SURGERY - Female Reproductive Surgery Flashcards
What is the best age to neuter female animals?
There is no defined age at which to neuter female animals (it’s a big debate within the industry), there is pre-pubertal and post-pubertal neutering
What is pre-pubertal neutering?
Pre-pubertal neutering is neutering prior to first oestrus
What are the benefits of pre-pubertal neutering?
Pre-pubertal neutering has the most protection against the development of mammary neoplasia
Be aware if you spay after 2 seasons, doesn’t have much benefit agaisnt mammary neoplasia
What are the cons of pre-pubertal neutering?
Pre-pubertal neutering can predispose animals to other complications such as obesity, developmental and musculoskeletal problems
What is post-pubertal neutering?
Post-pubertal neutering is neutering after their first oestrus
What is uterus unicorni?
Uterus unicorni is where there is only one uterine horn present. However be aware there may still be a second ovary
What are the main indications/benefits of a canine ovariohysterectomy?
Prevent/treat pyometra
Prevent mammary tumours
Eliminate risk of neoplasia
Prevent oestrus behaviour
Prevent pseudopregnancy
Population control
Increased life expectancy
What is the best time to carry out a canine ovariohysterectomy?
It is best to spay bitches when they are in anoestrus (if in oestrus wait 2 - 3 months before spaying)
When should you avoid a canine ovariohysterectomy?
Oestrus
Pseudopregnany
Remember you can spay cats when they are in oestrus
Why should you avoid spaying bitches in oestrus?
When bitches are in oestrus there is increased oestrogen levels and increased risk of complications such as haemorrhage and tissue friability
Why should you avoid spaying bitches in pseudopregnancy?
Spaying bitches in pseudopregnancy can actually prolong the pseudopregnancy. You should wait until the bitch is in anoestrus before spaying
Which local anaesthetic blocks can be done in a spay (to provide additional analgesia)?
Incisional block
Infiltration of ovarian pedicle
Intraperitoneal lavage
What are the basic steps for an ovariohysterectomy?
- Incise
- Exteriorise
- Ligate
- Transect
- Check
- Close
How do you carry out a ventral midline ovariohysterectomy?
- Put patient in dorsal recumbency, and make a ventral midline skin incision using the umbilicus and the pubis as landmarks. Incise at the proximal two thirds (with deep chested bitches incise more cranially, with puppies and cats incise more caudally)
- Incise into the subcutaneous tissue using blunt dissection with mayo scissors
- Tent up the linea alba with rat tooth forceps and make a stab incision with your scalpel (making sure to face the blade away from the abdomen) and extend with mayo scissors
- Identify the uterus, trace caudally to identify the bifurcation (you can use the colon and bladder as landmarks)
- Trace cranially along the uterine horns to locate the ovaries (remember right ovary is more cranial)
- Exteriorise the ovary through breaking down the suspensory ligament using gentle but steady traction
- Make a window in the broad ligament
- Place 2 - 3 clamps at the ovarian pedicle, proximal to the ovary
- Place a surgeons or millers ligature proximal to the clamp most distant to the ovary
- Remove the clamp most distant to the ovary and place a surgeons or millers ligature in the groove of the clamp (pre-clamping technique)
- Transect the pedicle between the two remaining clamps using a scalpel
- Evaluate the pedicle and check for bleeding. Remove the remaining clamp from the pedicle and gently holding the fat of the pedicle with a pair of serrated forceps, allow the pedicle return into the abdomen, making sure to check again for bleeding
- Repeat this with the other ovary
- Break down the broad ligament for better exposure to the uterine body
- Place 2 - 3 clamps on the uterine body, just proximal to the cervix
- Place a surgeons, millers or transfixing ligature proximal to the clamp most distant to the uterine body
- Remove the clamp most distant to the uterine body and place a surgeons, millers or transfixing ligature in the groove of the clamp (pre-clamping technique)
- Transect between the two remaining clamps using a scalpel
- Check for bleeding, count your swabs
- Normal laparotomy closure
What can you do to help you confirm you have located the uterus rather than intestine?
Trace you fingers along the tubular structure caudally and if you can identify a bifurcation, this is the uterus
What is the ovarian pedicle?
The ovarian pedicle comprises of the suspensory ligament, ovary and ovarian vessels
What should you be aware of when carrying out an ovariohysterectomy in a bitch?
In the bitch, the ovarian pedicles have a lot of fat which can make it challenging to visualise. The ovarian vessels are tortuous and difficult to see as the fat is opaque
What are the benefits of laprascopic canine ovariohysterectomies?
Decreased recovery time
Decreased post operative pain
Decreased complications
What are the cons of laprascopic canine ovariohysterectomies?
Requires specialised equipment and training
More expensive
Larger clip requires
If there is a complication, the abdomen has to be opened anyway
What are the main indications/benefits of a feline ovariohysterectomy?
