Rabbit Surgery Flashcards
Halstead’s Principles?
- Gentle tissue handling
- Meticulous haemostasis
- Preservation of blood supply
- Strict aseptic technique
- Tension free closure
- Accurate apposition of tissues
- Eliminate dead space
Pre-Op Considerations?
blood and urine sampling
thoracic radiographs (abdo calculi & pulm uterine adenoC ?)
- Stabilisation (no fasting)
- Hypothermia (min fur removal, limit use fo alcohol-based products)
What is the blood volume of a rabbits?
55-65ml/kg
10% loss safe
Above 15-20% = hypovol
Fluid therapy?
- Marginal ear vein IV
- IO, s/C
Surgical kit for rabbits?
- Iris scissors
- Metzenbaum scissors
- Debakey atraumatic forceps - cautery
- sterile cotton buds
- Crile and halstead forceps
What to use or not use in rabbit surgery?
Don’t use powdered gloves reduces adhesions
DO use flush & swabs
What suture materials to use?
- 4-0, 3-0 (larger rabbit)
- Absorbable synthetic (PDS, vicryl, monocryl)
- Avoid catgut
- Tissue glue may be enough for skin
Clipping fur ?
- Thin skin, easily injured
- Dense fur
- Well maintained clipper blades
- Clip slowly
- Spread skin
- Flat surface of blade parallel
- Avoid damaging skin
- Only what is needed
CARE as skin tears easily
Detail skin prep?
- Gentle scrub
- Chlorehex / spirit
what species differences of skin?
- Easy to create unwanted dead space
- Prone to granulation tissue formation
- Rapid healing
TOP TIPS ?
- Well maintained clippers with sharp blades & small teeth & care to minimise trauma
- Wavoid excess scrubbing
- keep alcohol to minimum
Describe Adhesions in Rabbits
pain & inappetance
- Minimise tissue handling
- Meticulous haemostasis
- Keep tissue moist
- Minimise surgical time
- Appropriate suture material
Tx for adhesions?
Mild cases analgesia
Severe may require revision surgery
Describe abscessation as post-op complication?
PUS is thick, infections difficult to manage
CLs: redness, heat pus, swelling
TX: debride , swab? delayed closure or secondary intention healing
Post-op complications- wound breakdown?
- Meticulous surgical technique
- Minimally reactive sutures
- Appropriate closure
- Analgesia
- Avoid buster collar -> t shirt better
Post-op complications : gut stasis.
- Inappetance/ gut stasis
potentially fatal
CLS: anorexian reduced fecal output, depressio,
TX for Gut stasis?
- IVFT
- analgesia
- Prokinetics - metoclopramide
- Anti-ulcer therapy - ranitidine
- Avoid buster collar (caecotrophy)
- Nursing & monitor
- Minimal stress
INdications for OVH?
- Prevent unwanted pregnancies
- Avoid hormonal territorial bhvr
- AdenoCs
when should we do OVH?
5-9 months
describe anatomical consideration of OVH?
- Bixornuate duplex uterus.- 2 uterine horns into 2 distinct cervices
- Lots of fat encasing ovary (mesovarium) in the mesometrium
- Long fallopian tubes, convoluted and friable
- Ovaries small, elongated pale
Step 1 OVH?
- Ventral midline incision (halfway between umbilicus and pubic symphysis or between caudal nipples)
- Tent linea alba away 2-3cm long
Step 2 OVH?
- Exteriorise cervix
- Follow the horn - follow along to exteriorise ovary (encased in fat) & identify blood supply
- Make your window (tear)
Step 3 OVH?
- Place one/two clamps beneath ovary & fat pad
- Small window in mesovarium
- Ligate artery in the body of fat
STEP 4?
Incise between clamps to release ovary
Surgical technique difference?
- Vessel in broad ligament which needs ligating
- Uterine artery passes along horn and meets with ovarian artery
- Make small hole in mesometrium in avascular area and ligate ovarian and uterine artery together in one
STEP 5?
- Ligate just caudal to the cervices (far cranial vagina): transfixing or encircling -> ligate more distally risks damage to ureters, bladder vasc & urine leakage
- Transect and remove uterus & ovaries
STEP 6?
Check stump for bleeding
Closure?
- Routine abdo closure (scs linea alba, intradermal if poss or skin suture)
- AVOID TENSION
- 3-0 or 4-0 synthetic absorbable
Post op care?
- ABs not necessary if no complications
- Analgesia (NSAID & Opioid)
- +/- prokinetics
- Nutritional support (syringe feeding asap, monitor eating & faecal output)
OVH: Complications?
Hemorrhage
- Leakage of urine into the abdomen
- Granuloma/adhesion
- Fat necrosis
- WOund interference
- Gut stasis
top tips for OVH?
- Ligate at level of cervix
- Intradermal skin closure with tissue glue
- Small suture material
- Small suture material
- Careful tissue handling
- EXcellent post op care
Why do orchiectomy?
- Hormone-related aggression
- Unwanted litters
- Reduce unwanted sexual bhvr or sexual frustration
- Testicular neoplasia
- Testicular torsion
When to do Orchiectomy?
- Once testes decend from around 10 weeks (usually from 5 months)
- It is not always necessary to neuter male rabbits (less health benefits as neoplasia and torsion rare)
Castration anatomy?
