ultrasound can be used to accurately determine fetal sex from day 55–60 post ovulation. The genital tubercle is located between the tail and hind limbs in the female. In the male fetus, it is located just caudal to the point where the umbilicus enters the body. Accurate identification of fetal sex may be useful for dairy herd management programs. Ultrasound appearance of the scrotum of a male fetus at 75 days of gestation (transversal plane). The left side of the figure shows the position of the probe in relation to the fetus inside the uterus. The right side of the figure shows what will be seen on the screen at the same moment. 1: Hindlimbs; 2: Umbilicus; 3: Scrotum. 8 Chapter (3) Reproductive tract pathology Chapter (3) Reproductive tract pathology Ultrasonography is also useful in diagnosis of cyclic abnormalities or pathologic conditions affecting the ovaries and/or uterus dairy cattle such as cystic ovarian disease and endometritis and pyometra. 1. Cystic ovary: Cystic ovary results in abnormal cyclic activity and a subsequent decrease in fertility. Cystic ovary defined as the presence of fluid-filled structures greater than 25 mm in diameter on the ovary for longer than 10 days in the absence of a functional CL. Two types of cysts on the ovary led to cyclic dysfunction are follicular theca cysts and luteal theca cysts. Follicular cyst Luteal cyst Smooth, thin wall clear Cyst. Thicker wall (greater than 3 mm) due to a lining of luteal tissue. (arrows) with reticular pattern of internal echoes, typical for hemorrhagic cyst. 2-. Endometritis 9 Chapter (3) Reproductive tract pathology Clinical endometritis is defined as purulent or mucopurulent uterine discharge present approximately 21 to 26 days postpartum. Subclinical cases of endometritis may not have uterine discharge; however, fertility is negatively affected. Trans -rectal ultrasonography may be used to evaluate cows for signs of endometritis. ultrasound exam revealed accumulation of intrauterine fluid containing echogenic particles (‘snowy’ appearance) and thickening of the endometrium due to endometrial edema and inflammation. Ultrasound imaging in transverse section of the uterus with endometritis, using a micro convex 8.5 MHz probe, characterizing intrauterine contents in abnormal proportions; intrauterine-fluid (left) and hyperechoic intrauterine content. 3-. Pyometra Pyometra is defined as an accumulation of pus within the uterus. Compared to manual palpation, the differences between uterine enlargement due to pregnancy and pyometra are easily recognizable on ultrasound examination. While fetal fluids in the uterus appear anechoic, pyometra appears as distension of the uterine lumen with contents of mixed echogenicity. 10 Chapter (3) Reproductive tract pathology Moreover, there is no evidence of a fetus, fetal membranes or placentomes on ultrasound examination of a cow with pyometra. Pyometra in Mare 11 Chapter (4) Ultrasonographic Examination of Non-Pregnant Mare Chapter (4) Ultrasonographic Examination of Non-Pregnant Mare Benefits of reproductive ultrasonography in equine practice Normally used to assess a mare’s suitability for breeding and to predict the most suitable time for covering or artificial insemination. Used to detect pregnancy from 14 days and allows the diagnosis and treatment of twin pregnancies. Can be used to investigate infertility in mares failing to conceive or to maintain a pregnancy. Trans-abdominal ultrasound can be used to assess fetal health in the latter stages of pregnancy. Can be used in the investigation of mares with erratic behavior and suspected hormonal problems. A manual trans-rectal examination of the reproductive tract should be performed. Preparation This palpation allows the examiner to arrange the mare’s reproductive tract so as to make the ultrasonographic examination easier. The tract should be arranged so that it is free of any intestine and the ovaries should be positioned so that they are not behind the broad ligament. The operator should be able to follow the tract from one ovary to the other without any obstruction. This will allow the examination to be done without the interference of abdominal structures that can make the examination difficult and, in some instances, cause confusion in interpretation. 12 Chapter (4) Ultrasonographic Examination of Non-Pregnant Mare More importantly, this examination allows the operator to become aware of possible abnormalities that will need closer visualization when the ultrasonographic examination is being performed. Proper restraint In order to properly perform an ultrasonographic examination of the reproductive tract it is very important that the mare be properly restrained. The amount of restraint that is required will differ greatly depending on the temperament of the mare and the quality of the available help. Older mares that have been examined multiple times often need very little restraint, while younger, more fractious individuals may need considerable restraint. It is very important that the animal is handled so that the safety of the animal, help and veterinarian is maintained. Remember that the veterinarian is often times the only professional involved and therefore the person responsible for the proper execution of the procedure. If stocks are not available the mare is frequently positioned with the hindquarters in a stall door, in order to prevent too much lateral movement and give some protection to the operator and equipment. Sedation If the mare is not accustomed to being palpated some form of minor sedation can be helpful. Xylazine (0.5–1.1mg/kg) will cause much less uterine relaxation and will provide ample sedation in most instances. Detomidine (0.02–0.04mg/kg IV) is also a good choice. If the mare resists transrectal examination by persistent straining or if the operator must do extensive manipulation of the reproductive tract, a small dose of N- butylscopolammonium bromide (Buscopan, 20–40mg IV) can 13 Chapter (4) Ultrasonographic Examination of Non-Pregnant Mare be given to relax the rectum and make examination easier on the operator and the patient. 2- Scanning by ultrasonography When scanning is being performed it is important for the operator to hold the probe in a manner that will allow the head of the probe to have full contact with the ovaries and uterus. This can best be done by grasping the probe in a way that the index finger is placed along the dorsal surface of the probe, with the thumb on one side and the remaining fingers on the other, being careful not to cover the crystals on the bottom. The middle finger can be used as a guide to move the probe along the anterior edge of the uterus so that the probe will be easily centered over the uterus while the examination of the horns is being performed. The examination should always be done in the same manner so that all of the structures are examined thoroughly and the operator will be able to cover the entire tract. For left-handed operators, it is easiest to start at the right ovary, and then examine the right horn, left horn, left ovary, body and cervix, ending with the vagina. It is very important that the operator makes sure that the entire uterus is examined. If the probe is held correctly the horns of the uterus will appear as a cross-section of a piece of sausage on the screen and can easily be followed from one ovary to the other. When scanning the body of the uterus, sometimes the body is wider than the width of the probe and parts of the lateral areas can be missed. In order to make sure that the operator has covered the entire uterus the probe is moved from left to right. This is particularly important when mares are being examined for very early pregnancies. The ultrasound examination of the non-pregnant mare’s reproductive tract can be done as a single examination, for reasons such as breeding soundness examination or 14 Chapter (4) Ultrasonographic Examination of Non-Pregnant Mare purchase, or as one