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Procedures in this Presentation
• Partial and total splenectomy (dorsal and ventral approach) Common Surgical Procedures in • Ovariectomy Mice and Rats • Ovariohysterectomy • Orchiectomy (scrotal and abdominal approach) Marcel Perret-Gentil • Scrotal and abdominal vasectomy The University of Texas at San Antonio [email protected] • Adrenalectomy LARC Main Page: vpr.utsa.edu/larc • Nephrectomy LARC Training Page: http://goo.gl/rzR3sl • Ureter ligation
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Procedures in this Presentation Disclaimers
• Partial hepatectomy in mice (with and without gall bladder removal) 1. Images and videos associated with this presentation are for the purpose of demonstration of surgical techniques and are • Subdiaphragmatic vagotomy not intended to teach or demonstrate aseptic technique • Piloroplasty secondary to subdiaphragmatic vagotomy 2. As author of this presentation, I firmly advocate that survival surgery in rodents should be performed with meticulous • Removal of sciatic nerve section attention to aseptic technique • Common carotid catheterization 3. Procedures shown in this presentation conducted as terminal procedures in anesthetized animals, under a protocol • External jugular vein catheterization approved by the animal ethics committee at my institution • Femoral artery catheterization • Femoral vein catheterization 3 4
Surgical clips Before beginning…
Skin Closure
Clips, clip applier & clip remover 6
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Non absorbable, monofilament suture Silk on Skin
fdfdfd • It is easy to handle making it the suture of choice of many investigators… however… • Should not be used for skin closure for following reasons: – Produces undue local reaction and inflammatory response – It is braided and through its wicking action serves as a fomite to introduce microorganisms into the wound – These properties result in potential clinical and subclinical infections – As such, it is not consistent with sound principles of veterinary medicine Silk is not an appropriate suture for skin closure 7 8
Dorsal Approach
13th Rib ~1 cm skin incision Approaching the Spleen On animal’s left side Parallel to 13th rib Dorsal & Ventral Approach Dorsal extreme
beginning just below Spinal the spinal muscle }muscle 13th rib Incision
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Spleen Separate (no need to cut) Ventral Approach abdominal muscle fibers with tips of sharp scissors (iris scissors) • Make a 1-2 cm mid ventral skin incision with its extreme cranial end at the level of the stomach Spleen is seen below opening • Abdomen is entered through the linea alba • Spleen is identified below and to the left of the linea alba • Exteriorize spleen
Exteriorize spleen
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Spleen is accessed via a dorsal or Partial Splenectomy (Biopsy) ventral approach
Via a Ventral or Dorsal Approach
1. Tie a ligature around the spleen arm to stem bleeding Do not include splenic vessels into ligature Partial Splenectomy (Biopsy) in 2. Excise splenic tissue distal to ligature the Mouse – Video
Ventral Approach 3:08
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Video – Partial Splenectomy
Total Splenectomy
Via a Ventral or Dorsal Approach
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1. Exteriorize spleen
2. Cut gastro-splenic ligament Spleen is accessed via a dorsal or with scissors or cautery to separate spleen from stomach ventral approach 3. Identify, isolate and ligate splenic vessels. In tiny mice careful cauterization of vessels without a ligature may be performed with caution
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Cauterize or transect blood vessels distal to ligature
In rats (especially large ones) isolate individual blood vessel bundles and ligate
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Ligate & Cut Isolating blood vessels
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• Muscle layer is closed with absorbable suture • Skin is closed with – Monofilament, non-absorbable suture in an interrupted fashion, or – Surgical Clips
Surgical skin glue (cyanoacrylate) may be applied to close small skin incisions or to reinforce (and provide a microbial barrier) larger incisions Cautery alone works well in smaller animals (mice) 25 26
Video – Total Splenectomy
Total Splenectomy in the Mouse Video
Ventral Approach 3:28
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Hump of • Make a transverse or back longitudinal dorsal incision ~ half distance between Ovariectomy hump of back and level of Transverse or knee with animal in ventral longitudinal incision recumbency Knee • Transverse incision allows easier bilateral access to both ovaries through same incision
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Hump of Ovary knee back
Hump of back Ovary knee Not as obvious in heavy animals 31 32
Spinal White fatty Muscle tissue Uterine horn surrounding ovary
White fatty tissue
Fallopian tube Ovary Abdominal muscle Fallopian tube Cut or penetrate and separate abdominal wall muscle fibers with tips of sharp scissors Uterus (iris scissors) to locate ovary 33 34
1. Identify white fatty tissue surrounding ovary 2. Identify ovary, fallopian tube under white fatty tissue 3. Retract ovaries with forceps Cut or cauterize to remove ovary
With rats (specially if large) may place a ligature to minimize bleeding
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Alternative to Traditional Cautery • Muscle layer is closed with absorbable suture 1. Submerge tips • Skin is closed with of hemostatic – Monofilament, non-absorbable suture in an forceps in a hot interrupted fashion, or bead sterilizer – Surgical Clips 2. Remove and immediately Surgical skin glue (cyanoacrylate) may be applied to clamp tissue close small skin incisions or to reinforce (and provide a microbial barrier) larger incisions
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Video – Ovariectomy
Mouse Ovariectomy Video
1:55
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Ovary
Horn Ovariohysterectomy Body Cervix Bladder Vagina
Mouse & rat female reproductive track 42
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Linea alba
1. Make a ventral midline skin incision with its extreme caudal end at level of the pubis (bladder)
2. To enter abdomen, linea alba is incised in same direction as skin incision • Exteriorize uterus with its surrounding fat & tissues – If necessary move bladder to the side or empty it with a syringe & needle
43 • Identify uterine body, horns and ovaries 44
• Ovaries, uterine horns and uterine body are dissected Clamp uterine body or Place a ligature distal to free to separate from other tissues. In large rats, a cervix with hemostatic hemostatic forceps ligature distal to ovary minimizes bleeding forceps
• Cautery is useful to dissect tissues away from uterus 45 46
• Muscle layer is closed with absorbable suture • Skin is closed with – Monofilament, non-absorbable suture in an interrupted fashion, or – Surgical Clips
Surgical skin glue (cyanoacrylate) may be applied to close small skin incisions or to reinforce (and Remove (excise) uterus along with ovaries proximal to provide a microbial barrier) larger incisions hemostats with cautery, surgical blade or scissors
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Video – Ovariohysterectomy
Mouse Ovariohysterectomy Video
1:58
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Scrotal Orchiectomy
• Rats & mice have open (loose) inguinal canals. This allows free movement of testes between scrotum and abdomen • During scrotal castration, testes may need to be forced into scrotum. This may be done by exerting pressure on testes towards the scrotum in the caudal abdomen with fingers or Q-tips
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Incise scrotum Incise parietal tunica, avoiding on midline cutting the vaginal tunica, which is intimately associated with & adhered to the testes
53 In mice, use scissors 54
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A firm tug exteriorizes the Pull until testes spermatic cord is exposed Procedure is similar in mice & rats
55 56
Alternative to Standard Cauterization
1. Submerge hemostats in a hot bead sterilizer
2. Immediately clamp to seal and transect the spermatic Cauterize or ligate cord spermatic cord
57 58
Orchiectomy Video, Scrotal Repeat procedure on contralateral testis Approach
Close scrotum (options) 2:44 • Monofilament, non-absorbable suture in an interrupted fashion • Surgical Clips • Surgical glue 59
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Video –Scrotal Orchiectomy
Abdominal Orchiectomy
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Traditional approach: Incision started near pubis
• Rats and mice have open inguinal canals, allowing free movement • The traditional abdominal castration makes a ventral midline of testes between scrotum and abdomen incision close to the pubis, which can damage seminal vesicles • Testis may need to be pushed from scrotum to lower abdomen while testis are being searched towards. This may be done by exerting pressure on scrotum • Suggested is a refinement to this technique in next slide towards abdomen with fingers or Q-tips 63 64
Umbilicus
Exteriorize Pull this fat • A refined approach consists of making a ventral midline skin whitish fat along with and muscle incision, starting at umbilicus & continuing caudally that is related testis for a few millimeters to the testis • Testis are pulled out through the incision and removal is performed as described under the scrotal orchiectomy 65 66
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• Replace excess tissue back into abdomen • Muscle layer is closed with absorbable suture • Skin is closed with – Monofilament, non-absorbable suture in an interrupted fashion, or Clamp below the Cauterize testis ensuring between the – Surgical Clips no testicular testis & clamp – Surgical skin glue (cyanoacrylate), which provides tissue is trapped in the clamp a microbial barrier
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Vasectomy – Vas Deferens Testis is exteriorized through the incision and closure as described under
