Cirugias reproductivas mas comunes para incrementar la fertilidad de las yeguas.
Surgical procedures on the mare's reproductive tract to increment fertility are performed primarily to correct urogenital abnormalities that contribute to contamination of the reproductive tract. Contamination results from injuries that occur during parturition or from conformational changes that occur as mares age. We will discuss only the most common surgical procedures performed to reconstruct vulvar, vestibular, and cervical abnormalities. For more detailed descriptions of these and other surgical procedures involving the reproductive tract, the reader should refer to veterinary medical surgical texts.
Mares with conformational changes of the urogenital tract that can be corrected by surgical reconstruction are candidates for surgery, provided that the results of a thorough breeding soundness examination indicate that the procedure has a good chance of restoring the mare's fertility. An exception to the need for a breeding soundness examination is a mare with a rectovestibular laceration or fistula, because these injuries nearly always arise in fertile, young mares during foaling as a result of fetal malposture during delivery. An affected mare has no reason to be infertile after surgical reconstruction of the vestibule and vulva prevents contamination of the reproductive tract. For other procedures used to surgically correct reproductive abnormalities, however, a breeding soundness examination is indicated to assess the breeding potential of the mare. If the endometrium, cervix, vagina, or vestibule has been severely and irreparably damaged, the owner may elect not to invest time and money into surgery and aftercare. Defects commonly corrected by reconstructive surgery of the reproductive tract include the following:
Pneumovagina is a condition characterized by constant contamination of the vestibule and vagina with feces that results from conformational faults that cause a mare to aspirate air into the into the tubular portion of the reproductive tract. The condition is commonly called "wind-sucking," and it usually culminates in ascending infection of the vagina, cervix, and endometrium. Causes of pneumovagina include tearing or stretching of the vulvar seal or the vulvovaginal sphincter and a sunken perineal body, characterized by cranial displacement of the anus, resulting in tipping of the vulva cranially over the brim of the pelvis. The condition is quite common in underweight, aged, pluriparous mares. The most common surgical procedure used to correct pneumovagina is the Caslick operation, sometimes referred to as a vulvoplasty.
To perform a Caslick vulvoplasty it is better if you placement of mare into stock and tranquilize and wrap and tie tail so you can wash mare's perineum. Local anesthetic solution is injected subcutaneously at the dorsal commissure of the and infiltrated along the margin of each labium to slightly below the floor of the ischium. The level to which the margins of the labia are sutured ventrally can be determined by placing firm pressure with the fingers on either side of the vulva and pressing down to locate the ischium. If the labia are not sutured to slightly below the floor of the ischium, the vulva may bounce far enough cranially, as the mare moves, to permit air to be aspirated into the vagina. Care should be taken to ensure that the ventral portion of the vulva remains spacious enough to allow urine to escape during urination, for insertion of the stallion's penis during copulation, or for insertion of a vaginal speculum, if the mare is to be bred by artificial
Lidocaine 2% is injected at the mucocutaneous junction (Junction of pigmented skin and pink vulvar mucosa) in adequate volume to create a bleb (bubble like swelling) from the level of the pubis dorsally to connect with the bleb from the other side of the vulva. Lidocaine is also placed lateral to the lower extend of each bleb for the future placement of the "Breeding Stitch".
The large bleb of lidocaine utilized in this procedure provides analgesia of the area for an extended period of time. The procedure routinely takes less than 15 minute s per animal. A thin band of tissue (2-4 mm) is removed from the area injected with local anesthetic.
An alternative method is to incise the bleb with a surgical scalpel. Either of these methods will expose underlying tissue.
Surgical incisions are sutured in a manner which opposes the tissue from each side of the vulva and closes the upper side of the vulvar opening.
Breeding stitch. If the labia must be opened for breeding, for vaginal examination, or to permit unobstructed foaling, they should be reapposed when a large vulvar opening is no longer required. A breeding stitch is a single, simple interrupted suture sometimes placed at the ventral aspect of the vulvar closure to preclude the need to open the sutured labia of a mare that must be bred A wide based suture is placed in the subcutaneous tissue and is tied loosely. This suture will prevent the tearing of the sutures or tissue of the vulvoplasty in the event of natural breeding or the future vaginal examination by the veterinarian.
Mares receiving this procedure do not demonstrate any residual, pain, or problems. This procedure can be repeated at least yearly with no residual effects.
