WO2020050735A1 - Method of laparoscopic spaying of female dogs - Google Patents

Abstract

The invention relates to veterinary medicine, in particular to a method of laparoscopic spaying of female dogs. An animal prepared for the operation is placed on an angled rotating plate on its back and anesthetized, and transvaginal access to the ovaries is made via a perforation. Antiseptic sterilization of the vagina and calibrated blind dilatation of the vagina are carried out. The animal is turned over and a vaginoscopy is carried out. An endoscope having an operating channel with a diameter of 5 mm is inserted into the vagina, which is equipped with a video camera connected to a monitor. The position of the internal organs is determined, and the location of the forthcoming perforation of the vaginal wall is marked. The wall of the vagina is coagulated and dissected. The endoscope is inserted in a trocar and passed into the abdominal cavity, the endoscope is used to visually identify the ovaries, and an elongated manipulator is inserted into the endoscope. Soft tissues of the first ovary and second ovary are extracted and temporary pexia of the first ovary and second ovary to the ventral abdominal is carried out. The ovaries are mobilized and extracted via the trocar. The vessels are ligated, clipped and coagulated. Then the uterus is removed. The uterine horn is engaged and retracted into the vagina, and 'everted' through the vagina. Then the vessels supplying the uterus are ligated or sutured, clipped or coagulated. The uterine stump is sutured or ligated. The uterine stump is tucked into the abdominal cavity by means of the trocar. The postoperative wound is treated with antiseptics. A sterile antiseptic drape is inserted into the vagina.

Description

 METHOD OF LAPAROSCOPIC CASTRATION OF DOGS

The field of technology.

 The invention relates to veterinary medicine, in particular to veterinary surgery, and can be used in castration (ovarian and ovariogisterectomy) of female dogs.

 The prior art.

 Castration (lat. Castratio — hollowness, from castro — clipping, cleansing, scattering) is a surgical operation, the essence of which is to remove the sexual glands from the animal in order to prevent natural fertilization. Castration methods are known. There are methods of castration of male animals, for example, the method of castration of small domestic animals (source [1] - patent RU 2130299), the method of castration of male farm animals (source [2] - patent RU 95 111 112), the method of castration of boars (source [3] - patent RU 2391941), a method of castration of gobies (source [4] - patent RU 2104674). These methods [1,2, 3,4] are not suitable for castration of female dogs. During the surgical castration of female dogs, the genital ovaries (ovariectomy) are removed or the genital glands are removed along with the uterus (ovariogysterectomy). To remove the sex glands, in female dogs, intracavitary surgery is performed. Access to the gonads and uterus of animals, today, is through an incision (laparotomy) in the abdominal cavity, an incision is made on the abdomen, in the navel (along the white line) or along the side surface, or through punctures (laparoscopy) into the abdominal cavity performed abdominal wall. Punctures are made with a sharpened stylet inserted into the trocar. After performing the puncture, the stylet is removed, and the trocar is left in the thickness of the tissues. The necessary surgical instrument is inserted through the trocars into the body cavity. Access through punctures is less traumatic and can reduce the duration of the rehabilitation postoperative period. For free and safe manipulation of surgical instruments inside the abdominal cavity, it is necessary to create an operating cavity.

A known method of ovariohysterectomy in cats, ferrets with video endoscopic control (source [5] - RU 2326581). 1.5 cm back from the navel caudally along the white line of the abdomen, puncture with a Veress needle. Through a trocar with a magnetic valve, a video endoscope is inserted at the same point. Under visual control, the uterine horn and ovary are hooked. The hook is removed along with the uterine horn and ovary. Coagulate and dissect the uterine vessels of the extracted horn, ovarian ligament. The second uterine horn is removed. The uterus is cut off entirely in the area of its neck. The uterine stump is set into the abdominal cavity. An internal suture is applied to the muscles of the abdominal wall. The skin defect is sealed.

 This method [5] is minimally invasive, but leaves on the outer surface of the animal’s body, a postoperative puncture that can disturb the animal, the animal can tear off the patch and contaminate the wound, especially with high motor activity. As a result, an inflammatory process may occur at the puncture site.

 A known method of performing an operation (ovariohysterectomy) with mass sterilization of dogs (source [6] - patent RU 149181). Method [6] includes performing an incision of a skin and muscle fragment of an operative wound, an incision of the peritoneum, removal of reproductive organs and suturing of the wound. The wound incision is carried out 1-3 cm below the umbilical ring and 3-5 cm from the midline of the abdomen. The length of the cut is from 2 to 5 cm, depending on the need. Then, the surgical wound is displaced by pulling the skin to the right or left until the aponeurosis is exposed, along which an incision is made to penetrate the abdominal cavity. After surgery, long-absorbable sutures are applied to the peritoneum and aponeurosis. The skin wound is displaced back, thereby the skin covered the muscle wound. Subcutaneous tissue (saphenous suture) is then sutured, preventing the "dead space" and creating additional tightness of the wound. Use a long-absorbable material. In conclusion, an intradermal suture was applied with subcutaneous fixation of nodes on both sides.

