2. 40 minute-spay surgery from incision to last stitch.

May 23, 2008

12-year-old with large mammary tumours and sternal abscess.
Best not to operate immediately. Antibiotics for 2 weeks.
7.7 kg, 38.4 deg. normal.
Sternal abscess has reduced by 80% to 1 cm.

Young man brings in the dog as scheduled.
"Can spay be done together with removal of sternal abscess?" he asked.
"Yes," I said. "It is not good for the old dog as the anaesthetic time will be longer as the chances of the dog dying on the operating table increases as the anaesthesia is prolonged. The spay itself takes around one hour."

"I thought it takes 30 minutes to spay a dog?" the young man must have done his home work and research.

"Yes," I said. "In some cases, the surgery is as fast as 30 minutes. But if you include the pre-operation shaving, scrubbing and anaesthetic gas given, the whole procedure takes 1 hour.

He agreed to take one surgery at a time. Spay, then 2 weeks later, sternal abscess and then mammary tumour removal.

So, I started to time this spay surgery commenced at 10 am. The patient was not slim and there would be some difficulty accessing the ovaries.

Procedure:
The dog was clipped first. Then proceed to the operating room. Body stretched out tightly.

Gas anaesthesia was given by mask, taking around 15 minutes. Dog snoring. Intubated. Maintenance dose 2%.
Last 3 stitches 0.5% to 0%. Dog woke up within 2 minutes at end of anaesthesia.

SURGERY - Incision to last stitch is 40 minutes.
Incision 1 cm from umbilicus. Inserted the spay hook. Could not get the left ovary for 5 tries. Omental fat kept appearing. Getting desperate. Switch to hooking the right ovary. Intestine kept coming hooked out. What to do?

If the dog is slim, it would normally be easy for me to hook the left ovary after 1 or 2 tries. Hooked further caudally at 45 degree away from rib cage and liver.
Caught right uterine horn. What a relief. I hope not to get fat dogs to spay as they are very challenging hook cases.

So much fat surrounded the ovaries. Asked assistant to release the tension on front legs tied to strings. Ovarian ligament very tight. Extended incision cranially by 0.5cm, skin and linea alba. This extra space permitted the huge ovary to be pulled out.

How do I know it is the ovary? Connected to the uterine horn and a very tight ovarian ligament can be felt. High tension. I used the scalpel blade to rupture it. Ligate 2 times. Finally pulled out the left uterine horn and repeated process. Uterine body ligated 3 times. 3/0 absorbable sutures did not feel strong enough compared to 2/0. 3 simple interrupted sutures in the muscle layer. No fanciful continuous subcutaneous sutures. 2 horizontal mattress sutures in the skin. One packet of suture was fully used in this case.

This whole procedure took more than 60 minutes. Not much bleeding. Carprofen injection 0.5 ml given to prevent pain and swelling. Antibiotics. Dog should be going home in the evening.

NEXT STAGE
As the female hormones have had been removed, it is unlikely that the breast tumours will grow fast. 2 weeks later, scheduled for tumour removal plus removal of sternal abscess probably.

Could the dog be able to take the anaestehsia again?