Rabbit Spay and Neuter Techniques
<pPacific Veterinary Conference 2017
Zarah Hedge, DVM, MPH, DACVPM
The domestic rabbit (Oryctolagus cuniculus) is the 3rd most common species seen in animal
shelters and there are an estimated 3–7 million pet rabbits in the United States.1 There are few
studies evaluating shelter population dynamics of rabbits. One study focusing on the shelter
rabbit population in Massachusetts and Rhode Island, found that a majority of rabbits were
between one and six years of age, were surrendered by their owners, and were unaltered at the
time of intake.2 Many shelter veterinarians routinely perform spays and neuters on rabbits prior
to adoption.
It is important to have a good understanding of the reproductive anatomy and physiology of the
rabbit. The doe has a bicornuate uterus; the uterine horns have separate openings into the vagina
through their own cervix. There is no uterine body. The vagina is long and flaccid and can retain
urine, as the urethra opens into a vestibulum in the vagina called the urogenital sinus,
approximately 4 cm from the vaginal orifice. Does are induced ovulators with a normal gestation
period of 30–32 days. Fetuses are visible radiographically after day 12 of pregnancy.4,5 Females
often develop a dewlap as a secondary sex characteristic.
In bucks, the testicles descend at 10–12 weeks of age, and the inguinal canals remain open,
allowing them to retract the testicles into the abdomen. Motile spermatozoa appear in the
ejaculate around 4 months of age. Males are considered sterile around 5–6 weeks after
castration.3 Male rabbits do not have a scrotum but rather two mostly hairless scrotal sacs.
Neutering can be beneficial in reducing male mounting behaviors and aggression, although may
not entirely prevent it.6
Rabbits can be difficult to sex, especially when they are young. Adult males are typically easier
to sex due to the presence of prominent descended testicles. Applying gentle pressure on the
genital orifice will evert either the penis or the vulva. The vulva is commonly misidentified as a
penis, especially to the novice, but is shorter and less rounded with a slit-like opening, as
opposed to the penis which has a circular opening. The anogenital distance in females is shorter
than that of males.3,4
Spaying female rabbits is beneficial to prevent reproductive complications, as well as
overpopulation. Extra uterine pregnancy is common in rabbits, due to the escape of a fertilized
ovum into the abdominal cavity or rupture of a pregnant uterus. When this occurs, the ovum
typically attaches to the parietal peritoneum and the fetus becomes mummified. Uterine
adenocarcinoma is the most common tumor in female rabbits, with an incidence of 60% in some
breeds of rabbits (i.e., Dutch rabbits) over 4 years of age. These tumors often involve both horns
of the uterus and appear as polypoid structures that project into the uterus, and metastasis can
occur. To prevent this disease in female rabbits it is recommended to perform
ovariohysterectomy prior to 2 years of age.4
Rabbit Ovariohysterectomy
Rabbit tissues are often more thin, friable and delicate than that of dogs and cats. Gentle surgical
technique and minimal tissue handling is important to minimize surgical complications,
including adhesion formations. Rabbits are particularly prone to adhesion formation between
abdominal organs, which can be exacerbated from foreign material such as talc from gloves or
lint from gauze sponges. Appropriate suture material selection can also minimize post-operative
adhesion formation, and newer suture materials that dissolve via hydrolytic degradation are less
reactive. For ovariohysterectomy, a 3-0 or 4-0 monofilament suture is commonly used. Bladder
expression prior to surgery is not recommended, due to the tendency of urine to pool in the
vagina and due to the fact that the bladder wall is thin and easily damaged.4,6
Prepubescent rabbits have a much smaller reproductive tract with minimal fat, and it can be more
difficult to locate and exteriorize for ligation. Spaying after 4 months is typically performed due
to this reason; however, depending on surgeon experience, they may opt to perform the surgery
at an earlier age, especially in a shelter setting. A ventral midline approach is used for
ovariohysterectomy in rabbits. A 2–3 cm skin incision is made midway between the umbilicus
and pubis. In my experience, a slightly more cranial approach can aid in adequate exposure of
both ovarian pedicles. The linea should be well elevated prior to stab incision, as the cecum and
bladder are frequently large and pressed against the ventral abdomen. A spay hook is not needed
as the uterine horns, which are a bright red color, are easily visualized within the abdomen. A
spay hook can also cause damage to abdominal organs. Use of rat tooth forceps should be avoid
in the abdomen as well, as they can cause damage to thin walled organs. If needed, they can be
used to tent the linea for stab incision. The uterine horns should be traced cranially to the uterine
or infundibular tubules, which are long and coiled.
