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Ovariohysterectomy and Orchiectomy Flashcards

1
Q

Gonadectomy

A

Removal of repro organs

- spay and neuter

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2
Q

Early spay/neuter

A

Gonadectomy performed prior to puberty

- 4-6 weeks of age in shelters

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3
Q

Castration

A

Excision of gonads

- both sexes

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4
Q

Neuter

A

To de-sex an animal

- both sexes

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5
Q

What are the 3 components of a spay?

A
  • ovariohysterectomy: removal of ovaries and uterus
  • ovariectomy: removal of ovaries
  • hysterectomy: removal of uterus
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6
Q

What are 3 components of a neuter?

A
  • orchiectomy: removal of one or both testicles
  • castration
  • cryptorchid: one or both testicles retained in abdomen/inguinal area
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7
Q

Indications for a spay/neuter

A
  • population control
  • prevention of repro diseases
  • behavior modification
  • decreased roaming
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8
Q

OHE - indications

A
  • prevention of estrus, unwanted puppies/kittens, behavior modification
  • termination of pregnancy
  • treatment of uterine/ovarian dz (pyometra, neoplasia)
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9
Q

Decreased risk of mammary neoplasia in dogs

A
  • before 1st heat: 0.05%
  • after 1st heat: 8%
  • after 2nd heat: 26%
  • cats: 0.6% risk if spayed by 1 year
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10
Q

After _____, the risk of mammary cancer is no different than in intact dogs

A

2nd heat

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11
Q

Chance of malignant mammary tumors

A
  • dogs: 50% of mammary tumors are malignant

- cats: 90% of mammary tumors are malignant

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12
Q

____ ovary is more cranial than the _____

A

Right; left

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13
Q

OHE - gutters

A
  • kidneys
  • ureters
  • urinary bladder
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14
Q

Biologic retractors

A
  • descending duodenum on the right side

- descending colon on the left side

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15
Q

OHE - caudoventral midline approach

A

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
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16
Q

Canines have ____ ovarian pedicles and ____ uterine body

A

Short; long

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17
Q

Cats have ____ ovarian pedicles, and ____ uterine body

A

Long; short

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18
Q

OHE - long approach

A

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
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19
Q

How to find uterine horn

A
  • 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
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20
Q

Alternative uterine horn ID

A

Find and lift the bladder

- uterine body located between bladder and colon

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21
Q

If already spayed:

A

Use anatomic retractors to check gutters

  • find ovarian pedicles –> immediately caudal to kidneys, check for ovarian remnants
  • find uterine stump –> between bladder and colon
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22
Q

How to exteriorize ovary

A

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.
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23
Q

Once ovary is exteriorized

A
  • 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
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24
Q

Place circumferential ligature just _____ the 1st hemostat

A

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
25
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
26
Tear the ______ to the uterine horn to the level of the cervix
Broad ligament parallel
27
Dropped pedicle
Extend incision cranially - use anatomical retractors to inspect gutters - lap sponges to clear bleeding - find pedicle, elevate, clamp
28
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
29
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
30
Alternative ligature
Modified Miller's knot for fatty pedicles
31
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
32
Closure of SQ fat
Simple continuous - absorbable monofilament - 3-0, 4-0 monocryl ro biosyn
33
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
34
Alternative approaches
- flank - laparoscopic OHE or ovariectomy - laparoscopic-assisted ovariohysterectomy
35
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
36
Potential intraop complications
- hemorrhage via dropped pedicle | - damage to other organs (urinary, GIT)
37
Potential postop complications
17% - pain - seroma - hemorrhage - incisional dehiscence - infection
38
Other OHE complications
- recurrent heat cycle due to imcomplete removal of ovaries - stump pyometra due to incomplete removal of ovary - spay incontinence (estrogen)
39
Orchiectomy indications
- prevent breeding - behavioral modification - treatment of hormone responsive dz (benign prostate hyperplasia, perianal adenoma/hernia) - testicular neoplasia
40
Prescrotal, closed approach
- does not open peritoneal cavity | - ligature may be more likely to slip (less likely w/ transfixation ligature)
41
Prescrotal, open approach
- more direct exposure of vascular cord - opens peritoneum - preferred for large dogs >40 kg
42
Perineal approach
Must be performed as an open approach | - doesn't require repositioning when ventrally recumbent
43
Scrotal ablation
- pendulous scrotum | - scrotal dz
44
Scrotal approach
- juvenile castration | - done on mobile unit
45
Initial approach is the same for _______
Open and closed castration | - subcutaneously advance testicle cranially, pressure w/ non-dominant hand
46
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
47
3 clamp technique
2 hemostats proximal, 1 hemostat distal - 1st hemostat: circumferential ligature - transfixation ligature proximal to 2nd hemostat
48
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
49
Orchiectomy closure - fascia
Simple interrupted, cruciate, or simple continuous - slowly absorbable monofilament suture - 2-0 or 3-0 PDS or Maxon
50
Orchiectomy closure - skin
Subcuticular pattern - absorbable monofilament - 3-0 or 4-0 monocryl or biosyn
51
Orchiectomy post op care
- pain management - monitor hemorrhage - cold pack incision for 3 days, warm pack for 3 days - exercise restriction for 2 weeks
52
Orchiectomy potential complications
- pain - incisional dehiscence - infection - hemorrhage: intraop (dropped cord), post op (slipped ligature)
53
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
54
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)
55
Feline orchiectomy open technique
- separate ductus deferens from spermatic vessels - transect ductus deferens near testicle - tie 2 square knots w/ vessels and DD
56
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!
57
Pain management
NSAID - dogs: carprofen, meloxicam - cats: robenacoxib - opioid analgesic: buprenorphine, hydromorphone, oxymorphone, fentanyl patch
58
General anesthesia
- inhalant: isoflurane, sevoflurane | - injectable: can be unpredictable
59
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

SAMS (13 decks)

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