Veterinary surgery is surgery performed on non-human animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics (bones, joints, muscles), soft tissue surgery (skin, body cavities, cardiovascular system, GI/urogenital/respiratory tracts), and neurosurgery. Advanced surgical procedures such as joint replacement (total hip, knee and elbow replacement), fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, and minimally invasive procedures (arthroscopy, laparoscopy, thoracoscopy) are performed by veterinary surgeons (as registered in their jurisdiction). Most general practice veterinarians perform routine surgeries such as neuters and minor mass excisions; some also perform additional procedures.
The goal of veterinary surgery may be quite different in pets and in farm animals. In the former, the situation is more close to that with human beings, where the benefit to the patient is the important factor. In the latter, the economic benefit is more important.
In the United States, Canada and Europe, veterinary surgery is one of 22 veterinary specialties recognized by the American Veterinary Medical Association [1] respectively the European Board of Veterinary Specialisation. [2] Those wishing to become board certified must undergo a one-year clinical internship program followed by three years of intensive training in a residency program under direct supervision of board certified veterinary surgeons, including performance of a large number of surgical procedures in such categories as abdominal surgery, surgical treatment of angular limb deformities, arthroscopic surgery, surgery of the foot, fracture fixation, ophthalmic surgery, urogenital surgery, and upper respiratory surgery, etc. Once the minimum requirements of training are met, residents are required to pass a rigorous certification examination before being admitted as members (diplomates) of the American College of Veterinary Surgeons [3] or European College of Veterinary Surgeons. [4]
Anesthesia in animals has many similarities to human anesthesia, but some differences as well. Local anesthesia is primarily used for wound closure and removal of small tumors. Lidocaine, mepivacaine, and bupivacaine are the most commonly used local anesthetics used in veterinary medicine. [5] Sedation without general anesthesia is used for more involved procedures. Sedatives commonly used include acepromazine, hydromorphone, midazolam, diazepam, xylazine, and medetomidine. α2 agonists like xylazine and medetomidine are especially useful because they can be reversed, xylazine by yohimbine and medetomidine by atipamezole. Xylazine is approved for use in dogs, cats, horses, deer, and elk in the United States, while medetomidine is only approved for dogs. [6] Most surgeries in ruminants can be performed with regional anesthesia.
General anesthesia is commonly used in animals for major surgery. Animals are often premedicated intravenously or intramuscularly with a sedative, analgesic, and anticholinergic agent (dogs frequently receive buprenorphine and acepromazine). The next step is induction, usually with an intravenous drug. Dogs and cats commonly receive thiopental (no longer allowed in the UK), ketamine with diazepam, tiletamine with zolazepam (usually just in cats), and/or propofol. Alfaxalone is a steroid anaesthetic used in many practices in the UK to induce anaesthesia in cats and sometimes dogs. It is similar in physiological effect but different in composition to the now withdrawn Saffan. [7] Horses commonly receive thiopental and guaifenesin. [5] Following induction, the animal is intubated with an endotracheal tube and maintained on a gas anesthetic. The most common gas anesthetics in use in veterinary medicine are isoflurane, enflurane, and halothane, although desflurane and sevoflurane are becoming more popular due to rapid induction and recovery. [8]
Elective procedures are those performed on a non-emergency basis, and which do not involve immediately life-threatening conditions. These are in contrast to emergency procedures.
One of the most common elective surgical procedures in animals are those that render animals incapable of reproducing. Neutering in animals describes spaying or castration (also please see castration). To spay (medical term: ovariectomy or ovario-hysterectomy) is to completely remove the ovaries and often the uterus of a female animal. In a dog, this is accomplished through a ventral midline incision into the abdomen. In a cat, this is accomplished either by a ventral midline abdominal incision, or by a flank incision (more common in the UK). With an ovariectomy, ligatures are placed on the blood vessels above and below the ovary and the organ is removed. With an ovariohysterectomy, the ligaments of the uterus and ovaries are broken down and the blood vessels are ligated and both organs are removed. The body wall, subcutis, and skin are sutured. To castrate (medical term: orchiectomy) is to remove the testicles of a male animal. Different techniques are used depending on the type of animal, including ligation of the spermatic cord with suture material, placing a rubber band around the cord to restrict blood flow to the testes, or crushing the cord with a specialized instrument like the Burdizzo.
Neutering is usually performed to prevent breeding, prevent unwanted behavior, or decrease risk of future medical problems. Neutering is also performed as an emergency procedure to treat certain reproductive diseases, like pyometra and testicular torsion, and it is used to treat ovarian, uterine, and testicular cancer. It is also recommended in cases of cryptorchidism to prevent torsion and malignant transformation of the testicles. Please see spaying and neutering for more information on the advantages and disadvantages of this procedure.