Perineal body reconstruction
When the entire vulva of a mare has an extremely sunken anus and perineal bodythat deviated so far cranially and ventrally that the vulvar cleft assumes a nearly horizontal position over the ischium. A Caslick suture may not correct pneumovagina in such mares and may prevent the mare from adequately expelling urine. To prevent both pneumovagina and urine pooling caused by this extreme conformational abnormality, the perineal body must be reconstructed (i.e., perineoplasty or vestibuloplasty). Often a modified vestibuloplasty, as described by Slusher (1986) is performed.
This vestibuloplasty entails removal of an isosceles trangle of mucosa from the dorsal aspect of the vestibule.
In preparation for reconstruction of the perineal body, as described by Slusher (1986), the mare is placed n a stock and tranquilized, and the perineum is desensitized by a caudal epidural analgesia:
Caudal epidural analgesia is indicated for many of the procedures of the urogenital system. The most common indication is for standing urogenital surgical procedures of the perineum, anus, rectum, vulva, and vagina. It is also use for other non-surgical procedures such as multiple ovulation embryo transfer (MOET) and embryo recovery in horses.
The technique consists of the deposition of a local anesthetic solution between the dura mater and periosteum of the spinal canal. Because of the extremely importance of this procedure in bovine practice and that the veterinarian's experience/performance play a very important role in practice, this procedure is recommended to be performed by each of the students in the advance reproductive training.
Remove hair from the injection site if possible and clean the area well with alcohol or another skin antiseptic.
With the mare in standing restraint, the practitioner should stand alongside its pelvic region. Move the tail up and down while locating the fossa between the last sacral vertebra and the first coccygeal vertebra and then between the first and second coccygeal vertebrae (preferred site for mares).
Insert the needle ventrally and cranially at a 45-degree angle until contact is made with the floor of the spinal canal of the preceding vertebra. The use of a stylet is optional.
If blood appears in the lumen of the needle following insertion, presumably the needle has been inserted too ventrally and has invaded the ventral venous plexus. Two options may be considered: Retract the needle slightly, disregard the blood, and infuse the anesthetic solution (no serious sequelae result). Remove the needle, and discard, reinsert a new sterile needle to the proper depth, and infuse. Attach the syringe with the estimated optimal dose of anesthetic solution to the needle and start infusion. The plunger should go down freely (almost a gravity feeding) if the needle is properly situated. Optimal dose for a 1,000-1b mare: 3 to 4 ml of 2% lidocaine or mepivacaine (1 to 1.25 mL/100 kg), (additional 80 mg of xylazine is added to the lidocaine for better anesthesia). Detach the syringe from the needle; the needle may be retained in the inserted position during surgical for additional infusion of anesthetic solution, if indicated.
This procedure is a very safe procedure for the cow and the mare. The incidence of any complication to this procedure is rare.
The dorsal aspect of the vestibule is exposed by retracting each labium laterally, with a loose suture or Backhaus towel clamp placed through the labium at the juncture of its dorsal one-third and ventral two-thirds, and by retracting the dorsal commissure of the vulva dorsally and caudally, also with a loose suture or towel clamp. A point on the dorsal aspect of the vestibule that lies directly beneath the anus is marked to serve as the apex of a triangle of mucosa to be removed. The distance between this mark and the dorsal commissure of the vulva is measured, and one-half of this distance from the dorsal commissure of the vulva is marked on the mucocutaneous margin of each labium. A line between these two points on the labia serves as the base of the mucosal triangle to be removed.
The points of the triangle are connected using a scalpel, and the mucosa overlying this area is removed. Two or three, no. 1 or 2 nonabsorbable sutures are placed horizontally in a line from the apex of the triangle to the base.
Small rolls of gauze swabs work well as Stents to prevent the sutures from pulling through the skin. Just enough tension is placed on the sutures to bring the triangular area into a vertical position. Sutures are removed in 5 to 10 days. Excessive tension placed on the sutures causes tissue necrosis. If sutures begin to cause tissue necrosis, they can be removed, one daily, or at alternate-day intervals, to relieve pressure.
This surgical procedure effectively increases the area of the perineal body and returns the vulva to a more vertical position, but the sunken position of the anus remains unchanged. If the procedure is done properly, the vulvar opening is not diminishedappreciably, and the mare can be bred by natural service.