of a series of examinations, such as when the mare is being examined over several days for mating. Whatever the reason it is important to remember that the ultrasonographic examination is only one part of the evaluation of the mare’s reproductive tract and must be coupled with the history, the mare’s mental condition (in behavioral estrus or not), a speculum examination to evaluate the condition of the vagina and cervix, and palpation of her reproductive tract. Only when all of this information is put together can a proper interpretation of the examination be made. Examination in relation to mare's position (stage) of reproductive cycle It is important to be aware of the mare’s position in her reproductive cycle so that you know what you are expecting the normal mare’s reproductive tract to look like. During the period of anestrus that mares pass through during the winter, most mares, on palpation, will have no follicular development, their uterus will be relaxed, and the cervix toneless. She will be nonresponsive to the teaser and on speculum examination the vagina and cervix will be pale and dry. The cervix will have very little tone. The ultrasound examination will find ovaries that are very small and may have small, less than 10mm follicles present on them and a uterus with no edema and no fluid in the lumen. The mare that is entering and passing through the transitional period will have a reproductive tract that shows many different degrees of development. This can be the most difficult period for a veterinarian to interpret. The ovaries may have no follicles or clusters of small follicles and the mare may be showing strong estrous behavior or no estrous behavior at all. 15 Chapter (4) Ultrasonographic Examination of Non-Pregnant Mare The most confusing times for owner and veterinarian are when the mare is showing strong estrus and has no follicles, which may be a normal finding during transition. The uterus usually has very little tone and no edema or fluid, and the cervix will be pale and relaxed. As the mare moves into the cycling period, the first signs of estrus will be the beginning of uterine edema, follicular development, and the development of cervical edema, relaxation, and pinker color. As estrus progresses, uterine edema will increase and a small amount of fluid may normally be present in the mare’s uterus, follicular activity will become greater with the development of a dominant follicle, and behavioral signs of estrus will increase. The approach of ovulation will be signaled by the reduction of uterine edema, further relaxation of the cervix and vulva, and stronger behavioral signs of estrus. The follicle will lose its spherical shape and begin to migrate towards the ovulation fossa. When ovulation occurs the mare will begin to be less receptive to the teaser, the follicle will collapse and a corpus hemorrhagicum will begin to form. The uterine edema will resolve and there should be no fluid in the mare’s uterus. As the mare enters diestrus she will become non-receptive to the stallion, the vulva will be less relaxed, and the cervix will be closed, pale, and dry. The uterus will have some tone on palpation. The ovaries may or may not have palpable follicles and a corpus luteum will usually be palpable at the site of ovulation. Ultrasound examination of the uterus and ovaries should find a significant reduction in edema, no fluid in the lumen of the uterus and the ovaries may or may not have significant follicular development but should have a visible corpus luteum present at the site of ovulation. 16 Chapter (4) Ultrasonographic Examination of Non-Pregnant Mare Ultrasound characteristics of non-pregnant mare Ultrasonographic characteristics of the uterus during the anovulatory season, estrous cycle and pregnancy may often be differentiated. During anestrus, cross-section of uterine horns and longitudinal section of uterine body are often flat and irregular and may contour closely to surrounding abdominal organs. In estrus, uterine horns are well-rounded and both horns and body commonly have an interdigitated pattern of alternating echogenic and nonechogenic areas. The areas of decreased echogenicity are the outer edematous portion of endometrial folds. The edema is due to effects of estrogen. This ultrasonograhic pattern is reminiscent of a sliced orange. Endometrial folds, generally, are visible at the end of diestrus and become more prominent as estrus progresses, then decrease or disappear at approximately the time of ovulation which parallels estrogen production. Endometrial folds These folds were not distinguishable during diestrus, and were prominent during estrus. Endometrial folds are graded from 0 (no folds) to 3 (prominent endometrial folds). A change to a lower grade could be used to predict ovulation. For example, a change from grade 3 to 0 was concomitant with ovulation. Practitioners should be aware of the extent of change in height of endometrial folds between diestrus and early estrus. Prominence of endometrial folds during estrus should not be considered pathologic. Before this observation became common knowledge, some veterinary practitioners mistook prominent endometrial folds for endometritis, and unnecessarily treated mares. 17 Chapter (4) Ultrasonographic Examination of Non-Pregnant Mare Ability to clearly observe endometrial folds depends upon transducer frequency and resolution of ultrasonographic equipment. On occasion, impending abortion is suspected when, during routine scanning for pregnancy, the embryonic vesicle is located in a uterus with prominent endometrial folds. In diestrus, individual endometrial folds are less distinct, or not discernible, and the echo texture is more homogeneous. When scanning the uterine body, the uterine lumen is often identified by a hyperechogenic white line. This is due to apposition of endometrial surfaces, and probably is caused by specular reflection. In general, during diestrus the entire uterine portion of the reproductive tract is well-circumscribed and defined. Ultrasonographic images of the pregnant uterus are often identical to those of diestrus, with the exception that after day 16, endometrial folds may again appear. However, endometrial folds are not as prominent as during estrus and may be associated with increasing uterine tone. 18 Chapter (5) Ultrasonographic Examination of Pregnant Mare Chapter (5) Ultrasonographic Examination of Pregnant Mare Characteristics of the Conceptus Days 10 to 17 For diagnosis of pregnancy at 10 to 12 days, a 5 or 7.5 MHz transducer is needed. However, due to embryonic loss in early pregnancy, it is inappropriate to discontinue the teasing program after initial examination for pregnancy. From a practical standpoint, the first examination could be postponed until approximately 18 to 20 days post-ovulation, thus eliminating scanning of mares that are destined to return to estrus. One exception would be scanning of mares that have a history of twinning or multiple ovulations. These mares should be examined at day 12 to 15 post-ovulation to most effectively manage manual embryonic reduction. Frequency of subsequent scans will depend on such factors as presence of twins, size and quality of the vesicle and embryo, availability of the mare and economics. The early equine conceptus is highly mobile within the uterine lumen. Regardless of the side of entry into the uterus, the equine conceptus moves between the uterine horns and uterine body. Small yolk sacs (day 10) are spherical and found most frequently in the uterine body. Trans-uterine movement occurs at intervals of less than 2 to 4 hrs. Mobility begins to decrease by day 15, and after day 17, transuterine migration can no longer be detected. Thereafter, the vesicle is fixed at the caudal portion of one of the uterine horns. Extensive mobility of the early conceptus may be due to the 19 Chapter (5) Ultrasonographic Examination of Pregnant Mare spherical form and turgidity