Cat spays- flank or midline?

Re: Cat spays- flank or midline?

Michael Woodhouse — Wed, 16 Feb 2011 16:32:27 GMT

[quote user="Hannah Wynne Richards"]NEVER Micheal ????????????[/quote]

Never. I now wait for the cat I spayed this morning to come back tomorrow with small intestines hanging out.

Re: Cat spays- flank or midline?

Wren — Wed, 16 Feb 2011 16:03:36 GMT

[quote user="Hannah Wynne Richards"]

NEVER Micheal ????????????

Are you in the local opera groupproduction of Pirates of Penzance????????

Wynne

[/quote]

'What, never?' 'No, never' 'What,never?' 'Well....hardly ever!'

If that's what you had in mind I think it was HMS Pinafore

Re: Cat spays- flank or midline?

Hannah Wynne Richards — Wed, 16 Feb 2011 15:04:39 GMT

NEVER Micheal ????????????

Are you in the local opera groupproduction of Pirates of Penzance????????

Wynne

Re: Cat spays- flank or midline?

Evelyn Barbour-Hill — Wed, 16 Feb 2011 14:42:38 GMT

[quote user="Michael Woodhouse"]I've has a hernia op and I can assure you that wound was painful![/quote]

A NHS hernia op? Notorious for being painful due to the method employed.

[quote user="Michael Woodhouse"]If the cat is perceiving a flank wound as painful the surgeon is doing something wrong. I have never sent a cat spay home with a buster collar and have never had a cat remove its skin sutures.[/quote]

Re: Cat spays- flank or midline?

Michael Woodhouse — Wed, 16 Feb 2011 14:20:55 GMT

[quote user="Kate Richardson"]I think this really depends on where the wound is if we are talking about surgical wounds. If you have to cut through muscle, then yes the bigger it is the more likelihood there is of pain. A surgical wound shouldn't be really painful, no matter how big it is, if done correctly. [/quote]

I've has a hernia op and I can assure you that wound was painful!

If the cat is perceiving a flank wound as painful the surgeon is doing something wrong. I have never sent a cat spay home with a buster collar and have never had a cat remove its skin sutures. I do a nice loose cruciate and a tiny dab of superglue. They get a shot of painkiller [and antibiotic] at the time of surgery and that is all.

One main reason for the move to laproscopic surgery in people [and animals] is less pain and faster recovery over and above conventional open techniques. If I could spay a bitch through a 1cm hole in the flank, believe me I would!

Re: Cat spays- flank or midline?

Kate Richardson — Wed, 16 Feb 2011 11:52:32 GMT

[quote user="Michael Woodhouse"]a big wound is much more painful.[/quote]

I think this really depends on where the wound is if we are talking about surgical wounds. If you have to cut through muscle, then yes the bigger it is the more likelihood there is of pain. A surgical wound shouldn't be really painful, no matter how big it is, if done correctly.

I feel strongly that a midline approach is better, and can't get to grips with why practices charge more for a midline cat when they do bitches midline. It uses the same amount of suture material (regardless of what material you use), virtually the same amount of time once you are comfortable with the approach, but if people are spaying bitches regularly midline, I canot see why it should be difficult to get to grips with it. And I really believe they are less painful. I have seen more cats chew their sutures out from flank speys than midlines, and the reason they are attracted to the wound is because of pain. I have a friend who had her cat speyed recently, she (the cat) removed the sutures, wound broke down, had to be resutured, still wanting to get at the wound despite a buster collar, and the vets wouldn't give any extra pain relief despite my friend asking for some. If the owner can perceive pain in her cat, why couldn't the vet? It has all healed now, but at an extra cost of another £2-300 and an extra ga. (and the vets wouldn't even meet her halfway regarding the costs but thats another story.....)

It really seems to me that the UK stands out as being stuck in their ways- we've traditionally done it flank so we will continue to do so, even though their is literature out there supporting midline to be a less painful approach. I feel strongly about it as it is such a common surgery. I'm not saying flank is a bad way, but shouldn't we all be trying to improve the way we do things if there is a simple way to do so?

Re: Cat spays- flank or midline?

Michael Woodhouse — Tue, 15 Feb 2011 22:24:42 GMT

[quote user="Busybee"]As regards the argument for shorter incisions, as one lecturer always reminded us, "wounds heal side to side not top to bottom" so I'd always make an incision that I'm happy with and not try and fiddle about with a 1cm hole and thankfully my bosses agree with me![/quote]

I agree that they heel at the same rate but a big wound is much more painful. As you gain experience you will do things through smaller holes!

Did an interesting cat spay the other day. Left flank approach, reached in and grabbed horn straight away. Uterus quite turgid and friable so a squeeze out my muscle incision. Ovary seemed very tight, but had enough exposure and ligated it. Only when going for the second horn did I realise I had picked up the right horn first! Never [knowingly] done that before.

Re: Cat spays- flank or midline?