Known laparoscopic sterilization of cats and dogs (source [7] - Internet site "http://zoostatus.ru" of the veterinary clinic "ZOOSTATUS", Moscow, main>treatment> surgery and restoration of cats> Laparoscopic sterilization of cats and dogs "; mode access: http://zoostatus.ru/lechenie/hirurgiya-i-vostanovlenie-koshek/laparoskopicheskaja- sterilizatsija-koshek /). At the initial stage of the operation using a laparoscope the animal is pumped with carbon dioxide (insufflation). Make cuts on the side of the animal. After visualization of the uterus and ovaries, ligatures are applied and these organs are removed. Sutures are applied to the incisions.

 In these methods [6; 7], on the outer surface of the animal’s body, postoperative sections remain vulnerable to damage. As you know, dogs and cats exhibit motor activity after surgery. When performing incisions outside the abdominal cavity, postoperative tissue injury is allowed, the animal can lick the wound, contaminate, the stability of the surgical wound is not ensured during the motor activity of the animal. As a result, there may be a discrepancy in the edges of the wound, the occurrence of an inflammatory process, complications.

In human medicine, a method of laparoscopic hernioplasty of umbilical hernias and hernias of the white line of the abdomen is known (source [8] - patent RU 2326581). When implementing the method [8], to access the internal organs, during the operation, three trocars are introduced, in women, the trocar is introduced through the posterior vaginal fornix. In human medicine, a method for performing transvaginal appendectomy is also known (source [9] - patent RU 2531138). The operation according to the method [9] is performed under combined endotracheal anesthesia. The patient's position is on his back, legs are divorced. After processing the surgical field perform skin umbilical access 1 with a length of 10 mm Carboxyperitoneum is superimposed with a Veress needle using the double-click method. Two trocars with a diameter of 5 mm are introduced into the abdominal cavity through the wound of umbilical access. Laparoscopy is performed by a direct laparoscope with a diameter of 5 mm and a viewing angle of 30 degrees. In the second trocar, a working tool with a diameter of 5 mm is inserted into the abdominal cavity - a direct atraumatic clamp. Under visual control, a puncture of the posterior vaginal fornix with a 10 mm diameter trocar is performed on the monitor. A direct endoscopic clamp is rearranged into a vaginal access trocar, which grasps and holds the apex of the appendix towards the anterior abdominal wall, visualizing its mesentery and base. Through a 10 mm vaginal access trocar, the base of the vermiform appendix is clipped with three clips, and the appendix between the distal clips is intersected with endoscopic scissors. After which the vermiform appendix is removed from the abdominal cavity through a 10 mm vaginal access trocar. Perform a control audit, lavage, drainage of the abdominal cavity. The vaginal access trocar is then removed from the abdominal cavity under visual control. Carboxyperitoneum is eliminated, trocars are removed from umbilical access. The wound of the posterior vaginal fornix is not sutured, a napkin with hydrogen peroxide is introduced into the vagina. The wound of umbilical access is sutured in layers. These methods [8,9] are not applicable for castration of animals.

 The development of a method that provides minimally invasive, low-traumatic and easily implemented, with no need to shave wool on the ventral abdominal wall, castration of female dogs, is an urgent task of modern veterinary medicine.

 SUMMARY OF THE INVENTION

 The objective of the invention is to expand the arsenal of methods known in veterinary medicine for surgical interventions to castrate female dogs.

 The technical result consists in solving the problem. The technical solution allows minimally invasive transvaginal castration of the female dog, which is very beneficial for the postoperative state of the animal. The surgical puncture is not outside, but is completely hidden from the external environment, which provides faster healing compared to known methods, eliminating the need for postoperative wound treatment and removal of sutures.