Old, pluriparous mares sometimes suffer from reflux of urine into the vagina during urination attributable to conformational changes in the vestibule and vagina that result from progressive descent of these structures into the abdomen from repeated stretching, during pregnancy, of the tissues that suspend the uterus and birth canal., These conformational changes cause the external urethral orifice to be positioned cranial and ventral to the brim of the pelvis and dorsal to the cranial portion of the vagina, leading to pooling of urine in the vaginal fornix. Pooling of urine (i.e., urine pooling) into the vagina is termed urovagina or vesicovaginal reflux. The constant presence of urine is irritating and contributes to inflammation and sometimes infection of the uterus and birth canal (i.e., vaginitis, cervicitis, and endometritis). Severely affected mares dribble urine chronically from the vulva. The skin of the tail, ventral aspect of the vulva, and the inner aspect of the thighs may become chronically irritated causing exudate to accumulate in these areas. Before performing surgery to alleviate urine pooling, the endometrium should be biopsied for histological examination. If the mare has severe, widespread, periglandular endometrial fibrosis, which permanently lowers the mare's ability to conceive and carry a viable foal to term, the owner of the mare may choose not to proceed with surgery. The mare is a more suitable candidate for corrective surgery if the endometrium is not severely and permanently damaged.
Different surgical techniques have been described to correct urovagina in mares, including caudal retraction of the transverse fold, as described by Monin, and the McKinnon and Brown techniques of urethral extension. To correct urovagina, I prefer to use the urethral extension technique described by Prado et al (2012). (Prado TM, Schumacher J, Kelly G, Henry R. Evaluation of a modification of the McKinnon technique to correct urine pooling in mares. Veterinary Record 2012; 170: 24 621 Published Online First: 4 May 2012). The mare is prepared for surgery by systemic administration of a sedative and desensitization of the perineal region similarly as done for the perineal body recontruction.
Prado et al. (2012) modified the technique of urethroplasty described by McKinnon and Beldon (1988) by transversely splitting the urethral fold and retracting the dorsal half caudally to cover the caudal portion of the urethral extension. This modification was designed to help prevent a defect from forming in the cranial portion of the extension. Using this modification, the dorsal half of the transversely split urethral fold is retracted caudally, under tension, for 4 to 5 cm, to cover the submucosa of the dorsal aspect of the cranial portion of the urethral extension. The dorsal shelf can be retracted approximately 2 cm even further caudally by creating a large, cranially-pointed, V-shaped mucosal incision on the floor of the vagina, cranial to the external urethral orifice. The right and left margins and the central long axis of the retracted dorsal shelf are sutured to the exposed submucosa of the extension. The V-shaped incision on the floor of the vagina is left to heal by second intention.
Prado et al. (2012) reported that 10 of 30 mares (33%) that received this technique of urethroplasty developed a fistula in the extension. The fistula of 8 of the 10 mares (26.6 %) was grossly visible and palpable, but the fistula of 2 mares could be detected only by inserting a dye, under pressure, into the lumen of the extension. The defect in the extension of these 10 mares was, without exception, located in the caudal half of the extension, and caudal to the caudal edge of the retracted dorsal shelf of the urethral fold, where it was considered to be less likely to contribute to vesicovaginal reflux and to be more accessible for repair.
The study by Prado et al. (2012) showed that digital palpation alone is often insufficient to detect a fistula. A minute fistula may be detected only by infusing a dye, under pressure, into the extension. These authors speculated that even a minute fistula may contribute to failure of the extension to prevent vesicovaginal reflux, but whether or not a defect so small that it cannot be detected grossly can result in perpetuation of vesicovaginal reflux is not known. None of the mares in that study suffered from vesicovaginal reflux before surgery.
A Caslick's suture is placed in the vulva if the mare also suffers from pneumovagina, a condition that commonly accompanies urovagina.. Some mares may also require vestuloplasty, as described above. Aftercare consists of administration of a broad-spectrum antimicrobial drug for 3 to 5 days. Administering an antimicrobial drug that is eliminated through the urine (e.g., trimethoprim-sulfamethoxazole) may be beneficial. Administering a nonsteroidal, antiinflammatory drug, such as phenylbutazone or flunixin meglumine, for 12 to 24 hours after surgery may help to relieve postoperative pain.
