SURGERY - Female Reproductive Surgery

Question 1

What is the best age to neuter female animals?

Answer 1

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

Question 2

What is pre-pubertal neutering?

Answer 2

Pre-pubertal neutering is neutering prior to first oestrus

Question 3

What are the benefits of pre-pubertal neutering?

Answer 3

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

Question 4

What are the cons of pre-pubertal neutering?

Answer 4

Pre-pubertal neutering can predispose animals to other complications such as obesity, developmental and musculoskeletal problems

Question 5

What is post-pubertal neutering?

Answer 5

Post-pubertal neutering is neutering after their first oestrus

Question 6

What is uterus unicorni?

Answer 6

Uterus unicorni is where there is only one uterine horn present. However be aware there may still be a second ovary

Question 7

What are the main indications/benefits of a canine ovariohysterectomy?

Answer 7

Prevent/treat pyometra
Prevent mammary tumours
Eliminate risk of neoplasia
Prevent oestrus behaviour
Prevent pseudopregnancy
Population control
Increased life expectancy

Question 8

What is the best time to carry out a canine ovariohysterectomy?

Answer 8

It is best to spay bitches when they are in anoestrus (if in oestrus wait 2 - 3 months before spaying)

Question 9

When should you avoid a canine ovariohysterectomy?

Answer 9

Oestrus
Pseudopregnancy

Remember you can spay cats when they are in oestrus

Question 10

Why should you avoid spaying bitches in oestrus?

Answer 10

When bitches are in oestrus there is increased oestrogen levels and increased risk of complications such as haemorrhage and tissue friability

Question 11

Why should you avoid spaying bitches in pseudopregnancy?

Answer 11

Spaying bitches in pseudopregnancy can actually prolong the pseudopregnancy. You should wait until the bitch is in anoestrus before spaying

Question 12

Which local anaesthetic blocks can be done in a spay (to provide additional analgesia)?

Answer 12

Incisional block
Infiltration of ovarian pedicle
Intraperitoneal lavage

Question 13

What are the basic steps for an ovariohysterectomy?

Answer 13

1. Incise
2. Exteriorise
3. Ligate
4. Transect
5. Check
6. Close

Question 14

How do you carry out a ventral midline ovariohysterectomy?

Answer 14

1. 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)
2. Incise into the subcutaneous tissue using blunt dissection with mayo scissors
3. 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
4. Identify the uterus, trace caudally to identify the bifurcation (you can use the colon and bladder as landmarks)
5. Trace cranially along the uterine horns to locate the ovaries (remember right ovary is more cranial)
6. Exteriorise the ovary through breaking down the suspensory ligament using gentle but steady traction
7. Make a window in the broad ligament
8. Place 2 - 3 clamps at the ovarian pedicle, proximal to the ovary
9. Place a surgeons or millers ligature proximal to the clamp most distant to the ovary
10. Remove the clamp most distant to the ovary and place a surgeons or millers ligature in the groove of the clamp (pre-clamping technique)
11. Transect the pedicle between the two remaining clamps using a scalpel
12. 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
13. Repeat this with the other ovary
14. Break down the broad ligament for better exposure to the uterine body
15. Place 2 - 3 clamps on the uterine body, just proximal to the cervix
16. Place a surgeons, millers or transfixing ligature proximal to the clamp most distant to the uterine body
17. 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)
18. Transect between the two remaining clamps using a scalpel
19. Check for bleeding, count your swabs
20. Normal laparotomy closure

Question 15

What can you do to help you confirm you have located the uterus rather than intestine?

Answer 15

Trace you fingers along the tubular structure caudally and if you can identify a bifurcation, this is the uterus

Question 16

What is the ovarian pedicle?

Answer 16

The ovarian pedicle comprises of the suspensory ligament, ovary and ovarian vessels

Question 17

What should you be aware of when carrying out an ovariohysterectomy in a bitch?

Answer 17

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

Question 18

What are the benefits of laprascopic canine ovariohysterectomies?

Answer 18

Decreased recovery time
Decreased post operative pain
Decreased complications

Question 19

What are the cons of laprascopic canine ovariohysterectomies?

Answer 19

Requires specialised equipment and training
More expensive
Larger clip requires
If there is a complication, the abdomen has to be opened anyway

Question 20

What are the main indications/benefits of a feline ovariohysterectomy?

