RU2396923C2 - Method of ovariohysterectomy of cats by lateral access - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of veterinary. Method lies in the following: laparotomic cut 0.5-1.0 cm long is made on lateral abdominal wall. Ovary ligaments and uterine horns are extracted. Extraction of ovary ligaments and uterine horns are performed by means of instrument which is eyelid lifter with narrowed to 0.5 cm working blade. As ligature, ovary vessels and supporting it ligament, as well as round uterine ligament and uterine vessels of wide uterine ligament are used.

EFFECT: application of claimed method results in reduction of rehabilitation term, as well as in minimisation of risk of abdominal cavity infection.

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Description

The invention relates to the field of practical veterinary surgery, and in particular to methods of castration of domestic cats.

A known method of ovariogysterectomy, involving silyotomy in the midline, which is performed at a distance of about 2 cm in front of the pubic fusion. Access to the abdominal cavity is through the white line. The surgical incision for the convenience of the surgeon's manipulations is 3-6 cm. The uterus is found by touch with the fingers, or under the control of vision with a uterine hook, for which the bladder is emptied by catheterization immediately before surgery or manually immediately after opening the abdominal cavity. After ligatures are applied, the uterus and ovaries are separated, the abdominal cavity closes as usual: a continuous catgut or silk suture is applied to the white line tissue, and an intermittent knotted one from silk is applied to the skin. Skin sutures are removed on day 8-10. The named method is widely used by most veterinarians in Russia and abroad and is described in the educational literature. In detail: "Therapy and surgery of puppies and kittens." J. Hozgood, D. D. Hoskins and others. Translation from English. E. Makhiyanova. - M: AQUARIUM PRINT LLC, 2004, p. 348-353.

The disadvantages of this method are: a significant length of the surgical wound, the healing of which requires more than 8 days and is often painful; the risk of suture spreading - both due to the fact that the animal will lick them, and due to tissue incompatibility of the body with suture material, which often causes postoperative complications - adhesive peritonitis and hernias. The disadvantages include the need to empty the bladder and, therefore, the danger of introducing pathogenic microbes into it. A flaw in the traditional method is to recognize the undesirability of blindly manipulating the uterine hook, which can injure the intestines, uterus and other organs.

The closest known technical essence to the proposed solution is the method of “sterilizing cats through lateral access”, presented on the Internet http://vet.rudn.ru/?pagec=100 - the essence of which is described as follows: “Premedication twenty minutes before surgery : atropine - 0.3 ml subcutaneously, pipolfen (diphenhydramine, suprastin) - 0.3-0.6 ml intramuscularly. Drugs for anesthesia: propofol, xylazine, zolet in combination with epidural anesthesia.

Suture material: Ligation of the ovarian ligaments, body, and uterine horns: Dacron (2/0), fluoride (2/0, 0), capron (2/0). Suturing of the surgical wound: peritoneum, transverse abdominal muscle, internal oblique muscle of the abdomen - Ethibond, Surgidac, Ticron, Vicryl, Dexon S, Polysorb, Polyglycolide, Caproag, Ftorrest (3/0, 4/0); external oblique muscle of the abdomen and subcutaneous inlet: Polypropylene, Ftrest (3/0, 4/0); leather - Polypropylene, Ftorest (3/0, 4/0).

To extract the ligaments of the ovaries and uterine horns, the operation requires a special tool, designated in the nomenclature of surgical instruments manufacturing plants as a “hook for removing polyps in the nasal cavity” (Fig. 1).

The area of surgical intervention is the area of the right puff, the point of dissection of the tissues: from the last costal arch, backing by 4-5 cm, and from the longest muscle of the back by 3-3.8 cm. The incision is 1-1.5 cm. The tissue is dissected in layers. After extirpation of the ovaries, the uterus, suturing of the surgical wound is performed in layers, respectively. The seams were not removed. " (Retrospective analysis Kalinin A.V. “Center for Biology and Veterinary Medicine of the RUDN University”, Savinkina M.M., Veterinary Clinic “Aesculapius”).