In general, factors that contribute to formation of a fistula in the urethral extension, regardless of the technique used, are the difficulty in apposing the cranial aspects of the mucosal flaps, hydrostatic pressure created during urination, fibrosis from chronic vaginitis or injury suffered during parturition, and a jet-effect dorsal to the urethral opening during urination. Another factor that could contribute to dehiscence of the urethral extension is using a suture that may prematurely lose tensile strength if placed in an alkaline environment. Using polyglactin 910 or polyglylcolic acid, therefore, is best avoided in surgeries where this suture contacts the normally alkaline urine of horses.
Retrovestibular laceration and fistulas
A perineal laceration or fistula occurs at parturition when the fol's foot or nose catches the annular fold of the hymen at the vaginovestibular junction. This injury occurs predominately in primiparous mares because their annular fold is more prominent than that of pluriparous mares. A 1st-degree perineal laceration involves only the skin and mucous membrane of the dorsum of the vestibule. A 2nd-degree perineal laceration is characterized by disruption of the constrictor vulvae muscle, compromising the ability of the perineal musculature to constrict the vestibule. A 3rd-degree perineal laceration is characterized by a complete disruption of tissue between the rectum and vestibule, resulting in a common rectal and vestibular vault. A rectovestibular fistula occurs when the tissue between the rectum and vestibule is perforated by the calf, but the malposture of the foal is corrected before the foal is delivered, allowing
at least a portion of the perineal body to remain intact. A rectovestibular laceration or fistula allows the mare's vestibule to become contaminated with feces, which results in bacterial infection of the vagina and endometrium. Mares with a 1st-degree perineal laceration can be treated with a Caslick's vulvoplasty, but mares with a 2nd-degree perineal laceration require a vestibuloplasty because the constrictor vulvae muscle is disrupted, causing the perineum to sink, predisposing the cow to pneumovagina and urovagina.
An attempt to repair a perineal laceration immediately after injury is usually unsuccessful because the lacerated tissue soon becomes inflamed and contaminated with feces and other debris. Before repairing a rectovestibular laceration or fistula, the mare's reproductive tract should be palpated per vagina and per rectum to determine if the mare has also incurred a cervical laceration, has uterine adhesions or pyometra, or is pregnant. Histologic evaluation of the endometrium may be indicated if the mare has gone through more than one reproductive season. Even though the vagina is constantly contaminated with feces, the uterus is unlikely to be permanently damaged, provided that repair was not neglected beyond several reproductive seasons.
A 2nd-degree perineal laceration or fistula is usually repaired with the mare sedated and standing after administering epidural anesthesia. The procedure to repair a rectovestibular lacertion is performed in a manner similar to that described for mares with a laceration and is composed of 2 stages-rectovestibular reconstruction and a anoperineal reconstruction. Both stages can be performed during the same operation, or the anoperineal reconstruction can be completed 3 weeks or more after rectovestibular reconstruction. Note: When performing the rectovestibular stage of repair, I prefer to use a six-bite suture pattern. Dissection between the rectal and the vaginal submucosa is extended for several inches cranial to the tear to enable placement of sutures that invert vaginal submucosa and mucosa into the vaginal lumen and rectal submucosa into the rectal lumen, thereby relieving tension on more caudally placed sutures that oppose the rectal and vestibular shelves, which in turn, decreases the likelihood of a fistula forming at the cranial aspect of the repair.
Postoperative treatment of a mare after repair of a 3 -degree perineal injury usually includes administering antimicrobial non-steroidal, anti-inflammatory therapy for several days. The mare's stool should be kept soft and scanty for at least 8 days, The integrity of the repair should not be evaluated before the 8th day to avoid disrupting the repair. Most mares are capable of eliminating bacteria from the endometrium within 1 estrous cycle. Natural breeding should not be allowed for at least 6 weeks, but mares may be bred by artificial insemination within 2 weeks after repair.
A rectovestibular fistula should be converted into a laceration only if it is exceptionally large (i.e., greater than 3 fingers in diameter). A fistula 3 fingers or less in diameter can be repaired using the Forssell technique, which spares complete disruption of the intact perineal body. Using this technique, the skin of the perineum is incised in a frontal plane, midway between the ventral aspect of the anus and the dorsal commissure of the vulva. The incision is extended cranially through the perineal body to 3 to 4 cm beyond the fistula, separating the rectovestibular defect into a dorsal, rectal hole and a ventral, vestibular hole. The rectal hole is closed in a transverse plane (because the musculature of the rectum is primarily circular, and sutures placed perpendicular to the muscle fibers are subject to less stress than are sutures placed parallel to the direction of the muscle fibers with no. 00 or 0 absorbable, monofilament suture placed in an interrupted or Lembert or Halsted suture pattern. Preplacing all sutures and then tying the sutures from the center outward may allow the sutures to be placed more uniformly. Care must be taken to place all sutures into submucosal tissue to avoid tearing tissue when sutures are tightened. The vestibular hole is closed in a sagittal plane (because its muscle fibers are primarily longitudinal) with no. 00 or 0 absorbable, monofilament suture placed in an interrupted or Lembert or Halsted suture pattern.
