INFORMATION ON VARIOUS SURGICAL PROCEDURES
I.
ONYCHECTOMY- Declaw (removal of the claw and P3)
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II.
Elective procedure that usually involves only the front feet to prevent scratching issues by
the cat
Surgical site is scrubbed, but not necessarily clipped for the procedure
it is not recommended to trim the nails of the cat before the procedure
A tourniquet placed DISTAL to the elbow will greatly reduce hemorrhage at the surgical site.
Placing the tourniquet proximal to the elbow may cause permanent radial nerve damage.
Tourniquet should not be in place for longer than 1.5 hours.
3 techniques for performing the surgery: scalpel, Rescoe nail trimmer, laser
Care must be taken to avoid cutting the digital pads
If the laser is used, alcohol is not to be used in the prep as it could cause a fire
Sutures or surgical glue is used to close each incision. Care must be taken to not place glue
INTO the incision as it can cause lameness and a foreign body reaction.
The feet are bandaged while the patient is still under anesthesia and should remain in place
for 24 hours.
Clay/sand litter should be avoided for 10 days post-operatively to avoid accumulation within
the wounds.
Sensitivity of the limbs should improve within 2 weeks of surgery
CANINE CASTRATION- (orchidectomy, orchiectomy, neuter), removal of the testicles
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Usually performed to prevent unwanted pregnancies, roaming, or aggressive behaviors.
Medical indications include prostate disorders, perinanal tumors, perineal hernias, and
testicular tumors.
Surgery is often performed around 6 months of age prior to the development of unwanted
behaviors and sexual maturity.
ALWAYS be sure that both testicles are present in the scrotum before the surgery begins.
Clip for a routine castration extends from the tip of the prepuce to the abdominal/scrotal
skin margin, and wide laterally to the inguinal region. Care is taken not to involve the
scrotum in the clip as the skin is very delicate and thin which makes it prone to clipper burn
and lacerations. Long scrotal hairs that will overlap into the surgical field are trimmed.
A preputial flush with a diluted antiseptic solution is performed before the site is scrubbed.
Prescrotal incision is made on the ventral midline which each testicle is removed from. Each
testicle is exteriorized from the abdomen by freeing all attachments and fat from the
spermatic cord. Each cord is clamped and ligated and each testicle is excised.
-The single incision is closed in 2 layers: SQ and skin.
The animal should be monitored post-operatively for excessive scrotal or incision licking.
Some swelling will normally be present. Excessive hemorrhage into the scrotal sac can lead
to a scrotal hematoma which can be severely painful and may necessitate a scrotal ablation.
III.
FELINE CASTRATION
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IV.
CELIOTOMY- (also called a laparotomy) incision into the abdominal cavity
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Performed to prevent fighting, roaming, spraying and to decrease urine odor. If any
improvement will be seen, it can take up to one month.
Usually performed around 6 months of age, but more frequently this surgery is being
performed as early as 3 mths.
-Check to be sure that the sex of the cat is correct.
Cat is usually placed in dorsal recumbency, with the legs tied cranially.
Incision is made on the scrotum over each testicle.
Hair is removed from the testicle by either plucking or clipping.
Alcohol is avoided, saline is used instead.
Testicle is removed by tying off the spermatic cord with suture or using the cord itself.
Scrotum is left to heal via second intention.
Scrotal swelling is common post-operatively.
Clay litter is avoided to prevent foreign objects in the surgical site.
Location of incision is usually ventral midline, however other options include paramedian,
paracostal, parapreputial, and flank (FIGURE 24-18).
Examples of surgeries requiring a celiotomy include, OHEs, biopsies, cystotomies, C-sections,
GI surgeries, abdominal cryptorchidectomies, splenectomies, diaphragmatic hernias, and
exploratory surgeries.
A wide area is always clipped and prepped for a laparotomy. Clip should extend from
xiphoid to the pubis. Laterally, the clip should extend to the edge of the ribs.
Actual incision length will vary with each procedure.
Ventral midline incision is the most common. A scalpel or electrocautery (set to cut) is used
to incise through the skin and subcutaneous layers. Once the linea alba is reached, the
surgeon uses forceps to elevate the linea and will perform a stab incision into it which will
be extended cranially and caudally.
