RU2658156C2 - Method of transvaginal laparoscopic spaying of female dogs and cats - Google Patents

Abstract

FIELD: veterinary medicine.

SUBSTANCE: animal is laid on the back on a special angled swivel pad on the operating table. Anesthesia and narcosis are performed. The anterior abdominal wall is shaved, treated with antiseptics, and carboxypneumoperitoneum is created. Antiseptic sanitation of the vagina is performed. Calibrated blind dilation of the vagina is performed. The animal is turned over to the right side on the angled swivel pad. Vaginoscopy is carried out by entering the endoscope with a diameter of 10 millimeters, a length of 200 to 295 millimeters, with an operating channel of 5 mm in diameter, equipped with a video camera which is connected to the monitor, into the vagina. The position of the internal organs is determined, the site of the future puncture of the vaginal wall is marked, the site that is located dorsally, to the left of the midline. Coagulation and dissection of the vaginal wall is performed. An elongated trocar with a diameter of 11 mm, a length of 180 to 200 mm is administered into the vagina towards the left cupula of the diaphragm, the trocar is guided into the abdominal cavity. The endoscope is administered into the trocar and guided into the abdominal cavity, the ovaries are visually determined through the endoscope, an elongated manipulator is inserted into the endoscope. The soft tissues of the first and second ovaries are allocated, temporal pexing of the first and the second ovaries is performed to the ventral abdominal wall. The ovaries are separated and extracted through the trocar. The vessels are ligated, clipped and coagulated. The troakar is removed, the postoperative wound is treated with antiseptics.

EFFECT: reduction of surgery trauma and reduction of postoperative complications.

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Description

The field of technology.

The invention relates to veterinary medicine, in particular to veterinary surgery, and can be used in castration of females (females) of dogs and cats.

The level of technology.

Castration (lat. Castratio - raking, from castro - trimming, cleansing, scattering) is a surgical operation, the essence of which is to remove the sex glands of the animal in order to prevent natural fertilization. Castration methods are known. More often in published sources there are methods of castration of male animals, for example, the method of castration of small domestic animals ([1] - RU 2130299), the method of castration of male farm animals ([2] - RU 95111112), the method of castration of boars ([3] - RU 2391941 ), a method of castration of gobies ([4] - RU 2104674). These methods [1, 2, 3, 4] are not suitable for castration of females (females) of dogs and cats. In the surgical castration of female dogs or cats, the genital ovaries (ovariectomy) are removed or the genital glands are removed along with the uterus (ovariogysterectomy).

To remove the sex glands of female dogs or cats, intracavitary surgery is performed. Access to the genital glands and uterus of animals is currently provided through an incision (laparotomy) in the abdominal cavity, the incision is performed on the abdomen, in the navel (along the white line) or along the side surface or through punctures (laparoscopy) into the abdominal cavity the wall. Punctures are made with a sharpened stylet inserted into the trocar. After performing the puncture, the stylet is removed, and the trocar is left in the thickness of the tissues. Through trocars, the necessary surgical instrument is inserted into the body cavity. Access through punctures is less traumatic and can reduce the duration of the rehabilitation postoperative period. For free and safe manipulation of surgical instruments inside the abdominal cavity, it is necessary to create an operating cavity.

A known method of creating an operating cavity ([5] V. M. Sedov, V. V. Yurlov, S. S. Yeltsin, E. V. Ivanikha. Prevention of complications of laparoscopic cholecystectomy. Bulletin of surgery. Volume 155, N 2. - 1996 . - S. 72). In the method [5], pneumoperitoneum is formed in the abdominal cavity; for this, a gas is introduced through the needle or trocar into the abdominal cavity - air or carbon dioxide. The trocar (or needle) is connected by means of pneumatic pipelines to the compressor. Gas is injected into the abdominal cavity under pressure, it exerts uniform pressure in all directions, inflating the abdominal cavity and forming a free internal operating space. The method [5] is not intended for castration of dogs or cats.

