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Large Animal Orchiectomy     (Castration Lecture)    Dane Tatarniuk, DVM  Resident, Large Animal Surgery          April 5t...
Terminology•   castration,•   orchiectomy,•   emasculation,•   gelding,•   cutting,
Equine Castration• Overview  – Age  – Indication for surgery     •   Behavior     •   Neoplasia     •   Inguinal herniatio...
Anatomy•   Scrotum•   Testicle•   Epididymis•   Tunica    Vaginalis    – Parietal      Tunic    – Visceral      Tunic• Ing...
Anatomy• Spermatic Cord• Cremaster Muscle
Pre-operative Considerations• Systemically healthy• Palpation  – Two testicles descended?• Vaccination  – Tetanus• NSAIDs ...
Supplies•   General instrument pack•   Sterile gloves•   Scrub•   Emasculators•   Suture•   Ropes•   Towels•   +/- IV cath...
Standing Castration• Advantages    – Less cost & assistance    – Quicker    – Choice if poor anesthetic candidate• Disadva...
Recumbent Castration• Environment   – Field conditions   – Hospital conditions• Anesthesia       • Xylazine followed by   ...
Open Castration• Incision   – Through both scrotum and     parietal tunic• Dissection   – Ligament of tail of epididymis• ...
Emasculation      • “Nut to Nut”      • Held clamped for        minimum of 1 minute        – Anecdotal rule of ‘1         ...
Closed Castration• Incision   – Only through scrotum, not     through parietal tunic• “Stripping”   – Dissection of scrota...
Semi-Closed    • Incision       – Scrotum       – 2cm incision into parietal         tunic    • Eversion of tunic       – ...
Scrotal Healing• Second Intention Healing  – Drainage  – Stretching incision  – Trim excess fascial tissue• Primary Closur...
Other• Already anesthetized• Remove wolf teeth  – 505 & 605• Interfere with bit  placement in the  mouth
Post-Operative Recommendations• Open Scrotal Incision  – Movement     • Lunging at the trot daily  – Hydrotherapy     • De...
Complications“The one who does notoperate, does not have   complications.”
Hemorrhage• Emasculator application   – Thick cords   – Angle non-perpendicular   – Instrument condition• Testicular Arter...
Evisceration   • Prolapse of intestine /     omental tissue through     inguinal canal and scrotum   • Breed      – Standa...
Edema• Common, normal result• Management  – Exercise  – Hydrotherapy• If non-responsive,  – Re-open scrotal incision  – Pr...
Septic Funiculitis      • Definition: Infection of        spermatic cord      • Open castration         – More tissue left...
Clostridial Infection• Clostridium tetani  – Spastic paralysis• Clostridium botulinum  – Flaccid paralysis• Malignant Edem...
Septic Peritonitis• Anatomy  – Vaginal cavity communicates    with abdomen• Treatment  – NSAIDs  – Antibiotics  – Peritone...
Penile Damage•   Inadvertent emasculation of penis•   Edema formation•   Paraphimosis•   Know your anatomy
Hydrocele• Scrotal swelling   – Excess abdominal fluid in vaginal cavity• Open castration• Cosmetic problem   – Usually pa...
Behavior•   Perpetual masculine behavior•   Learned response•   Older stallions•   Warm owners
Cryptorchidism• Definition: Failure of one or  more testicles to descend• Location   – Abdominal vs. inguinal   – Left vs....
Food Animal    • Principles of castration similar      to equine    • Meat quality, behavior    • Often performed by produ...
Food Animal Tools• Newberry knife  – Splits scrotum in half  – Good access  – Good drainage
Food Animal Tools• Bloodless Castrators   – Elastrator   – Callicrate• Strangulation of vasculature -> atrophy -> necrosis...
Food Animal Tools• Burdizzo  – Crushes spermatic    cord from the    outside  – May have to apply    multiple times  – Tes...
Food Animal Tools• Henderson castrating tool  – Attached to power drill  – Twisting motion  – Good hemostasis in older ani...
Conclusion• Understand the anatomy, know your basic surgical  principles, and evaluate the unique factors present  (specie...
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Large Animal Orchiectomy

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Powerpoint complimenting written lecture notes discussing equine and food animal castration, surgical considerations, and complications. Prepared for lecture to 2nd year veterinary students.

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Transcript of "Large Animal Orchiectomy"