of the vesicle, and longitudinal arrangements of endometrial folds. When scanning for an early vesicle, the transducer should be moved slowly so the image or tissue slice visualized (2 to 3 mm wide) is not passed over the vesicle too rapidly. A systematic technique should be developed to avoid omitting or scanning too rapidly a portion of the reproductive tract. Because the vesicle is moving, it may be found anywhere within the uterine lumen from the tip of a uterine horn to the cranial aspect of the cervix. Early detection of an embryonic vesicle requires a high frequency transducer (5 MHz) and a high-quality screen. Frequently, ultrasonographic images of a 10- to 14-day vesicle have a bright echogenic line on the dorsal and ventral poles with respect to the transducer. These are not associated with the embryonic disk or other structures of the developing conceptus, but are due to specular reflection. A water-filled balloon (1.5 cm [.59 in] diameter) placed in the uterus will have similar, if not identical, ultrasonographic characteristics. Characters of the conceptus at days 17 to 22 The vesicle is spherical in shape before day 17. The vesicle has a growth plateau between days 17 and 26, then growth resumes at a slightly slower rate. After day 17, the vesicle is often irregular in shape. Fixation of the early conceptus on days 16 to 17 apparently is due to increased uterine tone and thickening of the uterine wall as well as rapid growth of the conceptus. Increasing uterine tone may explain why the vesicle changes shape as pregnancy advances. Fixation generally occurs in the caudal portion of the uterine horn near the bifurcation (corpus cornual junction). In post-partum mares, the previously gravid horn provides less restriction, thus the conceptus generally fixes in the opposite 20 Chapter (5) Ultrasonographic Examination of Pregnant Mare uterine horn. Fixation occurs with greater frequency in the right horn in maiden and barren mares. Characters of the conceptus at days 22 to 55 It is important that the ultrasonographer understands and interprets clinically the growth of the allantois, which is initially recognized on day 24 and, concurrent with its expansion, the contraction of the yolk sac. The interplay of growth between these two fluid-filled structures results in the embryo moving from the ventral (day 22) to the dorsal (day 40) aspect of the vesicle. After day 40, the yolk sac degenerates and the umbilical cord elongates from the dorsal pole, permitting the fetus to gravitate to the ventral floor where it is seen in dorsal recumbency from day 50 onwards. Apposition of yolk sac and allantois results in an ultrasonographically visible line normally oriented horizontally. Twin vesicle walls, when in contact, generally appear as an ultrasonographically visible, vertically oriented line. Knowledge of the approximate stage of gestation and growth characteristics of the conceptus can help the clinician can differentiate between the presence of an abnormally oriented singleton or two apposed yolk sacs (twins). 21 Chapter (6) Ultrasonographic Examination of Small Animals Chapter (6) Ultrasonographic Examination of Small Animals Introduction Ultrasonography (US) is a non-invasive, real-time, imaging modality, which causes no hazard to either operator or patient. Compared to other imaging techniques, like magnetic resonance imaging or computed tomography, US is cheap and widely available, and many veterinary practitioners having access to an ultrasound machine of some sort. Small rectum size, high fertility of ewes relative to cattle and low individual animal value means that ultrasonographic imaging of ovaries and the non-pregnant reproductive tract is rarely performed in sheep; reproductive ultrasonographic examinations are usually confined to pregnancy diagnosis. In some countries, e.g., the United Kingdom, ultrasonographic pregnancy diagnosis of sheep is usually performed by non- veterinary personnel, further limiting the use of ultrasonographic examination in sheep veterinary practice. Principles of small animal reproductive ultrasound  The examination is carried out only through the trans- abdominal route in pet animals and small ruminants  Occasionally the trans-rectal examination can be carried out in sheep during early pregnancy and to characterize uterine and ovarian status.  Trans-abdominal US examination of reproductive organs is difficult and not an easy task and requires extended periods of training particularly with pet ultrasound.  The frequency of the probe is usually set at 3 to 5 MHz for sheep and goat examinations and at 5 to 7 MHz in bitch.  US examination of non-pregnant small animals is one of the approaches of the scheme for gynecological investigation. It 22 Chapter (6) Ultrasonographic Examination of Small Animals can help diagnose various infertility problems as ovarian cyst and CEH/pyometra complex in pet animals. Types of ultrasound scanners commonly used in sheep 1)-. Linear trans-rectal probe Produces rectangular image. Commonly used to examine non-pregnant ewe's uterus and ovarian structures. Can be used to examine pregnancy during the first 40 days as it may be inaccessible trans-abdominally particularly in fat ewes. May be used to assess the condition of accessory male genital glands in ram. 2)-. Sector probe Produces a wider arc-shaped field. Used commonly with dairy sheep and goat breeds Pregnancy diagnosis in sheep using ultrasonography Approaches and sensitivity ➔ A trans-rectal or trans-abdominal approach may be used with very high degree of sensitivity up to 100%. ➔ The frequency used during examination varies between 3.5 and 5 MHz. ➔ The trans-rectal approach gives better results if pregnancy is before day 40. The trans-rectal technique: The ewe is examined while she is standing. The probe can be maintained inside an introducing rod to facilitate handling. The tip of the probe is lubricated with methyl cellulose. 23 Chapter (6) Ultrasonographic Examination of Small Animals The probe is introduced gently inside the rectum for 15 cm. Once the UB is demarcated on the US monitor, the probe is carefully and slowly rotated in RT and LT 90-degree angels to locate the uterine horns and the ovaries. The trans-abdominal technique: This examination may be carried out while the ewe is standing or while she is recumbent laterally on her left side. The probe is introduced in front of the mammary gland and is directed caudo-dorsally into the inguinal region to locate the neck of the urinary bladder. The right inguinal region and peri-mammary area are usually preferred for trans-abdominal scanning as the left region is usually occupied by the rumen. Characteristics of pregnant uterus of ewe examined by US ☺ Anechoic fluid in the uterine lumen ☺ The lumen is divided into multiple parts. ☺ The placentomes appear as C or O shape. ☺ Presence of the embryo/fetus (echoic). Determination of fetal numbers ☺ Number of foeti can be determined in pregnant ewes. ☺ The ability to detect number of foeti is diminished in late pregnancy. Determination of fetal health ☺ Ultrasonography can help determine the viability of sheep and goat foeti and other pathological conditions as pyometra and hydrometra. ☺ Appearance of pathological fluid (containing hyperechoic particles) around the fetus may indicate fetal death. 