Care should be taken to remove these tubules in their entirety along with the ovaries. There can
be a considerable amount of fat in the ovarian pedicle, which can make visualization of vessels
challenging. I prefer to exteriorize the ovary by placing it between my thumb and first finger and
gently elevating the pedicle from the body. A mosquito or Kelly hemostat can be placed
proximal to the ovary to keep the pedicle elevated outside the abdomen. A single circumferential
ligature with surgeons knot or modified Miller's knot is sufficient. The uterine vessels sit
approximately 1 cm or more lateral to the cervices and vagina and can either be ligated with the
uterine horns/vagina or separately. I prefer to ligate these vessels separately with a
circumferential ligature. The mesometrium is a fat storage area in a rabbit, and can contain a
large amount of adipose tissue in adult and overweight rabbits, making visualization of the
uterine vessels difficult.6,7
The uterus can be ligated either just cranial or caudal to the cervices. Many sources reference
ligating caudal to the cervices, as it allows for removal of all uterine tissue.6,7 A transfixing or
modified Miller's ligature can be placed just caudal to the cervices, with care taken to preserve as
much of the vagina as possible. If the vagina is ligated further caudally, there is a risk of ligating
a branch of the uterine artery, the caudal vesicular artery, which supplies the bladder. It is also
possible to incorporate a ureter if the ligature is placed incorrectly in the caudal vagina, so care
should be taken to place the ligature in the cranial vagina, near the cervices.7 Ligating cranial to
the cervices, on the uterine horn side, is another technique that allows the cervices to remain
intact. This can serve as a natural barrier to prevent urine backflow into the abdomen. While
some sources state the potential risk for adenocarcinoma development if uterine tissue is left
behind, I could find no studies evaluating this risk in the rabbit. The risk is likely very small, as
the hormonal influence of the ovaries is removed.6,7 Closure of the abdomen can be performed
with a simple continuous suture pattern. Care should be taken to elevate the body wall on each
suture bite to prevent inadvertent suturing of the body wall to the cecum or other abdominal
organs. A subcutaneous closure is not needed and a subcuticular pattern can be used to close the
skin. The skin is very thin so care should be taken to avoid going through the skin during
suturing. Skin glue can be applied after the skin incision has been closed. Skin sutures should be
avoided as rabbits will chew them out, however sources indicate skin staples can be placed.6,7 In a
shelter setting, subcuticular skin closure is preferred as it removes the need to remove skin
staples in a follow-up exam.
Rabbit Castration
There are multiple techniques for castration of a rabbit, and the skin incision can be made scrotal
or prescrotal. The testicles can move freely between the scrotal sacs and the abdomen, and can be
exteriorized into the scrotal sacs by gently pressing on the inguinal region. I prefer a scrotal
approach; however, a prescrotal approach has been described. A 1–1.5 cm skin incision is made
on the midline just cranial to the base of the scrotal sacs and blunt dissection is used to penetrate
through the subcutaneous tissue to identify the testicles within the vaginal process.8 In the scrotal
approach, a small 1 cm incision is made over the scrotal sac, with care taken to have a firm grip
on the testicle to prevent it from slipping into the abdomen. With either approach, an open or a
closed technique can be used. For a closed technique, the parietal vaginal tunic surrounding the
testicle is kept intact and the testicle is exteriorized to reveal the testicular cord using gentle
digital pressure. A modified closed technique can also be used, in which the parietal vaginal
tunic is incised and the testis and epididymis removed. The parietal vaginal tunic is then
manually dissected to remove it from the skin, or dissected with scissors. The testicle and
parietal vaginal tunic is pulled out of the incision and a hemostat placed across the tunic and
cord. With either the closed or modified closed technique the testicular cord surrounded by
parietal vaginal tunic is ligated with 3-0 absorbable monofilament suture prior to transection and
removal of the testicle.7
I prefer to perform an open scrotal technique. In this technique, the parietal vaginal tunic is
incised and the testicle exteriorized by gently tearing the ligament of the testicle from the tunic.
