CASTRATION (ORCHIECTOMY)

Clip and Prep

Clip and prepare the pre-scrotal region for aseptic surgery. Do not clip the scrotum as this is
unnecessary and results in significant inflammation and self-trauma postoperatively. Canine
castration is performed through a midline, pre-scrotal incision.

Area to clip for routine canine castration

Skin and Subcutaneous Incision

With the dog in dorsal recumbency, drape the prepped area just cranial to the scrotum
(covering the unclipped scrotum with the surgical drapes).

Canine Castration: Extruding testes through

incision

Vaginal Tunic and Epididymal Attachment

To perform an ‘open’ castration, you must

incise the vaginal tunic. Once incised, the
testis will easily extrude from the vaginal
tunic but remains attached at the level of the
epididymis.

Canine Castration: Incising Vaginal Tunic

 Place a hemostatic clamp across the tunic
where it attaches to the epididymis and digitally
separate the ligament of the tail of the
epididymis from the tunic without avulsing the
tail of the epididymis from the testis. The tunic
can now be separated and reflected towards the
patient, exposing the testicular arteries, the
venous pampiniform plexus and the ductus
deferens.

Canine Castration: Tearing attachment to

epididymis

Clamp, Ligate and Transect

Apply three Carmalt clamps across these structures. Using absorbable suture material, apply
a circumferential ligature within the crush of the most proximal clamp (closest to the patient-
C1). Then, apply another circumferential or a transfixing suture between the first suture and
the next clamp (C2), just a few millimeters from the first ligature. Assess the ligatures
(ensuring not to occlude the vascular plexus with your clamp or forceps), and if satisfied,
transect the spermatic cord between the two remaining clamps. Then remove the clamp
attached to the stump and carefully assess for hemorrhage before replacing the stump within
the vaginal tunic.

Canine Castration:
Clamps and Ligatures

Repeat the process with

the contra-lateral
testis. As you mobilize
the second testis
cranially, you will need to
make a second incision
in the subcutaneous
tissues and spermatic
fascia in order to
exteriorize the
contralateral testis.If you
do not open the vaginal
tunic, you will perform a
closed castration… in
this instance, you should
apply at least one
transfixing suture to
prevent slippage and retraction of the ductus deferens, testicular arteries or venous
pampiniform plexus from the ligatures.
Closure

Note that the vaginal tunic is not

typically transected or sutured closed
in dogs. Close routinely by apposing
the three edges of subcutaneous
tissues (left, middle, and right) in a
simple interrupted pattern with small
diameter (3-0 or 4-0 depending on the
size of the patient), absorbable,
monofilament suture. Close the skin
with non-absorbable suture and the
pattern of your choice, or better yet,
appose the skin with an intradermal
pattern using small diameter,
absorbable suture material on a
cutting or reverse cutting
needle. Make sure to bury the knot!

Possible Complications

• Scrotal swelling is to be expected

• Incisional bruising
• Scrotal hematoma
• Abdominal hemorrhage
• Wound inflammation / infection / dehiscence

Infection and Breakdown of Incision

1) When preparing a male dog for a castration, you should clip the hair in the pre-scrotal
region and on the scrotum.

• True
• False
2) Canine castration is performed through what type of incision?

• Ventral midline caudal to the umbilicus.

• Ventral midline in the pre-scrotal region.
• Parapreputial
• Scrotal
3) The “open” castration technique involves

• Leaving the incision unsutured to allow for drainage.

• Transecting the cremaster muscle to further exteriorize the testes.
• Incising the tunica albuginea to visualize the seminiferous tubules.
• Incising the vaginal tunic to visualize the spermatic cord and testicular vessels.
4)The tunica vaginalis must be sutured to prevent scrotal herniation post-operatively.

• True
• False
5) When closing a canine castration, there will be 3 edges of subcutaneous tissue that need
to be apposed since there were 2 incisions made in the subcutaneous tissue in order to
exteriorize the testes.

• True
• False

SPAY (OVARIOHYSTERECTOMY)

Cat clipped for an ovariohysterectomy

Canine Ovariohysterectomy Procedure

The patient is positioned in dorsal

recumbency. The patient should
be clipped, prepped and draped
from xiphoid to pubis to ensure
that you can easily extend your
incision in case of emergency (e.g.
uncontrolled hemorrhage). The
width of the clip should be to the
level of the mammary chain or
beyond.

