Cystotomy and Laparoscopic Techniques
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Questions and Answers

What is the primary purpose of performing a vulval suture in cows?

  • To enhance mating performance
  • To prevent vaginal prolapse (correct)
  • To facilitate urine flow
  • To improve overall fertility
  • Which method is described as causing less discomfort to the patient during vulval suturing?

  • Single interrupted suture
  • Mattress-suture method
  • Cross-lacing method (correct)
  • Purse-string suture
  • What is the main indication for performing a medial patellar desmotomy in bovines?

  • Surgical correction of tendon injuries
  • Chronic lameness due to fractures
  • Upward fixation of the patella (correct)
  • Severe arthritis in the knee
  • How many straight ligaments of the patella are there in bovines?

    <p>Three (A)</p> Signup and view all the answers

    What is the primary goal of a medial patellar desmotomy?

    <p>Mechanically bring down the patella (C)</p> Signup and view all the answers

    What is the position of the animal during a medial patellar desmotomy?

    <p>Cast and secured in lateral recumbency (B)</p> Signup and view all the answers

    In the cross-lacing method for vulval suturing, what material is used for the sutures?

    <p>Sterile umbilical tape (A)</p> Signup and view all the answers

    Which ligament is cut during a medial patellar desmotomy?

    <p>Medial straight ligament (A)</p> Signup and view all the answers

    What is the purpose of administering ammonium chloride after surgery?

    <p>To act as an acidifier (A)</p> Signup and view all the answers

    When is clamping of the Foley's catheter initiated during the treatment protocol?

    <p>From day 5 (D)</p> Signup and view all the answers

    What suture materials are used for closing the abdominal muscle layer and the skin?

    <p>Catgut for muscle and silk or nylon for skin (A)</p> Signup and view all the answers

    What indicates the need for a cystotomy procedure?

    <p>Vesical calculi or neoplastic growth (D)</p> Signup and view all the answers

    What is the primary method used to check for the patency of the urethra post-surgery?

    <p>Positive contrast cysto-urethrography (B)</p> Signup and view all the answers

    What type of anesthesia is required for the cystotomy procedure?

    <p>General anesthesia (B)</p> Signup and view all the answers

    What is the outcome expected after the removal of the Foley’s catheter?

    <p>Healing without complications (A)</p> Signup and view all the answers

    What suture technique is used to close the incision on the bladder?

    <p>Cushing's inversion sutures (D)</p> Signup and view all the answers

    What is the first step in severing the ligament during the surgical procedure?

    <p>Position the cutting edge towards the ligament (B)</p> Signup and view all the answers

    Which method is particularly useful for uncooperative patients?

    <p>Lateral recumbency blind method (D)</p> Signup and view all the answers

    During the open method, where is the linear incision made?

    <p>0.5 cm lateral to the medial patellar ligament (B)</p> Signup and view all the answers

    What is used to manage the fascia during the open method procedure?

    <p>Artery forceps (A)</p> Signup and view all the answers

    What is indicated by a deep depression between the cut ends of the ligament?

    <p>Successful severance of the ligament (B)</p> Signup and view all the answers

    What is a common post-operative complication after surgical procedures on the ligament?

    <p>Penetration of the joint capsule (A)</p> Signup and view all the answers

    What is the recommended post-operative care after the open method surgery?

    <p>Daily antiseptic dressing and antibiotic cover (C)</p> Signup and view all the answers

    Which step is NOT part of the blind method in lateral recumbency?

    <p>Making a 3 cm incision on the limb (D)</p> Signup and view all the answers

    What occurs when the patella is carried dorsally by slight manual pressure during a clinical examination?

    <p>The animal displays a locked gait (C)</p> Signup and view all the answers

    Which ligaments connect the patella to the tibial tuberosity?

    <p>Patellar ligaments (D)</p> Signup and view all the answers

    What is the most suitable site for skin incision during the procedure?

    <p>Close to the insertion of the medial ligament to the anterior tuberosity of the tibia (A)</p> Signup and view all the answers

    In which direction does circling the animal with the affected limb outermost lessen symptoms?

    <p>Counter-clockwise (C)</p> Signup and view all the answers

    Which type of anaesthesia is appropriate for this procedure?

    <p>Local infiltration anaesthesia or epidural anaesthesia (A)</p> Signup and view all the answers

    What is a disadvantage of making an incision at Site No.2?

    <p>Increased chance of injury to articular vessels (A)</p> Signup and view all the answers

    What should be applied to the operational site before making an incision?

    <p>Tincture of iodine (D)</p> Signup and view all the answers

    What is the preferred local anaesthetic used during the surgery?

