RU2503419C1 - Method of ovariohysterectomy in cats and ferrets with videoendoscopic control - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of veterinary. Puncture with Veress needle is made with 1.5 cm indent from umbilicus caudally on white line of abdomen. Videoendoscope is introduced into the same point through trocar with magnetic valve. Uterine horn with ovary is hooked under visual control. Hook is extracted together with uterine horn and ovary. Uterine vessels of extracted horn and ovarian ligament are coagulated and dissected. Second uterine horn is extracted. Uterine is cut off entirely in the area of its cervix. Uterine stump is reset into abdominal cavity. Internal suture is applied on muscles of uterine wall. Skin defect is glued.

EFFECT: method makes it possible to reduce rehabilitation period, reduce operation cost.

1 ex, 5 dwg

Description

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

A known method of ovariogysterectomy, comprising a section along the midline of the abdomen, which is made at a distance of 2 cm in front of the pubic fusion. The surgical incision for the convenience of the surgeon's manipulations has a length of 3-6 cm. The uterus is found by touch with the fingers, or under the control of vision with a uterine hook. 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 abdominal wall tissues, and an intermittent knotted silk suture 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. Hoskins and others. Translation from English by E. Makhiyanova. - M: AQUARIUM PRINT LLC, 2004., p. 343-353.

The disadvantage of this method is: a significant length of the surgical wound, the healing of which requires more than 8 days, the risk of rejection of sutures, due to the fact that the animal will lick them and tissue incompatibility, a large amount of foreign suture material, which causes postoperative complications. In addition, blindly manipulating the uterine hook can injure the intestines, blood vessels and other vital structures of the abdominal cavity.

Closest to the technical nature of the proposed method is a two-trocar video endoscopic access described in "Small Animal Endoscopy" 3rd edition, Todd R. Tams, Clarence A. Rawlings, Copyright © 2011, 1999, 1990 by Mosby, Inc., an affiliate of Elsevier Inc, p. 466. The site of operative access - four points of injection: two points for introducing trocars - in the midline of the abdomen, departing 2 cm cranial and 2 cm caudal from the navel. A video endoscope is inserted into one of the trocars to locate the uterus and ovaries, and into the other, manipulation forceps to capture the uterus and ovaries. Two injections and two punctures with fixation needles are also required in the area of the projection of the left and right ovary onto the lateral abdominal walls to suspend the uterus and ovary to the dome of the abdominal wall. After crossing the uterine ligaments and ovaries with an electrocoagulator, both uterine horns with the uterine body are removed outside through the caudal trocar injection hole, then the cervix is ligated, the uterus with horns is cut off and the stump is set into the abdominal cavity.

The disadvantage of this method is the significant area of the surgical field (requiring cutting, shaving, treatment with antiseptics), significant damage to the musculoskeletal cover (two punctures with trocars and four puncture fixation needles), increased intra-abdominal pressure during insufflation (12-15 mm Hg) ), the penetration of carbon dioxide through these holes into the subcutaneous tissue of the skin of the abdomen.

The objective of the invention is to reduce the area of the surgical field, reduce the number of inflammatory and other post-traumatic reactions of the body, reduce damage to the skin and muscle cover (only one puncture), reduce insufflation pressure to 8 mm Hg, identify pathologies of the abdominal organs upon preliminary examination with a video endoscope , reducing the time of rehabilitation of the animal after surgery, preventing the penetration of carbon dioxide into the subcutaneous tissue of the skin of the abdomen.