Laser surgery offers a number of benefits, [9] [10] including reduced risk of infection, less post-operative pain and swelling, reduced bleeding and improved visibility of the surgical field. Better hemostasis and visibility can in some cases minimize the need for anesthesia and/or reduce overall surgical time.
Other common elective surgical procedures in the United States are declawing in cats (onychectomy), ear-cropping in dogs, tail docking in dogs, horses, and dairy cattle, and livestock dehorning in cattle, sheep, and goats. These procedures have been controversial and recently debated among breeders, veterinary organizations, and animal welfare scientists. The controversy is different for each procedure, but issues arise based on reasons to perform the procedure, differing opinions on techniques and methods, perceived long-term benefits in individual animals, and the development of alternatives. Declawing, for example, consists of removal of the distal phalanges using either a scalpel, scissors or laser. It is typically performed to prevent property damage in house cats, but may also be performed in purebred dogs to meet certain show requirements. Some procedures are illegal in some countries (in the UK, declawing is illegal and tail docking is only allowed in working dogs) and face ethical challenges in others.
Common dental surgical procedures:
In older dogs and cats tumors are a common occurrence, and may involve any or multiple body systems: skin, musculoskeletal, gastrointestinal tract, urogenital tract, reproductive tract, cardiovascular system, spinal cord and peripheral nerves, the spleen and the lining of body cavities. Common skin tumors include lipomas, mast cell tumors, melanomas, squamous cell carcinomas, basal cell carcinomas, fibrosarcomas, and histiocytomas. Skin tumors are removed through either simple excisions or through excisions needing reconstructive plastic surgery. Common oral tumors include melanomas, fibrosarcomas, and squamous cell carcinomas, which are removed with as much surrounding tissue as possible, including parts of the mandible and maxilla. Other types of cancer requiring surgery include osteosarcomas, stomach and intestinal tumors, splenic masses, and urinary bladder tumors.
Common ophthalmic surgeries in animals include:
Common orthopedic surgeries in animals include:
Common cardiology surgeries in animals include:
Caesarean sections are commonly performed in dogs, cats, horses, sheep, and cattle. Usually it is done as an emergency surgery due to difficulties in the birthing process. Certain dog breeds such as Bulldogs often need to have this surgery because of the size of the puppy's head relative to the width of the bitch's birth canal.
Gastric dilatation volvulus (bloat) is a common condition in dogs in which the stomach fills with gas, and can become torsed. This requires immediate surgical intervention to prevent necrosis of the stomach wall and death of the dog. During surgery, the stomach is deflated and put back into its normal position. A gastropexy may be performed, whereby the stomach is attached to the body wall to prevent this condition from recurring. A splenectomy or partial gastrectomy may also be required.
A cystotomy is a surgical opening of the urinary bladder. It is commonly performed in dogs and cats to remove bladder stones or tumors.
Bite wounds from other animals (and rarely humans) are a common occurrence. Wounds from objects that the animal may step on or run into are also common. Usually these wounds are simple lacerations that can be easily cleaned and sutured, sometimes using a local anesthetic. Bite wounds, however, involve compressive and tensile forces in addition to shearing forces, and can cause separation of the skin from the underlying tissue and avulsion of underlying muscles. Deep puncture wounds are especially prone to infection. Deeper wounds are assessed under anesthesia and explored, lavaged, and debrided. Primary wound closure is used if all remaining tissue is healthy and free of contamination. Small puncture wounds may be left open, bandaged, and allowed to heal without surgery. A third alternative is delayed primary closure, which involves bandaging and reevaluation and surgery in three to five days. [17]
Wounds occurring in the udder and teats of cows are more difficult to repair, due to the difficult access and sensitivity of the organ, and because deep anaesthesia may not be applied to cows. [18]
A variety of non-edible objects are commonly swallowed by dogs, cats, and cattle. These foreign bodies can cause obstruction of the gastrointestinal tract causing severe vomiting and resulting electrolyte imbalances. The stomach (gastrotomy) or intestine (enterotomy) can be surgically opened to remove the foreign body. Necrotic intestine can be removed (enterectomy) and repaired with intestinal anastomosis. Foreign bodies can also be removed by endoscopy, which although requires general anesthesia does not require surgery and significantly decreases recovery time. [19] However, endoscopic foreign body retrieval is anatomically limited to objects lodged in the esophagus, the stomach or the colon. The condition in cattle is known as hardware disease.
Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions, to alter bodily functions, to reconstruct or improve aesthetics and appearance, or to remove unwanted tissues or foreign bodies. The subject receiving the surgery is typically a person, but can also be a non-human animal.
Neutering, from the Latin neuter, is the removal of a non-human animal's reproductive organ, either all of it or a considerably large part. The male-specific term is castration, while spaying is usually reserved for female animals. Colloquially, both terms are often referred to as fixing. In male horses, castrating is referred to as gelding. An animal that has not been neutered is sometimes referred to as entire or intact.
Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.