    <p>2% lignocaine (D)</p> Signup and view all the answers

    What is the primary purpose of instilling Tr.Iodine into the incision?

    <p>To disinfect the wound (D)</p> Signup and view all the answers

    During the blind method of surgery, where is the incision made?

    <p>Between the middle and medial patellar ligaments (C)</p> Signup and view all the answers

    Which technique involves cutting through a longer incision?

    <p>Open technique (D)</p> Signup and view all the answers

    What is the main drawback of Site No.3 for making an incision?

    <p>Higher risk of joint capsule injury (C)</p> Signup and view all the answers

    What should be the orientation of the cutting edge when pushing the tenotom through the skin incision?

    <p>Vertical (C)</p> Signup and view all the answers

    When using the closed technique, how is the scalpel positioned before cutting the ligament?

    <p>Flat-wise under the ligament (D)</p> Signup and view all the answers

    What action should be taken if protruding fat tissue is observed during the procedure?

    <p>Snip it off (D)</p> Signup and view all the answers

    What is the primary advantage of cystotomy for bladder stone removal?

    <p>It allows for the removal of all stone debris. (A)</p> Signup and view all the answers

    Which method requires specialized instrumentation and experience to perform stone removal?

    <p>Laparoscopic cystotomy (D)</p> Signup and view all the answers

    What is a significant risk associated with laparoscopic cystotomy?

    <p>Suturing techniques that can cause future stone formation. (A)</p> Signup and view all the answers

    In what situation would tube cystostomy be most appropriately utilized?

    <p>For temporary urethral repair due to trauma. (A), As a permanent solution for bladder cancer. (D)</p> Signup and view all the answers

    Which procedure is described as having a potential for lower risks compared to perineal urethrotomy?

    <p>Pararectal cystotomy (D)</p> Signup and view all the answers

    What is a disadvantage of performing cystotomy in adult horses?

    <p>Difficulty accessing the bladder. (C), Higher anesthesia costs. (D)</p> Signup and view all the answers

    What exactly does tube cystostomy involve?

    <p>Placement of a catheter into the bladder via a skin incision. (C)</p> Signup and view all the answers

    Which of the following methods is most commonly used for bladder stone removal?

    <p>Standing removal in the field. (A)</p> Signup and view all the answers

    Flashcards

    Cystotomy

    Surgical removal of bladder stones through an incision in the bladder wall.

    Laparocystotomy

    The gold standard for bladder stone removal in horses, allowing for intact stone removal, bladder wall culture, and debris clearance.

    Laparoscopic Cystotomy

    A minimally invasive technique for removing bladder stones using specialized instruments and a small incision.

    Pararectal Cystotomy (Gokel's Operation)

    A rare procedure used to remove large bladder stones by creating an incision near the rectum.

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    Tube Cystostomy

    A procedure involving inserting a Foley's catheter into the bladder through a small skin incision, diverting urine flow.

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    Urine Diversion by Foley's Catheter

    A temporary or permanent method of urine diversion using a Foley's catheter, employed in cases of urethral obstruction, rupture, or bladder issues.

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    Stone Busting

    The process of breaking up bladder stones before removal.

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    Lithotripsy

    A non-invasive method using shock waves to break up bladder stones.

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    Foley's catheter

    A tube inserted into the bladder to drain urine and prevent blockage.

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    Ammonium chloride

    A medication used to make urine more acidic, helping to dissolve bladder stones.

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    Linea alba incision

    The surgical incision made along the linea alba, a tough fibrous tissue that runs down the middle of the abdomen.

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    Cushing's inversion sutures

    A surgical technique used to close an incision by inverting the tissue edges, creating a strong and watertight seal.

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    Removal of contents and neoplastic growth

    The removal of stones or tumors from the bladder.

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    Positive contrast cysto-urethrography

    A procedure to check if the urethra is open and functioning properly, usually involves injecting a contrast material and taking X-rays

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    Mattress sutures

    A type of suture that is placed through the tissue and tied on the outside, securing the edges of the incision.

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    Vulval suture

    A surgical technique to prevent vaginal prolapse in cows by tightening the vulva using sutures.

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    Purse-string suture

    A type of vulval suture where a continuous stitch is placed beneath the skin around the vulval opening.

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    Cross-lacing method

    A method where multiple independent stitches are made on both sides of the vulva, and then laced together with tapes to provide support.

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    Median straight ligament

    The middle (anterior) straight ligament of the knee joint in cattle.

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    Medial Patellar Desmotomy

    A surgical procedure to cut the medial straight ligament of the patella (kneecap) in cattle.

