Opening multiple packs is a waste of time. Place your instruments of choice in a single pack to make surgery easier.Photo courtesy Phil Zeltzman Quite often considered “routine” procedures, spays and neuters can lead to complications and frustration. Here are 10 tips to consider to improve your comfort, efficiency, and patient care. 1) Consolidation When it comes to spays and neuters, it is not unusual to have to open an instrument pack, a drape, and a scalpel blade. Opening multiple packs is a waste of time. Consider adding a medium-sized drape to your spay packs and a small drape to your neuter packs. You do have dedicated spay and neuter packs, right? Eliminate all unnecessary instruments, and add the surgical blade of your choice to each one. 2) Location Remember the differences in anatomy (granted, there is no new information here!). In dogs, the abdominal incision should be more cranial than in cats to expose the ovaries more easily. In young dogs, the incision should start midway between the umbilicus and the pelvis, and extend cranially. In adult dogs, the incision should start at the umbilicus and extend caudally. Finally, in cats, the incision should be midway between the umbilicus and the pelvis. 3) Length What is the ideal incision length for a spay? Make it too small, and it will increase tension on the ovarian and uterine pedicles. Make it too long, and it will require a much longer time to close. The truth is somewhere in the middle. Not too short, not too long. With experience, you will find the sweet spot, the ideal compromise that allies safety and efficiency. 4) Legs The traditional position for a spay is to stretch and tie the front legs above the head. Consider tying them on either side of the thorax. This will relax the abdominal wall muscles and will make it easier to release the suspensory ligament. 5) Suspension Speaking of suspensory ligament… Do you break it by “playing the guitar” or “digital strumming”? This could be risky, especially when it’s done blindly. And it often leads to stimulation of the patient, which can interrupt surgery and prolong anesthesia time. Another technique (Shivley, Vet. Surg. 2018) is to visualize the suspensory ligament and cut it with scissors or a scalpel blade. It has been shown to be faster and safer. 6) Autoligate Autoligation is commonly done in cat neuters. It is fast and avoids the need for suture material, thereby saving time and money. And by definition, it eliminates the risk of bleeding after slipping of a ligature. So, who said it can’t be done in other procedures? You can perform autoligation or a “pedicle tie” during cat spays at any age (Miller, J. Feline Med. Surg. 2016). You can even use autoligation while neutering pediatric and juvenile dogs (Miller, JAVMA 2018). 7) Knots Many practitioners interested in sleeping well at night, double ligate all pedicles, both in males and females. While it is a reasonable and prudent practice, and definitely recommended in the case of pyometra or pregnancy, it takes more time to perform. Mastering the Miller’s Knot would eliminate the need for double ligation. 8) Quilt Postop seromas are a classic, but avoidable complication after a spay. Using a quilting pattern in the subcutaneous tissues is a quick and easy way to decrease the risk of seromas (Lopez, Vet. Surg. 2020). During your simple continuous pattern, grab a bite in the rectus fascia every third pass, thereby decreasing the dead space and reducing the risk of seroma. 9) OHE Although rarely performed in the U.S., yet common in other countries, ovariectomy is a great option to decrease morbidity and save time during a spay. This procedure leaves the uterine but removes the ovaries. As long as all the ovarian tissue is removed properly, the risk of pyometra or uterine neoplasia is close to zero (Zeltzman, Veterinary Practice News 2009). 10) Flank Also more predominant outside of the U.S., a flank spay can be considered. It is performed by placing the patient in left lateral recumbency and making a dorsoventral incision in the right flank. Separate the muscles, puncture the peritoneum and locate the right uterine horn. From there, the procedure is relatively similar to a traditional spay. Benefits include a lower risk of dehiscence. 11) Bonus: Scrotal Dare to try a scrotal approach, rather than prescrotal, for dog neuters. The scrotal technique, described in 1974, is a safe and ethical alternative for both pediatric and adult canine castrations. The approach offers many benefits, including, depending on the technique chosen, reduced anesthesia time, less suture material, decreased cost, smaller incision, reduced pain, no risk of urethral trauma, and reduced likelihood of scrotal hematoma or seroma formation. When done correctly, the scrotal approach seems to significantly reduce the odds of patients’ self-traumatizing the surgical site during recovery. Overall, surgical time is cut by approximately 30 percent (Zeltzman, Veterinary Practice News 2017). If you use some or all of the above tips, you will gain in efficiency, proficiency, and safety. And your patients and clients will be the big winners. Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified, is a board-certified veterinary surgeon and serial entrepreneur whose traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. He also is cofounder of Veterinary Financial Summit, an online community and conference dedicated to personal and practice finance (www.VetFinancialSummit.com). A.J. Debiasse, a technician in Blairstown, N.J., contributed to this article.
