Common surgical procedures of the reproductive tract in the dog and cat

Question 1

How do you locate the uterus for OVH?

Answer 1

Push intestines cranially and bladder caudally. Locate ovaries by following uterine horns

Question 2

What is ovarian release?

Answer 2

In OVH, the ovaries can be released by breaking down the suspensory ligament (cut>tear), create window in mesovarium.

Question 3

How do you do pedicle clamping in OVH?

Answer 3

Haemostasis using 3 artery forceps (either 3 dorsal to ovary OR 2 dorsal and 1 ventral)

Question 4

What should you use to do an ovarian ligature?

Answer 4

SYNTHETIC ABSORBABLE MATERIAL:
Vicryl
One/two/instrument tie
Encircling ligature/figure of 8

Question 5

Why must ovarian ligature be tight?

Answer 5

Ovarian a arises from aorta. Reduce risk of slippage by leaving 0.5cm between ligature and cut edge.

Question 6

What should you use for a broad ligament ligature?

Answer 6

Synthetic absorbable material cases in all cases except very immature/ small dogs and cats (Vicryl ideal)

Question 7

What should you use for a cervical ligature?

Answer 7

Synthetic absorbable material (Vicryl)
3 forcep technqiue
EITHER: encircling ligature, transfixing ligature, stick ties

Question 8

How do you check the right ovarian pedicle?

Answer 8

Elevate descending duodenum

Question 9

How do you check the left ovarian pedicle?

Answer 9

elevate descending colon

Question 10

How do you check the right broad ligament pedicle?

Answer 10

elevate descending duodenum/ more SI to left

Question 11

How do you check left broad ligament pedicle?

Answer 11

elevate descending colon

Question 12

How do you check the cervical pedicle?

Answer 12

elevate bladder and reflect caudally

Question 13

Complications of OVH?

Answer 13

GENERAL - wound breakdown, infection, haemorrhage, retained swab
SPECIFIC - ureteral injury, retained ovarian remnant
OTHER - SMI, weight gain, anaesthetic complications

Question 14

What variations are there in the technique to perform an OVH?

Answer 14

FLANK SPAY - usually L flank, care with oriental cats and the regrowth of their fur (darker)
OVARIECTOMY VERSUS OVH - latter commoner in UK, ovariectomy used in many EU countries routinely, more logical for elective sterilisation but not appropriate for management of uterine disease
LAPAROSCOPIC DISEASE - ovariectomy with a vessel sealing device (i.e. no ligature), gaining popularity, quicker recovery but high capital cost to set up

Question 15

How common are c-sections?

Answer 15

64% dogs with dystocia treated this way
80% cats with dystocia treated this way
Base decision based on dam, foetuses and owner

Question 16

What are some causes of dystocia?

Answer 16

Primary uterine inertia (>70d)
Incomplete primary uterine inertia refractory to medical management
Secondary uterine inertia (exhaustion)
Relative/absolute foetal oversize
Anatomical abnormality of maternal pelvic canal
Foetal monstrosity
Uncorrectable fetal malpresentation
Foetal death
Previous CS?

Question 17

What are pre-op considerations for CS?

Answer 17

Electrolyte and other metabolic abnormalities
Foetal death increases significantly after 5 h since onset of labour
Owners should be advised of surgical risks to dam and neonate
NRCW classification variable

Question 18

What are anaesthesia considerations for CS?

Answer 18

Regurgitation and aspiration
CV and resp. 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

Question 19

What are the 2 approaches for CS?

Answer 19

MIDLINE - take care

EXTERIORISE UTERUS - you may want to incise both uterine horns if many foetuses

Question 20

How do you detach the umbilical cord?

Answer 20

Clamp it. Only remove placentas if come freely.

Question 21

How do you stitch back the uterus after a CS?

Answer 21

Synthetic absorbable material - Monocryl ideal
Simple appositional OR inverting pattern
Single OR double layer

Question 22

What are potential complications of CS?

Answer 22

GENERAL surgical
Remove ALL foestusess
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

Question 23

What is an en bloc OVH?

Answer 23

Hysterectomy performed prior to hysterotomy and removal of neonates. Review of 63 cases (dogs/cats) concluded it was a safe and effective alternative to CS (neonatal survival comparable). BUT all neonates need resuscitating IMMEDIATELY.

ADVANTAGES: minimised anaesthesia time, minimal peritoneal contamination, effective population control and no need for second surgery.

Question 24

How does castration differ between dogs and cats?

Answer 24

DOG - single pre-scrotal incision

CAT - paired scrotal incisions

Question 25

Indications for castration

Answer 25

``` Population control Behavioural modifications Testicular neoplasia Cryptorchidism Testicular torsion Orchitis/epididymitis Testicular trauma Anal adenoma (dog) Perineal rupture (dog) Prostatic disease Repair inguinal/scrotal hernia ```

Question 26

What is the NRCW classification for clean and closed castration techniques?

Answer 26

CLEAN

Question 27

What is the open dog castration technique?

Answer 27

Ligate using synthetic absorbable material (Vicryl) 3 forcep technique Encircling or transfixing ligatures

Question 28

What is the difference between an open and a closed castration?

Answer 28

OPEN - tunic and associated structures are incised an deach structure is ligated separately. vaginal tunic not repaired. CLOSED - tunic not incised --> vessels, vas deferens and associated structure ligated at once, usually with 2 or 3 separate knots to prevent bleeding.

Question 29

Advantages of closed and open castration are?

Answer 29

OPEN - may reduce post-op swelling and reduce the risk of ligature slippage CLOSED - reduces risk of internal herniation

Question 30

T/F: cat castrates are usually done as a clean rather than aseptic procedure.

Answer 30

True (open castration - two scrotal incisions)

Question 31

Are ligatures regularly used for cat castrations?

Answer 31

No: Vas deferens and spermatic vessels are knotted together Overhand knot in spermatic cord

Question 32

What is scrotal ablation?

Answer 32

Removal of scrotum as well as testes (relatively unusual)

Question 33

When is scrotal ablation indicated?

Answer 33

``` Scrotal diseae (MCT or trauma( Improved cosmesis and reduced complications (bruising and swelling) in mature dogs Part of a scrotal/ perineal urethrostomy procedure When scrotum is used as a skin donor site. ```

Question 34

What are the surgical approaches for cryptorchid castration?

Answer 34

Inguinal or caudal midline laparotomy

Question 35

Where a places to look in a cryptorchid castration if you can't find the testes?

Answer 35

Examine the gutter from the caudal pole of the kidney to the inguinal ring Does vas deference enter the inguinal ring from the abdomen?

Question 36

Complications of castration?

Answer 36

GENERAL SURGICAL - wound breakdown, infection, haemorrhage SPECIFIC COMPLICATIONS - scrotal swelling, urethral injury, failure to locate retained testicle OTHER SEQUELAE - weight gain, SMI, anaesthetic complications

Question 37

What is the RCVS advice on castration?

Answer 37

RVNs aren't allowed to perform dog/cat castration under Schedule 3 ammendment of Vet Surgeons Act as it involves a body cavity. Use of prosthetic testicles deemed unethical by RCVS