A known method of surgery (ovariohysterectomy) with mass sterilization of cats and dogs ([6] - RU 149181). Method [6] includes performing an incision of a skin and muscle fragment of an operative wound, an abdominal incision, removal of reproductive organs and suturing of the wound. The wound incision is carried out 1-3 cm below the umbilical ring and 3-5 cm from the midline of the abdomen. The length of the cut is from 2 to 5 cm, depending on the need. Then, the surgical wound is displaced by pulling the skin to the right or left until the aponeurosis is exposed, along which an incision is made to penetrate the abdominal cavity. After surgery, long absorbable sutures are applied to the peritoneum and aponeurosis. The skin wound is displaced back, thereby the skin covered the muscle wound. Subcutaneous tissue (saphenous suture) is then sutured, preventing “dead space” and creating additional tightness of the wound. Use a long absorbable material. In conclusion, an intradermal suture was applied with subcutaneous fixation of nodes on both sides.

Known laparoscopic sterilization of cats and dogs ([7] - Internet site "http://zoostatus.ru" of the veterinary clinic "ZOOSTATUS", Moscow, home> treatment> surgery and restoration of cats> Laparoscopic sterilization of cats and dogs "; access mode : http://zoostatus.ru/lechenie/hirurgiya-i-vostanovlenie-koshek/laparoskopicheskaja-sterilizatsija-koshek/). At the initial stage of the operation, with the help of a laparoscope, the animal is pumped with carbon dioxide (insufflation). Make cuts on the side of the animal. After visualization of the uterus and ovaries, ligatures are applied and these organs are removed. Sutures are applied to the incisions.

There is a method of castration of cats ([8 - Internet site "http://zoostatus.ru"; main> cats> advantages of laparoscopic sterilization of cats>; access mode: http://www.tinydog.ru/zhivotnyj-mir/porody-koshek /preimushhestva-laparoskopicheskoj-sterilizacii-koshek.html). Before starting, the hair is shaved off at the place where the incision will be made, after which the animal is introduced into anesthesia. An abdominal incision is made, when the uterus and ovaries are removed, the incision is not more than 2 cm. A surgical instrument is introduced into the peritoneal cavity, which is equipped with a video camera and a light source, which allows the doctor to detail and also increase the inside of the animal on the monitor. After visualization of the uterus and ovaries, these organs are removed. Sutures are applied to the incisions.

In these methods [6; 7; 8] on the outer surface of the animal’s body, postoperative incisions remain vulnerable to damage. As you know, dogs and cats exhibit motor activity after surgery. When performing incisions outside the abdominal cavity, postoperative tissue injury is allowed, the animal can lick the wound, contaminate, the stability of the surgical wound is not ensured during the motor activity of the animal. As a result, there may be a discrepancy in the edges of the wound, the occurrence of an inflammatory process, and complications.

In human medicine, a method of laparoscopic hernioplasty of umbilical hernias and hernias of the white line of the abdomen is known ([9] - RU 2326581). When implementing the method [9], for access to internal organs, three trocars are introduced during surgery, in women, the trocar is introduced through the posterior vaginal fornix. In human medicine, a method for performing transvaginal appendectomy is also known ([10] - RU 2531138). The operation according to the method [10] is performed under combined endotracheal anesthesia. The patient's position is on his back, legs are divorced. After processing the surgical field perform umbilical access 1 with a length of 10 mm Carboxyperitoneum is superimposed with a Veress needle using the double-click method. Two trocars with a diameter of 5 mm are introduced into the abdominal cavity through the wound of umbilical access. Laparoscopy is performed by a direct laparoscope with a diameter of 5 mm and a viewing angle of 30 degrees. In the second trocar, a working tool with a diameter of 5 mm is inserted into the abdominal cavity - a direct atraumatic clamp. Under visual control, a puncture of the posterior vaginal fornix with a 10 mm diameter trocar is performed on the monitor. The direct endoscopic clamp is rearranged into the vaginal access trocar, which grasps and holds the apex of the appendix towards the anterior abdominal wall, visualizing its mesentery and base. Through a 10 mm vaginal access trocar, the base of the vermiform appendix is clipped with three clips and endoscopic appendix between the distal clips is intersected with endoscopic scissors. After that, the vermiform appendix is removed from the abdominal cavity through a 10 mm vaginal access trocar. Perform a control audit, lavage, drainage of the abdominal cavity. The vaginal access trocar is then removed from the abdominal cavity under visual control. Carboxyperitoneum is eliminated, trocars are removed from umbilical access. The wound of the posterior vaginal fornix is not sutured; a napkin with hydrogen peroxide is introduced into the vagina. The wound of umbilical access is sutured in layers. These methods [9, 10] are not applicable for castration of animals.