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    Why perform Medial Patellar Desmotomy?

    The surgical indication for Medial Patellar Desmotomy is chronic upward displacement of the patella (kneecap).

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    How is the animal positioned for Medial Patellar Desmotomy?

    The animal is positioned on its side with the affected leg facing up during Medial Patellar Desmotomy.

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    Limb Positioning for Medial Patellar Desmotomy

    The affected limb is extended and secured, while the other limbs are tied together for stability during surgery.

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    Anaesthesia for Medial Patellar Desmotomy

    Local infiltration anaesthesia or epidural anaesthesia are commonly used to numb the surgical area.

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    Incision Site for Medial Patellar Desmotomy

    The incision for the surgery is made close to the medial patellar ligament, with three possible locations.

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    Site No. 1 for Incision

    The most common and preferred site for the incision, located near the insertion of the medial ligament onto the tibia bone.

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    Site No. 2 for Incision

    A less desirable site because of a thicker layer of fat and potential risks of injuring blood vessels.

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    Site No. 3 for Incision

    The least recommended incision site due to increased risks of injuring the joint capsule, blood vessels, and muscles.

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    Open vs. Closed Technique for Medial Patellar Desmotomy

    Two techniques can be used to cut the medial patellar ligament: 'open' technique, with a clear incision, and 'closed' technique, where the ligament is cut through a small stab wound.

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    Stifle Lock

    A condition where a horse's stifle joint locks, causing difficulty in moving, often due to patellar displacement.

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    Patellar Mobility

    The patella is abnormally mobile and can be easily moved dorsally with slight manual pressure.

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    Blind Method

    A surgical approach where the surgeon works blind, using palpation and feeling to identify the medial patellar ligament.

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    Open Method

    A surgical approach where the surgeon makes a visible incision and directly sees the surgical area.

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    Tenotomy

    Using a tool to cut through the medial patellar ligament near its insertion on the tibial tuberosity.

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    Ligament Insertion

    The point where a ligament attaches or connects to a bone.

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    Tibial Tuberosity Depressions

    The site where a ligament attaches to the tibial tuberosity is marked by a small depression.

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    Standing Approach

    The surgical technique used to access and cut the medial patellar ligament in standing horses.

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    Blind Method in Lateral Recumbency

    A surgical technique for medial patellar desmotomy where the horse is lying on its side, used when the horse is uncooperative.

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    Post-operative Care

    Daily wound care and antibiotics after surgery.

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    Post-operative Complications

    Possible unwanted outcomes following surgery.

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    Transaction of Incorrect Ligaments

    Cutting the wrong ligament, like the middle patellar or collateral ligaments.

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    Penetration of Joint Capsule

    Damaging the joint capsule surrounding the knee joint.

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    Study Notes

    Cystotomy

    • Bladder stone removal can be done through the urethra (standing) or via cystotomy (general anesthesia).
    • Gradual urethral dilation/sphincterotomy may assist stone removal in mares.
    • Male stones are often removed via perineal urethrotomy or perirectal incision.
    • Alternatives include stone-busting lasers, laparoscopy, and lithotripsy.
    • Standing removal is most common and possible in the field.

    Laparocystotomy

    • Removal of stones via cystotomy under general anesthesia is the preferred method.
    • Allows intact stone removal, bladder wall culture, and complete debris removal.
    • Leaving debris can cause future issues.
    • Bladder access is difficult in adult horses.
    • Laparocystotomy is the most expensive option with a long recovery period.

    Laparoscopic Cystotomy

    • Reported removal method, requiring experience and specialized equipment.
    • Stones need to be contained in a bag.
    • Closure is difficult to prevent lumen penetration and future stone formation.
    • Can handle stones up to 6-8cm.

    Pararectal Cystotomy

    • Less common but potentially cost-effective for large cystic calculi.
    • Recent suggestion for lower risk than other procedures (PU).

    Tube Cystostomy

    • A urinary diversion/urethral bypass technique.
    • A Foley's catheter is placed via a small incision into the bladder.
    • Used in urethral obstruction, rupture, or ruptured bladder in small ruminants.
    • Temporary or permanent, for urethral repair, acute urethral obstruction, or bladder cancer/neurogenic bladder atony.
    • Provides an avenue for cysto-urethrography.
    • Useful to assess issues like urethral obstruction, post-op healing, medical therapy evaluation, and when animal should urinate through the urethra.
    • Used as an avenue to monitor urethral healing, assess medical therapy for calculi dissolution, and to determine when the animal should be encouraged to urinate through the urethra.

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