Canine Ovariohysterectomy:
Draping
Skin and Subcutaneous Incision

In your mind, divide the space between the umbilical scar and the pubis into three thirds. In
a dog, your incision will be centered on the cranial third; it will begin at or just caudal to the
level of the umbilicus and end somewhere approximately half way between the umbilicus and
pubis. In cats, the incision is made slightly more caudal and is centered over the central third.

Divisions of the Caudal Abdomen

After incising the skin and subcutaneous tissues with a blade, dab or clamp (mosquito
forceps) any subcutaneous bleeders. These rarely require ligation. Extend your
subcutaneous incision to the level of the external fascia using a blade or scissors depending
on your comfort level. Try not to incise the external rectus fascia during this step or to dissect
the subcutaneous tissues excessively. Lateral subcutaneous fat dissection should be limited
to what is necessary in order to identify the linea alba. Excessive lateral dissection should be
avoided, since the increased tissue trauma and dead space can increase the risk of incisional
complications. Do not resect subcutaneous fat.

Canine Ovario
hysterectomy: Incising

Linea Alba Incision

If you have difficulty identifying the linea alba, remember that it is widest at the level of the
umbilicus. You might also be able to palpate a dimple or an irregularity at the level of the
umbilicus which can guide you to find the linea alba.

Canine Ovario
hysterectomy:
Tent the linea
alba and stab
with the blade
pointing up

Once you have identified the linea alba, grasp it with a pair of thumb forceps and tent it upward
to create a distance between it and the internal organs. The right-handed surgeon typically
stands on the patient’s right side and should stab as caudal as possible along the incision to
facilitate handling of the instruments and tissues during extension of the incision (cutting
from right to left). Using a scalpel blade with the cutting edge facing up, stab all layers of the
abdominal wall along the linea alba. Observe the stab incision to determine if you are along
the linea alba or off midline (rectus muscle visible). A slight paramedian incision may result
in the external rectus fascia and muscle being cut/exposed, while the internal rectus facia
and peritoneum remains intact. In this instance, a separate incision through the internal
fascia/peritoneum is required in order to enter the abdominal cavity. If you find you have
stabbed along the linea alba or very close to the linea alba, proceed by extending the incision
with a pair of Mayo scissors in a cranial and caudal direction along the linea laba; correcting
a mildly off midline stab as you incise further. Tenting the abdominal wall while you extend
the incision will limit the risk of trauma to internal organs. Digital palpation (or palpation with
a closed Mayo scissor) through the initial incision may help determine if there are any
intraabdominal adhesions prior to extending the incision further. If you have stabbed farther
away from the linea alba, you might want to consider a new stab incision to limit tissue trauma
and hemorrhage. Incising along the linea alba creates less hemorrhage and allows for easiest
closure. The falciform ligament is typically located cranial to the umbilicus and will not be
encountered through this incision.

Find the Left Uterine Horn

Spay Hook
 Canine Ovariohysterectomy: Left
Uterine Horn

Use a finger or a spay hook to identify

the left horn (it’s easiest to find). To use
the hook, retract the left abdominal wall
(not the skin) with thumb forceps and
insert the hook a few centimeters
caudal to the kidney (mid to caudal
aspect of incision) with the hook sliding
against the abdominal wall. Be aware
that the spleen might be enlarged due to
anesthetic drugs and could be in your
way. If this is the case, gently move the
spleen cranially with your fingers prior
to inserting the spay hook. Once the
hook is inserted deep into the
abdominal cavity, turn it 180 degrees
(hook facing the abdominal organs) to
engage the uterine horn or broad
ligament and gently retract to identify the structure(s) hooked. If you insert the hook too far
cranially, you might pick-up the ovary which will be tight and could traumatize the vascular
pedicle. Observe the tissues carefully. If the tissue is not the uterine horn, it is most likely to
be the broad ligament. Follow it with digital palpation to find the uterine horn. Confirm that
you indeed have the correct structures by visualizing an ovary, a horn and the uterine
bifurcation. If the hook picked up intestine or omentum, replace these structures within the
abdominal cavity and begin again or use an alternative method. Another option is to use your
fingers to identify the kidney and then the ovary just caudal to it. That will allow you to follow
the horn and exteriorize it. Alternatively, you can elevate or retroflex the urinary bladder (you
might need to extend your incision for this to be possible) to identify the cervix of the uterus
and to follow the horns up towards the ovary.