Busybee — Tue, 15 Feb 2011 22:01:19 GMT

A recent grad, again of RVC, I can verify they still teach both flank and midline depending on the lecturer - the 'this-is-how-you-do-it' video they showed us was midline but when in the college hospital, it was done flank. All practices I did EMS at spayed flank. But having spent the summer working in Africa, I've now done far more midline spays than flank. In my current job, I generally feel happier doing midline as that's what I've done more of, but again, our practice charges more for midline spays than flank so I tend to do a bit of both depending on the cat.

As regards the argument for shorter incisions, as one lecturer always reminded us, "wounds heal side to side not top to bottom" so I'd always make an incision that I'm happy with and not try and fiddle about with a 1cm hole and thankfully my bosses agree with me!

Re: Cat spays- flank or midline?

salome2001 — Tue, 15 Feb 2011 15:36:20 GMT

midline. never done a flank spay in 19 years of clinical practice. 11 of these in the UK.

very happy with it, rarely need more than a 1.5cm incision (unless in season) as long as you make it in the right place :)

why? I was taught by the redoubtable CR Bellenger at UniSyd, who would have tied our guts in single interrupteds if we did anything other than midline.... and TBH I've never found a reason to change. main reason i like it is getting equal access to both R and L sides, and you don't cut muscle.

Re: Cat spays- flank or midline?

Mark Holmes — Sun, 30 Jan 2011 18:53:43 GMT

Me too for the same reason... it was a bit like driving in France.

Re: Cat spays- flank or midline?

Simon Neuhoff — Sun, 30 Jan 2011 10:34:18 GMT

[quote user="Jonathan Kirby"]

Worked with a vet who had always spayed cats via RIGHT flank approach! - I guess the best technique is what you're used to

[/quote]

Did a right flank spay once - because the nurse shaved the wrong side! Found it a bit tricky.

Re: Cat spays- flank or midline?

Jonathan Kirby — Sat, 29 Jan 2011 17:17:14 GMT

I always do a left flank incision - a much quicker, easier and neater procedure than midline. Usually a 1 to 1.5 cm incision in the skin is sufficient and there is minimal trauma to the muscle if the abdominal muscles are divided with blunt incision rather than cutting. I only use a midline approach if the cat has a colour-point coat or is pregnant. Anecdotally, I've seen fewer signs of discomfort and fewer complications from flank spays. I guess it depends on which procedure one learns.

Re: Cat spays- flank or midline?

Jonathan Kirby — Sat, 29 Jan 2011 17:07:07 GMT

[quote user="Dagmar Steele"]

never done flanks as I'm based in Germany and nearly everyone here does midline. Need half an inch incision, no muscles cut, so no hemorrhage, fast quick and easy. I wonder if I would see things differently if I'd learned flank instead of midline... but here customers are appalled if someone does flank spays because there are two incisions and they are very visible - no option.

[/quote]

?TWO incisions?

Re: Cat spays- flank or midline?

Jonathan Kirby — Sat, 29 Jan 2011 17:05:00 GMT

Worked with a vet who had always spayed cats via RIGHT flank approach! - I guess the best technique is what you're used to

Re: Cat spays- flank or midline?

Gareth Dowdeswell — Sat, 29 Jan 2011 16:50:43 GMT

I was at RVC until 2008, we were taught midline and flank approaches, but all the cat spays we did were done flank. Don't remember any discussion of the pros and cons of flank vs midline. There's a brief line in our notes about ovary removal alone been more logical, but then they taught us to take out the uterus anyway!

[quote user="Kate Richardson"]

[quote user="Gareth Dowdeswell"]I'd rather be going midline[/quote]

so why don't you?

[/quote]

Couple of reasons - because my practice charges more for midline, and because I'd have to explain to clients why I was using a different technique to the other vets in the practice, especially as it's not uncommon for multiple cats from the same household to be spayed by different vets here.

I don't know why my practice charges more for midline - we have separate pregnancy surcharges anyway. I would use vicryl rather than catgut midline, but one of the vets here uses Vicryl for flank anyway so that wouldn't make a difference. I'd rather be going midline, and if it was my practice I would spay midline unless the client really wanted flank, but I don't feel strongly enough to make a big issue about it in my current position.

Re: Cat spays- flank or midline?

Clive Ansell — Sat, 29 Jan 2011 10:05:05 GMT

[quote user="robloxley"]

[quote user="Kate Richardson"]Does anyone know what approach they teach at universities these days? [/quote]

Fine but IME most of students experience of neutering surgery is out in practice on EMS, where the majority of cats are spayed flank.

[/quote]

I qualified in 1996 and we were taught told to use either flank or midline approach. The only training at university was one flank cat spey between 2 students; and what with all the paraphernalia of 15 minute 6 point scrubbing up procedures, 12 foot square drapes, masks, gowns, gloves, it was about as far removed from planet real world as it could be. It was a really scary experience; one would enter theatre first, followed by masses of old anaesthetic monitoring equipment, including the machine that goes "ping" - It would not have been out of place in Star Wars and I was half expecting R2-D2 and CP-30 to appear.

Re: Cat spays- flank or midline?

