Unlike human medicine where surgery is the exclusive domain of the specialist, general practitioners in veterinary medicine
are often called upon to perform a wide variety of surgical procedures.
Photo 1: Hartman alligator forceps with round cup jaws.
|
Due to the cost of equipment and the potentially more daunting nature of orthopedic surgery, most non-specialty trained practitioners
have become more experienced with soft-tissue surgery. Although soft-tissue surgery may not seem as intimidating as orthopedic
surgery, difficulties can be encountered that can complicate even routine procedures. Many procedures can be made easier by
having the right instrument or by knowing "tricks" that may not be found in the surgery texts. The following are some of our
favorites for a few commonly encountered soft-tissue surgery situations.
Alligator forceps with round cup jaws
This is a favorite instrument in our practice. We have the Hartman alligator forceps, but there are other very similar models
(Photo 1). This instrument can be used for biopsies of the nasal passage and removing or obtaining biopsies of masses in the
ear canal. It can also be used for extracting nasopharyngeal polyps in cats. After retracting the soft palate rostrally with
a blunt spay hook, the polyp is grasped with the alligator forceps near its base and removed, hopefully in its entirety, with
firm steady traction.
We keep our Hartman forceps sterilized in an individual package so that it may be used in aseptic procedures as well.
Cryptorchid castration tips
Photo 2: Spermatic cord entering the left inguinal canal (black arrow). The body of the penis is immediately to the right
of the spermatic cord (white arrow). (Patient is in dorsal recumbency. Cranial is at the top of the image.)
|
It may be difficult in the case of unilateral cryptorchid pets to determine which testicle is undescended. Even testicles
located external to the inguinal ring can be difficult to identify by palpation alone in cats or heavier dogs. An easy method
to determine this at the time of surgery is to remove the scrotal testicle first. With the descended testicle exteriorized,
the spermatic cord can be traced to the corresponding inguinal canal (Photo 2). The contralateral inguinal canal can then
be explored for the undescended testicle.
Abdominal cryptorchid
If you do need to explore the abdomen for an undescended testicle, remember to first identify the vas deferens as it joins
the proximal urethra. This structure can then be followed to the testicle that is often discovered deep into the urinary bladder.
If the vas deferens is traced to the inguinal ring, the testicle has passed into the inguinal canal. Exploration then should
be carried out from the external surface of the body wall.
Culturing the urinary tract mucosa or calculi
When performing a cystotomy for cystic calculi or chronic cystitis, before closing the bladder wall, obtain a small piece
of mucosa from the edge for culture and sensitivity. Alternatively, if multiple calculi are removed, one of these can be crushed
into the culture media. A study by Hamaide, et al, demonstrated that 18.5 percent more cases will have a positive culture
result when either the bladder mucosa or urolith are cultured compared to urine alone. In the same study, if the urine cultured
positive, the same organism was cultured from the urolith or bladder mucosa. A stone and mucosa can be cultured together to
increase the odds of obtaining a positive result. It is especially important to have an accurate culture in cases of chronically
treated urinary tract infections where the risk of infection by drug-resistant organisms is high.
Featuring Information from:
