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.
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 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.
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.
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.
Laser Surgery
Using the laser has many advantages over using a
scalpel blade. These include negligible bleeding during the procedure
and post operative pain.
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.
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 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.
Here is our short movie. Double
Click on the movie and in a few seconds it will play. This dog will
feel almost pain free after the surgery due to a lack of bleeding and
swelling, all courtesy of the laser. This is the pre-scrotal
technique.
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