Common Surgical Procedures of the Reproductive Tract in Small Animals

Question 1

What is an ovariohysterectomy? Routes of access?

Answer 1

Removal of ovaries and uterus
Usually performed via ventral midline incision
Can also be performed via flank incision (cat)

Question 2

What are the indications for an OVH?

Answer 2

Elective sterilisation
Pyometra
Ovarian cysts
Hydrometra/mucometra
Uterine torsion/prolapse/rupture
Neoplasia
Metritis
Improved control of diabetes mellitus/epilepsy

Question 3

How can you located the uterus and ovaries via the midline approach?

Answer 3

Uterus = push intestines cranially and bladder caudally
Ovaries = follow uterine horns

Question 4

How do you release the ovaries during an OVH?

Answer 4

Break down suspensory ligament

Create window in mesovarium

Question 5

Describe pedicle clamping during an OVH…

Answer 5

Haemostat using 3 forcep technique
Most proximal forcep removed leaving crush mark
Crush mark makes it easier to ligate

Question 6

Describe ovarian ligature during an OVH…

Answer 6

Ligate using synthetic absorbable material e.g. vicryl
Leave 0.5cm between ligature and cute edge
Divide between two remaining clamps making sure whole ovary removed

Question 7

Describe broad ligament ligature during OVH? When is it particularly important?

Answer 7

Ligature using synthetic absorbable material in larger and mature bitches
May not be necessary in immature/small dogs and cats
Particularly important during pyometra, pregnancy, fat due to presence of many vessels

Question 8

Describe cervical ligatures….

Answer 8

Ligate using synthetic absorbable material e.g. vicryl
Use 3 forcep technique
- Encircling ligature
- Transfixing ligature

Question 9

Checking pedicles….

1. Right ovarian pedicle
2. Left ovarian pedicle
3. Right broad ligament pedicle
4. Left broad ligament pedicle
5. Cervical pedicle

Answer 9

1. Elevate descending duodenum
2. Elevate descending colon
3. Elevate descending duodenum/move SI to left
4. Elevate descending colon
5. Elevate bladder and reflect caudally

Question 10

Complications associated with OVH?

Answer 10

Haemorrhage
Wound breakdown
Wound infection
Retained swabs
Uretral injury
Retained ovarian remnant
Urinary incontinence
Anaesthesia

Question 11

Surgical variations of OVH?

Answer 11

1. Flank spay
   - Seen in cats
2. Ovariectomy
   - More logical for routine sterilisation
3. Laparoscopic technique
   - Use vessel sealing device

Question 12

Indications for caesarean section?

Answer 12

Fetal distress
Dystocia due to:
- Primary uterine inertia
- Secondary uterine inertia
- Oversized foetus
- Anatomical abnormalities
- Foetal monstrosity
- Foetal death

Question 13

Preoperative consideration for small animal caesarian sections…

Answer 13

Electrolytes and other metabolic abnormalities

Owners should be advised on risks to dam and neonate

Question 14

Anaesthetic considerations with caesarean section…

Answer 14

Regurgitation and aspiration
CVRS compromise
Depression of neonates
Use of good analgesia
- Local block
Minimise surgery time

Question 15

How would you carry out a caesarean section?

Answer 15

1. Midline approach
2. Exteriorise uterus
3. Single incision into uterine body and milk foetuses down one by one
4. Clamp umbilical cord
5. Only remove placentas if come freely
6. Uterine repair
   - Monocyrl
   - Simple appositional

Question 16

Care of neonates following caesarean section?

Answer 16

Dry and warm
Suction airways
Check for congenital abnormalities

Question 17

Complications of caesarean section in small animals?

Answer 17

General surgical complications
Foetus all removed
Post parturient problems
- Haemorrhage
- Retained placentas
- Acute metritis
- Subinvolution 
- Rupture and prolapse of uterus
- Milk production issues

Question 18

Indications for castration…

Answer 18

Population control
Behaviour
Testicular neoplasia
Cryptorchidism
Testicular torsion
Anal adenoma
Perineal rupture
Prostatic disease
Repair inguinal/scrotal hernia

Question 19

How do you carry out an open castration?

Answer 19

Ligate using synthetic absorbable material

• Vicryl
• 3 forcep technique
• Encircling or transfixing ligatures

Question 20

What is the difference between open and closed castrations?

Answer 20

Open
Vaginal tunic cut and not repaired

Closed
Vaginal tunic left intact

Pros and cos:

• Closed reduced risk of intestinal herniation
• Open castration may reduced post-op swelling and reduce the risk of ligature slippage

Question 21

What is open castration?

Answer 21

Vaginal tunic cut and not repaired

Question 22

What is closed castration?

Answer 22

Vaginal tunic left intact

Question 23

Describe castration in a cat…

Answer 23

Clear rather than aseptic procedure
Open castration
2 scrotal incisions
Ligatures rarely used
- Vas deferns and spermatic vessels knotted together

Question 24

What is scrota ablation?

Answer 24

Removal of scrotum as well as testes

Question 25

When is scrotal ablation indicated?

Answer 25

Scrotal disease e.g. MCT or trauma
Improved comesis and decreased complications in older dogs
Scrotum can be used as skin donor site

Question 26

How would you carry out a cyptorchid castration?

Answer 26

Determine where testicle is
- US/CE
Surgical approaches
- Inguinal
- Caudal midline laparotomy
- Dependent on location of testicle
Excise using haemostasis
Consider submitting for pathology

Question 27

Complications associated with castration in small animals…

Answer 27

General surgical complications

Specifics:
Scrotal swelling
Urethral injury
Failure to locate retained testicle

Other:
Weight gain
Urinary incontinence
Anaesthetic complications