Closing the openings of the rectum and vestibule at right angles to each other reduces the likelihood of rectal contents leaking into the repair site. The dead space remaining between the rectum and vestibule is then closed using simple interrupted sutures of no. 0 or 1 absorbable suture material. The incised skin of the perineal body is closed with interrupted, nonabsorbable, monofilament sutures, which are removed at 10 to 14 days. The frontal plane of dissection is difficult to close and so may be left unsutured to heal by second intention.
Postoperative treatment of the mare following repair of a rectovestibular laceration or fistula is similar tan the one for RV tears.
Repair of third-degree perineal lacerations or rectovaginal fistulas are often accompanied by complications:
Dehiscence of the repair. the most common of which is dehiscence, regardless of the method of repair.
Complications caused by failure to recognize a concurrent abnormality. A complication of surgery to correct a third-degree perineal injury is failure to recognize a concurrent abnormality or to recognize that the mare is pregnant.
Preoperative considerations to avoid failure of repair. A mare with an acute, third-degree perineal injury should receive tetanus prophylaxis, broad-spectrum antimicrobial therapy until the wound begins to fill with granulation tissue, a nonsteroidal anti-inflammatory drug for at least several days to relieve discomfort, and a stool softener
A cervical laceration is incurred during parturition and is often not detected until it is discovered during routine postpartum examination or during examination to determine the cause of infertility, abortion, or repeated uterine infection. Most cervical lacerations are longitudinal and are best identified by palpating the wall of the cervix between an index finger (or thumb) inserted into the lumen of the cervix and a thumb (or index finger) placed on the vaginal aspect of the cervix. Repair of a torn cervix may not be necessary if the cervix remains competent.
Competency can be evaluated in the mare the best when the mare is in diestrus because during this stage of the cycle, a competent cervix must be dilated to allow insertion of a finger into the lumen of the uterus. The result of cervical incompetency is failure to conceive or eventual loss of the conceptus early or late in gestation. Opinions vary about the length of laceration that causes the cervix to be incapable of maintaining a seal. LeBlanc (2006) and Embertson (2009) recommended repairing those lacerations that extend more than one-third of the length of the portio vaginalis (i.e., that part of the cervix extending cranially from the external os to the junction of the cervix and vagina), whereas Brown et al. (1984) advocated repairing lacerations that extend more than 50% of the length of the portio vaginalis. O'Leary (2009) and Pollock and Russell (2011) advised repairing only those lacerations that extend the entire length of the portio vaginalis. Regardless of it length, a cervical laceration that interferes with the competency of the cervix must be repaired to restore fertility. The cervix should be repaired while the mares are in diestrus. Before the cervix is repaired, the owner should be warned that the cervix is often lacerated during the subsequent parturition because fibrosis at the site of repair may render the cervix incapable of dilating completely.
The cervix is usually repaired in two or three layers. The mare should receive sexual rest for one month. Complications include dehiscence of the repair and formation of luminal adhesions, which can result in pyometria. Preparation for repair of a cervical defect is similar to that for repair of a third-degree perineal laceration (i.e., sedation, epidural anesthesia, tail wrap and tie, etc.).
The inner mucosal layer (i.e., toward the cervical lumen) is sutured first with no. 0 or 00 absorbable suture placed in an inverting (i.e., into the cervical lumen) continuous horizontal mattress pattern. Suturing begins at the cranial end of the defect and continues caudally to the external os.
The middle, muscular layer is sutured with no. 0 absorbable suture inserted in a simple continuous pattern (F). This is the critical layer of closure, and so, sufficient tissue must be procured to ensure that the layer remains intact after healing. Thickness can be checked periodically during insertion of this suture line by inserting a finger into the cervical lumen.
The outer mucosal layer (i.e., toward the vaginal lumen) is sutured cranially to caudally in an everting manner (i.e., into the vaginal lumen) using no. 0 or 00 absorbable suture material inserted in a continuous horizontal mattress pattern.
