Lesson 19 - Castration and Spay Procedures

What does the red outline represent?

skin

What layer is between the red and green layers?

subcutaneous

What does the green outline represent?

spermatic fascia

What does the yellow outline represent?

vaginal tunic

What does the pink outline represent?

tunica albuginea

How are dogs prepared for castration?

1. Aseptic technique

2. Clip hair CAREFULLY

3. Avoid rough scrubbing

4. Chlorhexidine prep

How are cats prepared for castration?

1. Usually "clean" procedure

2. pluck hair from scrotum •

3. Chlorhexidine prep

What tissues are desensitized with a testicular block?

spermatic cord and associated structures

What is happening here?

skin incision

What kind of grip is the surgeon using to hold the scalpel?

pencil grip

What side of the patient should a right handed surgeon stand on for a castration?

left side

Which hand should a right handed surgeon use to push the testicle into the prescrotal area?

left (nondominant) hand

Which hand should a right handed surgeon use to incise over the testicle?

right (dominant) hand

Which layer is being incised in this step?

subcutaneous

What is the pink star?

incised skin

What is the green star?

incised subcutaneous

What is the blue star?

intact spermatic fascia

Why does the spermatic fascia need to be incised?

to exteriorize the testicle

How much pressure does it take to incise the spermatic fascia with a scalpel?

very light touch

What step of a closed castration is this?

testicle being pushed through skin, subcutaneous and spermatic fascia, up to the level of the parietal vaginal tunic

What step of a closed castration is this?

manual detachment of the scrotal ligament (caudal) with the surgeons non-dominant hand

What is the yellow arrow pointing to?

intact scrotal ligament

How can the scrotal ligament be broken down?

manually or slightly incised with Metzenbaum scissors

How can you release the connective tissue attachments around the spermatic cord?

move dry gauze 360 degrees around the spermatic cord

What is an important consideration when using the 3 clamp technique?

1. need to adapt the size of the hemostats to the size of the patient

2. make sure not to clamp too tight (only go to the 1st or 2nd ratchet)

What step of a closed castration is being shown?

three clamp technique

What kind of ligature is the arrow pointing to?

circumferential

What kind of ligature is being placed above the circumferential?

transfixing

What is important to remember when placing your ligatures?

1. flash the middle hemostat on the first two throws

2. do thumb to thumb technique to tighten the first two throws

3. place a "safety line" hemostat on your circumferential ligature

Why is it important to place a "safety line" hemostat on your circumferential ligature?

easy retrieval of the pedicle

What step of a closed castration is being shown?

checking the ligated pedicle for bleeding

What extra layer is incised in an open castration?

parietal vaginal tunic

What layers have been incised in this picture of an open castration?

1. skin

2. subcutaneous

3. parietal vaginal tunic

What layer is still intact in this picture of an open castration?

tuncia albuginea

What is the pink star?

epididymis

What is the red star?

ligament of the tail of the epididymis

What is the purple star?

parietal vaginal tunic

What is the green star?

ductus deferens

What is the blue star?

pampniform plexus

What step of an open castration is being shown?

tearing the attachment of the vaginal tunic to the tail of the epididymis

What is the left arrow pointing to?

pampiniform plexus

What is the right arrow pointing to?

ductus deferens

What steps of an open castration are the same as a closed one?

1. three clamp technique

2. circumferential ligature

3. transfixing ligature

4. checking the pedicle

5. pushing the pedicle back in the scrotum

Where do you cut when removing the testicle?

between the middle and distal hemostats

What is the ligament that gets torn in a closed castration?

scrotal ligament

What is the ligament that gets torn in an open castration?

ligament of the tail of the epididymis

Is the parietal vaginal tunic incised for a closed castration?

no

Which castration technique takes less time?

closed

Which castration technique has less risk of abdominal infection?

closed

Which castration technique allows for more secure ligations?

open

Which castration technique communicates with the abdominal cavity?

open

Which castration technique is used in most puppies?