The disadvantage of the “lateral” method in comparison with the proposed one is that there are a lot of medicament and suture materials, as well as the fact that the proposed hook is traumatic when working blindly, which makes the length of the surgical incision 1-1.5 cm, which requires stitching in layers. As a drawback, it should be noted the need to leave suture material in the body of the animal. The whole operation takes more than an hour. Cats overloaded with medications move away from anesthesia longer and harder, pain is more pronounced. The method seems to be risky for very young or old animals due to their exacerbated drug sensitivity.

With a large number of differences, the similarity of methods lies in the use of special tools: castration hooks. Especially for veterinary purposes, this type of tool is not manufactured by industry, so veterinarians use hooks to remove choanal polyps, button probes and other non-special tools bent in the form of a hook.

The technical result of the invention is: accelerated rehabilitation of the animal after surgery, the absence of inflammatory and other post-traumatic reactions of the body, minor damage to the skin and muscle; the absence of foreign material left in the abdominal cavity of a cat, reducing the cost of surgery.

The technical result is achieved by the fact that in the method of laparotomic bioligature ovarian hysterectomy in cats, including a laparotomy incision on the lateral abdominal wall using the anatomical structures of the reproductive system as cavity ligature materials, a non-traumatic castration hook is used that makes this surgery possible through an surgical incision in 0.5 cm. In contrast to the method proposed by the Center for Biology and Veterinary RUDN, tissue damage in Making a claimed method are small, and in the body of the animal foreign material remains. Tissue regeneration is accelerated, pain is not expressed, the likelihood that the cat will gnaw stitches is excluded. The proposed technical solution, due to the speed of the operation (about 40 minutes), requires an insignificant dose of anesthesia, due to which the rehabilitation period takes no more than a day, which reduces the cost of the operation itself and eliminates the need for expenses for keeping the animal in the hospital.

Comparison of the proposed technical solution with the prototype established distinctive features from the prototype, namely: the use of a special castration hook with an atraumatic configuration, which makes it possible to dispense with a gentle operative incision of 0.5-0.7 cm; the use of anatomical structures of the reproductive system itself as ligature materials; no need to empty the bladder; minimization of anesthesia and, as a result, prevention of postoperative complications, reduction of the rehabilitation period to a day, and the ability to operate free-living cats from 3 months of age.

Ovariohysterectomy by generally accepted methods has established itself as a successful and quite acceptable procedure for a healthy animal, but in the claimed method, the desired result is achieved by exposure not traumatic, but gentle, in combination with the ease of performing surgical procedures.

Therefore, this technical solution meets the criterion of "novelty."

The proposed method of ovariogysterectomy using a castration hook of an atraumatic configuration transforms this operation from an expensive cavity into a low-cost cosmetic one. The proposed method will allow society to reduce costs when implementing programs to humanely reduce the number of roaming and free-living cats. On the other hand, the insignificance of postoperative consequences should be attractive to the owner of animals that are not of breeding value.

Thus, the inventive method, the set of features of which clearly follows from the prior art, solves the problem: the implementation of safe efficient provisioning of cats at low cost of services, therefore, this technical solution meets the criterion of "inventive step".

The proposed method of laparotomic bioligature ovariogysterectomy of cats using a castration hook atraumatic configuration is as follows.

Instrumentation (Fig. 2): linen slippers - 3 pieces; hemostatic clamps - 3 pieces, including a mosquito clamp - 1 piece; anatomical tweezers - 1 piece; scissors with one sharp end - 1 piece; needle holder - 1 piece; surgical eye needle - 1 piece; atraumatic castration hook - 1 piece.

The atraumatic castration hook for animals (Fig. 3) is modified from the eyelid (Fig. 4) by narrowing the working blade to 0.5 cm (Fig. 5). This tool can be used blindly while searching for uterine horns, eliminating the risk of trauma to internal organs.

The progress of the operation.