24 Chapter (6) Ultrasonographic Examination of Small Animals Diagnosis of uterine torsion at lambing ☺ Ultrasonography can help determine uterine torsion in some lambing ewes where the uterine wall is increased in thickness from 5 to more than 10 mm. Ultrasonography and ram breeding soundness examination ☺ Ultrasonography may be a helpful diagnostic tool for some reproductive pathologies in rams as scrotal hernia, and epididymitis. ☺ The scanning frequency used from 5 to 7.5 MHz ☺ Thick wool around the scrotum should be shaved. ☺ Scan the testes using both the horizontal and vertical planes. Evaluation of testicular echo-texture and semen quality in rams ☺ Normal testicular echo-texture in ram is fine grained. ☺ The echo-texture of testicular parenchyma takes three grades, zero is the most homogenous, while 3 is the most heterogeneous. ☺ Rams with score 3 produced significantly fewer spermatozoa per ejaculate than rams with score 0. ☺Trans-abdominal US image: C-shaped and O-shaped placentomes in a pregnant ewe 25 Chapter (6) Ultrasonographic Examination of Small Animals Trans-rectal Cross-sectional ultrasound image of a non-pregnant ewe uterus Trans-abdominal US image of a 30-day old ovine embryo (5 MHz; 1. Uterus; 2. Embryo; 3. Amnion; 4. Amniotic fluid; 5. Allantoic fluid). Trans-abdominal US image of 60-day ovine fetus (5 MHz—A: 1. Head; 2. Eye; 3. Placentome; -- B: 4. Heart; 5. Ribs; 6. Umbilical cord; 7. Rumen filled with liquid. 26 Chapter (6) Ultrasonographic Examination of Small Animals US image of a dead ovine embryo: Notice the more pronounced hyper-echogenic appearance of the embryo (1) and small amount of amniotic fluid surrounding. US image of a mummified fetus (Arrows). Notice: Hyperechogenecity of the mummy and surrounding uterine wall and 27 Chapter (6) Ultrasonographic Examination of Small Animals absence of fluids and fetal body cavities. (All images are adapted from: Practical Atlas of Ruminant and Camelids ultrasonography; Eds. Luc D.; Giovanni G and Jill C; Wiley Blackwell, 2010). 28 Beni Suef University Faculty of Veterinary Medicine Department of Theriogenology Practical Notes In Reproductive Endoscopy For 5th Year Students By Theriogenology Staff Members 206 Chapter (7) Reproductive Endoscopy Chapter (7) Reproductive Endoscopy  Endoscopy is defined as the use of specialized video cameras to evaluate areas within the body in a minimally invasive manner.  Endoscopy is performed for diagnostic purposes allowing visualization and sampling of abnormalities and for therapeutic purposes. Types of endoscopic procedures At pet animal clinic, the following procedures could be done Urinary and genital tract endoscopy (cystoscopy, urethroscopy, vaginoscopy) Respiratory tract endoscopy (rhinoscopy, tracheoscopy and bronchoscopy) Upper GI tract e n d o s c o p y (esophagoscopy, gastroscopy, duodenoscopy). Lower GI tract endoscopy (colonoscopy, ileostomy). Abdominal endoscopy (laparoscopy). Interventional endoscopy. it is the endoscopic equipment in combination with other imaging modalities ultrasound, to perform therapeutic tasks of endoscopy. the following procedures could be offered: 1) Balloon dilation of strictures. 2) Foreign body retrieval. 3) Bladder polyp removal or stone retrieval. Endoscopic procedure performed on pet clinic ☺ Clinicians will record the pet’s history. 30 Chapter (7) Reproductive Endoscopy ☺ Perform a physical examination. ☺ Then determine if an endoscopic procedure is indicated. ☺ Endoscopic procedures are performed under general anesthesia. Endoscopy in Veterinary Medicine  Endoscopy permits a careful investigation of genital organs and body systems without surgery.  Endoscopy is performed with either a rigid or flexible fiberoptic instrument.  Flexible endoscopes, the tip of the endoscope is manipulated using a control knob in the hand piece.  One channel permits various endoscopic tools to be passed and fluids to be suctioned or samples taken.  Moreover, other channel allows air or water to be passed into the intestine to insufflate air and wash the present mucus.  The endoscope is provided with video cameras to investigating the exam on a television screen, and recording the exam on video. 31 Chapter (7) Reproductive Endoscopy Types of Endoscopies 1- Flexible endoscopy: Bronchoscopy: an exam of the lower airways. 2- Rigid endoscopy: Cystoscopy: an examination of the vagina, urethral opening, urethra, bladder, and ureteral openings. Thoracoscopy: an examination of the chest cavity. This is currently not performed frequently in veterinary medicine. Advantages and Disadvantages The major advantage of endoscopy 1- It is nonsurgical. 2-The technique allows for visualization of the lining of the digestive system and for taking samples of the lining of these organs, including biopsies. 3- Many foreign bodies in the esophagus and stomach may be removed via endoscopy. The major disadvantage of endoscopy 1- The necessity to anesthetize the patient. 2- Endoscopy should be preceded by adequate laboratory testing and radiology. 3- Animals are fasted for 12 hours before an elective endoscopy is performed. 4- General anesthesia with tracheal intubation is recommended. A mouth gag is used to prevent damage to the endoscope or the patient's teeth. 5- Complications due to the actual endoscopic exam are rare. Care needs to be taken to prevent perforation (tearing) of the stomach or intestines during the exam. 32 Chapter (7) Reproductive Endoscopy Endoscopes can be used to investigate multiple body systems  Endoscopes are used to investigate multiple body systems.  One of the first things veterinarians learn in school about endoscopes is how genital endoscopy (GI) can be used to aid in the diagnostic evaluation of clinical signs referable to the uterus FT ovaries, cervix and vagina.  The primary goal for endoscopic instrumentation is to be able to perform less invasive and more efficient procedures to allow for decreased anesthetic time and faster recovery.  Veterinary Specialty Hospital’s veterinary team commonly uses endoscopy for urogenital abnormalities retrieval in dogs and cats. 33 Chapter (7) Reproductive Endoscopy Video-endo-laparoscopic equipment 34 Chapter (8) Endoscopic Surgery in the Field of Animal Reproduction Introduction Chapter (8) There were many attempts for seeing inside the Endoscopic Surgery in the Field of patients’ bodies, to facilitate surgical manipulations, advanced imaging and precise surgical technologies. Animal Reproduction The first successful attempt at performing a laparoscopic procedure was reported, with canines being used for the experimental application in1902. However, Introductionapplications in the veterinary field have not yet been so widely attempted or established. It has only been within There were many the last attempts 10 to 15 yearsfor seeing that inside minimally the patients’ invasive techniques bodies, tohave been considered facilitate for application surgical manipulations, in veterinary advanced surgery, imaging and preciseparticularly in the field of animal reproduction. surgical technologies. Minimal invasiveness and reduced The first successful attempt at performing a laparoscopic postoperative pain facilitated by laparoscopy are clear procedureadvantages. was reported,For thewith canines surgeon, being better used for and magnification the visualization experimental of the application target in1902. organ as wellapplications However, as improved in patient the veterinary safety field have during surgery, not yet been render laparoscopy so widely attempted or attractive. established. It has only been within the last 10 to 15 years that Endoscopic surgery for small animal reproduction minimally invasive techniques have been considered for Laparoscopic surgery is becoming a substantial part application in veterinary surgery, particularly in the field of of the reproductive surgeon’s repertoire in veterinary animal reproduction. medicine. Laparoscopic Minimal invasiveness andneutering, reducedin particular, is regularly postoperative pain used in a number of veterinary hospitals and is gaining facilitated by laparoscopy are clear advantages. For the greater acceptance and preference among veterinary surgeon, practitioners. better magnification and visualization of the target organ as well as improved Most of thepatient safety techniques during used currently surgery, in small animal reproduction render laparoscopy attractive.are for gonadectomies (ovariectomy in females, and cryptorchidectomy and vasectomy in males); Endoscopic surgery for small animalcan however, ovariohysterectomy reproduction readily be performed by laparoscopy if indicated. Laparoscopic surgery is becoming a substantial part of the New applications of endoscopic surgery, and where it reproductive surgeon’s repertoire has greatest potential to in veterinary become medicine. the gold standard, in veterinary Laparoscopic neutering, in particular, is regularly used in a number of veterinary hospitals and is gaining greater acceptance and preference among veterinary practitioners. medicine will likely parallel the trends in human medicine. Most of the techniques currently used in small animal reproduction are for gonadectomies (ovariectomy in females, Improved Visibility and cryptorchidectomy andDuring Endoscopic vasectomy Surgery in males); however, Among all the advantages of endoscopic surgery, it is ovariohysterectomy can readily be performed by laparoscopy probably the feature of improved visibility that is most if indicated. helpful in reducing incidence of inadvertent complications, New applications which otherwise occur during of endoscopic the open surgery, andabdominal where it has approach, such as reported in companion animals with ovarian remnant syndrome or ligation of the ureters. 