Repro Surgical Procedures SA Flashcards
How is OVH usually performed (incision)?
- ventral midline
- flank in cats
What is the NRCW classification of OVH?
- clean contaminated as entering a viscus
How can the uterus and ovaries be located following vetnral midline incision?
- push intestines cranially and bladder caudally (uterus)
- follow uterine horns to ovaries
How are the ovaries released?
- Break the suspensory ligament - cutting more controlled than tearing, incise near kidney
- Create a window in the mesovarium AWAY from the overian a. and v. (ovarian a. arises from aorta)
How should the pedicle be clamped once the suspensory ligament has been transected?
- 3 forcep technique
- remove forcep most proximal to stump and tie a ligature here, then incise between remaining forceps
Which suture matierla should be used for the ovarian ligature? Knot?
- Vicryl (Polygalactin 910)
- Encircling ligature/figure of 8
How can risk of slippage of ovarian ligature be reduced?
Leave 0.5cm gap between cut edge
What is the 2nd ligament that must be ligated after transecting between the two clamps? Why is this ligated not transected? What suture material should be used?
Broad ligament
- contains small vessels
- synthetic absorbable suture
- Vicryl (Polyglactin 910)
What must be ligated following incision of the broad ligament? Suture material? Method? Ligature?
- cervix
- Vicryl (Polyglactin 910)
- 3 forcep technique
- encircling, transfixing or stick ties may be used
What should be checked for before clamping the cervix?
Cat is not in season - uterus becomes v. friable and will not be suturable! Will break down.
Which flank is entered for a cat spay?
Left
Which cats should not be spayed via the flank?
Oriental - hair will grow back dark and owner will not be happy
How can the ovarian pedicles be loacted once the OVH is compelte?
- right ovarian: elevate descending duodenum
- right broad: elevate desceding duodenum and move SI to the left [more difficult to find]
- left ovarian: elevate descending colon
- left broad: elevate descending colon
- cervical pedicle: elevate bladder and reflect caudally
Outline potential complications of OVH
>general surgical complications - wound dehiscence - infection - haemorrhage - retained swab - anaesthesia risks >specific - urethral injury (eg. urethra included in cervical ligature) - retained ovarian remnant > other sequalea - SMI incontinence - weight gain
When may OHE be indicated?
- more logical for steralisation alone
- not appropriate for management of uterine disease
Indications for C section
> fetal distress [more humans] > dystocia due to - 1* uterine inertia (gestation >70d) - Incomplete 1* uterine inertia refractory to medical managmeent - 2* uterine inertia (exhaustion) - fetal oversize - anatomical abnormality of maternal pelvic canal - malpresentation - foetal death -previous C sec
Pre-op considerations before C sec?
- electrolyte and other metabolic abnormlaities eg. hypoglycamia
- foetal death ^ significantly after 5 hours since onset of 2nd stage labour
- advise owners of risks of Sx
What is a C sec classified as according to NRCW?
- clean/contaminated
- dirty
C sec specific anaesthetic considerations?
- depression of neonates
- local block and epidrual for dam
- AVOID a2-ags, ketamine and thiobarbiturates
- minimise time taken to remove foetuses
Outline C- sec sx
- midline incision (careful of foetuses!!)
- exteriorise uterus
- milk babies out (dont force)
- clamp umbilical cord
- repair uterus with monocryl (poliglecaprone 25)
- simple apositional/inverting pattern, single or double layer
Main aspects of neonate care?
- dry and warm
- clear airways (suction)
- check congential abnormalties
- make sure dam ok and looking after young
Potential complications of c-sec?
- general Sx
- make sure ALL FOETUSES removed - check pelvic canal vaginal exam
- post-parturient probs (uterine haemorrhage, retained placenta/foetuses, acute metritis, subinvolution of placental sites, uterine rupture or prolapse, toxic milk syndrome, agalactia, galactostasis, acute mastitis, puerperal tetany, disturbed maternal behaviour)
What is an alternative method to c-sec?
> En Bloc
- OVH then remove neonates all at once
- survival comparable to normal
- disadvantage all neonates need rescuss at once
- minimises anaesthesia time and peritoneal contamination, no need for 2* Sx for population control
How is castration performed in the dog and cat?
- single pre-scrotal incision in the dog
- paired scrotal incisions in the cat
What is the NRCW classification of castration?
clean
Outline the open castration technique
- push testcle cranially and make incision in vaginal tubic over this to protect penis
- remove testicle
- ligate artery and spermatic cord using 3 forcep technique and Vicryl (ployglactin 910)
- encircling or transfixing ligature
What are the advantages of open castration
- clear view of spermatic cord
- decreased post op swelling and risk of ligature slippage
What are the advantages of closed castration?
v risk intestinal herniation
How does cat castration differ from dog?
- Performed as clean not aseptic procedure
- ligatures rrely used
- vas deferens and spermatic vessels knotted together
- or overhand knot in spermatic cord
What is scrotal ablation? When is it indicated?
- removal of scrotum as well as testes
- scrotal disease eg. MCT or trauma
- improved cosmesis, v complications in mature dogs
- part of scrotal/perineal urethrostomy
- scrotal skin donor
How may lost cryptorchid testicles be located?
ultrasound (often hidden my inguinal fat pads and hypoplasia)
What surgical approaches may be used to remove cryptorchid testicles?
- inguinal
- caudal midline laparotomy
> trace gutter from caudal kidney pole to inguinal ring
What shuold be considered after removing a cryptorchid testicle?
submitting for pathology
removing scrotal testicle (standard procedure but make sure you have owner consent!!)
Potential complications of castration
- general Sx
- scrotal swelling
- urethral injury
- failure to locatte retained testicle
- weight gain
- SMI
- anaesthesia complications
Are vet nurses allowed to perform castration?
no
Is use of prosthetic testicles ethical?
no according to RCVS
