Surgical procedures of reproductive tract in the cat and dog Flashcards
Ovariohysterectomy
v.common in general practice
remove ovaries + uterus
usually performed via ventral midline incision
can also be done via flank incision - more common in cats in UK
Ovariohysterectomy - indications for surgery
elective sterilisation pyometra ovarian cysts hydro/mucometra uterine torsion/prolapse uterine rupture ovarian/uterine neoplasia metritis diabetes control
Ovariohysterectomy - midline approach + location of uterus and ovaries
NRCW classification: clean/contaminated
locate uterus by pushing intestines cranially + bladder caudally
locate ovaries by following uterine horns
Ovariohysterectomy - ovarian release
ovaries can be released by breaking down suspensory ligament
create window in mesovarium
Ovariohysterectomy - pedicle clamping
haemostasis using 3 forcep technique
most proximal forcep removed leaving a crush mark
Ovariohysterectomy - ovarian ligature
ligate using synthetic absorbable material - vicryl ideal, one/two instrument tie
ligature MUST be tight - ovarian arteries arise from aortal, reduce risk of slippage by leaving space between ligature and cut edge
divide between 2 remaining clamps making sure whole ovary removed
Ovariohysterectomy - broad ligament
ligate using synthetic absorbable material exept v.immature/small dogs + cats
Ovariohysterectomy - cervical ligature
ligature using synthetic absorbable material
3 forcep technique
various techniques used - haemostasis must be achieved
Ovariohysterectomy - complications
general - wound breakdown + infection, haemorrhage, retained swab
specific - ureteral injury, retained ovarian remnant
other sequelae - urinary incontinence, weight gain, anaesthetic complications
surgical variations
flank spay - usually L flank
ovariectomy vs Ovariohysterectomy - used in many EU countries as routine. better for sterilisation but not appropriate for managing uterine disease
laparoscopic techniques - ovariectomy with vessel sealing device, quick recovery but expensive to set up.
Caesarean section (CS)
64% of dogs, 80% of cats with dystocia treated by CS
once decision made to perform CS it must be done without delay
Caesarean section (CS) - indications
foetal distress primary uterine inertia incomplete primary uterine inertia refractory to medical management secondary uterine inertia relative/absolute foetal oversize abnormal pelvic canal malpresentation of foetus foetal death monstrosity
Caesarean section (CS) - preoperative considerations
electrolytes + other metabolic abnormalities
foetal death increases after 5h since onset of second stage of labour
owners should know surgical risks
NRCW classification variable
Caesarean section (CS) - anaesthesia considerations
regurgitation + aspiration cardiovascular + respiratory compromise depression of neonates analgesia - local block, epidural post procedure, avoid alpha 2 agonists, ketamine + thiobarbiturates minimise op time
Caesarean section (CS) - surgery
midline approach - take care
extreiorise uterus
gentle squeezing to move foetus down uterine horn
clamp umbilical cord
only remove placentas if come freely
uterine repair - synthetic absorbable material, simple appositional/inverting pattern, single or double layer
care of neonates
make sure plenty of help available dry and warm pups/kits may need drug administration to aid resuscitation check for congenital abnormalities make sure dam recovers + cares for young
Caesarean section - complications/sequelae
make sure all foetuses removed uterine haemorrhage, rupture, prolapse retained placenta/foetuses acute metritis, mastitis subinvolution of placental sites toxic milk syndrome agalactia galactostasis puerperal tetany
En Bloc ovariohyterectomy
hysterectomy performed before removal of neonates
safe alternative to CS
disadvantage - all neonates need resuscitating at once
advantages - minimised anaesthesia time, minimal peritoneal contamination
Castration
v.common
removal of the testes
usually done by single scrotal incision in dog, 2 in the cat
Castration - indications
population control behavioural modification testicular neoplasia, torsion, trauma cryptorchidism orchitis/epididymitis anal adenoma (dog) perineal rupture (dog) prostatic disease
Castration - dog
aka orchidectomy
NRCW classification : clean
open + closed techniques
Castration - open technique dog
ligate using synthetic absorbable material
3 forcep technique
encircling or transfixing ligatures
Castration - open vs closed
open - vaginal tunic cut + not repaired. may reduce post op swelling + reduce the risk of ligature slipping
closed - vaginal tunic left intact. reduces risk of intestinal herniation
Castration - cat
usually done as a clean rather than aseptic procedure
open
2 scrotal incisions
ligatures rarely used - vas deferens + spermatic vessels knotted together. overhand knot in spermatic cord
scrotal ablation
removal of scrotum as well as testes indicated when: scrotal disease cosmesis + less complications in old dogs as part of scrotal/perineal urethrostomy scrotum used as skin donor site
cryptorchid castration
must determine where testicle is - may need ultrasound, comlicated by hypoplasia + inguinal fat pads
surigcal approaches - inguinal, caudal midline laparotomy
cryptorchid castration - surgical location of testicle
may not be obvious
examine gutter from caudal pole of kidney to inguinal ring
deos vas def enter inguinal ring from abdomen
cryptorchid castration - removal of testicle
once located excise observing haemostasis techniques
consider submitting for pathology
generally combined with removal of scrotal testicle but need client consent
castration - complications
wound breakdown, infection haemorrhage scrotal swelling urethral injury cant locate retained testicle urinary incontinence
