Surgeries of Repro Tract in SA Flashcards
1
Q
Ovariohysterectomy
A
- common procedure done in SA practice
- remove the overies and uterus SAFELY (key)
- normally via ventral midline incision
- but flank incision can be common in the UK for routine neutering of the cat
- not the most logical procedure for the elective sterilisation of SAs
2
Q
Ovariohysterectomy - midline approach
A
- classify as clean surgery, but can sometimes be considered clean-contaminated if for instance, its chosen to excise the uterus at the level of the caudal cervix or cranial vagina
how is it done?
- make a ventral midline incision
- easiest way to locate uterus is to push the bladder and intestines, separate them and then find uterus (either uterine body or maybe horns)
- follow uterine horn cranially to get to an ovary
- generally R hand surgeons (most) tend to stand on R hand side of animal
- the left ovary tends to be easier to exteriorize (and therefore easiest to start with), left is located slightly more caudal than the right due to kidney placement. the left kidney is slightly more caudal than the right (normal anatomical fact)
- The ovaries are attached to the dorsal body wall via the suspensory ligament
- suspensory ligament is quite white and feels quite taut
- shelter medicine rotations and EMS will allow a lot of observation for these hopefully
3
Q
Ovariohysterectomy - Ovarian release
A
- (in the dog in particular) it makes it easier to exteriorize the ovary if the suspensory ligament is broken down
- this is why you see vets breaking this blindly (pulling on it and breaking), but it is a much better controlled method to cut suspensory ligament than to tear it apart (can see vessels and ligament - want to cut the very white bit)
- NOTE: to be able to cut though, you want to be able to see what you are doing (never stick in scissors and cut blindly!)
- create a window in the mesovarium - choose a relatively avascular part of the mesovarium (easy if they are nice and slim)
- If they are relatively fat, can be extremely hard to see the vessels so be careful - go where there is less fat
4
Q
Ovariohysterectomy - Pedicle Clamping
A
- What many people will do before ligating the pedicle is to clamp the pedicle
- there are variations, not everyone will clamp
- but day 1, the most safe way is to CLAMP
- experienced vets will have a modified technique, but you need to be careful in the beginning!
- 3 forcep technique:
- stack three forceps close to the ovary on the pedicle (if it is tight, some with do 2 and then leave one on the uterine side of the ovary - right pic)
- then most proximal forcep is removed (one closest to things that stay in the animal)
- leaves a crush mark to help facilitate, provides a little bed (especially if they are fat) to seech your ligature in
- Next ligate the pedicle
5
Q
Ovariohysterectomy - ligature
A
- some find it is easier to ligate without cutting or with, but sometimes it can be easier to ligate without metal in the way
- many different ways to do the ligature
- THE LIGATURE MUST BE TIGHT AND STAY IN PLACE! - whole point is to obstruct the vessels that are branches of the aorta
- there are many ways to tie this ligature, but it must be tight! - friction knots tend to be easier to tighten and stay tight while doing the throws than a surgeons knot. Need to be confident in doing a tight ligature
- To reduce the risk of slippage, ant to leave about half a cm b/w ligature and cut edge to reduce risk of it slipping off
- remeber that the ovary is in an ovarian bursa, might need to extrude it to make sure you have the whole ovarian bursa
- (echo)
6
Q
Ovariohysterectomy - Broad Ligament
A
- not all surgeons will ligate the broad ligament
- but for fat animals, pyometras, well vesseled animals - need to ligate this
- good to do as it only really takes seconds, repeat for the other side!
7
Q
Ovariohysterectomy - Cervical Ligature
A
- most caudal forcep is removed to leave a crush mark
- beware of cats and dogs in season! (cats will have a friable uterus in season, a lot more turgent, be careful)
- in a cat not in season, it will leave a nice crush mark, but in season it may just clamp right through
- encircling ligature (A) is good for a cat or a small dog. need to make sure the bite goes through the muscle and not lumen of uterus
- transfixing: take a bite through cervical stump, fixed but doesnt ensure it is tight (echo)
- stick ties: know that you have haemostasis of those blood vessels and then add transfixing in addition?
- make sure you don’t have suture material in the lumen! - can get fistula developing between sutures and cervical stump (echo)
8
Q
A
Very important!
- won’t have the uterus to guide you, but should be able to guide yourself
- right is a bit more difficult
9
Q
Ovariohysterectomy - Complications
A
- hemorrhage is the major complication! - this is why ligatures are so important
- need to do a swab count to avoid retained swab count
- ureter can get included caudally (especially flank spay in cat) and sometime the ureter can actually get excised by accident
- echo
- sphincter mechanism incontinence
- these pets become more efficient at using their food - therefore don’t need as much!