With the existence of various methods of castration of animals, the fame of various types of access to internal organs, the development of a method that provides minimally invasive, less traumatic and relatively easy to implement, with the appropriate endoscopic tools and skills, castration of female dogs and cats is an urgent task of modern veterinary medicine. The author has not found published methods of castration of female dogs and cats that meet the above requirements.

The invention is based on the anatomical features of animals. It is known that the vagina of female dogs and cats is separated from the abdominal cavity of the mucous membrane, muscular-fascial dense tissue and pelvic peritoneum. In this case, the thickness, blood supply and bleeding of the vaginal wall depend on the stage of oestrus and the number of births in a female dog or cat. In the estrous period, the vaginal wall thickens by 3-5 mm due to edema and plethora. In sterilized animals, vaginal wall thickening due to edema and plethora does not occur. Sterilization (from lat. Sterilis - sterile) is the deprivation of the animal's ability to reproduce offspring while maintaining the endocrine function of the sex glands. Sterilization should be distinguished from castration, in which the endocrine function of the gonads is also eliminated. From experience, the author knows that in sterilized animals, laparocentesis via transvaginal access is less traumatic, relatively bloodless.

SUMMARY OF THE INVENTION

The objective of the invention is to expand the range of surgical procedures known in veterinary medicine for castration of female dogs and cats. The aim of the invention is to develop a rational, economically viable method of castration of female dogs and cats, which reduces tissue trauma, eliminates the possibility of spillage, pollution animals operating wounds, ensuring the stability of the operating wound during motor activity of the animal.

The technical result consists in solving the problem. The technical solution eliminates the need to cut the external tissues of the abdominal cavity, the access is located inside the body, which is very beneficial for the postoperative condition of the animal. Tissues are less injured, there is no incision and sutures on the wall of the abdominal cavity, there is no contact of the abdominal cavity with the external environment, which minimizes the risks of infection. It provides faster, in comparison with known methods, healing, eliminates the need for processing a postoperative wound and removal of sutures.

The technical result is achieved by the fact that in the method of transvaginal laparoscopic castration of female dogs and cats, the animal is placed on a special angular rotary lining, on the operating table, on the back, anesthesia, anesthesia are performed, the anterior abdominal wall is shaved, treated with antiseptics, and carboxypneopperitoneum is created, for this, pre-shaved area on the abdominal cavity, into the navel, insert the Veress needle, connect the Veress needle with tubes to the insufflator, pump gas under pressure from 10 to 12 millimeters of mercury into the abdominal cavity, perform vaginal antiseptic sanitation, calibrated blind dilatation of the vagina, using calibrated dilators with a diameter of up to 15 mm and blunt expander bougins, turn the animal on an angular rotary pad on the right side, perform vaginoscopy, insert an endoscope into the vagina with a diameter 10 millimeters, lengths from 200 to 295 millimeters, with a working channel of 5 millimeters in diameter, equipped with a video camera connected to the monitor, determine the position of the internal rganov, mark the site of the future puncture of the vaginal wall, which is located dorsally, to the left of the midline, coagulate and dissect the vaginal wall by working with elongated manipulators, made from 400 to 450 millimeters long, introduce an elongated trocar into the vagina with a diameter of 11 millimeters, lengths from 180 to 200 millimeters , in the direction of the left dome of the diaphragm, conduct a trocar into the abdominal cavity, lead the endoscope into the trocar and conduct into the abdominal cavity. The ovaries are visually determined through the endoscope, the elongated manipulator is inserted into the endoscope, the soft tissues of the first ovary are removed, the first ovary is temporarily pexed to the ventral abdominal wall, the first ovary is mobilized, the soft tissues connecting the first ovary are dissected, their own ligaments of the first ovary are captured, the first ovary is removed through the trocar, the described sequence of actions to remove the ovary is performed, on the opposite side, with the second ovary, ligated, clipped and coagulated vessel s, the trocar is removed, the postoperative wound is treated with antiseptics, a sterile napkin impregnated with a solution that promotes wound healing is inserted into the vagina.

As a result of transvaginal laparoscopic surgery, the problem of postoperative care for sutures on the abdominal wall due to their absence is completely resolved.

