a

Dog Neuter Surgery | A walkthrough of the surgical procedure

hello friends for those of you that are

new here I'm dr. Meg's and this is

everyday vet where we bridge the

communication gap between medical

professionals and pet owners today I'm

going to show you a surgery that I did

on a dog named Oreo specifically it was

a neuter surgery so this is gonna be an

actual video of the surgery that I did

if you're looking for just information

about the pros and cons of neutering

timing of neutering then I'd recommend

that you actually go and check out my

other video about neutering dogs but if

you're interested in seeing the actual

surgical procedure I'm gonna walk you

guys through that right now so as we can

see here we've got Oreo on the actual

surgical table I've got the blue

surgical drape I've got it just open so

the only part that exposed is the part

that I'm actually accessing for the

surgery that just keeps everything

sterile so it looks like you know he's

just about draped in so let's dive in so

I have my surgical site all draped in

the drape prevents any contamination

from outside of the surgical field from

entering the cleaned area I'm gonna do a

neuter here on Oreo Oreo is a dog he's a

little over a year old and what we do is

it's called a pre scrotal incision so

scrotums down here prepuce and penis is

up here so what I do is I push the

testicle forward to protect the urethra

which is the tube from the bladder out

so I push the testicle forward I'm going

to cut over the testicle that just

prevents me from entering any of the

urinary tract unintentionally I do this

approach it's called pre scrotal because

the actual scrotal tissue is more

sensitive and by doing it up here I'm

ideally reducing the risk of him licking

or trying to chew at his incision as

it's healing so I've got two petals down

here the black one's gonna be for my

vacuum to suck up any fumes from the

surgical laser and the white one here is

gonna be to actually turn on the

surgical laser so I'm gonna go ahead and

make my skin incision now so right now

I'm using a surgical laser to actually

like cut through the skin layers on the

surface layer

is gonna be the epidermis underneath

that is gonna be the dermis that's the

part that the hair follicle actually

extends down into and then beneath that

is what's called the subcutaneous layer

so the key with this incision is I want

to cut deep enough that I get all the

way through the my skin layer but I

don't want to accidentally cut into the

actual testicle so it's a little bit

delicate there so as you can see that

we've got the testicle intact so if you

notice there's not really any bleeding

from that incision

because that laser has cauterized as

it's cut so it's really reducing any

loss of blood but also reducing the

general inflammatory response so it does

make for a nice incision

and squeeze the testicle out so now I

have to break down some of the extra

tissues you need to suit your off these

vessels so there's no bleeding but I

need to get rid of the extra tissue

around it first that way we can get it a

good tight seal on those vessels so I'm

going to hold the testicle in my right

hand the gauze on the left I'm just

gonna pull until it loosens and do it to

the clamp technique

we use an aunt bison suture aught is the

size of the suture it's based on the

patient weight bias in is a monofilament

absorbable meaning that it's a single

strand so it's less likely to wick

bacteria along the suture material its

absorbable because it's going in the

body so it's gonna need to absorb on its

own I would not be able to remove this

stitch so this first type of suture I'm

doing is called circumferential because

it's just gonna loop it's just gonna

loop around the actual cord of the

testicle so I'm just gonna do one little

throw here of the knot I'm gonna keep it

fairly loose because what I'm gonna do

now is I'm gonna undo this clamp so that

tissue there's is crushed so I can slide

my suture up over it tighten down over

it and you get an even tighter tighter

hold over that vessel and now I'm just

gonna continue to try that off do a

couple of extra throws make sure you get

a good nice knot on this you can

actually see that the vessels are still

kind of all together with the the muscle

and everything and that's because

there's a layer actually covering all of

that

it's the vaginal tunic that covers the

testicle too but it's actually extending

down over all those vessels so that's

why I'm able to suture the artery in the

vein and all of that together my drapes

loosening up a little bit on me so I'm

just gonna add extra on there that's why

I'm always fighting with the drape

so that let's tie it up it's a tiny

little blood there but that's normal now

I'm gonna do what's called a trance

fixation suture so in order to get an

extra tight hold on that cord I'm gonna

actually pass the needle up through it

that way that suture is anchored right

in the middle I'm gonna do not here

I'm gonna bring my suture around I'm

gonna tie it this way so now that

sutures still looped around everything

but it's it's anchored right in the

middle of the vessels and the muscle

that's there so it'll really help hold

it in place

pretty sure it's called transfixing not

trans fixation oops but the key is that

it's anchored in the middle

right now I'm taking God's that has

sterile saline on it I'm putting this up

underneath the cord because I'm gonna

use the laser to cut I use this because

the laser is not going to go through the

wet gauze so it just protects it from

passing through but it allows me to lay

this out so I can get a good cut on it

and that little tube there over in the

corner is actually the vacuum hose that

sucks up all the fumes when I'm using

the laser now first Prime I'm cutting

through the red part on the left is the

muscle and then you can see there's a

little bleeding on the right as I get

over where the actual vessels are

sitting

[Music]

