Introduction
One of the most common
surgical procedures we perform is a dog
neuter, know medically as an orchectomy. It
is performed for several reasons:
- It minimizes roaming
- It minimizes aggressive behavior
- It prevents male dogs from impregnating
females.
- It prevents most prostate problems and
testicular cancer
At the end of this page we
have a short Quicktime movie on part of a
laser neuter. It shows you how the laser
makes an incision- note the lack of
bleeding. Due to the tremendous advantages
of using the laser for this surgery, it is
mandatory in our hospital that all neuters
are performed using the laser. Make sure you
have Quicktime on your machine so you can
view the short clip at the end.
Anesthesia
Pre-anesthetic preparation
is important in every surgery we perform, no
matter how routine. Surgery is not an area
to cut corners. All of our neuters receive a
physical exam several days prior to surgery.
At the same time we will draw a small amount
of blood for an in-hospital pre-anesthetic test.
Take away all food and
water before going to bed the night prior to
surgery. Do not feed or water the morning of
surgery and drop your pet off between
&:30 AM and 8:30 AM. Surgery is
completed by early afternoon. Our surgeon
will call you so please leave us a phone
number we can reach you at any time during
the day.
On surgery day when
everything is in order we will give a
sedative. This will calm your pet dog and
make the administration of the actual anesthetic,
along with post operative recovery, much
smoother. Once your pet is anesthetized,
prepared for surgery, and had its monitoring
equipment hooked up and reading accurately,
the surgery can begin.
Most neuters go home the
same day as surgery. You can pick up your
pet in the late afternoon or evening if that
is more convenient for you. We are open
until midnight 6 days per week. When you
pick up your pet you will be given detailed
and printed home instructions.
Surgery
This page shows the
surgical procedures for:
- A normal testicle
- A testicle that has not completely
descended into the scrotum and is in the
inguinal canal
- A testicle that is still in the abdomen.
- A short video of a bloodless laser
neuter incision
The following area contains
graphic pictures of an actual surgical
procedure performed at the hospital.
First we will show the method used at
some animal hospitals, then we will show
you a few ways of we perform it at our
hospital with the laser.
The dog being
neutered in this picture has only one
testicle in the scrotum, called a
cryptorchid or retained testicle. This
happens in only a small percentage of
the animals we neuter. The other
testicle can be in the abdomen or in
the inguinal canal (inner thigh
region). In this dog's case it is in
the inguinal canal, as evidenced by
the bulge (arrow). It is important to
remove the retained testicle because
it can become cancerous later in life.
In the following
example we will remove the normal
testicle without the laser. This is an
example of how surgery was performed
at our hospital prior to the advent of
laser for this surgery. In our
hospital the laser is mandatory for
this procedure due to its outstanding
advantages. The following example also
how surgery is still performed at
almost all of the low cost spay and
neuters.
The procedure begins
with an incision in the skin. We
prefer to make our incision in front
of the scrotum and not actually on the
scrotum. This tends to minimize post
operative licking and aids the healing
process.
The testicle is
gently squeezed forward and the
incision over the testicle is made
just big enough to gently squeeze it
out. Smaller incisions heal faster,
require less anesthetic time and there
is less chance for complications.
The testicle bulges
out of the incision cover by its
internal layers called tunics. These
tunics are carefully incised to expose
the testicle and all its associated
structures. In the picture on the
right you can see 3 main testicular
structures now that the covering is
off. The vertically running dark blood
vessels on the left are called the
pampiniform plexus. They are a group
of blood vessels that supply nutrients
to the testicle, keep the testicle at
an optimum temperature for viable
spermatozoa, and distribute
testosteron from the testicle into the
general bloodstream. The structure
just to the right of the pampiniform
plexus, and partially surrounding the
testicle, is the epididymus, the
storage area of spermatozoa already
produced by the testicle. The round
structure to the right is the testicle
itself.
The blood supply to
the testicle is brought out and two
sutures are placed around it. After
the testicle is cut the sutured tissue
is placed back through the incision.
Two layers of sutures
are used to close the incision. The
first is called the subcutaneous
layer, because it is the layer of
tissue under the skin. Sealing this
layer gives an added margin of safety,
especially if the dog licks the area
excessively.