This problem is solved by the fact that in the method of ovarian hysterectomy of cats, ferrets, including injection and insufflation with a Veress needle, the introduction of a trocar and a video endoscope to find the uterus and ovaries, coagulation and dissection of the uterine vessels and ligaments with an electrocoagulator, extraction of the uterine horns through the opening of the trocar incision and cervix, reduction of the cervical stump into the abdominal cavity, puncture with a Veress needle is carried out caudally 1.5 cm from the navel along the midline of the abdomen, then the abdominal bands are insufflated and carbon dioxide to a pressure of 8 mmHg and take out the Veress needle, and the introduction of an endoscopic trocar with a magnetic valve is carried out at the same point of injection introduced into the trocar with a video endoscope, first the organs of the abdominal cavity of the animal are examined for pathologies, then the uterus and ovary are examined, a hook is inserted into the trocar sleeve and hooked under the control of the video endoscope uterine horn with ovary, open the trocar tap, release carbon dioxide from the abdominal cavity of the animal, then remove the video endoscope, the trocar sleeve, the hook with the uterine horn and eggs from the abdominal cavity ohm, coagulate and dissect the uterine vessels and ligament, then sip on the prepared horn and uterine bifurcation, remove the second horn of the uterus, coagulate and cut off the uterine vessels and ligaments, then coagulate and cut off the uterus entirely in the area of its cervix, straighten the stump of the cervix into the abdominal cavity , impose an internal seam on the muscles of the abdominal wall, and the skin defect is sealed with glue.

Distinctive features of the proposed method are the implementation of the preparation of the surgical field, departing 1.5 cm from the navel caudally in the midline of the abdomen, piercing the abdominal wall with a Veress needle and carbon dioxide insufflation to a pressure of 8 mm Hg, introducing the endoscopic trocar with a magnetic valve at the same point injection (after removing the Veress needle), examination with a video endoscope inserted into the trocar sleeve, first of the abdominal organs of the animal for pathology, then finding the uterine horn with the ovary, introducing the trocar into the sleeve a handle (into the space between the wall of the sleeve and the video endoscope), hooking the uterine horn with the ovary under the control of the video endoscope, opening the trocar tap, releasing carbon dioxide from the animal’s abdomen, removing the video endoscope, the trocar sleeve, the hook with the uterine horn and ovary from the abdominal cavity, coagulation and dissection of the uterine vessels and ligaments of the extracted horn, pulling on the prepared horn and uterine bifurcation, extraction of the second horn along with the ovary, coagulation of the uterine vessels and ligaments of the second horn, coag uterine cervical and uterine cervical vessels clipping and cutting, whole uterine clipping in the cervical region, reducing the cervical stump into the abdominal cavity, applying an internal suture to the muscles of the abdominal wall and gluing the skin defect with glue, which can reduce the area of the surgical field, slightly damage the skin muscle cover (only one puncture), reduce the pressure of carbon dioxide to 8 mmHg, eliminate leakage of carbon dioxide into the subcutaneous tissue of the abdomen, identify abnormalities in the abdominal cavity, reduce rehabilitation This period is up to 3 hours, to reduce the inflammatory and other post-traumatic reactions of the animal organism.

The proposed method of ovariogysterectomy of cats and ferrets using a video endoscope, a trocar with a magnetic valve, a uterine hook atraumatic configuration is as follows.

Equipment: endovideo camera with the possibility of video recording - 1 pc, light source - 1 pc, monitor - 1 pc, insufflator - 1 pc, bipolar coagulator - 1 pc.

Instrumentation: scalpel No. 11 - 1 pc, Veress needle - 1 pc, endoscopic trocar 2 with a diameter of 5 mm with a magnetic valve - 1 pc, tweezers for bipolar coagulation - 1 pc, 3 video endoscope with a diameter of 2.7-4 mm - 1 pc, uterine hook 1 - 1 pc. (figure 1).

The atraumatic hook for ovarian hysterectomy (uterine hook) is modified from such hooks by reducing the width of the curved part to 5 mm, the diameter of the hook needle to 1 mm, so that it freely fits into the sleeve of the trocar.

The progress of the operation.

After preparation of the surgical field (haircut, shaving, treatment with skin antiseptics), preliminary sedation is performed: 0.2 mg / kg intramuscularly flies, 2 mg / kg foul for an hour intravenously and shaving - 2 × 2 cm surgical field disinfection along the white line of the abdomen, retreating caudally 1.5 cm from the navel, the veterinarian deepens the anesthesia by intravenous administration of 4 mg / kg pofol per hour.