Abdominal or Scrotal scrotal and abdominal orchiectomy
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Vas deferens • Vas deferens is relatively massive and easily visualized Blood Vas Deferens as a white/bright tubular vessel structure with a blood vessel running alongside it • Vas is also recognized as continuation of the epididymis • Dissect out/isolate the vas Epididymis Testis deferens
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Excise ~0.5 cm section of Epididymis Epididymis each vas deferens with a Testis blade, scissors or cautery with or without suture ligation
Vas Vas deferens Testis deferens
Vas deferens is relatively massive and easily visualized as a white/bright tubular structure associated with the epididymis
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Video – Vasectomía del Ratón
Vasectomy Video in the Mouse
2:15
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A 1-2 cm (depending on size Adrenalectomy of animal) mid-dorsal (or slightly lateral) skin incision is made with its extreme cranial end at the level of the 13th rib
Needle shows location of 13th rib
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Spinal Adrenal muscle gland
Dorsal • Adrenal gland is located cranial Muscle midline and medial to kidney, embedded (spine) window in fatty tissue Abdominal muscle • Remove the gland intact with Kidney is located just caudal & slightly lateral forceps without needing to cut to adrenal gland
A window is made through muscle fibers by entering muscle and separating fibers bluntly with sharp (iris) scissors 79 80
Nephrectomy
• Muscle layer is closed with absorbable suture • Skin is closed with – Monofilament, non-absorbable suture, or – Surgical clips
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• Adrenal gland is closely associated (medial and cranial to kidney) with the kidney and should not be extracted or damaged during nephrectomy • Adrenal gland is left intact in the body • Right kidney is slightly cranial to the left kidney • Right kidney is partially hidden under the right lobe of the liver • Left side nephrectomy is often the preferred approach for 83 unilateral nephrectomy 84
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Ureter Renal vessels and ureter are isolated Renal artery & vein
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• Muscle layer is closed with absorbable suture • Skin is closed with – Monofilament, non-absorbable suture in an interrupted fashion, or – Surgical Clips
Ligate with 1 or 2 sutures and remove kidney Surgical skin glue (cyanoacrylate) may be applied to close small skin incisions or to reinforce (and Second ligature more important the larger the animal is provide a microbial barrier) larger incisions
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Video – Nephrectomy
Nephrectomy Video
2:29
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Ureter Ligation The kidney is exteriorized as described under nephrectomy session To simulate unilateral obstructive nephropathy
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Renal pelvis
Ureter
Ureter Renal artery & vein
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Head Renal pelvis
Ureter
Blood vessels Tail
Ureter
Due to its translucid nature, ureter may be difficult to Ureter visualize Ureter is localized as it leaves the renal pelvis posterior (caudal) to renal artery and vein 95 96
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• Muscle layer is closed with absorbable suture • Skin is closed with – Monofilament, non-absorbable suture in an interrupted fashion, or – Surgical Clips
Ureter is ligated with 1 or 2 ligatures or with vessel Surgical skin glue (cyanoacrylate) may be applied to clamps (for temporary occlusion) to simulate close small skin incisions or to reinforce (and obstructive nephropathy provide a microbial barrier) larger incisions
97 98
2 /3 Partial Hepatectomy in Mice Liver Anatomy
Two Methods
Gall Right Left Bladder Median Median Gall Median Bladder Liver Lobes Median Right (superior) Left Left Caudate Right Caudate (inferior) Left Median Right Right Why is this a mouse & not Median a rat liver? Left Right • In most strains of mice the relative weights of the Rats lack a gall (superior) Left respective lobes are constant bladder (superior) 101 • Anatomy similar in rats, except rats lack a gall bladder102
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• Mammals can survive removal of up to 75% of total liver mass • If > 75% is removed, remaining liver mass is not sufficient to maintain critical levels of blood glucose • Removal of <1/3 will not elicit a generalized liver proliferative response Surgical Technique • Therefore, median and left lobe hepatectomy is considered ideal and results in removal of ~ 64-68% of total liver mass, a partial hepatectomy technique known as 2/3 Hepatectomy • After resection of 2/3 of the liver, remaining hepatocytes undergo one or two replication rounds without complications related to hypoglycemia • 2/3 hepatectomy is therefore a preferred method for studying dynamics of liver regeneration 103