Suspensory Ligament

Anatomy (feline):
Suspensory ligament,
Vascular pedicle,
Uterine horn

Once you have

retrieved the left
uterine horn, apply
the tip of a curved
mosquito forceps to
the proper ligament
(located between the
ovary and the uterine
horn). Grasp the
ovary between your
thumb and index
finger (palming the
mosquito forceps
with the same hand)
and apply caudal and ventral traction (towards the caudal abdomen and ceiling) to identify
the suspensory ligament as a taut fibrous band located at the cranial aspect of the ovarian
pedicle. To allow further exteriorization, stabilize the ovary and mosquito forceps with your
right hand (if you are a right handed surgeon) and use your left index finger to palpate, stretch
(caudomedial traction), and break the suspensory ligament. The orientation of the suspensory
ligament is caudo-cranial from the ovary towards the kidney and that of the ovarian pedicle is
ventrodorsal. For this reason, it is safest to break the suspensory ligament deep into the
abdomen (away from the ovarian tissue and vascular pedicle). The left suspensory ligament
can often be visualized while the right is often too short to be exteriorized (especially in deep
chested dogs). If the ligament can be visualized, you can break it using mosquito forceps or
cut it with Metzembaum scissors.

Clamp the Ovarian Pedicle

After breaking the suspensory ligament, identify the ovarian vessels and create a fenestration
in the broad ligament just caudal to the ovarian pedicle. Then, place two or three hemostatic
forceps (ideally Carmalts) across the ovarian vessels (below or proximal to the ovarian
tissue). I typically place two clamps along the ovarian pedicle and one across the proper
ligament (modified 3 clamp technique).

Clamping the Pedicle

Alternatively, three clamps can be applied along the ovarian pedicle. Carmalt forceps are
designed to create hemostasis along a large vascular pedicle and will prevent excessive crush
or slippage but are generally too big for small dogs and for cats. In smaller patients, use a
Crile or mosquito (thin cats only) forceps.

Ligate the Pedicle

Canine Ovario-
hysterectomy:
Ligating pedicle
Pedicle ligation is performed using absorbable suture such as PDS®, Vicryl® or Biosyn.®
While size 2-0 or 3-0 suture material is most commonly used, size 0 suture is sometimes
necessary to ligate very fatty pedicles in mature, large or giant breed dogs and size 4-0 suture
material is sometimes ideal for very small cats or immature small breed dogs. First, apply a
circumferential ligature within the crush created by the clamp farthest from the ovary (C1).
Then, apply a transfixing suture (medium / large dogs) or circumferential (small dogs and
cats) suture between the first suture and the second clamp (C2). Ligatures should be no more
than a few millimeters apart (those tissues will be ischemic). ‘Flashing’ the second clamp may
be necessary to ensure a tight ligature is applied. This is especially important for large / fatty
pedicles or when your ligature is very close to the clamp because the clamp might prevent the
pedicle from collapsing within your ligature. Avoid including the omentum or other tissues in
your clamps or ligatures as this may lead to suture loosening and slippage. This is especially
common on the right ovarian pedicle. Before transecting the ovarian pedicle, examine your
ligatures and replace any sutures that appear loose or are placed incorrectly.

Transect the Pedicle

Before transecting the pedicle distal to the ligatures, place a mosquito hemostat on a non-
vascular portion of the pedicle (e.g. along the suspensory ligament) and amputate the ovary
from the ligated pedicle using a scalpel blade. Make sure to remove all ovarian tissue and to
avoid excessive tissue distal to the ligatures (ischemic). Observe for any evidence of bleeding
as you release the tension on the pedicle and remove the mosquito forceps. You may not
notice hemorrhage while the pedicle is exteriorized and taut so keep a handle on it until it is
released in the abdominal cavity. Do not grasp the pedicle by the sutures as this is likely to
result in suture slippage.

