SURGERY - Ruminant Reproductive Surgery Flashcards
What are the indications for a cow cesarean?
Foetmateral disproportion (calf too big or cow too small)
Deformed calf
Dead calf
Unable to correct a uterine twist
Try and make the decision to do a c-section in conjunction with the farmer
How should you prepare for a cow cesarean?
- Restrain the cow in a clean (as much as you can), well lit area with plenty of clean straw beneath the cow
- Sedate the cow if necessary (depending on temperament)
- Instruct the farmer to retrieve buckets of warm clean water, string, table and extra assistants if possible
- Tie the tail with a piece of string to prevent it from entering the surgical site
- Clip and prep the surgical site (left flank)
- Administer local anaesthetic and any other drugs
- Open and organise your surgical kit and get suture material ready
- Surgically scrub in (as much as you can) and get your farmer to scrub in just in case you need assistance
- Make sure everyone knows the plan
Which drugs should you administer to prepare for a cesarean?
Caudal epidural (if the cow is straining)
Broad spectrum antibiotics
NSAIDs
Clenbuterol
Local anaesthetic
What are the landmarks for a cow cesarean?
A left flank laparotomy caudal to the last rib, ventral to the transverse spinal processes and cranial to the hindlimb muscles (make sure to do a very big surgical clip)
What are the three types of local anaesthetic blocks that can be used for a cow cesarean?
Line block
Inverted L-block
Paravertebral block
How do you carry out a line block?
Inject 100 - 150ml of local anaesthetic in the line of the planned incision
How do you carry out an inverted L-block?
Inject 150ml of local anaesthetic in an upside down, inverted L-shape, slightly away from where you plan to incise
Which local anaesthetic drug is used for local anaesthetic blocks in cows?
Procaine
Procaine is licensed for local anaesthetic blocks, HOWEVER, remember it is no licensed for epidurals
How do you carry out a cow cesarean incision?
- Make an approximately 45cm vertical skin incision using a scalpel
- Use scissors for blunt dissection of the external abdominal oblique, internal abdominal oblique and the transverse abdominus muscles (go layer by layer)
- Pick up the peritoneum with forceps and make a small incision and extend it with scissors. You should hear the sound of air being sucked in
Why is it so important to pick up the peritoneum with forceps before incising it?
It is important to pick up the peritoneum with forceps before you incise it as the peritoneum can appear very similar to the rumen and you can risk incising the rumen, however, if you can pick up the layer, this indicates it is the peritoneum
How do you locate and remove the calf during a cow cesarean?
- Locate the uterus
- If the calf is in the left uterine horn, grasp the metatarsal or hock of the calf and pull it towards you, and hook it over the incision
- If the calf is in the right uterine horn, you will likely feel the back of the calf and not be able to grasp any limbs. If this is the case you need to rotate the calf by using one hand on the calf’s back to push it over dorsally, and the other hand underneath the uterus to pull the calf under ventrally. Then, grasp the metatarsal or hock of the calf and pull it towards you, and hook it over the incision
- Use scissors to incise the uterus over the calf hoof that you have exteriorised and up to the calf hock
- Incise the placenta
- Ask the farmer to hold the calf leg over the metatarsal and both of you pull the calf gently, directing them caudo-dorsally to remove the calf
How do you suture the incision site for a cow cesarean?
- Allow the farmer to resusciate the calf - you need to focus on the cow
- Trim as much of the placenta as you can with scissors
- Ask an assistant to hold the uterus for you
- Use an inverting suture pattern (such as lembert or cushings) to close the uterus
- Gently push the uterus back into the abdomen
- Suture the peritoneum and transverse abdominus muscle as one layer using a simple continuous suture pattern
- Suture the internal abdominal oblique and external abdominal oblique muscles as one layer using a simple continuous suture pattern
- Suture the skin (suture pattern is usually the surgeon’s preference)
Which suture material should you use to close the uterus?
6 - 8 metric vicryl
Which suture material should you use to close the peritoneum and muscle layers?
6 - 8 metric vicryl
Which suture material should you use to close the skin?
6-8 metric supramid
Which drugs should you administer to the cow following a cesarean?
Oxytocin
Topical antibiotic spray
Five days of broad spectrum antibiotics
NSAIDs
Which instructions should you leave for the farmer for cesarean post-operative care?
Administer drugs as instructed
Monitor for retained foetal membranes
Monitor for excessive wound swelling
Remove sutures 14 - 21 days post-op
Phone veterinarian if concerned
What are normal changes that can be seen post-cesarean?
Wound swelling
Emphysema
How much do cow cesareans cost?
Cow cesareans cost approximately £230 with additional costs for drugs used and call out fees
Which complications can occur during a cow cesarean?
‘Downer cow’
Ruminal incision
Uterus can be friable and sutures can tear through it
Acidotic calf
Which complications can occur 1 - 3 weeks post a cow cesarean?
Retained foetal membranes
Wound infection
Peritonitis
Poor neonatal-materal bond
What are some of the potential long term complications of a cow cesarean?
Decreased subsequent milk production
Decreased subsequent fertility
What are the key differences for a sheep ceserean?
Only use 40 - 60ml of local anaesthetic as it can be toxic
Typically use an inverted L-block
Typically there will be multiple foetuses
Thinner muscle layers
What is an episiotomy?
An episiotomy is a surgical incision made into the vulva
What are the indications for an episiotomy?
Vulval stenosis
How do you carry out an episiotomy?
- Caudal epidural
- Make two 5 to 10cm full thickness skin incisions (± mucosa) into the vulva at 10 o’clock and 2 o’clock
- Calf the calf
- Suture the vulva with 6 to 8 metric vicryl, using a simple continuous for the mucosa and simple interrupted for the skin
What is a ‘teaser ram’?
A ‘teaser ram’ is a vasectomised tup so they are unable to produce viable sperm but still exhibit normal mating behaviour, and thus can be used to stimulate oestus in the ewes. Introducing teaser rams to the flock can synchronise oestrus in the ews and ensure ewes are ready for mating at the optimal time, improving the chances of successful breeding when the fertile tups are introduced to the flock
What is a vasectomy?
A vasectomy is a surgical procedure which involves cutting the vas deferens
How do you prepare for a vasectomy?
- Retrain the tup
- Administer NSAIDs, broad spectrum antibiotics and do caudal epidural
- Clip and prep the surgical site
- Do a local anaesthetic block along the surgical site using 8 - 10ml of local anaesthetic along the region of the spermatic cord
How do you carry out a vasectomy?
- Make an approximately 4cm skin incision over the region of the spermatic cord
- Use digital (use your finger) dissection to isolate the spermatic cord
- Hook the spermatic cord over your finger and locate the vas deferens, which should be white, firm and located medially within the spermatic cord
- Secure the vas deferens between your thumb and forefinger
- Make a small incision into the vaginal tunic to expose the vas deferens
- Exteriorise the vas deferens and clamp it at either end followed by ligating it at either end
- Suture the skin
- Repeat this process on the other side
What are the potential complications of vasectomies?
Infection
Haemorrhage
Removal of the wrong tissue
Vas deferens re-anastamosis
Which precautions should be taken to ensure you have removed the correct tissue when doing a tup vasectomy?
You should always keep the removed tissue in formalin and offer to do histology to ensure the correct tissue was removed. Additional, you should offer to carry out electroejaculation to ensure the tup is sterile before they are used as a ‘teaser ram’
