Cushing’s disease is a naturally occurring progressive pituitary disorder that can be found in multiple species, including dogs, donkeys, horses, and humans. In horses, treatment of Cushing’s disease is aimed at controlling and reducing the severity of the clinical signs using oral medication, rather than removing the tumor from the pituitary gland (which is often performed in humans), due to the fact that to date surgical removal has been technically impossible. Therefore, a new paradigm in pituitary surgery in horses was developed in close collaboration with expert veterinarian Johannes van der Kolk of the Faculty of Veterinary Medicine of the University Utrecht. In contrast to the human vascular system, multiple superficial veins in the horse, like the facial vein, can provide direct access to the pituitary gland. This superficial vein was used to guide an innovative flexible morcellator towards the pituitary gland. Once arrived at the pituitary gland, this morcellator uses a flexible drive cable to actuate a rotating cutting blade at the tip of the instrument to resect and subsequently remove the pituitary tumors. First cadaver experiments have proven successful in inserting this instrument and removing pieces of pituitary tumor. Further research needs to be done before clinical application of the instrument can take place. Nevertheless, continued development of this approach may in time improve the quality of life of horses suffering from Cushing’s disease.

Publications

• A.Sakes, E.A. Arkenbout, F.Jelinek, J.H.H.van der Kolk, P.Breedveld. Design of an endovascular morcellator for the surgical treatment of equine Cushing’s disease. Veterinary Quarterly, DOI: 10.1080/01652176.2015.1047676.
• Sakes A., Arkenbout E.A., Kolk J.H. van der, Breedveld P. (2014). Design of an endovascular morcellator for the surgical treatment of Cushing’s disease in horses. Proc. 26th International Conference of Society for Medical innovation and Technology (SMIT), Sept. 18-20, Shanghai, China, p 90.
• Sakes A., Arkenbout E.A., Kolk J.H. van der, Breedveld P. (2013). A comprehensive overview of removal methods for the surgical treatment of Cushing’s disease for human and veterinary applications. Proc. 2013 ASME Design of Medical Devices Conference, April 8-11, Minneapolis, MN, USA, 2 p.

Media

• http://www.thehorse.com/articles/37608/is-surgery-an-option-for-equine-cushings-disease
• http://www.pferderevue.at/?id=2500%2C5503129%2C%2C
• http://www.derbybarandgrill.com/railbird/2016/05/is-surgery-an-option-for-equine-cushings-disease/59283