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VET 457 Small Animal Surgery

Reproductive Surgery- Neuter: 15 March 2011


Lynne A. Snow, DVM, MS, DACVS

Reproductive Surgery- Neuter
15 March 2011
Learning objectives:
1. Define the terms: neuter, castration, ovariectomy, ovariohysterectomy, orchiectomy.
2. Identify the pertinent surgical anatomy of an ovariohysterectomy and orchiectomy.
3. Know the indications and potential complications of each castration technique.
4. Describe the surgical technique for ovariectomy, ovariohysterectomy, orchiectomy.
5. Know the importance of the ductus deferens in respect to cryptorchid castration.
6. Know the differences between canine and feline ovariohysterectomy.
7. Describe the surgical technique for feline orchiectomy.
Introduction
Neuter or castration is a general term which refers to the removal of the reproductive ability
of the animal. Ovariohysterectomy is the surgical removal of the ovaries and the uterus where
ovariectomy is the removal of only the ovaries. Orchiectomy is the surgical removal of the testicles.
The majority of patients presenting for routine castration are healthy and have a normal physical
examination. Complete physical examination should be performed to evaluate for other conditions
such as umbilical hernias or reproductive tract tumors and treated as indicated. Perioperative
antibiotics are generally not indicated for elective castration. A variety of surgical techniques have
been described and specific surgical technique can vary between patients. The goals however are
the same: (1) removed the gonads and (2) provide secure hemostasis.
Ovariohysterectomy (OHE)
Surgical anatomy: The female reproductive tract includes the ovaries, oviduct, uterus, vagina, vulva,
and mammary glands. The ovaries are within the ovarian bursa located just caudal to the pole of
each kidney. Each ovary is attached by the proper ligament to the uterine horn and to the
transversalis fascia medial to the last 1-2 ribs by the suspensory ligament. The mesovarium or
ovarian pedicle contains the suspensory ligament, the ovarian artery and vein, and a variable amount
of fat and connective tissue. The broad ligament (mesometrium) is the peritoneal fold that suspends
the uterus. The uterine artery and vein are present along the uterine horns within the broad ligament.
The cervix is the constricted caudal part of the uterus and is thicker than the uterine body and vagina.
The vagina connects to the vestibule at the urethral orifice.
Indications: The most common reason to perform OHE is to prevent estrus and unwanted offspring.
Other reasons include prevention of mammary tumors or the passing on of heritable conditions and
congenital anomalies. Specific medical conditions are prevented or treated by OHE such as
pyometra, metritis, neoplasia (ovarian, uterine), uterine cysts, uterine torsion, uterine prolapsed,
vaginal prolapsed, vaginal hyperplasia. Certain endocrine and dermatologic disorders are easier to
manage following OHE including diabetes mellitus, epilepsy, and generalized demodex.
Complications: Most complications following routine castration can be avoided with proper surgical
technique. Ovariohysterectomy is more difficult in larger dogs and has been associated with more
complications. Hemorrhage primarily occurs from the ovarian pedicles, uterine vessels, or uterine
wall when ligatures are improperly placed. Hemorrhage is more likely when OHE is performed in a
pregnant animal or during estrus. Ureter ligation or trauma may results from ligation of a dropped or
bleeding ovarian pedicle if exposure is not adequate. The ureter may also be ligated at the bladder
trigone region if the bladder is distended and the ureterovesicular junction is cranially displaced.
Ovarian remnant syndrome results in signs of estrus after OHE. This is typically due to inadvertently
leaving a portion of the ovary in the abdomen during OHE. Abdominal exploration usually identifies
ovarian tissue near the expected normal anatomic location although ectopic ovarian tissue has been
reported. Fistulous tracts or granulomas may occur following OHE due to contaminated suture
material or when non-absorbable suture material or cable ties are used. These fistulas may improve
with antibiotics but will not resolve until the suture material is removed.