After preliminary sedation with Rometar 0.1 ml / kg intramuscularly and shaving / disinfection of the surgical field 5 by 5 cm on the right side (Fig. 6), the veterinarian deepens the anesthesia with a combination of Zoletil (100) 0.05 ml + Rometar 0.1 -0.2 ml in a single syringe intramuscularly.

The cat is fixed on the left side. The point of dissection of tissues is determined. If the animal is fluffy, the body is draped (Fig. 7).

Surgical access is through a skin incision of 0.5 cm along the fibers of the external oblique abdominal muscle, 3-5 cm from the last rib and 2-4 cm below the ends of the transverse costal processes of the lumbar vertebrae (Fig. 8).

Using the natural elasticity of the skin, to preserve the minimality of the surgical incision, the surgeon carefully spreads the scissors branches directly in the resulting wound, thereby expanding it visually (Fig. 9). If the operation is planned by a seamless method, after the incision, the skin should be displaced caudally one centimeter.

Then the visible part of the subcutaneous tissue is removed, then the muscle layers of the abdominal wall are separated in a blunt way along the muscle fibers, after which the transverse fascia and peritoneum are cut (Fig. 10).

After that, the uterine horn is pulled into the wound using an atraumatic castration hook (Fig. 11). Then the ovarian ligament is captured by two hemostatic clamps and dissected between them with scissors (Fig. 12).

Then the ovary is removed, and its vessels and supporting ligament are dissected from each other with scissors and bandaged with a surgical unit (Fig. 13).

Resection of the resulting stump above the formed node is performed by 0.7-1 cm (Fig. 14).

Then, gently pulling the right horn, the surgeon with an atraumatic castration hook, brought under the bifurcation, looks for the left horn, removes it into the wound, fixes the ovary with a clamp (Fig. 15). The left ovarian ligament is cut between the hemostatic clamps (Fig. 16).

The left ovary is removed, and its vessels and supporting ligament are dissected with scissors and bandaged with a surgical unit, as already described above (Fig. 13-14).

In animals with a diameter of the uterine horns up to 3 mm, a resection of the uterine horns is performed using the formation of “eights” nodes on each of the horns in close proximity to the bifurcation. All nodes must be tightened very carefully and firmly, since a biological swab is formed due to them. The resulting stumps are treated with 5% iodine tincture. To prevent self-untying of nodes, resection of the uterine horn is performed 1 cm above the site of formation of nodes (Fig. 17).

The stump of the uterus is set into the abdominal cavity. 0.3-0.6 ml of gentamicin is introduced.

For cats giving birth and having small up to 1.0 cm hyperplasia of the uterine horns, a bioligature option with ligation of the uterine horns directly at the bifurcation is given. Here it is required to dissect a round uterine ligament and uterine vessels with the remains of a wide uterine ligament (Fig. 18).

These stumps are thrown through the horn for bifurcation in the forward and reverse directions, tying them on each side once, and finally one surgical node (Fig. 19). The horn is separated 0.7-1 cm above the ligation site, the stump is treated with tincture of iodine (Fig. 20).

An operative incision of 0.5 cm does not require suturing. Tissues in the wound are straightened along the muscle fibers, treated with a complex powder of tetracycline. A skin defect is quenched with Kubatol / Trauma Gel.

With an operative incision of 0.7-1.0 cm (with minimal damage to the peritoneum) and in animals with loose muscle wall, after pre-treatment of the wound with Tetracycline, one three-turn eight-stitch stitch with catgut thread No. 2 is superimposed: the first oblique muscle is assembled, the transverse fascia and peritoneum, the second is the external oblique muscle, the third turn is the subcutaneous tissue and the skin layer itself. The ends of the thread are connected by a double surgical unit (Fig. 21).

This type of suturing ensures good biological closure of the wound and allows not to leave foreign material in the animal’s body after the suture has been removed if non-absorbable suture material is used. The sutured skin wound is treated with tincture of iodine. On the first day after surgery, the animal is given rest.