If retractors are necessary, moistened laparotomy pads should be used.
Abdominal organs that are exteriorized should be kept moist with warm fluids and handled
with moistened gauze/lap pads.
If a cavity is to be entered (bladder, intestines, stomach, uterus), care is taken to isolate
organ with lap pads so that contents do not spill into the abdomen.
A gauze/ lap pad count should be performed at the beginning and end of every laparotomy.
Always check the abdomen for instruments before closure.
Closure is performed in 3 layers: linea alba, subcutaneous fat, skin.
OVARIOHYSTERECTOMY- spay (removal of the ovaries, uterine horns, and uterus)
Procedure performed to prevent pregnancy, correct hormonal imbalances, infections, injuries,
cysts, tumors, correct undesirable behaviors and congenital deformities. Can also be performed
to treat pyometra.
OHE is recommended before the first heat cycle in dogs, as the incidence of mammary tumors is
much less.
-Usually performed between 4-6 months of age.
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If OHE is performed during estrus or pregnancy, increased vascularity to the area may cause
increased hemorrhage. This is seen more so in dogs than cats.
Should wait 3-4 months post estrus or 6-8 weeks postpartum.
Ventral midline incision caudal to the umbilicus.
Spay hook is used to retrieve the uterine horns.
Ovarian pedicles are identified, clamped, and ligated before the ovaries are removed. Care
should be taken to visualize that the ureters are not involved in the ligatures. Failure to remove
the ovaries completely may result in the animal retaining signs of estrus, despite removal of the
uterine horns and uterus.
The broad ligament is transected to facilitate removal of the uterine horns and exteriorization of
the uterine body which is also clamped and ligated before being transected.
The left ovary is easier to remove than the right ovary due to the more caudal location within
the abdomen.
Inspection for hemorrhage from the ovarian pedicles and uterine stump should be performed
before the closure of the surgical site.
Post-operative weight gain is often a concern for owners, which can be attributed to alterations
of hormonal levels in the body. Diet and exercise modification should remedy the situation.
V.
PYOMETRA- infection/fluid accumulation within the lumen of the uterus due to
endometrial hyperplasia caused by progesterone production. Often occurs 1-2 months
after a heat cycle. Treatment of choice is ovariohysterectomy.
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Animals are generally compromised pre-operatively. Fluid and antibiotic therapy should be
instituted before the surgical procedure.
DO NOT perform a cystocentesis in these animals!
A spay is performed as described above, however the uterus is handled with extreme care as it
is enlarged, heavy, and friable. The ventral midline incision is typically longer than with a routine
spay.
Any cultures of the uterine contents are performed after the uterus is removed from the sterile
field.
Abdomen is flushed before closure with a sterile solution.
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VI. CESAREAN SECTION- laparotomy performed to remove neonates from the uterus. Can be
planned in advance, or performed in animals experiencing dystocia.
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Clip patient before they are anesthetized to minimize length of anesthesia. Keep the animal in
lateral recumbency as long as possible to avoid dyspnea. Also, providing adequate oxygen and
tilting the table may greatly help the breathing of the animal.
Ventral midline incision is performed.
The fetuses are removed through an incison in the ventral aspect of the uterine body either with
the uterus still in place, or once it has been excised if an OHE is also being performed.
Uterus is exteriorized and lap pads are placed if incision will be made with uterus still in place.
Care must be taken not to cut into a fetus when the uterus is incised.
The fetuses are “milked” out of the incision one by one with their associated placenta and the
fetus is taken away from the surgical site.
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The birth canal is inspected for any remaining fetuses.
The uterine incision is closed if the female is to remain intact and the abdomen is flushed with a
sterile solution. Skin sutures should be placed internally to prevent removal by the
puppies/kittens.
If the animal is to be spayed, the uterus is either removed as in an OHE before or after the
fetuses are removed. All ligations will be performed after the fetuses are removed. If the uterus
is removed before the fetuses are delivered, the technician will quickly deliver the fetuses by
making the uterine incision.
Milk production is not affected by performing an OHE at the same time as delivery.