Transecting the
Pedicle

Repeat Process on the Right Side

Identify the contralateral horn and ovary by following the uterus towards the other side and
repeat the procedures described for the left side. Be extremely careful with the right ovarian
pedicle since it is generally short and more friable than the left. Be careful not to include
omentum in your ligatures as this is more likely to result in suture slippage.
 Right Side

Broad Ligament

Trace the uterine horn to the

body of the uterus. Visualize the
course of the uterine vessels,
and bluntly separate the broad
ligament without transecting the
uterine vessels. Breaking the
broad ligament with fingers
typically creates better
hemostasis than cutting it with
scissors. The round ligament
runs through the broad ligament
and is often difficult to break
with fingers; it can be transected
with scissors. If large vessels are
noted within the broad ligament,
it should be bulk ligated prior to
cutting it.

Broad Ligament
Uterine Body

Canine Ovario- hysterectomy:

Ligating the Uterine Body

Identify the uterine body and ligate it just cranial to the cervix (leave the cervix within the
patient). The feline uterus and the uterus of dogs recently in heat are friable and should be
clamped with care or not clamped at all prior to applying ligatures. Place separate ligatures
around each of the uterine vessel (close to the cervix) including a small bite of the uterine
wall within each ligature. Then, apply one or two clamps to the uterine body, just adjacent to
the first ligatures. Place the circumferential or transfixing suture within the crush of the clamp
closest to your vessel ligations. Avoid leaving excessive (ischemic) tissue between the
ligatures. You can then transect the body of the uterus just distal to your sutures and observe
for bleeding as you return the uterine stump to the abdominal cavity.

Closure

Close the abdomen routinely.

Closing
Complications

Hemorrhage

If hemorrhage is suspected, each ligature / vascular stump should be inspected. This will
likely require that you extend your incision, depending on its initial length. The ovarian
pedicles will be located just caudal to the kidneys and the uterine stump will be dorsal and
slightly caudal to the urinary bladder. Use of a Balfour retractor or assistance for retraction
of the abdominal wall is helpful.

Exposing the left ovarian pedicle will sometimes require that the ovariohysterectomy incision
be extended cranially. Identify the descending colon along the left side of the abdominal wall
and use the mesocolon to ‘basket’ and retract the small intestine towards the animal’s right
side. A large spleen may require cranial or right lateral retraction to allow visualization of the
left paravertebral space.

Exposing the right ovarian pedicle generally requires that the ovariohysterectomy incision be
extended cranially. Identify the duodenum and use the mesoduodenum to “basket” and
retract the small intestine towards the animal’s left side. This is more difficult and less
effective than with the mesocolon.

Uterine Stump

The uterine stump can be found by retroflexing (exteriorizing) the urinary bladder; this will
expose the ligated stump between the neck of the bladder and the rectum. The incision may
need to be extended caudally.

The broad ligament may also be a source of bleeding. Inspect the transected broad ligament
between the ovarian and uterine stumps on either side of the abdominal cavity.

Other sources of hemorrhage include small vessels that run with the suspensory ligament
(these do not typically require ligation) and abdominal wall or subcutaneous bleeding vessels
that can cause a small amount of blood to pool in the abdominal cavity.If you must exteriorize
abdominal organs to explore and control hemorrhage, these should be covered with moist
laparotomy sponges to prevent tissue dessication.
Other complications:

• Incisional complications (infection, seroma, abdominal wall hernia / evisceration).

These are the same as those associated with any other abdominal incision.
• Inadvertent ureteral ligation can occur at the level of the uterine body if the surgeon
does not carefully identify the structures being ligated (typically with a full bladder) or
when a dropped or bleeding ovarian pedicle is clamped and ligated without carefully
identifying the structures included in the clamp/suture.
• Ovarian remnant. An animal that has been ovariohysterectomized and develops signs
of heat weeks to months postoperatively typically has an ovarian remnant due to
incomplete ovarian tissue resection. This often results from transecting too close to
the ovary but can also occur with fragmentation of the ovarian tissue and
revascularization into the omentum or mesentary
• Erosion of the uterine vessels causing intermittent vaginal bleeding in the days/weeks
that follow ovariohysterectomy. Typically the result of a single ligature along the uterine
body. This generally requires revision surgery to ligate the bleeding uterine vessel.
• Uterine stump pyometra requires that a source of progesterone be present (i.e.
incomplete ovariectomy or external administration.
• Urinary incontinence (especially in dogs)
• Fistulous tracts and granulomas. Described with the use of non-absorbable, braided
suture.

