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.
Specialization in surgery In the United States, Canada and Europe, veterinary surgery is one of 22 veterinary specialties recognized by the American Veterinary Medical Association respectively the European Board of Veterinary Specialisation. 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 or European College of Veterinary Surgeons.
Veterinary anesthesia
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. 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. 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. Horses commonly receive thiopental and guaifenesin. 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.
Common veterinary surgeries
Elective procedures 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.
Sterilization surgery
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, 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.
Controversial elective animal procedures
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