• Dorsal pressure helps with liver exposure
Xiphoid process Hemostats Paper clip Suture • Recommended retraction to expose liver with paper clips, rubber band Q-tip and needles • Midline incision is extended beyond (cranial to) xiphoid process • Xiphoid process is retracted with rubber band to further expose liver 105 Alternative Xyphoid Lifting 106
Q-tips soaked in saline are useful tools for moving lobes Before placing ligatures at the base of the lobes, cut various
107 ligaments as illustrated here in the middle lobe 108
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st Median 1 ligature • Gall bladder is removed with median lobe 2nd ligature Left • This technique should not be used in C57 mice, as it may Caudate result in death in 7 days or less Partial Hepatectomy – Method #1 vena cava Gall nd st bladder 2 ligature • 1 ligature placed at base Two ligating sutures of left lobe • 2nd ligature placed Gall Bladder Removed Median somewhere between the 2 Median dashed lines • Ligating too too close to vena cava, may result in stenosis of the vena cava110
Vena cava Gall 1st ligature bladder 2nd ligature
Median Left Median
Caudate Median Right
• 2nd ligature placed between 2 dashed lines • 2nd ligature, on right & • Ligating too too close to left median lobules vena cava, may result in 1st ligature placed at base left lobe include gall bladder vena cava stenosis
111 112
Vena cava
Vena cava is observed at base of median lobe After ligation use sharp scissors to Visualizing vena cava in method #1 is key to avoid excise (remove) liver placing ligature to close to lobe distal to ligature it and to avoid vena cava stenosis
Vena cava 113 114
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Video – Partial Hepatectomy
Partial Hepatectomy Video Method #1, Gall Bladder Removed
3:48
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1st ligature
Median Left
Caudate Partial Hepatectomy – Method #2 Right Vena cava
Three ligating sutures Gall Bladder Left in Place 1st ligature at base of left lobe
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Median 1st nd Median • 2 ligature around base of 3rd right median lobe 2nd Left • 3rd ligature around base of Caudate left median lobe Gall bladder Right ventral view
vena cava Median lobe 3rd 2nd
Median
Median Gall bladder – dorsal view
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• Muscle layer (linea alba) is closed with absorbable After ligation, distal suture to ligatures, lobes • Skin is closed with are excised with sharp scissors – Monofilament, non-absorbable suture in an interrupted fashion, or – Surgical Clips
Surgical skin glue (cyanoacrylate) may be applied to reinforce closure (and provide a microbial barrier) 121 122
Xiphoid
Subdiaphragmatic Vagotomy
• A mid-ventral skin incision is made with its extreme cranial end at the level of xiphoid process • Abdomen is entered through linea alba in same
direction as skin incision 124
dfdfdfdsaf dfdfdfdsaf dfdfdfdsaf Stomach dfdfdfdsaf Anterior Esophagus Spleen vagal branch
dfdfdfdsaf Posterior vagal branch
Dfsa f Diaphragm Dfd fd
Dfsa Dfd f fd
Both anterior and posterior branches of the vagus nerve are excised 125 126
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• Dissection/separation of vagus branches from Esophagus Posterior esophagus can be done with vagal branch micro-scissors, fine tip • Esophagus & both forceps or by branches of vagus hydrodissection Cánula (anterior & posterior) lacrimal • Hydrodissection is are identified caudal Stomach done by inserting a to diaphragm Anterior lacrimal cannula • With delicate blunt vagal branch attached to a 1 ml dissection separate syringe between both vagal branches esophagus & vagus away from esophagus branch, followed by injection of small volume of saline to separate tissues
127 128
Pyloroplasty as Adjunct Surgery to Subdiaphragmatic Vagotomy
Each vagal branch is individually cut or ligated depending on study objectives
Vagotomy in mice requires high magnification 129
The Problem and the Solution
• The pyloric sphincter controls output of food from the stomach into the duodenum • Problem: Vagotomy results in pylorus inability to allow stomach emptying into duodenum • Solution: Pyloroplasty widens the pylorus to allow passage of food into the duodenum
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Pyloric sphincter
Longitudinal incision is made across & into Duodenum pylorus Pyloric sphincter
Antrum Incision is closed Duodenum transversally Duodenum
133 134
Suture technique of pyloric Results incision method #1: Serosa • Suture: Monofilament, absorbable • Layers: 1 layer-closure, inverted • Instruments: Microsurgical
Muscularis Epithelium
Before pyloroplasty After pyloroplasty Emptying of stomach is now possible Serosa 135 Muscularis 136
Suture technique of pyloric incision method #2 (preferred): Pyloric • Suture: Monofilament, absorbable sphincter • Layers: 1 layer-closure, inverted • Instruments: Microsurgical Duodenum Pyloric region
stomach Horizontal mattress pattern
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Incisión Pyloric Pyloric convertida a sphincter sphincter transversal