At this point, the vas deferens and vessels of the spermatic cord can either be ligated with 3-0
absorbable suture or an overhand knot can be used to tie them, similar to a feline neuter.6 I have
performed several overhand knot ties in rabbits and found this technique to be efficient, however
rabbit testicular tissue is more friable than that of dogs and cats, and tearing can occur if tissue
handling is not gentle. With an open technique, the parietal vaginal tunic can be gently
exteriorized from the skin so that a single encircling ligature can be placed. Excess tunic can be
transected and the tunic placed inside the scrotum. The skin margins are rolled slightly inward to
appose the edges and skin glue applied to close the skin incisions.
Considerations for Rabbit Anesthesia & Surgery
All rabbits that are spayed or neutered should be identified as such by placing an abdominal or
ear tattoo. While rabbit anesthesia will not be addressed in this talk, there are a few
considerations to be aware of when performing surgery in rabbits. Rabbits should not be fasted
prior to surgery, as they are not able to vomit and fasting can result in hypoglycemia and/or
development of ileus. Rabbits are also at risk of hypothermia when under anesthesia, due to their
large surface area to body mass ratio. Proactive steps should be taken to prevent hypothermia in
rabbits, but care should also be taken not to overheat them, as they are have a low heat
tolerance.3 Rabbit skin is very thin, and it is recommended to use a high-quality clipper with a
#40 or #50 blade to avoid iatrogenic skin damage. Excessive scrubbing should also be avoiding
as it can also lead to skin damage, which can lead to post-operative irritation and possibly self-
mutilation.6 Proper perioperative analgesia is also required, and commonly involves the use of
opioids and nonsteroidal anti-inflammatory drugs. Staff should be trained to recognize signs of
pain in rabbits as well so it can be addressed in a timely manner.
References
1. House Rabbit Society. How many pet rabbits are there in the U.S.?
2014. [Link]
2. Cook AJ, McCobb E. Quantifying the shelter rabbit population: an analysis of Massachusetts
and Rhode Island animal shelters. Journal of Applied Animal Welfare Science. 2012;15(4):297–
312.
3. Varga M. Rabbit Basic Science. In: Varga M, ed. Textbook of Rabbit Medicine. 2nd Ed.
Edinburgh: Elsevier. 2014.
4. Vella D, Donnelly T. Basic anatomy, physiology and husbandry. In: Quesenberry, Carpenter,
eds. Ferrets, Rabbits, and Rodents Clinical Medicine and Surgery. 3rd ed. Saunders. 2011.
5. Varga M. Urogenital diseases In: Varga M, ed. Textbook of Rabbit Medicine. 2nd ed.
Edinburgh: Elsevier. 2014.
6. Jenkins J. Soft Tissue Surgery. In: Quesenberry, Carpenter, eds. Ferrets, Rabbits, and
Rodents Clinical Medicine and Surgery. 3rd ed. Saunders. 2011.
7. Varga M. Chapter 13. General surgical principals and neutering. In: Varga M, ed. Textbook of
Rabbit Medicine. 2nd ed. Edinburgh: Elsevier. 2014.
8. Lennox A. 2008. Comparing elective neutering techniques. DVM 360.
2008. [Link]
proceedings.