When each fetus is removed from the uterus, it is placed on a clean, dry towel and the fetal
membranes are removed (first from the face) and the airway/nose are suctioned with a bulb
syringe. The umbilicus is clamped/tied and the baby is rubbed vigorously in order to dry and
stimulate breathing. If the animal’s respirations are weak, doxapram (a respiratory stimulant)
can be placed under the tongue. Respiration can also be stimulated by using a 22-25 gauge
needle on the nasal philtrum until bone is felt to stimulate breathing. IF THE ANIMAL CANNOT
BE STIMULATED TO BREATH, “flinging” of the puppies can be attempted to remove any
additional fluid from the respiratory tract. IF A HEARTBEAT IS NOT AUSCULTATED, CPR is begun.
Return the neonates to the mother as soon as she has recovered from anesthesia and all should
be discharged as soon as possible from the hospital.
Monitor the meeting of the mother/babies to be sure that she accepts them and is not
aggressive towards them. Nursing should begin as soon as possible.
VII. CYSTOTOMY- incision into the urinary bladder
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Usually performed to remove stones, repair a rupture, remove tumors, or correct
congenital defects.
Urinary catheters are often placed to facilitate urethral flushing/stone removal.
Do not express bladder if the flow is obstructed or if the bladder wall may be friable.
Stay sutures are placed into the bladder wall prior to the incision.
Incision is made in an avascular area on the ventral aspect of the bladder.
Stones can be submitted for analysis and urine can be submitted for culture.
The bladder wall closure should be tested for leaks and the abdomen is flushed.
Hematuria may be present for 2-3 days post-operatively along with stranguria.
VIII. LUMPECTOMY- surgical excision of a mass in the skin or SQ tissues
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All masses should be ideally submitted for histopathology.
Metastasis check may be performed prior to surgery.
Masses should be manipulated as little as possible prior to surgery.
A generous clip should be performed.
1-3 cm margins are obtained if possible to allow for the submission of clean margins.
Margins are tagged to identify any areas of incomplete resection.
IX. MASTECTOMY- removal of a mammary gland (radical mastectomy is removal of a chain of
mammary glands)
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There is a significantly higher chance of a dog developing mammary cancer if it is spayed after
its first estrus.
Most frequently occurring neoplasm in the female dog.
Lung rads to check for metastasis should be performed along with lymph node evaluation.
Prognosis does not improve if the mass is removed, but metastasis is present.
50% of mammary tumors are malignant in dogs, 80-90% are malignant in cats.
If bilateral radical mastectomy is to be performed, the procedure must be staged to allow the
skin to close.
A drain may be needed if a large amount of dead space is present.
SURGERIES THAT INVOLVE A LAPAROTOMY PREP/INCISION
X. UMBILICAL HERNIA- A defect is present in the abdominal wall at the level of the umbilicus, allowing
intra-abdominal fat, omentum, or bowel to slip through.
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Usually congenital; discovered by a swelling at the umbilicus on physical exam.
Uncomplicated hernias can usually be repaired at the time of sterilization.
Complicated hernias involve bowel entrapment/strangulation and are emergency situations.
Ventral midline incision is made directly over the hernia without perforating hernia contents.
Depending on the contents of the hernia, they are either replaced back into the abdomen or are
excised.
The edges of the defect are trimmed to freshen and the defect is closed. SQ and skin are then
closed as previously described.
XI. GI SURGERY (Gastrotomy, Enterotomy, Intestinal Resection and Anastomosis)- Often performed to
obtain biopsies or remove foreign objects. An anastomosis is performed when a portion of the GI tract
needs to be removed due to disease or damage to the area.
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If these patients have been vomiting, the anesthetist should be aware that vomiting could
continue during the procedure. Insure proper tube placement and cuff inflation.
Normal bowel is pink, has good vasculature, and is active in motility. Devitalized bowel is black,
green, or gray in color, lacks motility, has a thin wall, and/or may lack bleeding when incised.
Always pay attention to bowel that is exteriorized to be sure that the surgical team doesn’t alter
the blood flow to the intestines by handling the bowel inappropriately.
*GI CONTENTS ARE NOT STERILE. Prevent leakage into the abdomen. New
instruments/gloves/drape are to be used after the bowel has been entered.
Stay sutures are used for gastrotomies and enerotomies to prevent leakage.
A resection and anastomosis will require the technician to isolate the section of bowel to be
excised using Doyen forceps or their fingers to prevent leakage.