  1. 1. Large Animal Orchiectomy (Castration Lecture) Dane Tatarniuk, DVM Resident, Large Animal Surgery April 5th, 2013
  2. 2. Terminology• castration,• orchiectomy,• emasculation,• gelding,• cutting,
  3. 3. Equine Castration• Overview – Age – Indication for surgery • Behavior • Neoplasia • Inguinal herniation • Testicular trauma
  4. 4. Anatomy• Scrotum• Testicle• Epididymis• Tunica Vaginalis – Parietal Tunic – Visceral Tunic• Inguinal Canal
  5. 5. Anatomy• Spermatic Cord• Cremaster Muscle
  6. 6. Pre-operative Considerations• Systemically healthy• Palpation – Two testicles descended?• Vaccination – Tetanus• NSAIDs – Bute, Banamine• Antibiotics – Penicillin, Ceftiofur
  7. 7. Supplies• General instrument pack• Sterile gloves• Scrub• Emasculators• Suture• Ropes• Towels• +/- IV catheter
  8. 8. Standing Castration• Advantages – Less cost & assistance – Quicker – Choice if poor anesthetic candidate• Disadvantages – Vulnerable position – Avoid on small horses, donkey’s, mules – Assess temperament prior• Sedation – Alpha-2 agonist +/- butorphanol• Local Analgesia – Essential to castrating standing – Spermatic cord or intra-testicle• Position – Tight to horse, keep head up, use reach of arms.
  9. 9. Recumbent Castration• Environment – Field conditions – Hospital conditions• Anesthesia • Xylazine followed by ketamine & diazepam• Recumbancy – Left lateral vs. dorsal• Rope Restraint – Tie the limbs to maintain safety
  10. 10. Open Castration• Incision – Through both scrotum and parietal tunic• Dissection – Ligament of tail of epididymis• Exteriorization – Testicle and spermatic cord• +/- Ligation – Hemostasis – Foreign material• Emasculation• Leaves parietal tunic behind
  11. 11. Emasculation • “Nut to Nut” • Held clamped for minimum of 1 minute – Anecdotal rule of ‘1 minute per age year of horse’ often used • Variable types of emasculators – Serra, White vs. Reimer
  12. 12. Closed Castration• Incision – Only through scrotum, not through parietal tunic• “Stripping” – Dissection of scrotal fascia• Emasculation – Parietal tunic vs. Cremaster muscle• +/- primary closure – Decrease risk of herniation and evisceration – Foreign material
  13. 13. Semi-Closed • Incision – Scrotum – 2cm incision into parietal tunic • Eversion of tunic – Flip parietal tunic over thumb – Provides grip to aide in retraction • Closed castration – Emasculate spermatic cord followed by parietal tunic
  14. 14. Scrotal Healing• Second Intention Healing – Drainage – Stretching incision – Trim excess fascial tissue• Primary Closure – Technique • Excellent hemostasis – Environment • Sterile operating conditions – Increased cost
  15. 15. Other• Already anesthetized• Remove wolf teeth – 505 & 605• Interfere with bit placement in the mouth
  16. 16. Post-Operative Recommendations• Open Scrotal Incision – Movement • Lunging at the trot daily – Hydrotherapy • Decrease swelling• Closed – Confinement to facilitate primary intention healing• Isolation from mares – Active spermatozoa – 2 days min.
  17. 17. Complications“The one who does notoperate, does not have complications.”
  18. 18. Hemorrhage• Emasculator application – Thick cords – Angle non-perpendicular – Instrument condition• Testicular Artery – Some dripping normal, from scrotal vessels – Active stream of blood is not normal• Treatment – Wait 20 – 30 min, observe – Sedate, re-grasp cord, ligate – Pack with gauze for 24 hours – Anesthetize and find bleeder• Monitor yourself – Stay on farm or refer
  19. 19. Evisceration • Prolapse of intestine / omental tissue through inguinal canal and scrotum • Breed – Standardbreds, Drafts • Clean and replace contents back into abdomen – May have to anestheize – Refer immediately • Sequela – Strangulation of intestine – Septic peritonitis
  20. 20. Edema• Common, normal result• Management – Exercise – Hydrotherapy• If non-responsive, – Re-open scrotal incision – Promote further drainage
  21. 21. Septic Funiculitis • Definition: Infection of spermatic cord • Open castration – More tissue left behind • Treatment – Antibiotics – Drainage – Surgery • Champignon vs. Scirrhous Cord – Streptococcus vs. Staphylococcus
  22. 22. Clostridial Infection• Clostridium tetani – Spastic paralysis• Clostridium botulinum – Flaccid paralysis• Malignant Edema – Tissue necrosis, cellulitis, fever, depression, toxemia, deat h• Poor prognosis
  23. 23. Septic Peritonitis• Anatomy – Vaginal cavity communicates with abdomen• Treatment – NSAIDs – Antibiotics – Peritoneal Lavage• Referral
  24. 24. Penile Damage• Inadvertent emasculation of penis• Edema formation• Paraphimosis• Know your anatomy
  25. 25. Hydrocele• Scrotal swelling – Excess abdominal fluid in vaginal cavity• Open castration• Cosmetic problem – Usually painless• Drainage not helpful – More abdominal fluid – Can introduce bacteria• Surgery – Remove parietal tunic
  26. 26. Behavior• Perpetual masculine behavior• Learned response• Older stallions• Warm owners
  27. 27. Cryptorchidism• Definition: Failure of one or more testicles to descend• Location – Abdominal vs. inguinal – Left vs. right• Inherited• Diagnostic techniques – Palpation, ultrasound, explorato ry, hormone assays• Surgical removal – Do not remove a descended testicle if the other testicle cannot be located.
  28. 28. Food Animal • Principles of castration similar to equine • Meat quality, behavior • Often performed by producer • Restraint alone vs. sedation/anesthesia • Scrotal incision – Overlying testicle – Transect distal 1/3rd • Strip, +/- ligate, emasculate, etc.
  29. 29. Food Animal Tools• Newberry knife – Splits scrotum in half – Good access – Good drainage
  30. 30. Food Animal Tools• Bloodless Castrators – Elastrator – Callicrate• Strangulation of vasculature -> atrophy -> necrosis• ~ 3 weeks• Small, young animals
  31. 31. Food Animal Tools• Burdizzo – Crushes spermatic cord from the outside – May have to apply multiple times – Testicles atrophy, don’t usually slough
  32. 32. Food Animal Tools• Henderson castrating tool – Attached to power drill – Twisting motion – Good hemostasis in older animals
  33. 33. Conclusion• Understand the anatomy, know your basic surgical principles, and evaluate the unique factors present (specie, purpose of animal, animal temperament, surgical environment, owner expectations, owner budget etc.)• Recognize potential complications from castration and know how to manage them appropriately.• There is no “one right way” to perform castration - the right way is to know every way and apply the appropriate technique to the individual / situation.
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