Ovariosalpingohysterectomy Technique Adapted in Bitches (Canis familiaris) - Advantages and Limitations
Authors: De Souza Campos Ana Carolina , Lopes Fernnades Maria Eduarda dos Santos , Lima Virginia Tavares , Fernandes Bruna Aguiar , Molinaro Coelho Cássica Marina , Albuquerque da Silva Marta Fernanda 
Published: March 2020

Background: The ovariosalpingohysterectomy (OSH) is one of the most performed surgeries in bitches often used in population control. Surgical techniques that decrease the chances of operative complications and cause less nociceptive stimulation and acute pain to the patient are highly sought after by veterinarians. We evaluated the inverted OSH technique (IT), which, after celiotomy, begins with the ligature execution, transection of the uterine body and subsequent ligation and ovarian disinsertion. The purpose of this investigation was to analyze aspects of IT execution in bitches, such as visceral manipulation, access to the uterus and ovaries, and surgical time compared to the traditional technique.Materials, Methods & Results: Inverted OSH was compared to the so-called traditional OSH technique, characterized by the initial removal of the ovaries followed by uterine section. The OSH techniques were performed in 24 healthy animals, with a body condition score of up to six (on a nine-point scale) in dogs aged between seven months and five years. All dogs were from the Birth Control Program of Dogs and Cats of the UFRRJ and were distributed into two groups: traditional technique (TT) and inverted technique (IT). Surgeries and anesthesia were carried out by the same veterinarian crew (surgeon, surgical assistant, and anesthesiologist). OSH techniques were evaluated by the surgeon and surgical assistant using semiquantitative analysis (multiple-choice questionnaire with closed questions that pointed scores related to the ease of uterine and ovarian manipulation, as well as to the level of manipulation of the intestinal and urinary vesicle) and qualitative descriptive methods (report of techniques with the opinion of surgeons and an external evaluator-veterinarian surgeon who attended surgeries). Also, the total surgical time and the indication of a positive analgesic response according to changes in the vital parameters observed by the anesthesiologist during specific moments of the operation were evaluated (traction of the ovarian pedicles and the uterine body). There was a greater intraoperative nociceptive stimulation in TT (five analgesic rescues and zero in IT) and greater ease of exposure, access, and manipulation of the ovaries in IT (right ovary P = 0.042 and left ovary P = 0.021); no difference in the manipulation of adjacent organs between groups (P = 0.944); with no statistical difference in total intraoperative time (P = 0.190). In the descriptive qualitative evaluation, inverted OSH revealed advantages concerning the ease of surgical access to the ovaries (especially the right ovary), particularly in heavier dogs.Discussion: The IT was considered easy to perform because the surgical team performed the two techniques at similar times despite having more experience and routine practice with the TT. The anatomy of the bitch challenges the performance of OSH during median celiotomy due to the dorsal location of the reproductive system in the abdominal cavity and, therefore, there is a need to manipulate the intestine and urinary vesicle. Moreover, the ovarian location near the chest wall concavity impairs the manipulation for its disinsertion. In this context, the IT appears useful in this species due to the greater ease of manipulation of the ovaries, highlighted in the semiquantitative and qualitative descriptive analyzes. In general, the OSH technique is impaired in dogs of greater bodyweight because there is a high amount of fat in their ligaments and the increase of the weight is considered a risk factor for the occurrence of complications in this surgery; in these patients, the IT may be advantageous because it allows cranial uterine flexion promoting greater ovarian exposure, thus facilitating its manipulation, hemostasis and pedicle section.