Ovarian Remnant

Pyometra

Ovariohysterectomy for pyometra is

performed using the technique described in
the ovariohysterectomy section. However,
depending on the severity of the pyometra
(open or closed), the uterus is likely to be
enlarged and more friable than usual. A larger
incision is recommended and the uterus
should be handled with care to prevent
rupture and abdominal contamination. Gently
lift the distended uterus and isolate it from
the remainder of the abdominal cavity with
moist laparotomy sponges. Avoid the use of
a spay hook.
Then proceed with the ovariohysterectomy procedure. Use absorbable, monofilament suture
for all ligatures. Braided suture is more likely to harbour bacteria in the crevasses of the suture
material. Ensure that you remove the uterus at the level of the uterine body (close to the
cervix). Do not leave excessive space between your ligatures around the uterine body as you
may create a pocket filled with purulent material that could lead to abscess formation. Do not
oversew the uterine edges at the level of transection as this creates a closed, contaminated
pocket that can also lead to abscess formation. Instead, gently wipe the uterine stump with a
moistened gauze sponge to reduce potential contamination. Abdominal closure is routine.
Bacterial culture swabs of the purulent material should be collected once the abdominal cavity
is closed. When uterine rupture was present preoperatively or occurs during surgery,
contain the contamination as much as possible, collect samples for bacterial culture, perform
thorough abdominal lavage and if available, insert a closed-suction to provide postoperative
drainage.

Ovario hysterectomy for a

Pyometra

Pyometra: Post-Op
1) When preparing for a canine ovariohysterectomy, the patient only needs to be clipped and
prepped from the umbilicus to the pubis, since the incision will be made in the caudal
abdomen.

• True
• False

2) For a canine ovariohysterectomy, the skin and subcutaneous incision should be made

• At the cranial third of the caudal abdomen (from the umbilicus to approximately half
way between the umbilicus and pubis)
• At the middle third of the caudal abdomen (a few inches cranial and a few inches caudal
to the half way point between the umbilicus and pubis)
• At the caudal third of the caudal abdomen (from a few inches caudal to the half way
point between the umbilicus and pubis to the pubis)
• In the middle of the abdomen (from a few inches cranial to the umbilicus to a few inches
caudal to the umbilicus)
3) If you encounter a lot of fat in the subcutaneous tissues when performing a canine
ovariohysterectomy, you should cut out as much of the fat as possible to ensure good
visualization of the linea alba.

• True
• False
4) Which of the following is the least acceptable method for finding and retracting the left
uterine horn during an ovariohysterectomy?

• Slide a finger or a spay hook along the abdominal wall and gently retract the first
structure it hooks onto.
• Use your fingers to identify the kidney and follow caudally until you find the ovary and
uterine horn.
• Exteriorize the intestines onto the skin and sterile drape to visually identify the uterine
body and horns.
• Retroflex the urinary bladder to identify the cervix and follow along the uterine body and
horn towards the ovary.
5) If the suspensory ligament is not visible, what should you do to it in order to further
exteriorize the ovary?

• Transect it with a pair of Metzembaum scissors

• Grasp it with a pair of mosquito forceps
• Cut it with a scalpel blade
• Break it with your index finger
6) What type of hemostatic forcep is ideal to clamp the ovarian pedicle in a large dog?

• Carmalt
• Crile
• Kelly
 • Mosquito
7) It is acceptable to place either two or three hemostatic forceps across the ovarian pedicle
during a canine ovariohysterectomy.

• True
• False
8) Which of the following suture materials would not be appropriate for ligating the ovarian
pedicle?

• PDS®
• Prolene®
• Vicryl®
• Biosyn®
9) Transecting the ovarian pedicle far away from the ligatures on the distal side (closer to
the ovary) will result in excessive tissue (which will become ischemic) remaining in the
body.

• True
• False
10) The right ovarian pedicle is generally shorter and more friable than the left.

• True
• False
11) Cutting the broad ligament with scissors generally creates better hemostasis than
breaking it with fingers.

• True
• False
12) The uterine body should be ligated

• On the cervix
• Just cranial to the cervix
• At the base of each uterine horn
• Where the attachment of the broad ligament ends