The invention is illustrated by graphic materials, which show:

FIG. 1 - Photo, shown angular rotary lining;

FIG. 2 - Photograph showing abdominal puncture with a Veress needle;

FIG. 3 - Photograph showing the end of the trocar in the abdominal cavity;

FIG. 4 - Photograph showing the extraction of the ovaries, uterine horns with an “eversion” of the vagina.

The method is as follows.

The method is used to remove the internal genital organs in dogs for medical or social reasons. Prior to the planned surgical intervention, a temporary chemical sterilization of the female dog is carried out. They inject drugs that can suppress the production of hormones and temporarily suppress the desire for reproduction. A preliminary chemical sterilization carried out over several months (usually from 1 to 6) helps to reduce blood flow in the uterus and ovaries. Temporary preliminary chemical sterilization is carried out using drugs in tablets or injections. For these purposes, the drug proligestone can be used. The drug is administered strictly subcutaneously, in the middle part of the skin fold, avoiding intradermal injections, as well as injections into the subcutaneous fat deposits, scar tissue. The drug is administered once in a dose, depending on the weight of the animal: up to 20 kg - 1 ml, from 21 kg - 40 kg - 2 ml, over 40 kg - 3 ml. Before surgery, especially for older individuals (over 10 years old), a blood test and an ultrasound scan are performed to determine the ability of the animal to undergo surgery. 12 hours before the planned operation, the animal is limited in food intake and 3 hours before the planned operation, fluid intake is limited. The female dog or cat (hereinafter referred to as the animal) is placed on the operating table, on a special corner swivel pad (Fig. 1), on the back.

To implement the method, endoscopic equipment is used, consisting of a video system, an insufflator, a special endoscope (laparoscope with end optics) with a diameter of 10 millimeters, a length of 200 to 230 millimeters (295 mm long), with a working channel with a diameter of 5 mm, an elongated trocar with a diameter of 11 mm, from 180 to 200 millimeters long with a blunt stylet and a set of elongated manipulators (dissector, scissors, bipolar clamp-coagulator) from 400 to 450 millimeters long.

For transvaginal endoscopy, both a rigid and flexible system can be used. They carry out anesthesia, anesthesia. The anterior abdominal wall is prepared, shaved, treated with antiseptics. A carboxypneumoperitoneum is created, for this purpose, a Veress needle 1 is inserted into a pre-shaved area on the abdominal cavity, in the navel, (Fig. 2). Connect the Veress needle 1 with tubes to an insufflator (not shown in the photographs). Using an insufflator, they inject gas, under pressure from 10 to 12 millimeters of mercury, through the Veress needle 1 into the abdominal cavity. Carry out antiseptic sanitation of the vagina (douching with antiseptics). A calibrated blind dilatation of the vagina is carried out, which is achieved by calibrated dilators with a diameter of up to 15 mm, blunt-ended bougie expanders of the required caliber are used, as a result of which they maximize the disclosure of the soft tissues of the vagina. The animal is turned over on an angular swivel plate on the right side, for this, the angular swivel plate is turned at an angle of about 90 degrees. Perform vaginoscopy. An endoscope (a laparoscope with end optics) is inserted into the vagina. Using vaginoscopy, the position of the internal organs in relation to the dilator is determined, the anatomical features and the condition of the vaginal wall are determined, the site of the future puncture of the vaginal wall is planned.

To puncture the vaginal wall and create a vaginal port during vaginoscopy, a place is planned, a site that is located dorsally, to the left of the midline, trying to avoid injury to large blood vessels. Blood vessels pass in the lateral parts of the vagina, there is always a space between them on the dorsal wall of the vagina, which should be used to create the vaginal port. Long manipulators are inserted into the vagina. They carry out coagulation and dissection of the vaginal wall by working with elongated manipulators. Given the good blood supply to the muscular-fascial layer of the vagina, a longitudinal direction is recommended for coagulation and dissection of the vaginal wall. Remove the extended arms. A trocar is inserted into the vagina, without a stylet, towards the left dome of the diaphragm. A trocar is carried out into the abdominal cavity (Fig. 3), holding it in the longitudinal direction during advancement, while bimanual control is performed through the abdominal wall, detecting the end of the trocar in the region of the free abdominal cavity without pre-organs (rectum, bladder).