Duodenum Distal end of Proximal end of longitudinal longitudinal incision incision Estómago Longitudinal incision Add 1 stay sutures ½ way on both sides of pyloric incision & retract with forceps to convert into transverse incisional closure
139 140
Distal end of longitudinal incision Proximal end of Suture longitudinal incision completed Retracted suture on both sides stretch pylorus transversally before beginning closure of pylorus
141 142
Femur
Sciatic Sciatic Nerve Excision nerve Nervio Nervio Ciático Ciático
• Sciatic nerve runs caudal y parallel to femur • Femur is identified by palpating knee & coxofemoral
joint 144
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Intermuscular white band With sharp pointed scissors (e.g., iris scissors) penetrate white fibrous band, separating Longitudinal incision: • muscle bellies without cutting • ~3-5 mm caudal to femur muscle • Most proximal end at level Continue separation & of coxofemoral joint (or dissection until white sciatic greater trochanter) nerve becomes visible • Bluntly dissect through White band intermuscular white band
145 146
Common Carotid Cannulation • Dissect & elevate sciatic nerve with fine mosquito hemostats This method is used to introduce • Cut sciatic nerve catheter or telemetry device into artery • Approximate muscles with absorbable suture in a simple continuous pattern • Close skin with clips or non absorbable,
monofilament interrupted suture 147
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External Jugular Common Carotid
Place a syringe hub or similar object (size depends on animal size) under neck to help expose the blood vessel 149 150
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Heart
• Surgeon position is cranial to nose or caudal to animal depending on surgeon’s preference (I prefer cranial to nose) • Make a ~2-3 cm mid ventral incision over trachea (or just
lateral to it) 151 Head 152
Common carotid is identified Cut here after separating muscles that run parallel to trachea
Carotid
Cut here Trachea
Removal of this muscle facilitates access toCabeza carotid. With greater experience, this muscle may be left intact
Animal’s head 153 154
• When arteries are manipulated, they easily go into spasm Vagus and collapse, complicating the introduction of the catheter nerve (cannula) into the artery • Suggestions to minimize spasm & collapse 1. Prevent the artery from drying ... Keep moist with warm saline at all times 2. Minimize handling the artery ... If manipulating artery is necessary, grasp the tissue adjacent or above the artery rather than the artery itself • Artery is carefully separated from vagus nerve • Avoid damaging recurrent laryngeal nerve, which runs along 3. 1-2 drops of 2% lidocaine over artery helps minimize side the trachea (medial to carotid & vagus) spams • Note in image above: Great care is taken to minimize 155 grasping artery, but rather grasp tissue surrounding it 156
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Heart Heart
Head
• Place 2 ligatures distal & proximal to where catheter will be introduced. 3 ligatures can be placed for added security • Distal suture (towards head) is tightened to ligate artery • Proximal suture (towards heart) is kept lose Head 157 158
Heart Heart
With forceps place tension on proximal suture (closest to Alternative to kinking: heart) to kink artery Artery can be occluded This avoids excessive bleeding with vascular clamps when artery is entered (incised) proximal (closer to heart) to artery incision point
Head
Head 159 160
Heart
• ~50% of artery’s diameter is incised • Arterial incision should be made close to distal suture (closest to head)
Head Suggestion to create a catheter introducer 161 162
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Suggestion to create a catheter introducer: • With needle driver, bend hypodermic needle at 90-1200 as illustrated 2 images on right • This creates a channel to help slide catheter under cut lumen of the needle point • Point of needle penetrates blood vessel & catheter is introduced under needle
Catheter insertion site
Catheter enters here
163 164
Catheter enters here
Instead of kinking artery with proximal suture (closest to heart), artery occlusion can be made with a vascular clamp This prevents excessive bleeding when artery is incised
165 166
Catheter introducer
Forceps Although using either method will lead to some bleeding, use of vascular clamps will lead to less bleeding Catheter is inserted directing towards the heart
167 168
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Suggestion: Catheter forceps (with internal grooves) are useful tools to grasp & introduce catheter into artery or vein, while minimizing damage to catheter 169 170
Common Carotid Artery Catheterization Video
4:24
• After introducing catheter, tie proximal suture over artery and catheter • Tie distal suture around exteriorized catheter 171
Common Carotid Artery Catheterization Video
External Jugular Vein Catheterization
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Pectoral muscle
External jugular is visualized as it disappears under pectoral muscle
175 176
