One of the most common surgical procedures we perform on dogs is a spay, known medically as an ovariohysterectomy (removal of the ovaries and uterus). It is performed for several medical reasons:
It prevents dogs from going into heat.
It prevents dogs from getting pregnant.
It significantly helps prevent dogs from get breast cancer later in life.
It prevents dogs from getting uterine infections later in life. An infected uterus is called a pyometra, and is a serious disease. After you view the pictures of a routine surgery you will be given an chance to see a picture of the uterus of a dog that has a pyometra.
In addition to these medical reasons, it prevents unwanted pregnancies, a significant problem in our society. Millions of dogs are euthanized every year because they are strays.
We usually spay a dog when it is around 6 months of age. This timetable is variable, the important point is to perform the surgery before it goes into heat. The ongoing old wives tale that states dogs should go into heat before spaying is incorrect. Most dogs go into heat starting around 9 months of age, and do it twice each year.
On the day of surgery we need your pet in the hospital between 7:30 AM and 8 AM. Please take away all food and water when you go to bed the evening before surgery, and do not give your dog anything to eat or drink the morning of surgery.
Our surgeon will call you after the surgery is complete and your dog is awake. It can go home in the late afternoon the day of surgery. Please call our office at 4 PM for pickup time, you will be given written post operative instructions then. We are open in the evening if you need to pick up later.
This area contains graphic pictures of an actual surgical procedure performed at the hospital.
Pre-anesthetic preparation is important in every surgery we perform, no matter how routine, because surgery is not an area to cut corners. All of our spays receive a physical exam prior to surgery. Only if they pass this exam will we draw a small amount of blood for an in-hospital pre-anesthetic test. When everything is to our satisfaction we will administer a sedative. This will calm the pet down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.
Once our surgeon has scrubbed up and is in sterile gown, gloves, and mask, the surgery begins
While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments. Our surgeon is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around. All of this is to minimize anesthetic time.
We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.
This machine monitors:
Carbon dioxide level
In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters
Every major surgery we perform begins with proper patient preparation. This will help prevent infection, which could be a serious complication in this surgery because during a spay we have an opening into the abdomen.
Our nurse is using a special cleaning agent and scrubbing the skin 3x in a circular motion
This is the final look of the skin in a pet that is ready for surgery. In the very center of the screen is the umbilicus (belly button), an important landmark for the surgery.
The surgeon makes an incision near the umbilicus and extends it 3-5 inches in the direction of the tail (the tail is at the left in this picture). We try to make our incisions as small as possible to minimize anesthetic time, decrease post operative discomfort, and minimize the healing time.
The tissue just underneath the skin is called the subcutaneous layer. It consists mostly of fat and small blood vessels, and is the next layer we cut into after the skin. If these small blood vessels don’t clot within a few minutes they are clamped with instruments, and if necessary, they are cauterized.
The final layer we need to cut before we are actually into the abdomen is called the linea alba. It is an area of muscle in the center of the abdomen that is covered by a tough layer of tissue. This is the most important layer resutured at the end of the surgery because it is the only layer strong enough to hold the abdominal muscles together to prevent a hernia. In this picture the linea is being held up with a forceps and a scalpel blade (held upside down) is being used to make the incision.
A scissors is commonly used to extend the linea incision and facilitate the removal of the uterus. Care has to be taken not to puncture internal organs like the bladder.
Buried within the abdominal organs and abdominal fat is the uterus. A special instrument called a spay hook is sometimes utilized to gently pull one of the uterine horns through the abdominal incision. In this picture our surgeon is using his finger to bring the uterus out of the incision.
The uterine horn is traced into the body cavity until the ovary is found. It has to be gently teased from its location near the kidneys in order to be able to pull it out through the abdominal incision. In older dogs this part of the procedure is much more difficult. The ovary (arrow) is usually covered with fat.
The blood supply to the ovary is extensive so a special technique is utilized to prevent hemorrhage. This technique involves the use of 3 clamps. In this picture the first clamp is being applied to the left of the ovary (arrow). Besides making it easier to place a suture on the tissue, this clamp stops the flow of blood from within the abdomen to the ovary.
A second clamp is applied just above the first. The third and final clamp is applied to the right of the ovary (arrow). All of the tissue to the right of the second clamp is removed during the surgery.
The tissue is cut with a scissors between the second and third clamp
The third clamp (with ovary) is pulled away leaving the first two clamps to prevent any hemorrhage.
Two sutures are securely placed under the first two clamps. When the surgeon is certain there is no risk of bleeding the clamps are released and the sutured tissue is allowed to fall back into the abdomen. In this picture one of the two clamps has been removed and the second suture is being placed. This whole process is repeated for the other ovary that female dogs have in their abdomen.
Both ovaries with their attached clamps have been removed from the abdominal cavity. They have been pulled towards the right enabling the surgeon to gently pull the cervix out of the abdominal cavity also.
In this picture the two ovaries are off the screen to the far right. Two clamps are placed at the cervix and the remaining body of the uterus with its two attached ovaries is cut away.
The uterus is sutured in the same manner at the ovaries, with two secure stitches placed under the clamps. Once our surgeon is certain the cervix sutures are secure the cervix is placed back into the abdominal cavity.
The linea alba is now securely resutured. Stainless steel sutures are sometimes used because they are very strong, cause minimal tissue reaction, and show up vividly on an x-ray of the abdomen .
The subcutaneous layer is now closed with a type of suture that dissolves over several months.
The last layer sutured is the skin. Sometimes we put the sutures on the outside, which means they have to be removed in 7-10 days. In this example we put the sutures in just under the skin, so no removal is needed. They will dissolve on their own in a few months just like the sutures in the subcutaneous tissue.
It is at this point that we will give a pain injection, which might make this dog groggy for the evening. When you pick up a pet after a spay operation you will be given detailed post operative instructions.
This is a picture of a uterus in a female dog that has an infected uterus, called a pyometra. The uterus is completely filled with pus, and this dog is very ill. If surgery is not performed to remove this uterus it could rupture and even cause death. The uterine tissue is very fragile and can easily rupture during the surgery, so great care is taken to prevent any release of pus into the abdominal cavity.
An occasional pyometra can be tremendous in size. Great care has to be taken to minimize this uterus from rupturing during the surgery.
A diagnosis of pyometra is made based on several findings. There is a history of being in heat a few months prior, along with lethargy, lack of appetite, and sometimes even vomiting. Most dogs will be drinking and urinating excessively because of the toxic effects of the infection on the kidneys. A blood sample will somtimes show a very elevated white blood cell count, and an x-ray of the abdomen might show an enlarged uterus.
This x-ray shows an enlarged uterus in the abdomen. The uterus (U) is the area just to the left of the bladder (B). You can see it as several areas that are circular or elongate. A normal uterus does not usually show up on an x-ray.
Most dogs go home late in the afternoon on the day we perform the surgery. They might be groggy from the pain injection which is advantageous because they will remain calm and allow the healing process to start immediately. By the following morning the grogginess will have worn off.
When you first get home do not be in a big rush to feed. After 1 hour at home offer a small amount of food and water. If the appetite is good, offer more several hours later. Do not over do the feeding the first night because anesthesia can make them nauseous.
Keep contact with children and other pets to a minimum the first night, and restric activity for several days to allow the incision to heal. Do not let your dog go outside until healing is complete.