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Urinary incontinence is uncommon after OHE (11-20%). When it occurs it is typically soon
after surgery or in geriatric bitches. Potential causes are low estrogen levels, uterine stump
adhesions or granulomas to the bladder, and vaginoureteral fistula. Some owners believe that OHE
leads to obesity however this is not true if the animal is properly fed and exercised.
Surgical technique:
The ventral abdomen is clipped and aseptically prepared from the xiphoid to the pubis.
Ovariohysterectomy is performed through a ventral midline incision in the caudal abdomen. The
incision in dogs is made immediately caudal to the umbilicus to facilitate ligation of the ovarian
pedicles. The incision in cats in made approximately 2cm caudal to the umbilicus (middle 1/3 of
caudal abdomen) to facilitate ligation of the uterine body because the ovarian pedicles are more
mobile in the feline. The incision is approximately the length of 1/3 of the caudal abdomen but can be
extended as needed.
The uterine body is identified in its normal anatomic location dorsal to the bladder and ventral to the
colon. Alternatively a spay hook (Snook hook) can be used by sliding it with the hook along the
abdominal wall 2-3 cm caudal to the kidney. The hook is then turned medially to ensnare the uterine
horn, broad ligament, or round ligament and gently elevated from the body. The identity of the uterine
horn is confirmed by following it to either the ovary or the uterine bifurcation.
A mosquito forceps is placed on the proper ligament. The suspensory ligament is palpated by
applying caudal and medial traction on the uterine horn. The suspensor y ligament is identified as a
taught fibrous band at the proximal edge of the ovarian pedicle. The suspensory ligament is broken
down by stretching with controlled caudolateral traction (no strumming) while maintaining
caudomedial traction on the uterus. The suspensory ligament can be cut with Metzenbaum scissors if
it can be clearly seen and isolated from other abdominal contents.
A hole is made in the broad ligament directly caudal to the ovarian pedicle. Two Rochester-Carmalt
forceps are placed across the ovarian pedicle approximately 1.5 cm apart and one Rochester-Carmalt
forceps across the proper ligament of the ovary including the uterine vessels. A circumferential
ligature is placed in the crush of the most proximal (deepest) clamp on the ovarian pedicle. A
transfixation ligature is placed just distal to the circumferential ligature (between the circumferential
ligature and the remaining clamp on the ovarian pedicle). The ovarian pedicle is transected just distal
to the remaining clamp on the ovarian pedicle (between the clamp and the ovary). The ovarian
pedicle is grasped with Brown-Adson forceps and the clamp is removed and evaluated for bleeding.
The ovarian pedicle is gradually replaced into the abdomen while evaluating for bleeding. Replace
the Rochester-Carmalt if bleeding is noted and religate. The ovarian bursa is opened to be certain
the entire ovary is removed. The broad ligament is manually transected avoiding the uterine vessels.
If large vessels are encountered they may need to be ligated with a circumferential ligature. Ligation
and transection of the contralateral ovarian pedicle is performed identically.
The uterine body is ligated just cranial to the cervix. A circumferential ligature is placed on each side
of the uterus engaging 2 mm of uterus and including the uterine vessels laterally. A transfixation
ligature is placed just distal (cranial) to the circumferential ligatures. Two Rochester-Carmalt forceps
are placed distal (cranial) to the ligatures. The uterus is divided between the forceps and the ovaries
and uterus are discarded. The uterine stump is evaluated for bleeding as before. If bleeding is
present the forceps are replaced and the uterine stump religated. Prior to closure all pedicles are
double checked for bleeding. Abdominal closure is routine with closure of the external rectus fascia,
subcutaneous tissue, and skin.
Orchiectomy
Surgical anatomy: The major components of the male reproductive tract are the testicles, penis,
and prostate. The scrotum is located between the inguinal region and the anus. The scrotum is a
membranous pouch with a midline septum that houses the testes epididymis, and the distal spermatic
cords. The ligament of the tail of the epididymis attaches the head of the epididymis to the vaginal
tunic and the spermatic fascia. The ductus deferens travels through the inguinal ring, loops around
the ureter and enters the craniodorsal surface of the prostate. The spermatic cord begins at the
inguinal ring where the testicular a. and v., lymphatics, testicular autonomic nerve plexus, ductus
deferens (and associated a. and v.), smooth muscle, and visceral layer of the vaginal tunic come