- radiograph: cervical ligature actually ended up including ureter, there was a urreto-vaginal fistula
10
Q
Surgical Variations
A
- oriental cats have dark tips on hairs, legs, etc. - due to temperature
- the hair will grow back black (echo) - just beware of clipping, hair will go back to normal but it may take months or years
- a lot of pracices are beginning to use laproscopic techniques
- use a vessel sealing device instead that uses radiofrequency to create heat instead of using ligatures
*
11
Q
Caesarean Section
A
- once a decision has been made, do not delay!
12
Q
Caesarean Section - Indications
A
- lst of indications
13
Q
Caesarean Section - preoperative considerations
A
- dip stick can be a quick and effective result in house
- longer you delay in 2nd stage, the higher the risk gets for dam and neonates
- could be contaminated if there has been a lot of intervention per vagina prior to surgery
- clean contamination at best
14
Q
Caesarean Section - Anaesthesia Considerations
A
- dam needs good pain relief but need to beware of suppressing normal response of neonates
15
Q
A
- everything is going to be stretched, don’t slash as it will be very easy to puncture layers of tissue and even hit the babies!
16
Q
A
- ideally make one incision in uterus and milk down puppies or kittens
- but sometimes can be hard to just go on uterine body, but if a large litter may be hard to milk down appropriately
- if you need to make one incision in each uterine horn you can do that
*
17
Q
A
- only remove placentas if they easily come out, dont force it! may get hemorrhage
18
Q
A
- have someone who is scrubbed in to check vaginal exam to see if the incision has been closed especially by the pelvis
*
19
Q
Care of Neonates
A
- big litters are most likely going to need to be resusscetated
- need good facilities to suction airways and keep them warm
- check neonates for congenital abnormalities - cleft palate
- dam needs to be looked after - they will not realize often what the hell had happened
20
Q
Caesarean Section- Potential Complications
A
pic: persistent vaginal discharge, had a mummified fetus
owners will be PISSED, but you need to be honest with them, especially if it was you! keep good records, and if necessary - contact veterinary defence
21
Q
En Bloc Ovariohysterectomy
A
- take whole uterus out on block
- someone not scrubbed in will take out puppies and ressucitate them
- you neuter the bitch at the same time
- need to expect live offspring and have lots of help at the same time!
22
Q
Castration
A
- single pre-scrotal: incision right before (echo) - don’t want to damage the urethra!
- Dogs dont tolerate scrotal incisions very well (nibble and bite)
- pre-scotal incisions tend to heal really well
23
Q
Orchidectomy (castration) - Dog
A
- clean procedure –> DO NOT NEED AB’s!
- can castrate dogs or cats by open or closed technique
24
Q
Castration - Open Technique Dog
A
- echo
- whether the testis is removed out of the vaginal tunic or if it is left intact
- cut vaginal tunic or leave it intact
- 3 forcep technique: ligate that crushed mark
- ligature must compress vessels and stay there - msut regulate haemostasis!
25
Q
A
- cut through the vaginal tunic
- can see epidisymus, echo
26
Q
A
- can see crush mark where you will place the ligature
27
Q
Castration
(open vs. closed)
A
- can see where vaginal tunic is intact - will reduce the chance of intestinal hernia
- If you have trouble doing ligatures with that extra layer being present, then may be good to remove or else the ligatures will not be as strong
28
Q
Castration - Cat
A
- ligatures rarely used
- overhand knot is more neat - touching less of the stuff you are leaving behind
29
Q
A
- need to make sure your knot is tight!
30
Q
Scrotal Ablation
A
- remove the scrotum as well as testes
- will do especially if there is a neoplasia involved
- dangly scrotum can be removed for cosmetic reason as well as reduce swelling
*
31
Q
Cryptorchid Castration
A
- Need to determine where the testicle is (exam, US)
- testes have quite a characteristic look on US
- need to make an incision over each inguinal bulge and remove in the picture
- if in abdomen, may be more ideal to remove laproscopically
32
Q
Cryptorchid Castration - surgical location of the testicle
A
If you know what side it is, push up scrotum and then you will be able to tell if it is left or right
look down the whole gutter
if you cant find it, need to look as vas deferens. is it going through the inguinal ring? (very white, easy to see) –> if it is going through the inguinal ring will either be in that area (echo)
33
Q
Cryptorchid Castration - removal of testicle
A
- pathology may not happen due to $$ concerns
- if it is associated with a scrotal testicle (most owners will want to remove both), MUST have informed consent to remove the other one
34
Q
Castration- Complications
A
- ligature slip –> bleeding into the scrotum
- testicular vessels are part of the aorta (trickling out) - if you see this, may need to consider going back in
- sometimes can get bleeding into the abdoment with a ligature slip
- castrated dogs may be more prone to incontinence, but some studies show that entire and castrated dogs are no more likely
35
Q
Orchidectomy - RCVS advice
A
- remember that you need to abide by RCVS guidelines even when working in the U.S. if you want to keep as part of the RCVS
- no testicle implants! - not legal under the RCVS
36
Q
When to Neuter??
A
- subject of debate