The technical result is achieved by the fact that in the method of laparoscopic castration of female dogs, the animal is placed on an angular rotary pad, on the back. They carry out anesthesia, anesthesia. They treat the vagina with antiseptics. Access to the ovaries is carried out transvaginally through a puncture. A calibrated blind dilatation of the vagina is performed using calibrated dilators with a diameter of up to 15 mm and blunt expanders of dilatation. Turn the animal over on the corner swivel plate on its side. Carry out a vaginoscopy with the supply of carbon dioxide (6-8 mm Hg), while the gas can be supplied both through the endoscope and through the trocar. To form access to the abdominal cavity, a trocar is inserted sequentially into the vagina, with a diameter of 10 to 20 mm (depending on the estimated size of the ovaries and uterus) and a length of 25 to 35 cm, through a sealing adapter that prevents the outflow of carbon dioxide is injected with an endoscope with a diameter of 10 millimeters and a length of 29 to 32 cm, with a working channel with a diameter of 5 millimeters, equipped with a video camera connected to the monitor. Determine the position of the internal organs. They plan a place for a future puncture of the vaginal wall, which is located dorsally, lateral to the midline. Elongated (not less than the length of the endoscope) electrosurgical manipulators carry out coagulation and dissection of the vaginal wall. A manipulator, an endoscope and then a trocar are carried out into the abdominal cavity. The endoscope is driven through a sealing adapter into the trocar and carried out into the abdominal cavity. The trocar is inserted into the abdominal cavity through the vagina to the maximum length. At this point, carbon dioxide is fed through the cannula of the trocar. Ovaries are visually determined through an endoscope. An elongated manipulator is inserted into the endoscope. The soft tissues of the first ovary are removed. Temporary pexia of the first ovary to the ventral abdominal wall is carried out, for this, a device for temporary pexia is introduced through the working channel of the endoscope. They mobilize the first ovary, dissect the soft tissues that bind the first ovary, capture their own ligaments of the first ovary, and the first ovary is removed through a trocar. The described sequence of actions to remove the second ovary is performed. The vessels are ligated and coagulated, then the uterus is removed, the uterine horns are captured and removed into the vagina, eversion is performed through the vagina to the uterus’s horns and body with the extraction of the endoscope, then the vessels that feed the uterus are ligated or stitched, clipped or coagulated, sutured or ligated uterine stump, uterine stump are inserted into the abdominal cavity through the trocar, the trocar is removed, the postoperative wound is treated with antiseptics, a sterile napkin impregnated with a solution that promotes wound healing is inserted into the vagina.

 The invention is illustrated by graphic materials, which show:

Figure 1 - Photo, shows an angular rotary lining;

 Figure 2 - Photograph showing the end of the trocar in the abdominal cavity;

Fig.Z - Photograph, showing the extraction of the ovaries, uterine horns with "eversion" of the vagina. b

 The method is as follows.

The method is used to remove internal genital organs in female dogs for medical or social reasons. 12 hours before the planned operation, the animal is limited in food intake and 3 hours before the planned operation, fluid intake is limited. To implement the method, they use endoscopic equipment consisting of a video system, an insufflator, an endoscope with a diameter of 10 millimeters, a length of 29 to 32 centimeters, with a working channel with a diameter of 5 mm, an elongated trocar with a diameter of 10 to 20 mm and a length of 25 to 35 cm , with a blunt stylet, a set of elongated manipulators (dissector, scissors, bipolar clamp-coagulator) with a length of 400 to 450 millimeters, a sealing adapter that prevents the outflow of carbon dioxide. The animal is placed on the operating table, on a special angular swivel pad (figure 1) on the back. Anesthesia and anesthesia are performed. Access to the ovaries is carried out transvaginally through a puncture. For this, antiseptic sanitation of the vagina is performed by douching with antiseptics. Calibrated blind dilatation of the vagina is performed using calibrated dilators with a diameter of up to 15 mm and blunt-bougie dilators of the required caliber, which maximize the opening of soft tissues of the vagina. The animal is turned over on an angular swivel plate, on its side; for this, the angular swivel plate is turned at an angle of about 90 degrees. Carry out vaginoscopy with the supply of carbon dioxide (6-8 mm Hg), while the gas can be supplied both through an endoscope and through a trocar. For this purpose, a trocar is inserted into the vagina sequentially, with a diameter of 10 to 20 mm (depending on the intended size of the ovaries and uterus) and a length of 25 to 35 cm. Then, through the trocar sealing adapter, which prevents the outflow of carbon dioxide, an endoscope is introduced, with a diameter of 10 millimeters and a length of 29 to 32 cm, with a working channel with a diameter of 5 millimeters, equipped with a video camera connected to the monitor. The trocar is inserted into the abdominal cavity through the vagina to the maximum length. At this point, gas is fed through the cannula of the trocar. Determine the position of the internal organs. The anatomical features and condition of the vaginal wall are determined, and the site of the future puncture of the vaginal wall is determined, which is located dorsally, lateral to the midline of the body, far from large blood vessels. In the lateral parts of the vagina, blood vessels pass between them there is always a space on the dorsal wall of the vagina, which should be used to create a vaginal port (puncture). Elongated electrosurgical manipulators are inserted into the vagina. The elongated (at least the length of the endoscope) electrosurgical manipulators coagulate and dissect the vaginal wall. Given the good blood supply to the muscular-fascial layer of the vagina, a longitudinal direction is recommended for coagulation and dissection of the vaginal wall. A manipulator is inserted into the vagina, then an endoscope and then a trocar, towards the left or right dome of the diaphragm. A trocar is carried out into the abdominal cavity (Fig. 2), holding it in the longitudinal direction while advancing, bimanual control is carried out through the abdominal wall, detecting the end of the trocar in the area of the free abdominal cavity without the corresponding organs (rectum, urinary tract) bubble). The endoscope is driven through a sealing adapter into the trocar and carried out into the abdominal cavity, establishing stable visual control over the state of the abdominal organs. The video signal from the endoscope is displayed on the monitor. Through the endoscope, the ovaries are visually determined. The uterine horns are determined. An elongated manipulator (dissector) is inserted into the endoscope. The soft tissues of the first ovary are removed. Temporary pexia of the first ovary to the ventral abdominal wall is carried out; for this, a device for temporary pexia introduced through the working channel of the endoscope is used. The first ovary is mobilized, the soft tissues connecting the first ovary are dissected. For this, an elongated manipulator (bipolar clamp-coagulator) is introduced into the endoscope. The soft tissues that bind the first ovary are treated. An elongated manipulator, scissors, is inserted into the endoscope, soft tissues connecting the first ovary are dissected. The section of soft tissues fixing the pexed first ovary is performed simultaneously with coagulation. Withdraw the elongated manipulator - scissors. An elongated manipulator, a clamp, is inserted into the endoscope. Capture the elongated manipulator - clamp, own ligaments of the first ovary. The mobilized first ovary is removed through the trocar, taking out the endoscope together with an elongated manipulator - a clamp. The described sequence of actions to remove the second ovary is performed. The soft tissues of the second ovary are removed, and the second ovary is temporarily secreted to the ventral abdominal wall. They mobilize the second ovary, dissect the soft tissues connecting the second ovary. Captured by an elongated manipulator - clamp, self- ny ligaments of the second ovary. Ligate, coagulate vessels. The mobilized second ovary is recovered via a trocar. In large dogs, it is recommended to suture the vaginal trocar wound with one suture of absorbable suture material. As a result of transvaginal laparoscopic surgery, the problem of postoperative care for sutures on the abdominal wall due to their absence is completely resolved. When ovariogysterectomy is performed, the uterus is additionally removed. The horns of the uterus and ovaries are captured and removed into the vagina, “eversion” is performed (Fig. 3), through the vagina and to the outside of the ovaries, horns and uterine body with the extraction of the endoscope through the vagina. Then, vessels feeding the uterus are also ligated or stitched, clipped or coagulated. Sutured or ligated uterine stump. The uterine stump is inserted into the abdominal cavity through the trocar. In the case of ovariectomy, only the ovaries are removed, removing them one at a time. The trocar is removed. The postoperative wound is treated with antiseptics. A sterile napkin impregnated with a solution that promotes wound healing is inserted into the vagina.