Onychectomy, popularly known as declawing, is an operation to remove an animal's claws surgically by means of the amputation of all or part of the distal phalanges, or end bones, of the animal's toes. Because the claw develops from germinal tissue within the third phalanx, amputation of the bone is necessary to fully remove the claw. The terms onychectomy and declawing imply mere claw removal, but a more appropriate description would be phalangectomy, excision of toe bone.
Xylazine is a structural analog of clonidine and an α2-adrenergic receptor agonist, sold under many trade names worldwide, most notably the Bayer brand name Rompun, as well as Anased, Sedazine and Chanazine.
Devocalization is a surgical procedure where tissue is removed from the vocal cords.
Carprofen is a nonsteroidal anti-inflammatory drug (NSAID) of the carbazole and propionic acid class that was previously for use in humans and animals but is now only available to veterinarians for prescribing as a supportive treatment for various conditions in animals. Carprofen reduces inflammation by inhibition of COX-1 and COX-2; its specificity for COX-2 varies from species to species. Marketed under many brand names worldwide, carprofen is used as a treatment for inflammation and pain, including joint pain and postoperative pain.
Vaginectomy is a surgery to remove all or part of the vagina. It is one form of treatment for individuals with vaginal cancer or rectal cancer that is used to remove tissue with cancerous cells. It can also be used in gender-affirming surgery. Some people born with a vagina who identify as trans men or as nonbinary may choose vaginectomy in conjunction with other surgeries to make the clitoris more penis-like (metoidioplasty), construct of a full-size penis (phalloplasty), or create a relatively smooth, featureless genital area.
Butorphanol is a morphinan-type synthetic agonist–antagonist opioid analgesic developed by Bristol-Myers. Butorphanol is most closely structurally related to levorphanol. Butorphanol is available as the tartrate salt in injectable, tablet, and intranasal spray formulations. The tablet form is only used in dogs, cats and horses due to low bioavailability in humans.
Veterinary anesthesia is a specialization in the veterinary medicine field dedicated to the proper administration of anesthetic agents to non-human animals to control their consciousness during procedures. A veterinarian or a Registered Veterinary Technician administers these drugs to minimize stress, destructive behavior, and the threat of injury to both the patient and the doctor. The duration of the anesthesia process goes from the time before an animal leaves for the visit to the time after the animal reaches home after the visit, meaning it includes care from both the owner and the veterinary staff. Generally, anesthesia is used for a wider range of circumstances in animals than in people not only due to their inability to cooperate with certain diagnostic or therapeutic procedures, but also due to their species, breed, size, and corresponding anatomy. Veterinary anesthesia includes anesthesia of the major species: dogs, cats, horses, cattle, sheep, goats, and pigs, as well as all other animals requiring veterinary care such as birds, pocket pets, and wildlife.
Medetomidine is a veterinary anesthetic drug with potent sedative effects and emerging illicit drug adulterant.
Cancer in cats is the leading cause of death among cats. It is caused by uncontrolled cell growth, and affects a wide range of cell types and organs in the body. Feline cancer initially manifests as a lump or bump on any part of the body. It rapidly grows in the affected cell, attaches itself to the tissue under the skin in that area, and, depending on the tumour, it can spread to other parts of the body. Although cancer accounts for approximately 32% of deaths in cats over ten years old, it can be successfully treated if diagnosed early.
Many types of skin tumors, both benign (noncancerous) and malignant (cancerous), exist in cats and dogs. Approximately 20–40% of primary skin tumors are malignant in dogs and 50–65% are malignant in cats. Not all forms of skin cancer in cats and dogs are caused by sun exposure, but it can happen occasionally. On dogs, the nose and pads of the feet contain sensitive skin and no fur to protect from the sun. Also, cats and dogs with thin or light-colored coats are at a higher risk of sun damage over their entire bodies.
The health of domestic cats is a well studied area in veterinary medicine.
Pediatric spaying or neutering is defined as performing an ovariohysterectomy (spaying) or orchidectomy on a kitten or puppy between the ages of 6 and 14 weeks. Spaying and neutering are sterilization procedures which prevent the animals from reproducing. The procedures are also referred to as “gonadectomies” in the veterinary literature.
Urethrostomy is a surgical procedure that creates a permanent opening in the urethra, commonly to remove obstructions to urine flow. The procedure is most often performed in male cats, where the opening is made in the perineum.
Surgical stress is the systemic response to surgical injury and is characterized by activation of the sympathetic nervous system, endocrine responses as well as immunological and haematological changes. Measurement of surgical stress is used in anaesthesia, physiology and surgery.
Balanced anesthesia, also known as multimodal anesthesia, is a technique used to induce and maintain anesthesia in patients undergoing surgery or certain medical procedures. This method employs a combination of anesthetic agents and other drugs – and techniques – to selectively target various aspects of the central nervous system, allowing for a tailored anesthetic experience based on the individual patient's needs and the specific requirements of the procedure.