Leak tests are performed to ensure proper closure of incisions. Omentum is often placed over
the closure.
The abdomen is flushed and new instruments/gloves/drape are used to close the laparotomy
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Leakage will likely cause septic peritonitis. An abdominocentesis can be used to obtain fluid for
evaluation of peritonitis.
Most animals will be willing to eat within 24 hours of surgery. The intestinal tract thrives on food
for proper health and function. Begin with a small amount of water, then introduce small
amounts of food if vomiting does not occur. A highly digestible bland diet (I/D, EN) should be fed
until the animal shows they are recovering well from surgery.
XII. ORTHOPEDIC PROCEDURES
 Usually not life-threatening
 Elective procedures include cranial cruciate ligament rupture repair, patellar luxation, hip
dysplasia, osteochondritis dissecans; Non-elective procedures include open fractures, open
dislocations, fractures involving the skull or spine.
 Fractures noted upon exam must be immobilized and bandaged. External coaptation is
important to reduce further disruption or damage to the fracture or fragments and the
surrounding soft tissue and prevents blood loss.
o bandages used for pre-operative & post-operative support are Robert Jones, Ehmer
sling(hip luxation), spica splint(humeral or femoral fractures), velpeau sling(scapular
fractures). All these bandages except for the Robert Jones can be used for external
coaptation if surgery is not an option.
 Factors that may affect healing and recovery: 1) Age: younger patient are have faster healing
time, but are more difficult to confine for long periods. Complications related to growth plate
damage may be an issue. Older patients have a longer healing time and are more sedentary
which leads to muscle loss and weakness. 2) Weight: Obesity puts too much pressure on the
surgery site which could lead to premature loosening of the fixation. Large and overweight
animals need more assistance getting up and walking. 3) Owner Compliance: the animal’s
temperament influences how successful owners can be at following post-op procedures.
 Two types of fracture repair are internal fixation and external fixation.
o Internal fixation devices include bone plates and screws, IM pins, Kirschner wires,
cerclage wires, interlocking nails. Post-op care: strict confinement for 6-8 weeks,
radiographs should be taken every 4-6 weeks to monitor bone healing
o External fixation includes casts, rigid splints, kirschner-Ehmer fixation, and ring fixation.
Post-op care: regular visits for cleaning of the pin tracts and tightening of clamps. The
external bars or rings need to be padded and wrapped to prevent trauma to the patient
and protect it from the environment. Strict confinement for at least 4 weeks and
radiographs every 4 weeks. Casts and splints should be checked every week.
 Amputations - Indications include trauma, irreparable fractures, neurologic injuries, neoplasia,
congenital deformities
o Forelimb amputation – disarticulation of the shoulder joint, scapula removal, midhumeral
o hindlimb amputation- mid-femoral amputation, disarticulation of the coxofemoral joint
 Cranial Cruciate Repair
o rupture of this ligament causes instability of the stifle
o degenerative causes are the most common cause of the rupture
o Repair involves intracapsular or extracapsular repair or TPLO (performed by boardcertified surgeons)
EAR PROCEDURES (aural hematoma repair, lateral ear canal resection)
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Aural hematoma- refers to the formation of a hematoma within the auricular cartilage
on the concave surface of the ear.
o should be performed to relieve pain and prevent a permanently thickened,
cauliflower-like ear
o animals are placed in lateral recumbency with the affected ear dorsal
o the hematoma should be drained through an incision
o vertical mattress sutures should be placed to close the dead space between the
auricular cartilages
Lateral Ear Canal resection – indicated for animals with chronic otitis or neoplasia
o allows drainage and ventilation
o patients should wear and e-collar until healed & sutures are removed after 1014 days
o tympanic membrane is more susceptible to damage
Eye Procedures
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Entropion repair – rolling in of the eyelid causing ocular irritation from eyelashes or
facial hairs. The condition can either be developmental or spastic
o the patient is place in sternal or lateral recumbency
o shaving of the hair around the eye should be done carefully. Dilute baby
shampoo (1:3) with water can be used to clean the shaved area. It is then
followed by very dilute betadine solution (1:50). Sterile saline is then used to
flush the eye and any remaining dirt or particles.
o the Holtz-Celsus procedure is used to repair entropion
Other eye procedures include enucleation, eyelid mass removal, cherry eye repair