Pectoral muscle Pectoral muscle
Skin incision points of reference:
Direction of skin External Jugular incision will be a Angle of straight line the jaw somewhere between pectoral muscle & a point just (slightly) medial to the angle of the jaw
177 178
Heart
Skin incision points of reference: Angle of Direction of incision the Jaw will be a straight line somewhere between pectoral muscle & a point just (slightly) External jugular medial to the angle of Internal jugular the jaw
Head Note: Orientation of jugulars is not exact. Cartoon is for illustration 179 purposes and not to describe exact anatomical landmarks 180
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• Surgeon position is cranial to nose • Make a 1.5-2.5 cm incision • Incision started at level of pectoral muscle & directed Place a syringe hub or similar object (size depends on towards angle of jaw (or slightly medial to it) animal size) under neck to help expose the blood vessel 181 182
Heart Pectoral muscle Place 2 sutures under vein
Cut here
Head
Once located, dissect external
jugular free of surrounding tissue 183 184
Caudal Caudal Suggestion for passing suture suture suture under blood vessel (heart) (heart)
Grasp suture here (this is the “other” side) Cranial suture (head) Cranial suture (head) • Insert suture through hub of small/sterile pipette • Force tip of pipette under vessel while rotating pipette • Most cranial (towards head) ligature is tied back & forth about its longitudinal axis and knotted • Once through the “other” side, grasp suture with forceps • Most caudal (towards heart) ligature is left • While grasping suture on “other” side, remove pipette & loose without tying (for now)
leave suture in place 185 186
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~25% of vein’s diameter is Catheter is introduced directed incised towards (in the direction of) the heart
187 188
External Jugular Catheterization Video
6:41
• After introducing catheter, tie caudal (towards heart) suture over vein and catheter • Tie cranial (towards head) suture around exteriorized catheter 189
External Jugular Catheterization Video
Femoral Artery and Vein Catheterization
191
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• Femoral Vein & Artery catheterization is performed following the same principles discussed earlier in this presentation for the common carotid and external jugular sections • The difference is how to approach & manipulate the femoral vessels. See following slides for description of these differences • Femoral Vein, Artery & Nerve run adjacent and • Incision is made longitudinal or perpendicular to the femoral parallel to each other. Their orientation from furrow according to the surgeon’s preference posterior to anterior they run in this order, VAN • Incision is made on the medial surface of the thigh over the (Vein, Artery & Nerve) areas traversed by the femoral Vein, Artery & Nerve, with its most extreme cranial end (if incision is longitudinal) at the level 193 of the inguinal ligament 194
Abdomen
Inguinal ligament (white band) Immediately after making the incision, a body of fat Artery, vein & (fat pad) is encountered, which is retracted away or nerve excised to visualize femoral Vein, Artery & Nerve lying right underneath this body of fat
• Incision should expose inguinal area, evident by visualization of a white band of tissue (inguinal ligament) • Vein, Artery & Nerve disappear proximally under the inguinal ligament as they enter into the abdominal cavity 195 196
Inguinal ligament (white band)
• Incision should expose inguinal area, evident by visualizing a white band of tissue (inguinal ligament) Separation of Vein, Artery & Nerve can be done with • Vein, Artery & Nerve disappear proximally under the micro-scissors, fine tip forceps or hydrodissection inguinal ligament as they enter the abdominal cavity 197 198
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Hydrodissection is performed by inserting a lacrimal cannula attached to a 1 ml syringe between vessels, followed by
injection of small volume of saline to separate structures199 200
• Subcutaneous tissue is approximated with absorbable suture in a continuous pattern • Skin is closed with – Monofilament, non-absorbable suture in an interrupted fashion, or – Surgical Clips
Surgical skin glue (cyanoacrylate) may be applied to Femoral Vein or Artery catheterization is performed following reinforce (and provide a microbial barrier) the the same techniques described earlier in this presentation in incision the common carotid and external jugular sections
201 202
Femoral Artery Catheterization in the Rat Video
Femoral Artery Catheterization in the Rat Video
8:04
204
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Femoral Vein Catheterization in the Rat Video
Femoral Vein Catheterization in the Rat Video
4:01
206
Marcel Perret-Gentil, DVM, MS University Veterinarian & Director Laboratory Animal Resources Center (LARC) The University of Texas at San Antonio San Antonio, Texas
LARC Main Page: vpr.utsa.edu/larc Training Resources: http://goo.gl/rzR3sl
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