35 Furthermore, laparoscopy itself is an excellent tool for treating such complications, especially for ovarian remnant syndrome. Chapter (8) Endoscopic Surgery in the Field of Animal Reproduction Introduction greatest potential to become the gold standard, in veterinary There were many attempts for seeing inside the patients’ bodies, to facilitate surgical manipulations, advanced imaging and precise surgical technologies. The first successful attempt at performing a laparoscopic procedure was reported, with canines being used for the experimental application in1902. However, applications in the veterinary field have not yet been so widely attempted or established. It has only been within the last 10 to 15 years that minimally invasive techniques have been considered for application in veterinary surgery, particularly in the field of animal reproduction. Minimal invasiveness and reduced postoperative pain facilitated by laparoscopy are clear advantages. For the surgeon, better magnification and medicine visualization of thethe will likely parallel target trendsorgan as wellmedicine. in human as improved patient safety during surgery, render laparoscopy attractive. Improved Visibility During Endoscopic Surgery Endoscopic surgery for small animal reproduction Laparoscopic Among all the advantages of surgery endoscopicis becoming surgery,aitsubstantial is probablypart of the the feature of reproductive surgeon’sthat improved visibility repertoire is most in veterinary helpful in reducing medicine. incidence of inadvertent complications, which Laparoscopic neutering, in particular, is regularly otherwise occur during the open abdominal approach, such as used in a number of veterinary hospitals and is gaining reported greater in companion acceptanceanimals with among and preference ovarianveterinary remnant syndromepractitioners. or ligation of the ureters. Furthermore, laparoscopy itself is an excellent Most of the tool for techniques treating suchcurrently used in small complications, animal reproduction are especially for ovarian remnant syndrome. for gonadectomies (ovariectomy in females, and cryptorchidectomy and vasectomy in males); Technicalhowever, and technological progress has ovariohysterectomy played be can readily a significant performed by laparoscopy role in improving if indicated. the visibility facilitated by endoscopic surgical New applications approaches. Recently, of endoscopic high- definition videosurgery, systemsandhavewhere it has greatest been introduced into potential endoscopic to become surgery.theIt gold is notstandard, in solely an veterinary improved image quality that is achieved by use of such systems, however, and a significant improvement in performance of the medicine laparoscopic will likely parallelsurgeons them-selves the trends has in human medicine. been documented as well. In a study of the laparoscopic simulator knot- tying task, which Improved Visibility During Endoscopic Surgery requires fine depth perception, the high- definition system Among all the advantages of endoscopic surgery, it is allowed the procedure probably to be carried the feature out atvisibility of improved a significantly that is faster most pace thanhelpful in reducing the standard incidence definition of inadvertent complications, system. which otherwise occur during the open abdominal In anotherapproach, study, use of 3D laparoscopy has been assessed such as reported in companion animals with ovarian remnant syndrome or ligation of the ureters. 36 Furthermore, laparoscopy itself is an excellent tool for treating such complications, especially for ovarian remnant syndrome. Chapter (8) Endoscopic Surgery in the Field of Animal Reproduction Introduction and proven to be advantageous when compared to standard There were many attempts for seeing inside the 2D laparoscopy. patients’ bodies, to facilitate surgical manipulations, advanced imaging The digital operating room and (or)precise surgical technologies. and video/photo The first successful attempt at performing a documentation and distribution laparoscopic procedure was reported, with canines being used for the experimental application in1902. However, The surgeon’s working environment has recently been applications in the veterinary field have not yet been so improvedwidely by introduction attemptedand integration It or established. ofhas digital onlymedia into been within the OR. the last 10 to 15 years that minimally invasive techniques have been considered for application in veterinary surgery, Multiple monitors, endoscopic image acquisition and storage particularly in the field of animal reproduction. devices, as well as real- time integration with other imaging Minimal invasiveness and reduced modalities, postoperative painoffacilitated are just some the features of a digital are by laparoscopy ORclear that advantages. are currently For theof at the disposal surgeon, better endoscopic magnification and surgeons. visualization of the target organ as well as improved Intra- operative use of different imaging modalities is already a patient safety during surgery, render laparoscopy commonplace in the field of human endoscopic surgery. attractive. MRI/CT Endoscopic surgery for acquired images aresmall mostanimal reproduction commonly used for Laparoscopic preoperative planning; surgery yet, they alsoiscan becoming be fullyaintegrated substantialinpart the digitalofOR theand reproductive surgeon provide three- ’s repertoireintra- dimensional in veterinary operative navigationmedicine. and instrument tracking and thus help endoscopic Laparoscopic neutering, in particular, is regularly surgeons to exactly localize lesions or avoid vital anatomical used in a number of veterinary hospitals and is gaining structures. greater acceptance and preference among veterinary practitioners. Laparoscopic ultrasound LUS is another interesting modality that has already Most foundof the its techniques applicationcurrently in theused in small human animal reproduction are for gonadectomies (ovariectomy in Gynecology. females, and cryptorchidectomy and vasectomy in males); Reduction ofhowever, accessovariohysterectomy port number can readily be performed by laparoscopy if indicated. New applications Different techniques of endoscopic have been developed and surgery, and where are currently in it has greatestovariectomy use for laparoscopic potential to or become the gold standard, ovariohysterectomy in in the veterinary field of small animal reproduction. A trend has emerged in the past few years to-wards reducing the number of access ports. medicine The initial will likely reports parallel the trends of laparoscopic in human medicine. ovariohysterectomy frequently described three- port or even four- port techniques, however, introduced a single- port laparoscopic ovariectomy Improved Visibility During Endoscopic Surgery and describedAmong it in comparison with the two- port access all the advantages of endoscopic surgery, it is technique.probably Specifically, a 10 mm the feature 0° rigid visibility of improved operating telescope that is most equippedhelpful with anininstrument reducing incidence channel ofwasinadvertent used for thecomplications, single- which otherwise port technique, occur during with the ovary the open suspended abdominal to the abdominal approach, such as reported in companion animals with ovarian remnant syndrome or ligation of the ureters. 