Ovariohysterectomy and Orchiectomy Flashcards
Gonadectomy
Removal of repro organs
- spay and neuter
Early spay/neuter
Gonadectomy performed prior to puberty
- 4-6 weeks of age in shelters
Castration
Excision of gonads
- both sexes
Neuter
To de-sex an animal
- both sexes
What are the 3 components of a spay?
- ovariohysterectomy: removal of ovaries and uterus
- ovariectomy: removal of ovaries
- hysterectomy: removal of uterus
What are 3 components of a neuter?
- orchiectomy: removal of one or both testicles
- castration
- cryptorchid: one or both testicles retained in abdomen/inguinal area
Indications for a spay/neuter
- population control
- prevention of repro diseases
- behavior modification
- decreased roaming
OHE - indications
- prevention of estrus, unwanted puppies/kittens, behavior modification
- termination of pregnancy
- treatment of uterine/ovarian dz (pyometra, neoplasia)
Decreased risk of mammary neoplasia in dogs
- before 1st heat: 0.05%
- after 1st heat: 8%
- after 2nd heat: 26%
- cats: 0.6% risk if spayed by 1 year
After _____, the risk of mammary cancer is no different than in intact dogs
2nd heat
Chance of malignant mammary tumors
- dogs: 50% of mammary tumors are malignant
- cats: 90% of mammary tumors are malignant
____ ovary is more cranial than the _____
Right; left
OHE - gutters
- kidneys
- ureters
- urinary bladder
Biologic retractors
- descending duodenum on the right side
- descending colon on the left side
OHE - caudoventral midline approach
Umbilicus to pubis - divide into thirds
- dogs: incise from middle of cranial third to middle of central third
- cats: incise the length of the central third
Canines have ____ ovarian pedicles and ____ uterine body
Short; long
Cats have ____ ovarian pedicles, and ____ uterine body
Long; short
OHE - long approach
Incise from umbilical scar to middle of central third (dogs)
- incisions heal from side to side, NOT end to end!
- less time, less tissue trauma working in well exposed abdomen
How to find uterine horn
- elevate abdominal wall
- run hook along abdominal wall, face hook toward body until epaxial muscles
- rotate hook 180 degrees toward midline
- gently pull up
- positive ID
Alternative uterine horn ID
Find and lift the bladder
- uterine body located between bladder and colon
If already spayed:
Use anatomic retractors to check gutters
- find ovarian pedicles –> immediately caudal to kidneys, check for ovarian remnants
- find uterine stump –> between bladder and colon
How to exteriorize ovary
Follow uterine horn to ovary
- mosquito on proper ligament –> caudal traction
- exteriorize ovary by disrupting suspensory ligament
- finger pluck to break ligament –> avoid ovarian A. and V.
Once ovary is exteriorized
- identify ovarian vessels in pedicle
- make a window in broad ligament adjacent to the vessel –> open hemostats parallel to vessel
- place 1st hemostate proximal on pedicle
- place 2nd hemostat just proximal to ovarian bursa
Place circumferential ligature just _____ the 1st hemostat
Proximal (under)
- remove hemostat as you tighten the ligature over the crushed tissue
- replace hemostat distally (toward ovary)
- place circumferential ligature proximal to hemostat –> transfixation ligature if fatty pedicle
How to transect the ovarian pedicle
Transect distal to (above) the hemostat with scapel blade, use hemostat as cutting board
- grasp edge of pedicle with thumb forceps, remove hemostat via controlled release
Tear the ______ to the uterine horn to the level of the cervix
Broad ligament parallel
Dropped pedicle
Extend incision cranially
- use anatomical retractors to inspect gutters
- lap sponges to clear bleeding
- find pedicle, elevate, clamp
Uterus - 3 clamp technique
For dogs only!!