Prevent mammary tumours
Prevent/treat pyometra
Prevent oestrus behaviour
Prevent pseudopregnancy
Population control
Increased life expectancy
(T/F) You can spay cats when they are in oestrus
TRUE.
What are the cons of left flank spays in cats?
Be aware that the fur can grow back a different colour so if you’re spaying a show cat, use a ventral midline approach
What are the benefits of ventral midline spays in cats?
Easier
Better exposure
Best approach if pregnant or overweight
What are the cons of ventral midline spays in cats?
Increased recovery time
Increase risk of wound breakdown
How do you carry out a left flank ovariohysterectomy on a cat?
- Place the patient in right lateral recumbency
- Use the iliac crest as a landmark, drop your fingers ventrally off the lumbar muscle, make a caudo-ventral, diagonal skin incision
- Pick up the subcutaneous fat with forceps and use the mayo scissors to cut a window into the fat, extend with mayo scissors
- Repeat this process with the three muscle layers (external abdominal oblique, internal abdominal oblique and transverse abdominus) and into the peritoneum
- Identify the uterus, trace caudally to identify the bifurcation (you can use the colon and bladder as landmarks)
- Trace cranially along the uterine horns to locate the ovaries (remember right ovary is more cranial)
- Exteriorise the ovary through breaking down the suspensory ligament using gentle but steady traction
- Make a window into the broad ligament. You can either use pre-clamping or not as the tissue is much more friable
- If directly placing ligatures, place two clamps and place the two ligatures proximal to the clamps. Transect through the clamps
- If pre-clamping, use same technique as in the bitch
- Evaluate the pedicle and check for bleeding. Remove the remaining clamp from the pedicle and gently holding the fat of the pedicle with a pair of serrated forceps, allow the pedicle return into the abdomen, making sure to check again for bleeding
- Repeat this with the other ovary
- Break down the broad ligament for better exposure to the uterine body
- Place 2 - 3 clamps on the uterine body, just proximal to the cervix
- Place a surgeons, millers or transfixing ligature proximal to the clamp most distant to the uterine body
- Remove the clamp most distant to the uterine body and place a surgeons, millers or transfixing ligature in the groove of the clamp (pre-clamping technique)
- Transect between the two remaining clamps using a scalpel
- Check for bleeding, count your swabs
- Close the three muscle layers as one layer. Close subcutaenous fat, close skin
What should you be aware of when carrying out an ovariohysterectomy in a cat?
The uterine body is much more challenging to expose in the cat. The ovaries are generally easier to exteriorise but make sure not to handle it as it is very friable. The ovarian vessels are very easy to see
What kind of suture material should you use for ligatures?
Absorbable monofilament or polyfilament
What suture material should you use for closing the linea alba
Long lasting absorbable monofilament such as PDS
Which suture patterns can you use for closing the linea alba?
Simple interrupted
Cruciate
Simple continuous
Remember the external rectus sheath is strength holding layer
What suture material should you use for closing the muscle layers
Long lasting absorbable monofilament such as PDS
Which suture patterns can you use for closing the muscle layers?
Simple interrupted
Cruciate
Simple continuous
Which suture patterns can you use for the subcutaneous fat?
Simple interrupted
Simple continuous
Which suture patterns can you use for the skin?
Intradermals
Simple interrupted
Cruciate
Ford interlocking
What are some of the immediate surgical complications for an ovariohysterectomy?
Haemorrhage
Organ trauma
Oesophagitis
What can cause haemorrhage in an ovariohysterectomy?
Ligature slips due to poor technique or inadequate exposure of the ovary
What should you do if there is a ligature slip following an ovariohysterectomy?
Extend the excision
Ask for help
Identify which ligature has slipped through sweeping through the abdomen so you can reclamp and place another ligature
Use swabs and lap swabs to help visualise
Supportive care
How can you manage mild postoperative haemorrhage following an ovariohysterectomy?
Cage rest
IV fluid therapy
± Abdominal bandages
± Blood transfusion
What are some of the delayed surgical complications of an ovariohysterectomy?
Bruising
Infection
Swelling
Wound dehiscence
Suture reactions
Urinary incontinence
Ovarian remnant syndrome (ORS)
Stump pyometra
Pseudopregnancy
What is ovarian remnant syndrome (ORS)?
Ovarian remnant syndrome (ORS) is where residual ovarian tissue is left behind during an ovariohysterectomy. This tissue will produce hormones resulting in oestrus behaviour and pseudopregnancies
How do you definitively diagnose ovarian remnant syndrome (ORS)?
Hormone assay depending on the stage of the oestrous cycle
What is a stump pyometra?
Animals which had ovarian remnant syndrome (ORS) will have continued progesterone production which will decrease the local immunity which can result in secondary infection and a stump pyometra in the residual uterine tissue