37 Furthermore, laparoscopy itself is an excellent tool for treating such complications, especially for ovarian remnant syndrome. Chapter (8) Endoscopic Surgery in the Field of Animal Reproduction Introduction wall. There were many attempts for seeing inside the Use of this patients ’ bodies, operating to facilitate telescope wassurgical found to manipulations, eliminate the need for advanced triangulationimaging of the andlaparoscopic precise surgical technologies. instruments (as is The first successful attempt the case with multiport procedures) because the telescope at performing a laparoscopic procedure was reported, with canines being and the instrument have parallel axes. Thus, this single- used for the experimental application in1902. However, port technique can in applications bethesafely performed veterinary field havein not dogsyetwithout been so significantwidely attempted increase in timeoras established. com-pared It has withonly the been two- within port technique.the last 10 to 15 years that minimally invasive techniques have been considered for application in veterinary surgery, Finally, several studies particularly in thehave field evaluated the applicability of of animal reproduction. natural orifice transluminal endoscopic and Minimal invasiveness surgery (commonly reduced known aspostoperative NOTES) in the painfield facilitated of small by laparoscopy are clear animal reproduction. Although advantages. For the surgeon, technically demanding, and to better magnification a certain and extent time- visualization of the target organ as well as improved consuming, this method seems to produce less pain in the patient safety during surgery, render laparoscopy patient than traditional laparoscopy and even more so than attractive. open surgery. Endoscopic surgery for small animal reproduction Laparoscopic surgery Development of instruments dedicated is becoming a substantial part for endoscopic of the reproductive surgeon’s repertoire in veterinary surgery medicine. Laparoscopic neutering, in particular, is regularly As previously stated, technical development plays an important used in a number of veterinary hospitals and is gaining role in advancing the practiceand greater acceptance of preference laparoscopy. Use veterinary among of energy- practitioners.laparoscopic devices have significantly based sealer/divider improved safety of Most the of the techniques procedure currently used and shortened in small surgical times. animal reproduction are for gonadectomies (ovariectomy in females, and cryptorchidectomy and vasectomy in males); These devices however, have come into regular ovariohysterectomy use inbe veterinary can readily performed by endoscopic laparoscopy if indicated. due to their practicality and surgery. Nevertheless, ability to shorten New applications surgery time andof endoscopic to increase surgery, safetyand of where the it procedure, has thegreatest vessel-potential to become sealing devices willthe gold standard, continue to play anin veterinary important role in veterinary endoscopic surgery. Different stapling devices have been developed for use in medicine laparoscopy will likely and applied parallel the in veterinary trends in practice. human These medicine. devices, however, have been used less regularly for small animal reproductive laparoscopy, and a detailed elaboration Improved Visibility During Endoscopic Surgery on their applicability in veterinary minimally invasive surgery is Among all the advantages of endoscopic surgery, it is beyond the scope of this probably the review. feature of improved visibility that is most Efforts tohelpful reducein reducing incidence the number of of inadvertent ports, as wellcomplications, as the which otherwise occur during the open abdominal introduction of single- incision laparoscopic surgery, have approach, such as reported in companion animals with ovarian remnant syndrome or ligation of the ureters. 38 Furthermore, laparoscopy itself is an excellent tool for treating such complications, especially for ovarian remnant syndrome. Chapter (8) Endoscopic Surgery in the Field of Animal Reproduction Introduction created a need for hand- held laparoscopic instruments of There were many attempts for seeing inside the very specific design. patients’ bodies, to facilitate surgical manipulations, advanced imaging Use of articulating and precise instruments surgical technologies. in laparoscopic veterinary The first successful attempt at performing surgery, and the result was a positive effect on reduced a laparoscopic procedure was reported, with canines being “swording” (a term used to describe interference of used for the experimental application in1902. However, instruments). Yet, their applications subsequent in the study veterinary field highlighted have how not yet been so applicationwidely attempted of these or established. instruments requiresIt acquisition has only been of within new thefor skills, even last 10 to 15 years experienced thatcertified board- minimally invasive techniques surgeons. have been considered for application in veterinary surgery, Initial portalparticularly placement in laparoscopy in the field of animal reproduction. Minimal invasiveness and reduced  A recentpostoperative comparativepainstudy described facilitated the performance by laparoscopy of are clear veterinaryadvantages. surgeons withFor respect the surgeon, better magnification to accuracy and and repeatability of portal visualization of the target placement achieved withorgan as wellthe or without as improved use of an patient established safety placement orthogonal during surgery, render mapping laparoscopy system. attractive.  Use of the mappingsurgery Endoscopic systemforinsmall the laparoscopic procedures animal reproduction tended to enable Laparoscopic surgery correct portal is becoming placement a substantial and was especiallypart beneficialofforthe reproductive surgeons surgeonlevel with novice- ’s repertoire skill. in veterinary medicine.  It was also found that the mapping system could improve the Laparoscopic neutering, in particular, is regularly repeatability of a number used in laparoscopic procedures of veterinary hospitalsand and isfacilitate gaining communication within the laparoscopic surgeons’ community. greater acceptance and preference among veterinary practitioners. Working space in abdominal endoscopic surgery Most of the techniques currently used in small animal reproduction are for gonadectomies (ovariectomy in  Creation of a sufficient working space is prerequisite for females, and cryptorchidectomy and vasectomy in males); laparoscopic surgery however, and is commonly ovariohysterectomy can readilyachieved by by be performed laparoscopy insufflation if indicated. with gas (usually carbon dioxide).  Use of the liftNew applications of endoscopic surgery, and where it laparoscopy (a gasless technique) in a small has greatest potential to become the gold standard, in number of animal patients. Specifically, a custom- made veterinary device was used to create a working space for laparoscopic instruments without the need for a pneumoperitoneum.  