Veterinary surgery 5090546 222040062 2008-06-27T07:56:30Z 68.149.181.189 /* Bloat surgery */ '''Veterinary surgery''' is [[surgery]] performed on animals by [[veterinarian]]s. Most veterinarians perform surgery, but it is also possible to specialize in surgery by becoming [[Professional certification|board certified]]. [[Image:Spay 1.JPG|thumb|A cat spay]] The goal of veterinary surgery may be quite different in [[pets]] and in [[farm animals]]. In the former, situation is a bit like in human beings, and more and more complex operations are performed, with sophisticated anaesthesia technics. In the latter, the cost of the operation must not exceed the economic benefit in surgically treating the illness. A good physical restraint must often replace expansive anaesthesia procedures. This limits the number of surgical operations that can be performed on those animals. Moreover, operations practised in the farm can not be performed in such aseptic conditions as in small animals clinics. [[Image:Cérudjeye pés tinaedje astok.jpg|thumb|Preparing a cow for udder surgery in field conditions: the physical restraint with a set of roaps is necessary next to xylazine tranquilisation]] ==Specialization in surgery== In the [[United States]], veterinary surgery is one of 20 [[veterinary specialties]] recognized by the [[American Veterinary Medical Association]].<ref name=Specialists>{{cite web| url=http://www.avma.org/press/profession/specialties.asp| title=Veterinary Specialty Organizations| accessdate=2006-04-06}}</ref> Those wishing to become board-certified must perform a large number of large animal or small animal procedures in such categories as [[abdominal surgery]], surgical treatment of angular limb deformities, [[Arthroscopy|arthroscopic surgery]], surgery of the foot, fracture fixation, [[eye surgery|ophthalmic surgery]], urogenital surgery, and upper respiratory surgery.<ref>[http://www.acvs.org/Action/act_GetContent.cfm?ID=3584&FILE=ACVS%5FInfoBroch%5F06%2D07%5FCh%203%2Epdf&TYPE=1304 ACVS Residency Program]</ref> ==Veterinary anesthesia== {{main|Veterinary anesthesia}} [[Anesthesia]] in animals has many similarities to human anesthesia, but some differences as well. [[Local anesthesia]] is primarily used for wound closure and removal of small tumors. [[Lidocaine]], [[mepivacaine]], and [[bupivacaine]] are the most commonly used [[local anesthetic]]s used in veterinary medicine.<ref name=Muir>{{cite book | last = Muir | first = William W. | coauthors = Hubbell, John A. E. | title = Handbook of Veterinary Anesthesia (2nd ed.) | publisher = Mosby | date = 1995 | id = ISBN 0-8016-7656-8 }}</ref> [[Sedation]] without general anesthesia is used for more involved procedures. Sedatives commonly used include [[acepromazine]], hydromorphine, midazolam, [[diazepam]], [[xylazine]], and [[medetomidine]]. [[Adrenergic receptor|α2]] [[agonist]]s like xylazine and medetomidine are especially useful because they can be reversed, xylazine by [[yohimbine]] and medetomidine by [[atipamizole]]. Xylazine is approved for use in dogs, cats, horses, [[deer]], and [[elk]] in the United States, while medetomidine is only approved for dogs.<ref name=Paddleford_1999>{{cite journal|author=Paddleford, Robert R.|coauthors=Harvey, Ralph C.|title=Alpha<sub>2</sub> Agonists and Antagonists|journal=The Veterinary Clinics of North America|year=1999|volume=29|pages=737–744}}</ref> Most surgeries in [[ruminant]]s can be performed with [[regional anesthesia]]. [[General anesthesia]] is commonly used in animals for major surgery. Animals are often premedicated intravenously or intramuscularly with a sedative, [[analgesic]], and [[anticholinergic]] agent (dogs frequently receive [[buprenorphine]], acepromazine, and [[glycopyrrolate]]). The next step is induction, usually with an [[intravenous]] drug. Dogs and cats commonly receive [[thiopental]], [[ketamine]] with diazepam, [[tiletamine]] with [[zolazepam]] (usually just in cats), and/or [[propofol]].<ref name=Paddleford_1988>{{cite book | last = Paddleford | first = Robert R. | title = Manual of Small Animal Anesthesia (2nd ed.) | publisher = W.B. Saunders Company | date = 1999 | id = ISBN 0-7216-4060-5 }}</ref> Horses commonly receive thiopental and [[guaifenesin]].<ref name=Muir/> Following induction, the animal is [[intubation|intubated]] with an [[endotracheal tube]] and maintained on a gas anesthetic. The most common gas anesthetics in use in veterinary medicine are[[isoflurane]], [[enflurane]], and [[halothane]], although [[desflurane]] and [[sevoflurane]] are becoming more popular due to rapid induction and recovery.<ref name=Clarke_1999>{{cite journal|author=Clarke, Cathy W.