now the testicles are removed I'm gonna

toss it out so that's actually a bin for

medical waste we use it only in the

surgery room now I'm just gonna clean up

the edge of this a little bit I don't

want any of that charred tissue to stay

in the body so I'm just gonna clean that

off it's and I'm gonna inspect it and

make sure we have a good seal on those

vessels so I'm gonna undo my clamp while

still holding my cords over here there's

no bleeding so we're good still nothing

without tension so I can push that back

down in and now we're gonna use the same

incision for the second one we've just

got to cut through that layer that's

between the two testicles so I'm gonna

push that testicle forward I'm gonna

make another incision right over there

and then we're gonna repeat the same

process on this side

[Music]

so same thing as before that glistening

surface on the testicle is actually

still that vaginal tunic I did not cut

into it because it's called the closed

castration you can you can't actually

cut through that layer and then you have

individual access to the vessels but I

don't typically need to do that it just

makes it a little bit more lengthy so

again I'm gonna put my three clamps on

you can't cut through it in like a

bigger dog but I didn't need to so on

this one too you can see there's a

little bit of bruising here and the

reason for that is before I did any of

my incision we actually injected a

lidocaine nerve block into the actual

testicle so that's just an extra layer

of pain protection for this pet he also

had an injectable anti-inflammatory and

he's going to go home on pain

medications to use use a non-steroidal

anti-inflammatory for them to go home on

steroids just have a little bit more

side effects so again I'm doing that

first throw remove my clamp slide it

over the crushed tissue and then

continue to tie my knot

too much I know it's important to note

too we're doing what's called the square

knot in order for that to happen these

have to be equal if I do it like this

and just slide it down one side it's

called a granny knot and it's actually

gonna be a slipknot so I really would

need to make sure to keep both sides

even otherwise the knot is gonna be

weakened and it's not gonna hold

I'm gonna cut those ends and I'm gonna

do that trance fixation suture again

hooking this up through that muscle

layer right there the best the blood

vessels here nerve muscle

[Music]

[Music]

[Music]

so same thing I'm now gonna cut the

testicle from the cord

so I actually used this pack there to

turn on the laser I keep the handle part

sterile and then I just used the hook

ends to press the buttons but that's why

I kind of I put the hook over the side

of the my tool or my instrument tray

afterwards because I want to make sure

that the non sterile part doesn't end up

touching anything

if this testicle is gonna go in the

medical waste trash - now it's actually

kind of sticky sometimes that's why I'm

using the gauze I've definitely had it

get stuck to my glove before

clean that so this and I can actually

see it really well too got the nerve

that goes through the vessels and then

that muscle belly so again we're gonna

check out the bleeding

[Music]

no bleeding so that one can go back down

into and now I'm gonna close it up so we

can suture up that hole I'm gonna have a

two OTT please

I mean you use a smaller suture on this

need to use enough that it's strong

enough but not so much that we end up

with a excess suture left behind so this

is a two OTT so it's smaller than the

other one you can see the size

difference here so my left hand has OTT

my right hand has two OTT so the two

aughts definitely smaller than the op

needles also a little bit smaller

now i am called it that way so that way

the end of my suture is in the deep

tissue layer so deep as in closer to the

patient superficial as in closer to me

because when i tie that knot i want it

to be buried underneath those tissues so

I'm gonna take that into account to for

my next throw and I'm gonna cross over

to the other side of my incision and I'm

gonna go superficial to deep so I still

come out on those deep layers and I'll

pull that through and then I'm gonna use

this to tie it knot

[Laughter]