The cat is fixed on the back. The point of insertion of the Veress needle is determined (departing from the navel 1.5 cm caudally). The surgical field is draped with a cotton cloth with a pre-cut hole 2 × 2 cm in the middle. Using a scalpel, a 4 mm skin incision is made up to the subcutaneous tissue. A Veress needle is inserted into the abdominal cavity, the abdominal cavity is insufflated with carbon dioxide to a pressure of 8 mm Hg (Fig. 2), a trocar is inserted into the abdominal cavity with a puncture (Fig. 3). A video endoscope is inserted into the sleeve of the trocar, the abdominal organs are examined for pathologies. They find the uterine horn, grab it with an atraumatic uterine hook inserted into the trocar sleeve (Fig. 4). Through the faucet of the trocar, carbon dioxide is released from the abdominal cavity of the animal. A video endoscope, a trocar sleeve, a uterine hook with a captured uterine horn are sequentially removed (Fig. 5). The vessels, ligaments of the ovary and uterus are coagulated and cut off with bipolar forceps of the electrocoagulator. By pulling on the prepared horn and uterine bifurcation, the second uterine horn is pulled to the surgical opening and is removed with an atraumatic uterine hook. In the cervical region, coagulation and cutting off of the electrocoagulator with bipolar forceps is also carried out. The uterine stump is set into the abdominal cavity, then an internal suture is applied to the muscles of the abdominal wall, and the skin is sealed with Vetbond glue.

The proposed method, due to the speed of the operation (no more than 20 minutes), and less trauma (only one hole for a trocar with a diameter of 5 mm), requires a small dose of anesthesia, due to which the rehabilitation period takes an average of 3 hours, which reduces the cost of the operation and eliminates the need for costs on keeping the animal in the hospital, it prevents postoperative complications (leakage of carbon dioxide into the subcutaneous tissue, and complications due to increased gas pressure in the abdominal cavity), the operation is gentle, concealed with the simplicity of surgical procedures and cosmetic effect (surgical field no more than 2 × 2 cm).

The proposed method has been used by the author since May 2012 on the basis of his own veterinary clinic (veterinary center IP Ivanov V.V.) in Kazan, more than 30 cats and more than 10 ferrets underwent ovarian hysterectomy, no complaints have been received.

Claims (1)

A method of ovariogysterectomy in cats, ferrets, including injections and insufflation with a Veress needle, introducing a trocar and a video endoscope for finding the uterus and ovaries, engaging the uterine horn with the ovary, coagulating and dissecting the uterine vessels and ligaments with an electrocoagulator, removing the uterine horns through the trocra incision incision hole, cervix, reduction of the cult of the cervix into the abdominal cavity, characterized in that the puncture with a Veress needle is performed caudally, 1.5 cm from the navel in the midline of the abdomen, then insuffl tion of the abdominal cavity with carbon dioxide to a pressure of 8 mm Hg and take out the Veress needle, and the introduction of an endoscopic trocar with a magnetic valve is carried out at the same injection point, a video endoscope is inserted into the trocar and the organs of the animal’s abdomen are examined first for pathologies, then the uterus and ovary are searched for, the hook is inserted into the trocar sleeve and hooked under the control of the video endoscope uterine horn with ovary, open the trocar tap, release carbon dioxide from the abdominal cavity of the animal, then remove the video endoscope, the trocar sleeve, the hook with the uterine horn and eggs from the abdominal cavity ohm, coagulate and dissect the uterine vessels and ligament, then sip on the prepared horn and uterine bifurcation, remove the second horn of the uterus, coagulate and cut off the uterine vessels and ligaments, then coagulate and cut the uterus as a whole in the area of its cervix, straighten the stump of the cervix into the abdominal cavity , impose an internal seam on the muscles of the abdominal wall, and the skin defect is sealed with glue.

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