Tips for soft-tissue surgeries

Tips for soft-tissue surgeries

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.