Common surgical procedures of the reproductive tract in the dog and cat Flashcards
How do you locate the uterus for OVH?
Push intestines cranially and bladder caudally. Locate ovaries by following uterine horns
What is ovarian release?
In OVH, the ovaries can be released by breaking down the suspensory ligament (cut>tear), create window in mesovarium.
How do you do pedicle clamping in OVH?
Haemostasis using 3 artery forceps (either 3 dorsal to ovary OR 2 dorsal and 1 ventral)
What should you use to do an ovarian ligature?
SYNTHETIC ABSORBABLE MATERIAL:
Vicryl
One/two/instrument tie
Encircling ligature/figure of 8
Why must ovarian ligature be tight?
Ovarian a arises from aorta. Reduce risk of slippage by leaving 0.5cm between ligature and cut edge.
What should you use for a broad ligament ligature?
Synthetic absorbable material cases in all cases except very immature/ small dogs and cats (Vicryl ideal)
What should you use for a cervical ligature?
Synthetic absorbable material (Vicryl)
3 forcep technqiue
EITHER: encircling ligature, transfixing ligature, stick ties
How do you check the right ovarian pedicle?
Elevate descending duodenum
How do you check the left ovarian pedicle?
elevate descending colon
How do you check the right broad ligament pedicle?
elevate descending duodenum/ more SI to left
How do you check left broad ligament pedicle?
elevate descending colon
How do you check the cervical pedicle?
elevate bladder and reflect caudally
Complications of OVH?
GENERAL - wound breakdown, infection, haemorrhage, retained swab
SPECIFIC - ureteral injury, retained ovarian remnant
OTHER - SMI, weight gain, anaesthetic complications
What variations are there in the technique to perform an OVH?
FLANK SPAY - usually L flank, care with oriental cats and the regrowth of their fur (darker)
OVARIECTOMY VERSUS OVH - latter commoner in UK, ovariectomy used in many EU countries routinely, more logical for elective sterilisation but not appropriate for management of uterine disease
LAPAROSCOPIC DISEASE - ovariectomy with a vessel sealing device (i.e. no ligature), gaining popularity, quicker recovery but high capital cost to set up
How common are c-sections?
64% dogs with dystocia treated this way
80% cats with dystocia treated this way
Base decision based on dam, foetuses and owner
What are some causes of dystocia?
Primary uterine inertia (>70d) Incomplete primary uterine inertia refractory to medical management Secondary uterine inertia (exhaustion) Relative/absolute foetal oversize Anatomical abnormality of maternal pelvic canal Foetal monstrosity Uncorrectable fetal malpresentation Foetal death Previous CS?
What are pre-op considerations for CS?
Electrolyte and other metabolic abnormalities
Foetal death increases significantly after 5 h since onset of labour
Owners should be advised of surgical risks to dam and neonate
NRCW classification variable
What are anaesthesia considerations for CS?
Regurgitation and aspiration CV and resp. compromise Depression of neonates Good analgesia for dam (local block, epidural post procedure, avoid alpha 2 agonists, ketamine and thiobarbiturates) Minimise time taken to remove foetuses
What are the 2 approaches for CS?
MIDLINE - take care
EXTERIORISE UTERUS - you may want to incise both uterine horns if many foetuses
How do you detach the umbilical cord?
Clamp it. Only remove placentas if come freely.
How do you stitch back the uterus after a CS?
Synthetic absorbable material - Monocryl ideal
Simple appositional OR inverting pattern
Single OR double layer
What are potential complications of CS?
GENERAL surgical
Remove ALL foestusess
POST-PARTURIENT PROBLEMS: uterine haemorrhage, retained placenta/foetuses, acute metritis, subinvolution of placental sites, uterine rupture, uterine prolapse, toxic milk syndrome, agalactia, galactostasis, acute mastitis, puerperal tetany, disturbed maternal behaviour
What is an en bloc OVH?
Hysterectomy performed prior to hysterotomy and removal of neonates. Review of 63 cases (dogs/cats) concluded it was a safe and effective alternative to CS (neonatal survival comparable). BUT all neonates need resuscitating IMMEDIATELY.
ADVANTAGES: minimised anaesthesia time, minimal peritoneal contamination, effective population control and no need for second surgery.
How does castration differ between dogs and cats?
DOG - single pre-scrotal incision
CAT - paired scrotal incisions
Indications for castration
Population control Behavioural modifications Testicular neoplasia Cryptorchidism Testicular torsion Orchitis/epididymitis Testicular trauma Anal adenoma (dog) Perineal rupture (dog) Prostatic disease Repair inguinal/scrotal hernia
What is the NRCW classification for clean and closed castration techniques?
CLEAN
What is the open dog castration technique?
Ligate using synthetic absorbable material (Vicryl)
3 forcep technique
Encircling or transfixing ligatures
What is the difference between an open and a closed castration?
OPEN - tunic and associated structures are incised an deach structure is ligated separately. vaginal tunic not repaired.
CLOSED - tunic not incised –> vessels, vas deferens and associated structure ligated at once, usually with 2 or 3 separate knots to prevent bleeding.
Advantages of closed and open castration are?
OPEN - may reduce post-op swelling and reduce the risk of ligature slippage
CLOSED - reduces risk of internal herniation
T/F: cat castrates are usually done as a clean rather than aseptic procedure.
True (open castration - two scrotal incisions)
Are ligatures regularly used for cat castrations?
No:
Vas deferens and spermatic vessels are knotted together
Overhand knot in spermatic cord
What is scrotal ablation?
Removal of scrotum as well as testes (relatively unusual)
When is scrotal ablation indicated?
Scrotal diseae (MCT or trauma( Improved cosmesis and reduced complications (bruising and swelling) in mature dogs Part of a scrotal/ perineal urethrostomy procedure When scrotum is used as a skin donor site.
What are the surgical approaches for cryptorchid castration?
Inguinal or caudal midline laparotomy
Where a places to look in a cryptorchid castration if you can’t find the testes?
Examine the gutter from the caudal pole of the kidney to the inguinal ring
Does vas deference enter the inguinal ring from the abdomen?
Complications of castration?
GENERAL SURGICAL - wound breakdown, infection, haemorrhage
SPECIFIC COMPLICATIONS - scrotal swelling, urethral injury, failure to locate retained testicle
OTHER SEQUELAE - weight gain, SMI, anaesthetic complications
What is the RCVS advice on castration?
RVNs aren’t allowed to perform dog/cat castration under Schedule 3 ammendment of Vet Surgeons Act as it involves a body cavity.
Use of prosthetic testicles deemed unethical by RCVS
