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SAMS > Ovariohysterectomy and Orchiectomy > Flashcards

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
Q

How to transect the ovarian pedicle

A

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
Q

Tear the ______ to the uterine horn to the level of the cervix

A

Broad ligament parallel

27
Q

Dropped pedicle

A

Extend incision cranially

  • use anatomical retractors to inspect gutters
  • lap sponges to clear bleeding
  • find pedicle, elevate, clamp
28
Q

Uterus - 3 clamp technique

A

For dogs only!!

  • 1st hemostat: distal to cervix
  • 2nd hemostat: 5 mm distal to 1st
  • 3rd hemostat: farther distal to control back bleeding
29
Q

Ligation of uterus

A

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
Q

Alternative ligature

A

Modified Miller’s knot for fatty pedicles

31
Q

Closure of the abdominal wall

A
  • 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
Q

Closure of SQ fat

A

Simple continuous

  • absorbable monofilament
  • 3-0, 4-0 monocryl ro biosyn
33
Q

Closure of skin

A

Intradermal/subcuticular pattern

  • absorbable monofilament suture (3-0, 4-0 monocryl or biosyn)
  • if needed: simple interrupted or cruciate pattern with nonabsorbable suture
34
Q

Alternative approaches

A
  • flank
  • laparoscopic OHE or ovariectomy
  • laparoscopic-assisted ovariohysterectomy
35
Q

OHE - post op care

A
  • 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
Q

Potential intraop complications

A
  • hemorrhage via dropped pedicle

- damage to other organs (urinary, GIT)

37
Q

Potential postop complications

A

17%

  • pain
  • seroma
  • hemorrhage
  • incisional dehiscence
  • infection
38
Q

Other OHE complications

A
  • recurrent heat cycle due to imcomplete removal of ovaries
  • stump pyometra due to incomplete removal of ovary
  • spay incontinence (estrogen)
39
Q

Orchiectomy indications

A
  • prevent breeding
  • behavioral modification
  • treatment of hormone responsive dz (benign prostate hyperplasia, perianal adenoma/hernia)
  • testicular neoplasia
40
Q

Prescrotal, closed approach

A
  • does not open peritoneal cavity

- ligature may be more likely to slip (less likely w/ transfixation ligature)

41
Q

Prescrotal, open approach

A
  • more direct exposure of vascular cord
  • opens peritoneum
  • preferred for large dogs >40 kg
42
Q

Perineal approach

A

Must be performed as an open approach

- doesn’t require repositioning when ventrally recumbent

43
Q

Scrotal ablation

A
  • pendulous scrotum

- scrotal dz

44
Q

Scrotal approach

A
  • juvenile castration

- done on mobile unit

45
Q

Initial approach is the same for _______

A

Open and closed castration

- subcutaneously advance testicle cranially, pressure w/ non-dominant hand

46
Q

Closed technique

A
  • 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
Q

3 clamp technique

A

2 hemostats proximal, 1 hemostat distal

  • 1st hemostat: circumferential ligature
  • transfixation ligature proximal to 2nd hemostat
48
Q

Open technique

A
  • 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
Q

Orchiectomy closure - fascia

A

Simple interrupted, cruciate, or simple continuous

  • slowly absorbable monofilament suture
  • 2-0 or 3-0 PDS or Maxon
50
Q

Orchiectomy closure - skin

A

Subcuticular pattern

  • absorbable monofilament
  • 3-0 or 4-0 monocryl or biosyn
51
Q

Orchiectomy post op care

A
  • pain management
  • monitor hemorrhage
  • cold pack incision for 3 days, warm pack for 3 days
  • exercise restriction for 2 weeks
52
Q

Orchiectomy potential complications

A
  • pain
  • incisional dehiscence
  • infection
  • hemorrhage: intraop (dropped cord), post op (slipped ligature)
53
Q

Scrotal hematoma

A
  • 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
Q

Feline orchiectomy

A

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
Q

Feline orchiectomy open technique

A
  • separate ductus deferens from spermatic vessels
  • transect ductus deferens near testicle
  • tie 2 square knots w/ vessels and DD
56
Q

Cryptorchid castration

A
  • 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
Q

Pain management

A

NSAID

  • dogs: carprofen, meloxicam
  • cats: robenacoxib
  • opioid analgesic: buprenorphine, hydromorphone, oxymorphone, fentanyl patch
58
Q

General anesthesia

A
  • inhalant: isoflurane, sevoflurane

- injectable: can be unpredictable

59
Q

Ovary-sparing spay in dogs

A

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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