Rob Loxley — Fri, 28 Jan 2011 23:36:12 GMT

[quote user="Kate Richardson"]Does anyone know what approach they teach at universities these days? [/quote]

Fine but IME most of students experience of neutering surgery is out in practice on EMS, where the majority of cats are spayed flank.

Re: Cat spays- flank or midline?

Kate Richardson — Fri, 28 Jan 2011 13:52:59 GMT

[quote user="Mark Hedberg"]Basically, cats are spayed flank in the UK.[/quote]

I feel a bit like an annoying toddler now, going 'but why?' and then Mum or Dad eventually gets fed up after the millionth 'but why? and says, 'because it is'!

Does anyone know what approach they teach at universities these days?

Re: Cat spays- flank or midline?

Mark Hedberg — Fri, 28 Jan 2011 10:06:01 GMT

Basically, cats are spayed flank in the UK. I was given to understand that cat spays were done flank here in the UK, and so I learned to do them flank. Possibly "not invented here", but I don't know that for certain and I don't feel comfortable discussing my boss's motivations on a public forum.

I don't think flanks are inhumane; i do like midlines but only because of personal preference. I don't think a flank is necessarily bad surgery; there is just more than one way to spay a cat. :)

Re: Cat spays- flank or midline?

Kate Richardson — Fri, 28 Jan 2011 08:59:39 GMT

[quote user="Mark Hedberg"] The only reason I do flank spays is my employer prefers me to. :) I mean to say I understand why the clinic likes it like they like it [/quote]

Ok then, so why does your employer prefer you to do them flank? (in your opinion obviously, I don't expect you to get your boss on here and answer!!)

Re: Cat spays- flank or midline?

Mark Hedberg — Thu, 27 Jan 2011 21:33:30 GMT

[quote user="Kate Richardson"]

[quote user="Mark Hedberg"]Kate: I happen to think I can spay midline as fast as a spay, so I can understand the logic without agreeing with it. :)[/quote]

Do you mean that you understand the logic behind going midline, but you don't agree that it is possibly better to take this approach? If why not? I'm not trying to be argumentative for the sake of it, I genuinely want to understand why people still choose flank over midline when the evidence and certainly from my experience and so it seems from others on here, suggests midline is the better approach. I don't buy the 'it costs more' argument, and I don't buy the 'it takes longer' argument, and I don't even buy the 'there are more risks/poorer healing' argument. So does it just come down 'we have always done it this way so I ain't gonna change'?

[/quote]

Perhaps I wasn't clear. I am a devoted and loyal fan of the midline spay. The only reason I do flank spays is my employer prefers me to. :) I mean to say I understand why the clinic likes it like they like it (gramatically challenged though that sentence is), but I will cheerfully midline any cat spay any day, any time, any country. I've done a midline spay a day minimum for three years (statistically; I do get a day off these days) and I'll midline spay a cat pretty damn quick and LIKE it. :D

I personally don't charge extra when I midline a cat spay because I know well I will be done fast enough that you'll be waiting ages to reverse the dom. There have been times I want to charge extra for flank spays where the uterus has been hiding in rolls of fat or something silly.

Cheers,

Mark

Re: Cat spays- flank or midline?

Kate Richardson — Thu, 27 Jan 2011 17:47:04 GMT

[quote user="robloxley"]And for a lot of surgery tasks with multiple options they way one is practised at and very competent at is often the deciding factor?[/quote]

Don't disagree with this at all. However a midline spey is hardly taxing especially if used to doing bitch speys midline which is technically more demanding. So I don't buy that argument either!!!

Re: Cat spays- flank or midline?

Rob Loxley — Thu, 27 Jan 2011 16:22:57 GMT

[quote user="Kate Richardson"]So does it just come down 'we have always done it this way so I ain't gonna change'?[/quote]

And for a lot of surgery tasks with multiple options they way one is practised at and very competent at is often the deciding factor?

Re: Cat spays- flank or midline?

Kate Richardson — Thu, 27 Jan 2011 15:17:04 GMT

[quote user="Mark Hedberg"]Kate: I happen to think I can spay midline as fast as a spay, so I can understand the logic without agreeing with it. :)[/quote]

Re: Cat spays- flank or midline?

Kate Richardson — Thu, 27 Jan 2011 15:09:21 GMT

Would have thought that one would never have to put one's fingers (or even hands) into the abdominal cavity anyway for a cat spey , regardless of which approach was used, I use the instruments to find the uterus, either blunt tipped forceps (they probably have a proper name) or a spey hook. Thus the incision again regardless of approach needs be no bigger than 1-2 cm. Granted a pregnant cat will need a slightly larger incision, but as we usually go midline anyway, the extra cost here to spey a pregnant cat is relatively small.

I understand the concern re wound breakdowns on a midline incison, but several people on here have stated that they haven't had any problems. The abdominal contents of a cat surely place very little pressure on the wound. I appreciate that cats are hard to keep confined post op, but we honestly haven't had any problems with healing as the incison is so small.