February 20, 2008. Three-month-old Maaru cat, not purebred, short-haired, silver-striped with white, active, sociable, picked up on the street by a veterinarian employee. The patient was observed by the author of the method. Photographs of the operation are present in this essay. Active exit from anesthesia; less than a day after the operation, the cat already loudly demanded food and pain, did not show weakness. An operation incision of 0.5 cm without suturing was delayed on the second day and did not cause any concern to the animal (Fig. 22). Two weeks after ovariogisterectomy, Maaru was attached. The owner was Maksimeyko Galina Vladimirovna, mailing address: 680032, Khabarovsk, Promyvochnaya St., 4a apt. 114.

Medvedeva Maria Alekseevna dealt with a Persian tortoise-year-old cat named Busya on March 2, 2008. The cat is affectionate, calm, and phlegmatic. I did not give birth. Photographs of the operation are present in this essay. In the postoperative period, the owner kept a two-week observation diary. The way out of anesthesia is smooth, the restoration of activity and appetite is noted already on the second day. The cat did not show signs of anxiety, soreness. Physiological settings were normal.

Mailing address: Medvedeva Maria Alekseevna, 680038, Khabarovsk, 42 Serysheva St., 42 apt. 42.

Majdurov Maksim Sergeevich contacted April 6, 2008. Matilda’s cat, 5 months old, tortie with white markings, medium-haired. Affectionate, self-confident creature. During the operation, a cyst was found on the left ovary (Fig. 16), while the cat is still immature (a uterus with a diameter of 2 mm). Photographs of the operation are present in this essay. In the postoperative period, starting the exit phase of anesthesia, the owner kept a two-week observation diary. The animal did not experience anxiety in the seam area throughout the entire observation period. There was no refusal of food initially, and the appetite was completely restored already on the second day. No signs of inflammation were observed. The cat played less than the first three days than before, but cleaned up the coat, purred from the first day after the operation. Physiological settings were normal.

Mailing address: Maidurov Maxim Sergeevich, 680035, Khabarovsk, Tikhookeanskaya St., 142 apt. 541.

Skidan Svetlana Yuryevna dealt with a red-haired Siberian two-year-old cat named Manya April 27, 2008. The cat is obstinate, active, so far there have been normal births twice. Photographs of the operation are present in this essay. In the postoperative period, starting from the phase of withdrawal from anesthesia, the owner kept a two-week observation diary. The cat is capricious and in response to any interventions, has the habit of licking the coat nervously, so a postoperative bandage was recommended, which was not removed for a week, which apparently caused the animal inconvenience. Appetite appeared on the first day. Activity after surgery did not decrease. To purr, to look after wool began on the second day. No inflammation was observed. Physiological settings were normal.

Mailing address: Skidan Svetlana Yuryevna, 680033, Khabarovsk, Tikhookeanskaya st., 170a apt. 17.

This technique has been used by the author since 2006 on the basis of his own veterinary clinic “Veterinarian”, located at 680042, Khabarovsk, Malyi Prospekt 3. On average, about 100 cats underwent this type of ovarian hysterectomy every year. No complaints have been received.

The social value of the invention consists in the ability to reduce the number of stray cats without the cost of maintaining in a hospital after surgery. The nullity of postoperative consequences should be attractive to owners of animals that are not of breeding value. Patent protection of the invention will allow humanely reducing the population of non-breeding and free-living cats and, with the widespread use of the invention, will help solve the problem of street animals.

Claims (1)

A method of ovariogisterectomy in cats by lateral access, including a laparotomy incision, extraction of ligaments of the ovaries, uterine horns and ligature, characterized in that the laparotomy incision is 0.5-1 cm long on the lateral abdominal wall, while the extraction of ligaments of the ovaries and uterine horns is carried out using a tool that is an eyelid with a working blade narrowed to 0.5 cm, and the ovarian vessels and its supporting ligament are used as a ligature, as well as the round uterine ligament and the uterine vessels of the wide uterine ligament ki.

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