|title=Desflurane and Sevoflurane|journal=The Veterinary Clinics of North America|year=1999|volume=29|pages=793–809}}</ref> ==Common veterinary surgeries== ===Elective procedures=== [[Image:Kastration-katze.jpg|thumb|A cat spay]] One of the most common elective surgical procedures in animals is neutering. Neutering in animals describes [[spaying and neutering|spaying or castration]] (also please see [[castration]]). To spay (medical term: [[Oophorectomy|ovariectomy]] or ovario-hysterectomy) is to completely remove the [[ovary|ovaries]] and sometimes the [[uterus]] of a female animal. In a [[dog]] or [[cat]] this is accomplished through a [[ventral]] midline incision into the [[abdomen]]. With an [[Oophorectomy|ovariectomy]] [[Ligature (medicine)|ligatures]] are placed on the blood vessels above and below the ovary and the organ is removed. With an ovariohysterectomy the ligaments of the uterus and ovaries are broken down and the blood vessels are [[Ligature (medicine)|ligated]] and both organs are removed. The body wall, [[subcutis]], and skin are [[suture]]d. To castrate (medical term: [[orchectomy]]) is to remove the [[testicle]]s of a male animal. Different techniques are used depending on the type of animal, including ligation of the [[spermatic cord]] with suture material, placing a band around the cord, or crushing the cord with a [[Burdizzo]]. [[Image:Pyometra annotated.JPG|thumb|left|[[Pyometra]] surgery]] Neutering is usually performed to prevent breeding or prevent unwanted behavior or future medical problems. Please see [[spaying and neutering]] for more information on the advantages and disadvantages of this procedure. Neutering is also performed as an emergency procedure to treat [[pyometra]] and [[testicular torsion]], and it is used to treat [[ovarian cancer|ovarian]], [[uterine cancer|uterine]], and [[testicular cancer]]. It is also recommended in cases of [[cryptorchidism]] to prevent torsion and [[malignant transformation]] of the testicles. Other common elective surgical procedures include declawing in cats ([[onychectomy]]) and [[Docking (animals)|ear and tail docking]] in dogs and [[horse]]s. These procedures are illegal in some countries and face ethical challenges in others. Declawing consists of removal of the [[distal phalanges]] using either a [[scalpel]], [[scissors]], or [[Laser scalpel|laser]]. [[Soft tissue laser surgery|Laser surgery]] offers a number of benefits<ref>N. Berger, P.H. Eeg, Veterinary Laser Surgery, Blackwell, ISBN 978-0-8138-0678-5</ref> <ref>http://www.veterinary-laser.com/state-of-art-laser-surgery.php Veterinary laser surgery, URL accessed March 25, 2008</ref>, including reduced risk of [[Infection|infection]], less post-operative pain and [[edema|swelling]], reduced [[Bleeding|bleeding]] and improved visibility of the surgical field. Better [[Hemostasis|hemostasis]] and visibility can in some cases minimize the need for [[Anesthesia|anesthesia]] and/or reduce overall surgical time. ===Dental surgery=== [[Image:Fibrous epulis.JPG|thumb|Sedated dog with an [[Epulis fissuratum|epulis]]]] Common dental surgical procedures: *Horses - Floating (grinding down) of uneven teeth edges and removal of [[wolf tooth|wolf teeth]].<ref>{{cite web | last = Woolridge | first = Anne A. | coauthors = Seahorn, Thomas L. | title = Proper Dental Care Is Vital For Horses | work = Louisiana State University Equine Veternary Research Program Newsletter | date = 1999 | url = http://evrp.lsu.edu/07dentistry.htm | accessdate = 2006-07-29 }}</ref> *Dogs - Dental prophylaxis is commonly performed to remove [[Calculus (dental)|tartar]] and treat [[periodontal disease]]. This procedure is usually performed under anesthesia. Other common procedures include extraction of abscessed or broken teeth, extraction of [[deciduous teeth]], [[root canal]]s, and removal of [[gingival hyperplasia]] and [[Epulis fissuratum|epulides]]. *Cats - Dental prophylaxis as described above for the dog and treatment and extraction of teeth with [[feline odontoclastic resorptive lesion]]s (FORLs).<ref>{{cite web | title = Feline Odontoclastic Resorptive Lesions | work = Small Animal Dental Service | publisher = Texas A&M University Veterinary Medical Teaching Hospital | url = http://vmth.tamu.edu/hospservices/dentistry/FORL.shtml | accessdate = 2006-07-29 }}</ref> ===Surgical oncology=== In older dogs and cats [[tumor]]s are a common occurrence. Common skin tumors include [[lipoma]]s, [[mast cell tumor]]s, [[melanoma]]s, [[squamous cell carcinoma]]s, [[basal cell carcinoma]]s, [[fibrosarcoma]]s, and [[histiocytoma (dog)|histiocytoma]]s. Skin tumors are removed through either simple incisions or through [[plastic surgery]]. Common oral tumors include melanomas, fibrosarcomas, squamous cell carcinomas, which are removed with as much surrounding tissue as possible, including parts of the [[mandible]] and [[maxilla]]. Other types of cancer requiring surgery include [[osteosarcoma]], stomach and intestinal tumors, [[splenectomy|splenic