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.
At the Long Beach Animal Hospital use of the laster is mandatory for all neuters. In this page we will first show you the traditional way this surgery is performed without the laser, then we will show you how we do it with the laser. The advantages of using the laser will be obvious.
Towards 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 video.
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 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 in order we will give 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.
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 use of neuticles
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.
First we will remove the normal testicle without the laser. 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.
Using the laser has many advantages over using a scalpel blade. These include negligible bleeding during the procedure and post operative pain. Click on any of these pictures below for a larger version.
The initial skin incision in the scrotum
Notice the lack of bleeding from the skin as we enlarge the incision for room to remove the testicle. The white structure in the center is the testicle covered with protective tissue.
Once the incision is large enough the testicle bulges through with the aid of our surgeon.
The testicle is covered with a tissue called tunic. This tissue is gently opened with the laser to reveal the actual testicle.
All of the pertinent structures associated with the testicle are apparent in this picture. The white horizontal line below the testicle that the surgeon is holding is the epididymus. The dark structure to the right of this is the panpiniform plexus. This plexus contains arteries and veins to cool the testicle, supply it with nutrients, and allow testosterone to go into the bloodstream.
Our surgeon is losing a clamp to remove the excessive tissue of the tunic before ligating the vessels.
We always put two sutures on the blood vessels for safety’s sake and piece of mind for us.
We use the laser to cut the tissue. The testicle is to the right, and will be completely removed once the laser finishes the cut. The body is too the left, and once our surgeon makes sure there is no bleeding this blood vessel is allowed to retract back into the body cavity.
The appearance of the blood free initial incision just prior to suturing the skin
The final appearance of the sutured skin. There will be dramatically less postoperative swelling and pain with the use of this laser compared to the traditional way without the laser.
Our Laser Page has detailed information on the use of the laser for various surgeries. Click on the movie below to see the neuter performed by laser.
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 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.