The skin layer is
frequently closed in a suture pattern
called subcuticular. This layer is the
underside of the skin. This technique
gives a cosmetic appearance and makes
it difficult for a dog to chew its
stitches out.
Since our patient in
this case has one of his testicles in
the inguinal area, the surgery is not
finished yet. The skin incision and
exposure of the other testicle is
similar to the normal testicle
removal. In this region though, there
is significant fat under the skin.
The actual structures
of the testicle and its blood supply
are exposed, ligated with two sutures,
and placed back into the inguinal
area.
The same 2 layer
closure is used in the inguinal area
also. First the subcutaneous tissue,
then the skin.
Here is a final view
of our patient and his two incisions.
As he wakes up from anesthesia he will
be given an injection
for pain.
When the retained testicle
is not in the inguinal area it is located in
the abdomen. This testicle can also become
cancerous so it is important to remove it.
In this case we have
to make an incision along the penis
and literally find this testicle in
the abdomen. In this picture the
testicle has been brought out through
the 3 inch incision in the abdomen.
It is ligated like all the other
testicles that are removed.
Because we made an
incision in the abdominal muscles it
is imperative that these muscles are
sewn back together properly. A hernia
can result if the muscles don't hold
together. This sutured muscle layer is
identified in the picture as the
tissue just to the left of the two
headed arrow.
You can easily see
the difference in size between the
atrophied testicle in the abdomen
(left) and the normal testicle in the
scrotum. The testicle in the abdomen
was removed at a young age so it never
had a chance to become cancerous.
This is the
appearance of a different dog that had
a cancerous testicle, called a
seminoma. It was not removed until
later in life, so it had a chance to
enlarge tremendously.
This is the final
look of the incision sites for this
dog with the testicle in its abdomen.
The head is towards the right and it
is laying on its back. At the far left
(arrow) is the skin incision from the
removal of the normal testicle in the
scrotum. At the far right (arrow) is
the incision from the testicle in the
abdomen.
Immediatley after surgery
we will give medication
for pain. Most dogs recover from this
surgery in a few days, even those that have
incisions in their abdomen. It is important
to keep these dogs quiet for a few days
postoperatively to allow the incision sites
to heal. In most neuters we put in sutures
that are just under the skin and dissolve on
their own, so there is no need to return for
suture removal.
Laser Surgery
Using the laser has many
advantages over using a scalpel blade. These
include negligible bleeding during the
procedure and significantly reduced
post-operative pain. Healing time is reduced
due to substantially less post-operative
swelling.
With the laser we can
make an almost pain free incision in
the scrotum. This minimizes surgery
time and also allows healing without
any sutures. This picture shows a
closed neuter-note the small incision
and lack of bleeding.
Our Laser Page has
detailed information on the use of the laser
for various surgeries. Our laser neuter
movie is at the end of this page. It shows
you how we perform a open neuter
pre-scrotally.
In addition to using the
surgical laser, all of our neuters get the
added benefit of the Companion Laser to
stimulate the cells for faster healing. This
link to the
Companion Laser describes it in much
more detail.
Both of these laser
modalities are included in the price of our
neuter package.
Neuticles
An interesting variation on
this neuter surgery is the placement of
solid silicone implants in place of
testicles. This gives a natural look after
neuter surgery that is desirable to some
people. This is not done commonly, and
frankly we frown upon it because it is not
necessary.
This is the
appearance of a normal dog scrotum
prior to neuter surgery. Use it as a
basis of comparison at the end of this
section to see what the scrotum looks
like when we have implanted neuticles
in place of the testicles.
In this surgery the
testicle is removed and the neuticle
is placed in the sack that holds the
testicle, called the tunic.
This is the sterile
neuticle on the surgery tray ready for
placement. Neuticles come in various
sizes and shapes to be custom fitted
to each individual.
The neuticle is
gently implanted in place of the
testicle. A proper fit is imperative,
so it is important to order the proper
size ahead of time.
When we are sure of a
proper fit we carefully suture the
tunic with a suture material that will
eventually dissolve.
This is the final
appearance after the placement of the
neuticle.
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