The lift medicine will likely laparoscopy parallel was found tothe betrends in human a safe medicine. and feasible alternative to classical laparoscopy, in which CO2 is used for insufflation of the abdominal cavity. Improved Visibility During Endoscopic Surgery  The same groupAmong all thepublished recently advantages a of endoscopicstudy subsequent surgery,on it is probably the influence of the featurepositions/combinations different of improved visibility thatofis lifting most helpful devices and in reducing different incidence tensile force. ofThe inadvertent results complications, supported which otherwise occur during the open abdominal several recommendations on placement and tensile force for approach, such as reported in companion animals with ovarian remnant syndrome or ligation of the ureters. 39 Furthermore, laparoscopy itself is an excellent tool for treating such complications, especially for ovarian remnant syndrome. Chapter (8) Endoscopic Surgery in the Field of Animal Reproduction Introduction surgeries involving different compartments of the coeliac There were many attempts for seeing inside the cavity. patients’ bodies, to facilitate surgical manipulations, advanced imaging and precise surgical technologies. The first successful attempt at performing a Evaluation oflaparoscopic the influence of human procedure factors was reported, withand a being canines surgeon’s skills used for the experimental application in1902. However, applications in the veterinary field have not yet been so Researchwidely and attempted development or established. have not onlyIt hasaddressed only been within the the last 10 to 15 years that minimally invasive technical and technological aspects of laparoscopy but also techniques have been considered for application in veterinary surgery, the potential influence of human factors. particularly in the field of animal reproduction. An experienced laparoscopic Minimal invasiveness surgeon and canreduced achieve solid expertise postoperative after performing pain facilitated eight by laparoscopy are clear of the procedures. advantages. For the surgeon, better magnification and Additionally, objectiveoftools visualization have organ the target been ascreated well asto measure improved patient and improve safety surgical during skills surgery, render of laparoscopic laparoscopy surgeons. attractive. Surgeons’ laparoscopic skills were found to improve Endoscopic surgery for small animal reproduction significantly following training on an inanimate model, and this Laparoscopic surgery is becoming a substantial part was especially of the the case for novices. reproductive surgeon’s repertoire in veterinary medicine. Conclusion Laparoscopic neutering, in particular, is regularly Many of used the newin a number methodsof and veterinary hospitals applications and that is gaining have been greater acceptance and preference among veterinary developed remain to be thoroughly assessed or confirmed. practitioners. Continuous technicalMost of the and progress techniques currently technological used in small innovations will further improve the working environment for a in animal reproduction are for gonadectomies (ovariectomy females, and cryptorchidectomy and vasectomy in males); laparoscopic surgeon, and by doing so increase the safety of however, ovariohysterectomy can readily be performed by the animal patient undergoing laparoscopic procedures. laparoscopy if indicated. This trend should New be applications supported of endoscopic surgery,surgeon by the veterinary and where it community,has and greatest nonepotential more so to become than bythethe gold standard, small in animal veterinary reproductive surgeons themselves. medicine will likely parallel the trends in human medicine. Improved Visibility During Endoscopic Surgery Among all the advantages of endoscopic surgery, it is probably the feature of improved visibility that is most helpful in reducing incidence of inadvertent complications, which otherwise occur during the open abdominal approach, such as reported in companion animals with ovarian remnant syndrome or ligation of the ureters. 40 Furthermore, laparoscopy itself is an excellent tool for treating such complications, especially for ovarian remnant syndrome. Chapter (9) Endoscopy in small animal Theriogenology Chapter (9) Endoscopy in small animal Theriogenology Endoscopy means looking inside the body of an animal for medical evaluations or treatments using an endoscope. Simplification of endoscope structure: An endoscope has a rigid or flexible tube (depending on the procedure), a light to illuminate the area, a lens, an eyepiece and can have additional medical instruments to aid in procedures. Special video cameras allow viewing of the exam or procedure on a television screen as well as recording of the exam. General uses of endoscope 1- Veterinarians use endoscopy for many procedures that once required more invasive surgery, as cryptorchid surgery (removal of an undescended testicle) and minimally invasive spaying in female dogs. 2- Laparoscopic surgery has been employed in embryo transfer protocols in small ruminants. 3- For diagnosis of medical problems. 4- Specific procedures have different names, but all fall in the family of endoscopy. Some examples include: Laparoscopy: used to treat or diagnose medical conditions in the abdominal or pelvic cavity. Arthroscopy: used to examine the interior of a joint. Bronchoscopy: to examine the lower respiratory tract. Cystoscopy: to examine the urinary tract. Enteroscopy: to examine the gastrointestinal tract. Simplification of endoscopic procedures 1- Animals scheduled for laparoscopy procedure will be anesthetized and two to three small incisions (1/2-inch-long) 41 Chapter (9) Endoscopy in small animal Theriogenology will be made to allow for equipment access channels. 2- One or two channels allow endoscopic tools to be passed in for surgical procedures or to take biopsy samples. Advantages of endoscopy: 1- Endoscopic procedures are minimally invasive, 2- Complications in cases of endoscopy are rare. 3- Pain as well as recovery time are reduced as compared to other more invasive surgical procedures. 4- Some procedures, such evaluation of the digestive system and respiratory system, are nonsurgical and require no incisions, with a very quick recovery from anesthesia. Laparoscopic examination of reproductive organs in sheep  Endoscopy was initially used for “direct visualization of the ovaries of the ewe through the use of an illuminated endoscope which is inserted through an abdominal cannula.  Video cameras allowed the use of endoscopy as a therapeutic tool not only as a diagnostic tool in all fields of veterinary medicine including male and female reproduction. Using laparoscopy to improve sheep fertility 1- Overcoming cervical barrier problems in sheep Using laparoscopy, the “cervical barrier” problem has been overcome and satisfactory fertility rate has been achieved by significant reduction in the number of spermatozoa per insemination (from 200-300 to 1-10 million, or less for sex-sorted semen). Pregnancy rate is commonly over 75% and 50% for goats and sheep respectively. 2- Using endoscopy in assisted reproductive technology in sheep 42 Chapter (9) Endoscopy in small animal Theriogenology Laparoscopic technique was introduced in MOET to reduce adhesions of the reproductive system after surgical embryo recovery. Laparoscopy enables repeated flushing of sheep and goat’s uterus and satisfactory embryos recovery rate. Also, fresh or frozen-thawed embryos are transferred to the uteri or oviducts of recipients by laparoscopy, achieving high pregnancy rates. Laparoscopy is also used for oocytes aspiration (Laparoscopy Ovum Pick Up - LOPU) in small ruminants. 