masses]], and [[urinary bladder]] tumors. ===Ophthalmic surgery=== Common ophthalmic surgeries in animals include: *[[Enucleation]] to treat [[glaucoma]] or [[eye proptosis]]. *[[Cataract surgery]] *[[Entropion]] surgery *[[Ectropion]] surgery *Eyelid tumor removal *[[Cherry eye]] surgery *Exenteration (complete removal) of the [[orbit (anatomy)|orbit]], especially for squamous cell carcinoma in the cat and cow. ===Orthopedic surgery=== [[Image:Artificial hip in dog.JPG|thumb|X-ray of a dog with an artificial hip to repair hip dysplasia]] Common orthopedic surgeries in animals include: *Ruptured [[anterior cruciate ligament]] repair *For [[hip dysplasia]]: **[[Femoral head ostectomy]] **Triple pelvic [[osteotomy]] **[[Hip replacement (animal)|Hip replacement]] *Leg [[amputation]] *[[Bone fracture]] repair *[[Arthroscopy]] *MPL - medial patellar luxation *APL - anterior patellar luxation ===Other common procedures=== ====Caesarean section==== [[Caesarean section]]s are commonly performed in dogs, cats, horses, sheep, and cattle. Usually it is done as an emergency surgery due to difficulties in the birthing process. Certain dog breeds such as [[Bulldog]]s often need to have this surgery because of the size of the puppy's head relative to the width of the bitch's birth canal. ====Bloat surgery==== In dogs [[bloat]] or gastric dilatation volvulus (GDV) is a common condition where the stomach fills with gas and commonlly twists. If the stomach is torsed it requires immediate surgical intervention to prevent [[necrosis]] of the stomach wall. After radiographs to confirm the GDV and blood tests to determine the lactate and general health of the dog, surgical intervention is required. The stomach is put back into its normal position, deflated and tacked ([[gastropexy]]) to the body wall. Sometimes a [[splenectomy]] or partial [[gastrectomy]] is also required. ====Cystotomy==== [[Image:Blasenstein OP Situs.jpg|thumb|Cystotomy to remove bladder stones]] A [[cystotomy]] is a surgical opening of the [[urinary bladder]]. It is commonly performed in dogs and cats to remove [[bladder stone (animal)|bladder stone]]s or tumors. ====Wound repair==== [[Image:Cérudjeye pés rakeudaedje.jpg|thumb|Sutured wound on the teats of a cow]] Bite wounds from other animals (and rarely humans) are a common occurrence. Wounds from objects that the animal may step on or run into are also common. Usually these wounds are simple [[laceration]]s that can be easily cleaned and sutured, sometimes using a [[local anesthetic]]. Bite wounds, however, involve compressive and tensile forces in addition to shearing forces, and can cause separation of the skin from the underlying tissue and [[avulsion]] of underlying muscles. Deep puncture wounds are especially prone to infection. Deeper wounds are assessed under [[anesthesia]] and explored, [[lavage]]d, and [[debridement|debrided]]. Primary wound closure is used if all remaining tissue is healthy and free of contamination. Small puncture wounds may be left open, bandaged, and allowed to [[wound healing|heal]] without surgery. A third alternative is delayed primary closure, which involves bandaging and reevaluation and surgery in three to five days.<ref name=Aronson_2000>{{cite journal|author=Holt, David E.|coauthors=Griffin, Greg|title=Bite Wounds in Dogs and Cats|journal=The Veterinary Clinics of North America|year=2000|volume=30|pages=669–678}}</ref> Wounds occurring in the [[udder]] ant [[teat]]s of [[cow]]s are more difficult to repair, due to the difficult access and sensitivity of the organ, and because deep anaesthesia may not be applied to bovines. But some practitionner have acquired a great experience in dealing them.<ref>Grunert E. & Luhman F., ''Chirurgische Versorgung von Euter- und Zitzenwunden'', in Buiatrik, 2. Ed. Schaper Verlag, Hannover, 1972</ref> ====Foreign body removal==== [[Image:Bottle top swallowed by dog.JPG|thumb|Bottle top swallowed by a dog that had to be removed surgically]] A variety of objects are commonly swallowed by dogs, cats, and cattle. [[Foreign body|Foreign bodies]] can cause obstruction of the [[gastrointestinal tract]] causing severe vomiting and resulting [[electrolyte]] imbalances. The stomach (gastrotomy) or intestine (enterotomy) can be surgically opened to remove the foreign body. Necrotic intestine can be removed (enterectomy) and repaired with [[Surgical anastomoses|intestinal anastomosis]]. Foreign bodies can also be removed by [[endoscopy]]. The condition in cattle is known as [[hardware disease]]. ==References== <div class="references-small"> <references/> </div> ==See also== *[[Veterinary surgeon]] ==External links== *[http://www.acvs.org/flash.html American College of Veterinary Surgeons] [[Category:Veterinary professions]] [[Category:Surgical specialties]] [[wa:Cérudjeye veterinaire]]