closed

Which castration technique is used in most large dogs?

open

What is 1?

subcutaneous

What is 2?

median raphe

What do the green stars represent?

the windows where the testicles used to be

What direction do you close the subcutaneous layer in?

caudal to cranial

Why should you be very careful with how you manipulate the caudal end of the incision?

excessive pressure with thumb forceps will cause trauma, irritation and delayed healing

What is the first step to close the subcutaneous layer?

deep to superficial bite on the surgeons side of the incision

What is the second step to close the subcutaneous layer?

superficial to deep bites towards the surgeon on opposite side of surgeon (include median raphe on this bite)

What is the third step to close the subcutaneous layer?

tie the knot making sure short-end and needle-end are on the same side

What side should you take your first bite on to help keep the knot buried?

on your side

How should you continue to suture once you have successfully buried the knot when closing the subcutaneous layer?

simple continuous pattern including the median raphe

How do you bury the end knot when closing the subcutaneous?

1. begin this knot before the end of the incision to allow the intradermal buried knot some space

2. first, take a dive bite from superficial to deep

3. second, take a deep to superficial bite on the surgeons side and keep the loop

4. third, take a superficial to deep bite on the opposite side of surgeon and pull the loop through

What direction should you close the skin in?

cranial to caudal

What pattern should you use to close the skin?

intradermal with initial buried knot and aberdeen knot to end

What are some complications of castration?

1. Hemorrhage/bleeder

2. Scrotal irritation, bruising

3. Scrotal hematoma

4. Infection

Are castration complications more common in cats or dogs?

dogs

What complication is this?

scrotal swelling/hematoma

How much more likely is a cryptorchid testicle to become neoplastic than a descended testicle?

14 times

What is being shown here?

excision of a retained testicle

What are the indications for feline castration?

1. Sterilization

2. Urethral obstruction (as part of perineal urethrostomy)

3. Testicular or scrotal trauma

4. Elimination of male characteristics

What is the surgical technique for feline castration?

1. Pluck hair from scrotum

2. Scrub area

3. Scrotal incision/s

4. Place caudal traction on testicle until scrotal ligament breaks

5. Open or closed castration

What are the ligation techniques for feline castration?

1. Ductus Deferens/ Pampiniform plexus Tie

2. Absorbable ligature or hemoclips

3. Overhand technique (autoligation)

What is a ductus deferens tie?

separate ductus deferens and tie to vessels with two square knots

What ligation techniques for feline castration is being shown?

hemoclips

What ligation techniques for feline castration is being shown?

overhand/figure 8 technique

What is the proper post-op care for a feline castration?

1. Leave scrotal incisions open to drain and to heal by second intention

2. Instruct owner to use shredded paper or un-popped corn instead of kitty litter for a few days

What is the most commonly used surgical approach for spaying a female dog?

ventral midline

What grip should you use on the skin to stretch it before incising during a spay?

modified violin grip

modified violin grip

What step of an OVH is shown here?

use forceps to pick up the linea alba and lift the abdominal wall, face the blade at a 45-degree angle, and pierce carefully into the abdominal cavity

How do you use your spay hook to externalize the ovary and uterine horn?

insert hook along the abdominal wall, then rotate 180 degrees and" scoop up" vertical (90-degree angle from incision)

What step of an OVH is shown here?

piercing through the "window"

What ligature techniques do you use on the ovarian pedicles?

three clamp with circumferential and transfixing ligatures

During a routine ovariohysterectomy in a dog, what is the structure that must be ligated to prevent hemorrhage?

ovarian pedicle

What do you break away once both ovaries are free?

broad ligament

How do you close the linea alba in an OVH?

simple interrupted pattern with surgeon's knots

What is the holding layer?

external rectus sheath

How do you close the subcutaneous layer in an OVH?

simple continuous pattern from cranial to caudal with buried knots

How do you close the skin layer in an OVH?

intradermal pattern from caudal to crania with an initial buried knot ending with an aberdeen