3- Laparoscopic Artificial Insemination (LAI) Artificial insemination in sheep does not yield satisfactory conception results to trans-cervical insemination, especially out of the breeding season and using deep frozen-thawed ram semen. Fertilization failure is equally frequent in ewes bred naturally or artificially inseminated, and appears to be due to faulty transport of spermatozoa through the cervix. This problem can be overcome by intra-uterine deposition of semen through surgical procedure in superovulated ewes or by laparoscopic insemination. In sheep, intra uterine-laparoscopic insemination should be carried out in the middle of the estrous period. Technique of Laparoscopic Artificial Insemination 1) Ewes are fasted and restricted access to water for 16 hours before, and injected with local anesthetic 15 minutes before the procedure is performed. The ewe is than placed in a laparoscopy cradle. 2) The abdominal region is surgically prepared by shearing the wool and disinfecting the skin. Using the cradle, the ewe is positioned in a supine head-down (Trendelenburg) position to an approximate angle of 30oC. 3) The trocars and cannula for introducing laparoscope and insemination pipette are inserted 7 – 10 cm ventral to the udder and 5 – 10 cm on each side of the midline (linea alba). 43 Chapter (9) Endoscopy in small animal Theriogenology 4) Usually, a scalpel blade is used to make a small skin incision in order to facilitate trocar penetration. 5) The 7 mm trocar and cannula that is connected with the CO2 is first introduced and the abdomen is slightly inflated to reduce the chance of injury to organs. 6) Insertions of the first trocar and cannula should be well controlled and the sharp trocar is withdrawn as soon as the abdominal wall has been penetrated. The blunt cannula is pushed well into the abdomen, while the second trocar and cannula are inserted after inflation with CO2. 7) Endoscope and AI instrument go through the cannula and the uterus is located and fixed just ventral to the urinary bladder. 8) Semen is deposited in each uterine horn approximately halfway between the uterine bifurcation and the utero-tubal junction. 9) A light stab action of the aspic and the turn of the plunger deposit about 0,1 ml of diluted or frozen thawed semen into the lumen of each uterine horn (total 0,2 ml). 10) Instruments are withdrawn and put into disinfectants between each animal. 11) An antibiotic spray is applied to the wounds. Possible complications and manipulation 1) Occasionally b l e e d i n g may be caused by perforation o f a subcutaneous blood vessel or uterine horns wall (fig. 7). 2) The wound can be sutured or an artery clamp can be applied. 3) Fatalities are possible, when the abdominal aorta is pierced with an uncontrolled and brutal insertion of the first trocar. 4) It is possible to pierce a full rumen as well as a full bladder. Operators should be well trained. Ultrasonography and endoscopy for monitoring of ovarian structures Transrectal ultrasonography enables precise estimation of the ovarian size and diameter of follicles and CLs. However, ultrasound examination is less accurate for determination of 44 Chapter (9) Endoscopy in small animal Theriogenology number of ovarian structures. Laparoscopic recovery and transfer of embryos and Oocytes in sheep and goat  Procedure for laparoscopic embryo recovery is similar to the LAI, with using of three instruments: endoscope, forceps for holding uterine horn and a three-way balloon catheter for flushing of embryos.  Repeated SOV and oocyte or embryo collection causes adhesions caused by protrusions of the endometrium at the puncture site.  Laparoscopic transfer of embryos in uterine horn or tubal transfer resulted with higher pregnancy rates than the surgical transfer. 45 Chapter (10) Endoscopy in pet animal theriogenology On the contrary to small ruminants, endoscopy is mainly used to examine the posterior Chapter (10) reproductive tract in bitch. Endoscopy in pet animal Vaginoscopy theriogenology is performed in bitch with the following aims: On the contrary to small To determine ruminants, endoscopythe stage of the estrous is mainly cycle. used to examine the posterior To detect reproductive mechanical tract in bitch. or other causes of infertility as congenital affections inside Vaginoscopy is performed in bitch with the following aims: vaginal cavity. To determine the stageTo ofdetect the real the estrous cause of abnormal cycle. vaginal secretions either during pregnancy or To detect mechanical whileornotother causes of infertility as congenital pregnant. affections inside vaginal Tocavity. diagnose conditions like ectopic To detect the realureter. cause of abnormal vaginal secretions either To apply intrauterine insemination if during pregnancy or while not pregnant. frozen semen is used in breeding. To diagnose conditions like ectopic ureter. To apply intrauterine insemination if frozen semen is used in breeding. Vaginoscopy: Is defined as the technique of examination of the vaginal mucosa using a rigid endoscope. Vaginoscopic assessment is based upon: Observation of the mucosal fold contours and profiles and color of the mucosa. Enlarged edematous pink or pinky/white mucosal folds are present during pro-estrus and estrus. Progressive shrinking of these folds is accompanied by: pallor due to an abrupt withdrawal of the water-retaining effect of estrogen during pre-ovulatory decline. Subsequently, mucosal shrinkage is accompanied by wrinkling of the mucosal folds, which become distinctly angulated and dense cream to white in color. Assessment of the appearance of the vaginal wall (mucosal fold contours, mucosal color, and presence of fluid) during specific times of the estrous cycle. 46 Chapter (10) Endoscopy in pet animal theriogenology On the contrary to small ruminants, endoscopy is mainly used to examine the posterior Phases of the estrous cycle of bitch as determined by reproductive tract in bitch. endoscopy Vaginoscopy is performed in bitch with the following aims: A-. Inactive phase (I)To determine the stage of the estrous cycle. This phase is characterized by a thin, red, dry mucosa with low To detect mechanical or other causes of and flattened mucosal folds. infertility as congenital affections inside B-. Oedematousvaginalphasecavity. (O) To detect the real cause of abnormal This phase is demarcated vaginal secretions by a either during thickened pregnancy and or edematous mucosa, which iswhile not rounded, swollen, pregnant.and grey/white in color. To diagnose conditions like ectopic C-. Shrinkage phaseureter.(S) During this phase, there To is apply intrauterine a thickened insemination mucosa, normallyifwhite in color but withfrozen reducedsemen is used turgidity in breeding. and progressive furrowing, wrinkling, and indentations. D-. Angulated phase (A) This phase shows thickened mucosa, that is white in color, but in which there is significant reduced turgidity with progressive shrinkage of the vaginal mucosal folds. E-. Declining phase (D) This phase is characterized by a progressive decline in the size of the mucosal fold profile. F. Inactive phase (I) The decline phase is followed by a return to a phase in which there is a thin, red and dry mucosa, with low and flattened mucosal folds. 47 Chapter (10) Endoscopy in pet animal theriogenology On the contrary to small ruminants, endoscopy is mainly used to examine the posterior Models of endoscopes used for vaginoscopy in bitch reproductive tract in bitch. A rigid endoscope Vaginoscopy with a catheteris performed is better in bitch with for vaginal the following aims: examination in bitch than flexible endoscope. To determine the stage of the estrous Cystourethroscopecycle. with sheath length 30 cm is only suitable for small and giant breeds To butdetect not formechanical or other causes of miniature breeds. infertility as congenital affections inside Cystourethroscope with telescope (4 mm in diameter, 30 cm vaginal cavity. length, and 30 o angledTolens) andthe detect sheath (7X 5mm real cause diameter). of abnormal Cystourethroscopevaginal withoutsecretions either sheath and during pregnancy or bridge while not pregnant. MOFA global TCI endoscope (can be To diagnose used in all conditions dogs). like ectopic ureter. To apply intrauterine insemination if frozen semen is used in breeding. 48