The retention sutures are removed, and the vagina and the external cervical mucosa are covered with an oily, antimicrobial preparation. The mare should receive a Caslick vulvoplasty, if necessary. A suitable, broad-spectrum, antimicrobial drug can be administered to the mare for 3 to 5 days if infection is a concern. The mare should receive sexual rest for one month, and its cervix should be examined for competency and patency before the mare is bred.
The greatest difficulty in repairing a lacerated cervix is poor access to the cervix. A serious complication of repair of a cervical laceration is development of: Intra-luminal and peri-cervical adhesions, septic peritonitis.
Endometritis, failure to conceive or to produce a live foal or if a cervical Wedge Resection for Treatment for Pyometra.
Other reproductive invasive surgeries
The folowing surgeries are invasive and will require expensive equipment to be able todo them, However they are another way to sove some of the problems when mares felt to get preganant because the uterus is to low and has difficulties cleaning up aor there are obtruction of the oviducts. I will explain the surgeries on the power poit presentation, but the references for these surgeruies are the folowing articles:
Brink P, Schumacher J, Schumacher J. Elevating the uterus (uteropexy) of five mares by laparoscopically imbricating the mesometrium. Equine Vet J. 2010 Nov; 42 (8): 675-9.
Woods J, Rigby S, Brinsko S, Stephens R, Varner D, Blanchard T. Effect of intrauterine treatment with prostaglandin E2 prior to insemination of mares in the uterine horn or body. Theriogenology. 2000 Jun; 53 (9): 1827-36.
Inoue Y, Sekiguchi M1. Clinical application of hysteroscopic hydrotubation for unexplained infertility in the mare. Equine Vet J. 2018 Jul; 50 (4): 470-47.
Inoue Y. Hysteroscopic hydrotubation of the equine oviduct. Equine Vet J. 2013 Nov; 45 (6): 761-5.
Colpotomy for twinig reduction and others tasks
The vaginal celiotomy is often referred to as a colpotomy. It can be performed using laparoscopic techniques, including hand-assisted laparoscopic techniques, and can be performed with the mare anesthetized, using any of these approaches, or with the mare standing, through a vaginal or flank celiotomy. The mare must be placed in the Trendelenburg position when colpotomy is performed with the mare anesthetized, and this positioning increases the risk for cardiovascular anesthetic complications.
The temperament of the mare is an important factor when deciding whether to do it with the mare standing or anesthetized. Surgeries through a vaginal approach avoids a cutaneous scar and provides the most rapid return to function of all the approaches. The scar left by a paramedian, oblique paramedian, or ventral midline approach is inconspicuous, but the time between surgery and the mare's return to function is much longer than when surgery is performed using a vaginal approach. The vaginal approach also allows access to both ovaries and uterus through a single incision and, therefore, is most often used for spaying mares, removal of momify fetus or twin reduction after 60 days of preganancy. The colpotomy is generally left unsutured, making vaginal aproacha rapid procedure. If an ovariectomy needs to be performed performed with the mare standing, through a flank or vaginal celiotomy is less expensive than other methods of ovariectomy, because it avoids the expense of general anesthesia. Vaginal ovariectomy, however, requires the use of a specialized instrument, the ecraseur.
The approach selected is generally based on the reasons for what type of surgery is going to be performing, facilities and equipment available, financial constraints imposed by the owner, temperament of the mare, and experience and expertise of the surgeon. Each approach can be accompanied by complications, some of which are inherent to the approach, such as accidental transection of the circumflex iliac artery, when an ovary is removed through a flank celiotomy. for example.
I will explain the surgeries on the power poit presentation, but the references for these surgery is the folowing article: Tulio M. Prado, Jim Schumacher. How to perform ovariectomy through a colpotomy. Equine Veterinary Education, August 24, 2017.
Tulio M. Prado , DVM, MS, Dipl. ACT; Jim Schumacher DVM, MS, Dipl. ACVS
 Associate Professor-Theriogenology, College of Veterinary Medicine, Department of Large Animal Clinical Sciences; Adjunct Associate Professor Institute of Agriculture Department of Animal Sciences, The University of Tennessee.
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|Title Annotation:||I. Conferencias magistrales|
|Author:||Prado, Tulio M.|
|Publication:||Revista CES Medicina Veterinaria y Zootecnia|
|Date:||May 1, 2018|
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