- 1st hemostat: distal to cervix
- 2nd hemostat: 5 mm distal to 1st
- 3rd hemostat: farther distal to control back bleeding
Ligation of uterus
Circumferential ligature proximal to 1st hemostat –> remove hemostat while tightening
- transfixation ligature proximal to 2nd hemostat –> flash hemostat while tightening
- transect uterine body distal to 2nd hemostat
Alternative ligature
Modified Miller’s knot for fatty pedicles
Closure of the abdominal wall
- simple interrupted
- slowly absorbable monofilament suture (0, 2-0, 3-0, PDS, Maxon)
- holding layer: external rectus fascia
- suture lines fail at a knot
Closure of SQ fat
Simple continuous
- absorbable monofilament
- 3-0, 4-0 monocryl ro biosyn
Closure of skin
Intradermal/subcuticular pattern
- absorbable monofilament suture (3-0, 4-0 monocryl or biosyn)
- if needed: simple interrupted or cruciate pattern with nonabsorbable suture
Alternative approaches
- flank
- laparoscopic OHE or ovariectomy
- laparoscopic-assisted ovariohysterectomy
OHE - post op care
- monitor for hemorrhage
- exercise restriction for 2 weeks
- pain management
- check incision 2x/day
- cold pack incision for 3 days, then warm pack for 3 days
Potential intraop complications
- hemorrhage via dropped pedicle
- damage to other organs (urinary, GIT)
Potential postop complications
17%
- pain
- seroma
- hemorrhage
- incisional dehiscence
- infection
Other OHE complications
- recurrent heat cycle due to imcomplete removal of ovaries
- stump pyometra due to incomplete removal of ovary
- spay incontinence (estrogen)
Orchiectomy indications
- prevent breeding
- behavioral modification
- treatment of hormone responsive dz (benign prostate hyperplasia, perianal adenoma/hernia)
- testicular neoplasia
Prescrotal, closed approach
- does not open peritoneal cavity
- ligature may be more likely to slip (less likely w/ transfixation ligature)
Prescrotal, open approach
- more direct exposure of vascular cord
- opens peritoneum
- preferred for large dogs >40 kg
Perineal approach
Must be performed as an open approach
- doesn’t require repositioning when ventrally recumbent
Scrotal ablation
- pendulous scrotum
- scrotal dz
Scrotal approach
- juvenile castration
- done on mobile unit
Initial approach is the same for _______
Open and closed castration
- subcutaneously advance testicle cranially, pressure w/ non-dominant hand
Closed technique
- incise skin over testicle along median raphe
- incise subq tissues and spermatic fascia to reveal parietal vaginal tunic
- exteriorize testicle
- break down gubernaculum
- pull testicle up to exteriorize spermatic cord –> gauze to strip fat distally toward testicle
- double ligate spermatic cord with slow absorbable monofilament
3 clamp technique
2 hemostats proximal, 1 hemostat distal
- 1st hemostat: circumferential ligature
- transfixation ligature proximal to 2nd hemostat
Open technique
- incise parietal vaginal tunic, NOT visceral!
- exteriorize testicle
- separate ligament of tail of the epididymis
- digitally debride connective tissue from spermatic cord w/ moist gauze
- double ligate spermatic cord w/ circumferential ligatures
Orchiectomy closure - fascia
Simple interrupted, cruciate, or simple continuous
- slowly absorbable monofilament suture
- 2-0 or 3-0 PDS or Maxon
Orchiectomy closure - skin
Subcuticular pattern
- absorbable monofilament
- 3-0 or 4-0 monocryl or biosyn
Orchiectomy post op care
- pain management
- monitor hemorrhage
- cold pack incision for 3 days, warm pack for 3 days
- exercise restriction for 2 weeks
Orchiectomy potential complications
- pain
- incisional dehiscence
- infection
- hemorrhage: intraop (dropped cord), post op (slipped ligature)
Scrotal hematoma
- hemostasis
- cold pack 24-48 hrs
- warm pack next 48 hrs
- controlled exercise for 10-14 days
- if turgid, or continued, reoperate to find cord
Feline orchiectomy
Scrotal approach over each testicle
- pull testicle caudal to feel 2 pops of the cord
- ligate spermatic cord with overhand or open technique, suture ligature not needed
- incisions left open to drain, heal by 2nd intention (closed)
Feline orchiectomy open technique
- separate ductus deferens from spermatic vessels
- transect ductus deferens near testicle
- tie 2 square knots w/ vessels and DD
Cryptorchid castration
- palpate inguinal area under anesthesia
- incise over testicle if palpated
- caudal abdominal incision if intra-abdominal –> trace vas deferens to testicle, do NOT remove prostate!
Pain management
NSAID
- dogs: carprofen, meloxicam
- cats: robenacoxib
- opioid analgesic: buprenorphine, hydromorphone, oxymorphone, fentanyl patch
General anesthesia
- inhalant: isoflurane, sevoflurane
- injectable: can be unpredictable
Ovary-sparing spay in dogs
Removes uterus, leaves one or both ovaries
- must remove all of endometrial lining including cervix, stump pyometra
- decreases risk of neoplasia, but mammary neoplasia risk same as intact female, will still see heat cycles