Answer 20

Prevent mammary tumours
Prevent/treat pyometra
Prevent oestrus behaviour
Prevent pseudopregnancy
Population control
Increased life expectancy

Question 21

(T/F) You can spay cats when they are in oestrus

Answer 21

TRUE.

Question 22

What are the cons of left flank spays in cats?

Answer 22

Be aware that the fur can grow back a different colour so if you’re spaying a show cat, use a ventral midline approach

Question 23

What are the benefits of ventral midline spays in cats?

Answer 23

Easier
Better exposure
Best approach if pregnant or overweight

Question 24

What are the cons of ventral midline spays in cats?

Answer 24

Increased recovery time
Increase risk of wound breakdown

Question 25

How do you carry out a left flank ovariohysterectomy on a cat?

Answer 25

1. Place the patient in right lateral recumbency 2. Use the iliac crest as a landmark, drop your fingers ventrally off the lumbar muscle, make a caudo-ventral, diagonal skin incision 3. Pick up the subcutaneous fat with forceps and use the mayo scissors to cut a window into the fat, extend with mayo scissors 4. Repeat this process with the three muscle layers (external abdominal oblique, internal abdominal oblique and transverse abdominus) and into the peritoneum 5. Identify the uterus, trace caudally to identify the bifurcation *(you can use the colon and bladder as landmarks)* 6. Trace cranially along the uterine horns to locate the ovaries *(remember right ovary is more cranial)* 7. Exteriorise the ovary through breaking down the suspensory ligament using gentle but steady traction 8. Make a window into the broad ligament. You can either use pre-clamping or not as the tissue is much more friable 9. If directly placing ligatures, place two clamps and place the two ligatures proximal to the clamps. Transect through the clamps 10. If pre-clamping, use same technique as in the bitch 11. 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 12. Repeat this with the other ovary 13. Break down the broad ligament for better exposure to the uterine body 14. Place 2 - 3 clamps on the uterine body, just proximal to the cervix 15. Place a surgeons, millers or transfixing ligature proximal to the clamp most distant to the uterine body 16. 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) 17. Transect between the two remaining clamps using a scalpel 18. Check for bleeding, count your swabs 19. Close the three muscle layers as one layer. Close subcutaenous fat, close skin

Question 26

What should you be aware of when carrying out an ovariohysterectomy in a cat?

Answer 26

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

Question 27

What kind of suture material should you use for ligatures?

Answer 27

Absorbable monofilament or polyfilament

Question 28

What suture material should you use for closing the linea alba

Answer 28

Long lasting absorbable monofilament such as PDS

Question 29

Which suture patterns can you use for closing the linea alba?

Answer 29

Simple interrupted Cruciate Simple continuous | Remember the external rectus sheath is strength holding layer

Question 30

What suture material should you use for closing the muscle layers

Answer 30

Long lasting absorbable monofilament such as PDS

Question 31

Which suture patterns can you use for closing the muscle layers?

Answer 31

Simple interrupted Cruciate Simple continuous

Question 32

Which suture patterns can you use for the subcutaneous fat?

Answer 32

Simple interrupted Simple continuous

Question 33

Which suture patterns can you use for the skin?

Answer 33

Intradermals Simple interrupted Cruciate Ford interlocking

Question 34

What are some of the immediate surgical complications for an ovariohysterectomy?

Answer 34

Haemorrhage Organ trauma Oesophagitis

Question 35

What can cause haemorrhage in an ovariohysterectomy?

Answer 35

Ligature slips due to poor technique or inadequate exposure of the ovary

Question 36

What should you do if there is a ligature slip following an ovariohysterectomy?

Answer 36

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

Question 37

How can you manage mild postoperative haemorrhage following an ovariohysterectomy?

Answer 37

Cage rest IV fluid therapy ± Abdominal bandages ± Blood transfusion

Question 38

What are some of the delayed surgical complications of an ovariohysterectomy?

Answer 38

Bruising Infection Swelling Wound dehiscence Suture reactions Urinary incontinence Ovarian remnant syndrome (ORS) Stump pyometra Pseudopregnancy

Question 39

What is ovarian remnant syndrome (ORS)?

Answer 39

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

Question 40

How do you definitively diagnose ovarian remnant syndrome (ORS)?

Answer 40

Hormone assay depending on the stage of the oestrous cycle

Question 41

What is a stump pyometra?

Answer 41

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