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together. The cremaster muscle is a thin extension of the internal abdominal oblique muscle that
travels along the external surface of the parietal tunic.
Indications: The primary indication for orchiectomy is to reduce overpopulation and decrease male
aggressiveness and undesirable behaviors such as marking and roaming. Orchiectomy also prevents
and treats androgen related diseases such as prostatic diseases, perianal adenomas, and perineal
hernias. Other indications include the prevention of heritable and congenital anomalies, testicular or
epididymal abnormalities (neoplasia, infection, etc), scrotal neoplasia, trauma, inguinal or scrotal
herniorrhaphy, and scrotal urethrostomy. The abolishment of hormonal influences is also beneficial in
epilepsy and endocrine disorders.
Complications: Complications following a properly performed routine orchiectomy are rare. They
may include incision problems (swelling, seroma, cellulitis, infection, self-trauma, dehiscence),
hemorrhage, scrotal hematoma, scrotal bruising, abscess, granuloma, urinary incontinence,
endocrine alopecia, behavioral changes, and eunuchoid syndrome (failure of development of
secondary sex characteristics).
Trauma to the urethra and penis may occur during incision and dissection. This is more
common with scrotal ablation. This is prevented in routine orchiectomy by always incising over the
testicle. Unwanted pregnancy can still occur by a recently castrated male therefore the male should
be kept away from an intact female for at least 3 weeks. Inadvertent prostatectomy or removal of
inguinal lymph nodes has occurred during cryptorchid castration.
Surgical technique:
The ventral abdomen is clipped and aseptically prepared from the umbilicus to the prescrotal area,
including the medial thighs. The scrotum is not clipped as this can cause scrotal dermatitis. The fur
on the scrotum can be trimmed to prevent it from entering the surgical site. Drapes are placed
isolating the prescrotal area excluding the scrotum. One testicle is advanced as far cranial as
possible to the prescrotal area by pressure on the scrotum through the surgical drapes. A midline
incision is made directly over the testicle. Incising over the testicle prevents trauma to the underlying
penis and urethra. The incision is continued through the spermatic fascia to exteriorize the testicle.
The ligament of the head of the epididymis is broken down with firm traction while holding firmly at the
base of the scrotal attachment. The tissue surrounding the spermatic cord is stripped using gauze
squares until the spermatic cord is isolated.
Open (>15 kg) - The parietal vaginal tunic is incised over the testicle and the incision continued with
Metzenbaum scissors to approximately 1-2 cm from the body wall. The mesorchium between the vas
deferens, vascular cord, and parietal vaginal tunic (and included cremaster muscle) is manually
broken down. All ligatures are placed close to the body wall. The vas deferens is double ligated and
transected between the ligatures checking for bleeding before releasing the vas deferens into the
tunic. Three Rochester-Carmalt forceps are placed on the vascular cord (testicular artery and vein)
approximately 1 cm apart. A circumferential ligature is placed in the crush of the proximal clamp
(closed to the body wall) while removing the clamp. A transfixation ligature is placed just distal to the
circumferential clamp. The vascular cord is transected between the remaining forceps. The vascular
cord is grasped with Brown-Adson forceps and evaluated for bleeding. The forceps are replaced if
there is bleeding and the pedicle religated. The vas deferens and vascular cord are replaced into the
parietal vaginal tunic. The tunic is ligated with a transfixation ligature (being sure not to damage the
vascular cord). A Rochester-Carmalt forceps is placed on the tunic and the tunic transected thus
removing the testicle. The tunic and associated cremaster muscle is evaluated for bleeding. The
procedure is repeated for the other testicle through the same skin incision.
Closed (<15 kg) - Two transfixation ligatures are placed through the cremaster muscle and around
the entire spermatic cord and tunics.
The incision is closed in two layers (subcutaneous and skin). Closure of the spermatic fascia can be
performed but is not necessary. If this is closed caution is used to prevent damage or ligation of the
underlying penis and urethra.
Cryptorchid castration

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Cryptorchidism is the failure of the testicle to descend into the scrotum. The undescended testicle
can be found in the abdomen or in the inguinal area. Testicles in the inguinal area can be removed
similar to that previously described. The intra-abdominal testicle is found by following the vas
deferens from the prostate to the testicle. The testicle may be quite small and must not be mistaken
for the prostate or a lymph node. After the testicle is identified castration is performed similar to that
previously described by double ligating the testicular artery/vein and the ductus deferens separately.
Feline castration
Surgical technique:
Hair is plucked from the scrotum and the scrotum aseptically prepared. The cat is positioned in dorsal
or lateral recumbency with the hind limb pulled forward. A 1 cm scrotal incision is made directly over
the testicle while stabilizing the testicle with one hand. The parietal vaginal tunic is incised and the
testicle isolated. Most commonly the spermatic cord is tied on itself with the aid of mosquito
hemostats. The hemostat is placed on top of the cord. Wrap the distal (testicle) end over the
hemostat once. Direct the tips of the hemostat around the cord from dorsal to ventral. Grasp the cord
with the tips of the hemostat. The cord is transected on the testicle side and the testicle discarded.
The cord is manipulated with a gauze square sliding it off the hemostat. Snug the knot, resect the
excessive cord and check for bleeding. The cord is replaced in the scrotum and the procedure
repeated on the opposite side.
References and Additional information:
Tobias KM and Johnston SA. Veterinary Surgery Small Animal. Elsevier. 2011
Ch 109: Ovaries and uterus. pp 1871-1890.
Ch 111: Testes and scrotum. pp 1903-1916.
Fossum. Small Animal Surgery. 2
nd
Ed. Mosby. 2002.
Chapter 28: Surgery of the Reproductive and Genital Systems.