Small Animal - Surgery Flashcards
What is the aim of an ovariohysterectomy?
Safely remove ovaries and uterus
What is an ovariohysterectomy usually performed via?
Ventral midline incision
What is more common approach to an ovariohysterectomy in cats?
Flank incision
What are the indications for an ovariohysterectomy?
Elective sterilisation Pyometra Ovarian cysts Hydrometra/mucometra Uterine torsion/uterine proplapse Uterine rupture Ovarian/uterine neoplasia Metritis Improved control of diabetes mellitus
What is the NRCW classification of an ovariohysterectomy?
Clean/contaminated
How do you locate the uterus in an ovariohysterectomy?
Push intestines cranially and bladder caudally
How are the ovaries located in an ovariohysterectomy?
Follow uterine horns
How can the ovaries be released in an ovariohysterectomy?
Breaking down the suspensory ligament - cutting more controlled than tearing, do close to the kidney
What should be done after breaking down the suspensory ligament?
Create a window in the mesovarium
What method of haemostasis should be used in an ovariohysterectomy?
Three forcep technique
Remove most proximal forcep to leave crush mark
What material should be used as a ligature in an ovariohysterectomy?
Synthetic absorbable material - vicryl ideal, one/two/instrument tie, encircling ligature/figure of eight
What must the ovarian ligature be in an ovariohysterectomy?
Tight
Where do you make the final cut to remove the ovary in an ovariohysterectomy?
Between two remaining clamps
Make sure whole ovary removed
What material should be used to ligate the broad ligament?
Synthetic absorbable material in nearly all cases - vicryl ideal
When shouldn’t you use synthetic absorbale material to ligate the broad ligament?
Very immature or small dogs and cats
What material should be used for the cervical ligature?
Synthetic absorbable material - vicryl ideal
What technique should be used for the cervical ligature?
Three forcep technique
What animals do you need to take care in when ligating the cervix?
Cats in season - tissue becomes very friable and can just break down when clamped, test further up to ensure that the forcep technique is good to use
How do you check the right ovarian pedicle and the right broad ligament pedicle?
Elevate descending duodenum
How do you check the left ovarian pedicle and the left broad ligament pedicle?
Elevate descending colon
How do you check the cervical pedicle?
Elevate bladder and reflect caudally
What are the major steps in performing an ovariohysterectomy?
Ventral midline incision Locate uterus Locate ovaries Release ovaries Clamp pedicles Ligate ovarian artery Ligate broad ligament Ligate cervix Remove Check pedicles
What are some complications that can occur during an ovariohysterectomy?
General complications - wound breakdown, wound infection, haemorrhage, retained swab
Specific complications - ureteral injury, retained ovarian remnant
Other sequelae - urinary incontinence, weight gain, anaesthetic complications
What are the three surgical variations to a ventral midline ovariohysterectomy?
Flank spay
Ovariectomy
Laparoscopic techniques
What should the decision to perform a caesarean section be based on?
Interests of - dam, unborn foetuses and owner
What are the indications for caesarean sections?
Foetal distress
Dystocia - primary uterine inertia, incomplete primary uterine inertia, secondary uterine inertia, relative/absolute foetal oversize, anatomical abnormality of pelvic canal, foetal monstrosity, uncorrectable foetal malpresentation, foetal death, previous caesarean section
What are the preoperative considerations for a caesarean section?
Electrolyte and other metabolic abnormalities
Foetal death increases significantly after 5 hours of labour onset
Advise owners about surgical risk to dam and neonates
Variable NRCW classification
What anaesthesia considerations are there for caesarean sections?
Regurgitation Aspiration CV compromise Respiratory compromise Depression of neonates Good analgesia for dam - local block, epidural post procedure, avoid alpha 2 agonists, ketamine and thiobarbiturates Minimise time taken to remove foetuses
What is the main approach for a caesarean section?
Midline approach
What are the main steps in a caesarean section?
Midline incision Exteriorise uterus Cut into uterus Gently squeeze to move foetus down uterine horn Clamp umbilical cord Only remove placentas if come freely Repair uterus Close wound
What material and pattern should be used for uterine repair?
Synthetic absorbable material - monocryl ideal
Simple appositional/inverting pattern - single or double layer
Describe care of neonates after a caesarean section
Ensure plenty of help available
Facilities to - dry and warm pups/kits, suction airways
Consider drug administration to aid resuscitation
Check for congenital abnormalities
Ensure dam recovers
Ensure dam looks after young
What are the potential complications with a caesarean section?
General surgical complications
Not all foetuses removed
Possible post-parturient problems - uterine haemorrhage, retained placenta/foetuses, acute metritis, subinvolution of placental sites, uterine rupture, uterine prolapse, toxic milk syndrome, agalactia, galactostasis, acute mastitis, puerperal tetany, disturbed maternal behaviour
What is a safe and effective alternative to a caesarean section?
En bloc ovariohysterectomy
What is the major disadvantage to an en bloc ovariohysterectomy?
All neonates need resuscitating at once
What are the advantages to an en bloc ovariohysterectomy?
Minimised anaesthesia time for dam
Minimal peritoneal contamination
Effective population control
No need for second surgery
What is an en bloc ovariohysterectomy?
Hysterectomy performed prior to hysterotomy and removal of neonates
What is the aim of castration?
Safely remove testes
What is castration usually performed via?
Single pre-scrotal incision in the dog
Paired scrotal incisions in the cat
What are the indications for castration?
Population control Behavioural modification Testicular neoplasia Cryptorchidism Testicular torsion Orchitis/epididymitis Testicular trauma Anal adenoma Perineal rupture Prostatic disease Repair inguinal/scrotal hernia
What is the NRCW classification of castration in the dog?
Clean
What are the two techniques for castration in the dog?
Open
Closed
What material is used for ligation in castration of the dog?
Synthetic absorbable material - vicryl ideal
What are the main stages of the open castration technique in the dog?
Incision Cut into vaginal tunic Remove testes Digitally separate the ligament 3 forceps applied Ligature applied Remove testicle Close incision
What is the difference between open castration and closed castration?
Open - vaginal tunic cut, not repaired
Closed - vaginal tunic left intact
What are the benefits of open and closed castration?
Open - reduce post operative swelling, reduce risk of ligature slipping
Closed - reduces risk of intestinal herniation
Describe castration in the cat
Clean rather than aseptic procedure Open castration Two scrotal incisions Ligatures rarely used Vas deferens and spermatic vessels knotted together Overhand knot in spermatic cord
What is scrotal ablation?
Removal of scrotum as well as testes
When is scrotal ablation indicated?
Scrotal disease Improved cosmesis Reduced complications in mature dogs Scrotal/perineal urethrostomy procedure Scrotum used as a skin donor site
What must be determined with cryptorchid castration?
Where testicle is
What are the two approaches to a cryptorchid castration?
Inguinal
Caudal midline laparotomy
What is cryptorchid castration usually combined with?
Scrotal testicle removal
What are the complications with castrations?
General surgical complications - wound breakdown, wound infection, haemorrhage
Specific complications - scrotal swelling, urethral injury, failure to locate retained testicle
Other sequelae - weight gain, urinary incontinence, anaesthetic complications