- Cremaster muscle well developed and readily retract testicles (pressure on inguinal region to get out)
- Inguinal ring is open and prone to herniation (always closed castration or close tunic)
- Tunica vaginalis firmly attacked to scrotal skin (section attachment with scissors if needed)
Describe the modified open tachnique? (part 1)
Gently incise scrotal sac and vaginal tunic
* Gentle pressure to extrude testicle
* Incise the tunic
* Release the attachment between the scrotal skin and tunica vaginalis to
improve exteriorisation
* Break down ligament of the head of
* epididymis
Describe modified open tech (part 2)
- Place two clamps over cord
- Place two encircling ligatures
- Cut between clamps to remove testicles
Modified open to closed (Part 3)
- Release cord into tunic
- Excise some proximal
- Liagte tunica vaginalis
- Repeat for other testicle
Closed Castrate technique? (pt 1)
- Incise over scrotal sac
- Strip away vaginal tunic from scrotal skin
- Break down ligament at caudal tip of testicles
Pt 2 closed castrate?
- Place 2 clamps on spermatic cord
- One encircling and one transfixing
cranial to clamp - Incise between clamps
- Check stump for bleeding
- Repeat for other testicle
CLOSURE of closed castrate?
- SKin edges can be opposed (SI suture) or glued
- Continue to separate from female for minimum of 6 weeks
- Sperm can be stored and survive
post op care castrate ?
- As for OVH
- Continue to separate from female for minimum of 6 weeks
- Sperm can be stored and survive
Closed?
- Closed is simple
- Tends to be more painful
- Higher risk of bleeding from slipped ligatures
- Less chance of herniation
open to closed?
- Tend to be same time in length
- Less chance of bleeding
- Inguinal herniation is rare in rabbits
- Easy to accidentally open tunic upon opening
Cryptorchid what to do ?
- Even if testicle is abdominal, you can often find caudal end of tunica vaginalis in
inguinal canal and gently pull it into inguinal region
Describe facial (SC) abscesses in rabbits?
Underlying dental disease
* Must radiograph
* Extract affected teeth if possible
* Curette infected bone
* Abnormal suppurative reaction ➔thick caseous pus
* Fibrous capsule
* Culture capsule/not pus
* Location can affect prognosis
* Care with antibiotic-associated diarrhoea
aim of rabbit abscess?
remove in entirety without breaching capsule
Surgical technique for rabbit abscess?
- Surgical excision in total id poss
- Exploration and removal of infected tissue (flush and pack)
- Marsupialisation - location or size means surgical removal not poss
ABS
Abscess removal steps?
- Make skin incision.
- Blunt dissect skin away from abscess capsule taking care not to penetrate.
- Vessels ligated/ cauterised.
- Skin closed
- Rarely achievable near oral cavity
Describe Marsupialisation?
- Open abscess capsule and suture to surrounding skin
- Topical antibacterial preparation is applied which is non toxic if ingested
e.g. Manuka honey - Clean with chlorhexidine regularly before applying preparation
- Can suture hydrocolloid dressing which can draw pus away whilst
protecting wound (Remove in 3-5 days)
Complications of SC Abscess ?
- Jaw fracture
- Acquired malocclusion
- Recurrence or failure to resolve
TOP TIPS for abscesses?
- Always palpate mandible and maxilla to check for abscesses
- Always radiograph – include oblique views
- Remove surgically in total where possible
- Remove affected teeth/alveolar bone
- Always culture (capsule not pus)
Why do we get uroliths & sludge?
- Unique calcium metabolism and high levels of calcium excretion compared to
other species - Overweight animals with reduced exercise levels and low water intake are predisposed
How do we remove uroliths and sludge?
- If urethral obstruction attempt to catheterise and flush into bladder and remove via cystotomy
- If in bladder remove by cystotomy
- If in kidney - don’t remove poor rates
Cystotomy technique? (Pt 1?)
Midline incision from umbilicus to pelvis.
* Care not to incise bladder when cutting linea alba
* Exteriorise Bladder.
* Moistened laparotomy swabs are packed around the bladder.
* Stay sutures cranial and caudal to planned incision avoiding blood vessels.
* Incision in an avascular area on ventral surface.
Cystotomy pt 2?
- Stones may be embedded in bladder wall or may accumulate at bladder neck where
they can be easily missed. - Catheter placed through the bladder into urethra to help flush
- further calculi out and ensure free flow
Csytotomy pt 3?
- Flush bladder
- Closed using one or 2 layer closure, inverting suture pattern
- TOP TIPS
- Try to avoid suture penetrating full thickness as it can act as a nidus for stone
formation. - Can inject saline into bladder to leak test it
- Biopsy of the bladder wall can be taken for culture
- Routine closure of laparotomy wound.
How to diagnose gastric distention?
Abdo palp , CLS, onset of lethargy/weakness/bloating
Radiography of gas distended stomach
Management of gastric distention?
- Provide analgesia
- After radiography need to decide
FB?
- Intestinal surgery difficult in rabbit as intestines so thin
- Gastrotomy is possible
- At ex lap can try and move foreign body to stomach or ileo-colic valve
Causes of Obstruction?
- Trichobezoars-pellets of impacted hair
- Adhesions secondary to previous surgery
- Ingestion of other foreign material e.g. carpet
Post op Care?
- Fluids
- ANalgesia
- Prokinetics
- Syringe feeding
- Pg guarded