An endoscope (a laparoscope with end optics, a video camera unit, a lens) is inserted into the trocar and carried out into the abdominal cavity, establishing stable visual monitoring of the state of the abdominal organs. The video signal from the endoscope is displayed on the monitor. Ovaries are visually determined through an endoscope. The uterine horns are determined. An elongated manipulator-dissector is introduced into the endoscope. The soft tissues of the first ovary are removed, a temporary pexia of the first ovary is carried out to the ventral abdominal wall. The elongated manipulator-dissector is removed. Mobilize the first ovary. For this, an elongated manipulator is introduced into the endoscope - a bipolar clamp-coagulator. Soft tissues that bind the first ovary are treated. The elongated manipulator is removed - a bipolar clamp-coagulator. An elongated manipulator is introduced into the endoscope - scissors, soft tissues dissecting the first ovary are dissected. An incision of the soft tissues fixing the pexed first ovary is performed simultaneously with coagulation. The elongated scissors are brought out. An elongated manipulator-clamp is inserted into the endoscope. They capture the ligaments of the first ovary with an elongated manipulator-clamp. The mobilized first ovary is removed through the trocar, taking out the endoscope together with an elongated manipulator-clamp. Perform the described sequence of actions on the opposite side with the second ovary. The soft tissues of the second ovary are removed, and the second ovary is temporarily secreted to the ventral abdominal wall. They mobilize the second ovary, dissect the soft tissues that bind the second ovary. Capture the own ligaments of the second ovary with an elongated manipulator-clamp. The mobilized second ovary is recovered via a trocar. Vessels are ligated, clipped or coagulated. The trocar is removed.

When performing an ovariectomy, these actions are enough for castration. Then treat the postoperative wound with antiseptics. A sterile napkin, impregnated with a solution that promotes wound healing, is inserted into the vagina. When ovariogysterectomy is performed, the uterus is additionally removed. They capture and remove the horns of the uterus and ovaries into the vagina, perform an “eversion” (Fig. 4), through the vagina and to the outside of the ovaries, horns and uterine body with the extraction of the endoscope through the vagina. Then, vessels feeding the uterus are also ligated, clipped or coagulated. Sutured or ligated uterine stump. The uterine stump is set into the abdominal cavity through the trocar. The trocar is removed. A postoperative wound is treated with antiseptics. A sterile napkin, impregnated with a solution that promotes wound healing, is inserted into the vagina.

The method is used by the author in a veterinary clinic during the surgical castration of female dogs and cats.

Claims (1)

A method of transvaginal laparoscopic castration of female dogs and cats, characterized in that the animal is placed on a special angular rotary lining on the operating table, on the back, anesthetized, anesthetized, the anterior abdominal wall is shaved, treated with antiseptics, a carboxypnevoperitoneum is created, for this, in a pre-shaved area on the abdominal cavity, into the navel, enter the Veress needle, connect the Veress needle with tubes to the insufflator, pump gas under pressure from 10 to 12 millimeters of mercury of the first column into the abdominal cavity, they perform antiseptic sanitation of the vagina, calibrated blind dilatation of the vagina, using calibrated dilators with a diameter of up to 15 mm and blunt expander bougie, turn the animal on an angular rotary lining on the right side, perform vaginoscopy, insert an endoscope with a diameter of 10 millimeters, lengths from 200 to 295 millimeters, with a working channel of 5 millimeters in diameter, equipped with a video camera connected to the monitor, determine the position of internal organs c, the site of the future puncture of the vaginal wall is located, which is located dorsally to the left of the midline, coagulation and dissection of the vaginal wall by elongated manipulators, made from 400 to 450 millimeters in length, an elongated trocar 11 mm in diameter, from 180 to 200 millimeters long, is inserted into the vagina, in the direction of the left dome of the diaphragm, a trocar is carried out into the abdominal cavity, the endoscope is inserted into the trocar and conducted into the abdominal cavity, the ovaries are visually determined through the endoscope, an elongated manipulation is introduced into the endoscope the torus, the soft tissues of the first ovary are removed, the first ovary is temporarily pecified to the ventral abdominal wall, the first ovary is mobilized, the soft tissues that bind the first ovary are dissected, capture their own ligaments of the first ovary, the first ovary is removed through the trocar, the described sequence of actions to remove the ovary , on the opposite side, with the second ovary, vessels are ligated, clipped and coagulated, the trocar is removed, the postoperative wound is treated with antiseptics, in the vagina slit put a sterile cloth soaked in the solution, promotes healing of wounds.

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