 The method is used by the author in a veterinary clinic for surgical castration of dogs.

Claims

CLAIM  A method of laparoscopic castration of female dogs is characterized in that the animal is placed on an angular rotary lining, on the back, anesthetized, anesthetized, access to the ovaries is transvaginally performed through a puncture, antiseptic sanitation of the vagina is performed, calibrated blind dilatation of the vagina is performed using calibrated dilators with a diameter up to 15 mm, and obtuse bougie-expanders, turn the animal over on an angular rotary pad, on its side, perform vaginoscopy, inject the agonist successively a trocar with a diameter of 10 to 20 mm, depending on the estimated size of the ovaries and uterus, from 25 to 35 cm long, an endoscope with a diameter of 10 millimeters, from 29 to 32 cm in length, with a working channel is inserted through a sealing adapter that prevents the outflow of carbon dioxide with a diameter of 5 millimeters, equipped with a video camera connected to the monitor, the position of the internal organs is further determined, the site of the future puncture of the vaginal wall is determined, which is located dorsally, lateral to the midline, with elongated electrodes rurgic manipulators carry out coagulation and dissection of the vaginal wall, carry out a manipulator, an endoscope and then a trocar into the abdominal cavity, ovaries are visually determined through the endoscope, an elongated manipulator is introduced into the endoscope, the soft tissues of the first ovary are removed, temporary paxia of the first ovary is carried out to the ventral abdominal wall, for this the device for temporary pexia is introduced, introduced through the working channel of the endoscope, mobilize the first ovary, dissect the soft tissues that bind the first ovary, they capture their own ligaments of the first ovary, remove the first ovary through the trocar, perform the described sequence of actions to remove the ovary of the opposite side, ligate and coagulate the vessels, then remove the uterus with ovaries or only the ovaries, capture and remove the uterine horns into the vagina, perform an “eversion”, through the vagina to the outside of the horns and uterine body with the extraction of the endoscope, then the vessels feeding the uterus are also ligated or stitched, clipped or coagulated, the uterus stump, uterus stump are ligated or ligated for example they inject it into the abdominal cavity through a trocar, remove the trocar, treat the postoperative wound with antiseptics, put a sterile antiseptic wipe into the vagina.