I'm going to do a simple continuous so

I'm going to cut this end continuous

being that the same line so I'm going to

keep going with this half of the suture

attack - that scent this is that middle

layer that we caught through to get to

the second testicle

the middle layer was called the squirrel

septum it just makes suturing go easier

with less material if I'm able to just

suture all three layers together

so now that I'm getting towards the end

here I need to do planning for my knot I

want to make sure my knot on the other

end stays buried too so I'm gonna take

this one and I'm gonna go superficial to

deep and then I'm gonna make a loop that

I can tie with so I want my loop to have

both ends in the deep layer so this one

I'm gonna go deep to superficial so deep

superficial

keep that loop both entering the deep

tissues now I'm gonna need to come out

the other side so I want my suture line

to end deep so I'm gonna go back over

this side do a superficial to deep so

now I've essentially got two loops in my

strands I'm gonna pull this one through

I'm gonna use this side to tie

[Laughter]

so all the ends are in the deep layer

now

I'm gonna cut those up

this trip is getting in my field there

too so I'm just gonna tuck that up over

and then now I'm gonna do the skincare

before us so I'm gonna use it even

smaller size for the skin layer and I'm

gonna do what's called an intra dermal

pattern so if we look at here the

surface layer is the epidermis and then

underneath it here we've got the dermal

layer that's where the hair follicles

are extending down through and then

you've got the subcutaneous tissues so

I'm gonna say in that dermal layer which

is where those hair follicles are when

used for up because they need a smaller

suture otherwise you'll be too damaging

to the tissue layer this one is on a

different style needle - this is a

cutting needle so it's got a spine on

the bottom of the actual needle as

opposed to this one it's flat you can

see there's definitely a difference in

how they're shaped the reason being is

that I want something that's cutting

through the tissue as opposed to just

pushing it aside because that's much

less traumatizing to the actual skin

layer so again I'm gonna keep this not

buried so I need to start deep and go

superficial and then I'm gonna go

superficial to deep on the other side

but just like we did before with the

other layer

[Music]

[Laughter]

so you can see I'm actually making the

needle do most of the work I'm just

twisting my wrist and letting the needle

go its natural direction so it's just

it's very slight movement

and now again I'm gonna continue this

liner suture staying in that dermal

layer

suturing is very tedious

I'm definitely not my favorite part of

the surgery

so the other key thing to though with

the suturing is the forceps in my left

hand I'm using to grasp the tissue but

it's really important that I mostly

grasp the tissue underneath that

epidermal layer the epidermis is just

very sensitive and if you pinch it too

hard with the forceps you're gonna cause

extra bruising trauma patient discomfort

so I'm mainly grasping the dermal layer

or the subcutaneous layer

I'm gonna start tying the knot here soon

so the same principles I need to come

out on the deep aspect of the tissue

and since this is the loop I'm tying I

need to start from deep and go

superficial again I'm gonna save this

loop cross over to the other side I'm

due superficial to deep I move in

between the two loops pull that one

tight and I'm gonna use this part to

suture

[Laughter]

this one I'm gonna do a little

difference I'm gonna cut that there I'm

gonna take this

now I'm gonna really pull that knot down

deeper so I'm gonna pass it through here

up through the skin layer and use that

to pull in and that's gonna get that not

to sink right down in there

so now the whole skin layer is closed

but there's no exposed suture material

everything is dissolvable so he will not

need any stitch or move on I will just

continue to go

so that basically finishes up his

surgery

all right so now at this point we remove

the drapes he's also on a gas called

sevoflurane which is an inhalant that

was keeping him asleep during the

surgery so now that's been turned off

because actual surgery's done we're

still gonna provide some oxygen for him

though to the tube he has an

endotracheal tube which goes from his

mouth down into his lungs so we'll still

provide oxygen for a little bit you know

just support him through his recovery

and then as soon as he starts to like

you know lift his head up take a couple

of swallows once they've swallowed a

couple of times that's when we actually

take that that tube out of their throat

it just gives us control over their

Airways for a little bit longer that way

if there's any difficulty in recovery

we're able to provide oxygen to them if

needed Oreo actually did great though we

did not need to do anything really for

his recovery he woke up very smoothly

the whole surgery went very routinely

and he did great he went home that same

day hasn't really had any post-operative

complications at all so he did excellent

actually surgery was really routine but

thanks for watching that I hope you guys

found that interesting if you have any

questions though make sure to leave a

comment in the comment section below and

I'll be sure to to answer that for you

if you want to know just general more

information on you know should you

neuter your dog when should you neuter

your dog be sure to check out that other

video that I posted because it does

answer those questions a little bit more

but I hope you liked getting to see the

surgery side of things I know it's one

of my favorite things to do too so

thanks for hanging out with me