Veterinary videos

Re: Veterinary videos

Stephen Courtney — Sun, 14 Aug 2011 09:34:00 GMT

There is a lot of rumour and mythology about what the VDS will and won't defend - my opinion with neuters is that if you are starting with a healthy dog and it dies because an ovarian or cervical ligature comes off, or if the abdominal sutures dehisce - then it is the surgeon's responsibility. I'm not talking about situations where there is an undetected problem that would have been unreasonable to expect the vet to discover beforehand. There but for the Grace of God.....but I take time and trouble to make sure my spays aren't bleeding and are well sewn up. Never hurry.

By defend, I presume you mean argue your side in court? I would expect to be covered for any mistakes I might make, even if they were down to technique. And if that means making up to a client for an unexpected loss that should not have happened , so be it. I would be uncomfortable if a bled-out bitch spay was handled aggressively by my insurer.

Re: Veterinary videos

David Mills — Sat, 13 Aug 2011 22:53:32 GMT

Be interested to know how often people have ripped through the ovarian artery after breaking the ligament through injudicious pulling on the clamp? Was supervising a student the other day who managed to do this; never done it myself. As the student said afterwards 'its good to see soemthing going wrong because then you know you can fix it'.

When I was younger I had a few bleeding intraop, but once you've seen a bleeder and seen it isn't that bad, it's quite reassuring, especially when you've had to really dig for it. Agree with the 'working round' a problem post above though - tis better to work at technique.

I have always questioned the VDS' position on not defending a vet who doesn't transfix the ovarian ligature - transfixation has this hallowed position which is ignorant of the quality/tightness of the knot and I would say an encircling ligature done correctly will be adequately secure. Any LA practitioners will tell you how secure a catgut encircling ligature is on milk veins or bovine gastric arteries, can't see how it's any different with piddling ovarian arteries.

Re: Veterinary videos

Stephen Courtney — Sat, 13 Aug 2011 18:37:49 GMT

I don't usually transfix ovarian ligatures - there often isn't really enough room. What matters is that you have a GOOD ligature - I use a modified Wisconsin type knot, acts like a double ligature anyway - and they don't slip if tied correctly - and you always know when it has gone home properly!

I believe that the real secret to a good ovarian ligature is to stretch and snap the ovarian ligament properly, allowing you enough room to lift the ovary high enough and get at the pedicle and clamp and tie properly. One good ligature is enough. A whole cluster of poor ligatures is not the answer.

The other trick is to use a substantial thickness of suture material, if it is too thin it can cheesewire and you can drop a bleeding stump - not fun.

Re: Veterinary videos

Mark Rowland — Sat, 13 Aug 2011 16:07:31 GMT

I always get phone calls on basic procedures on exotic cases, so I have started to produce some dvds

Sorry for the self plug

Website is on my sig.

Re: Veterinary videos

Ana Bonache — Sat, 13 Aug 2011 14:06:32 GMT

I have always treated them with shock rate fluids and abdominal bandage. This has always worked for me and have also been told by soft tissue surgeon specialist that this is the best approach.

Re: Veterinary videos

Malcolm Ness — Fri, 14 Jan 2011 16:47:00 GMT

[quote user="Simon Neuhoff"]Transfixing ligatures, double ligatures or this bursa trick could easily be false security - what you need is at least one GOOD ligature.[/quote]

My point precisely.

If you do it right, it goes right.

I get a little concerned about these "work around" solutions by which I mean techniques that have been developed in response to a bad experience. The original technique gets the blame for the failure and rather than learn to do original technique properly, the surgeon changes technique.

Re: Veterinary videos

Mark Holmes — Fri, 14 Jan 2011 15:06:59 GMT

[quote user="i am ed"]

Does anyone know of a bitch dying from an ovarian bleed?

[/quote]

Yes two I can think of, one was a PM at uni whilst i was there. ligature missing, other one of mine I'm afraid, first year qualified. Owner assumed it was supposed to be sleepy after a ga so didn't bring it back. It really upset me and consequently I have been very careful to make sure spay owners know the dog should be walking and responsive following a spay.

Re: Veterinary videos

Simon Neuhoff — Fri, 14 Jan 2011 14:54:25 GMT

Transfixing ligatures, double ligatures or this bursa trick could easily be false security - what you need is at least one GOOD ligature.

Re: Veterinary videos

Simon Neuhoff — Fri, 14 Jan 2011 14:52:48 GMT

[quote user="Alan Tevendale"]

[quote user="Malcolm Ness"]

We offer 24/7 surgical service and consequently see quite a few OOH cases from St Elsewhere's.

Three or four times a year we will see an abdominal bleed following a routine spay.

The last two I have operated supposedly had transfixion ligatures.

Discuss.

[/quote]

Most that I have seen (not that I see many ) have come from ovarian stump bleeds rather than the cervical stump. An old colleague of mine always said that an animal will never bleed to death from an ovarian bleed - I've never tested this to it's limit so can't really comment too much myself.

I take it from your post that you weren't able to find the transfixing ligature that had been supposedly placed - very interesting.

[/quote]

My one (thankfully!) intra operative bleed of any significance was from an ovarian stump - and it bled with great gusto! I am quite certain that dog would have died form blood loss had I not located and tied off the stump properly.

Re: Veterinary videos

Niall Taylor — Thu, 13 Jan 2011 22:12:07 GMT

[quote user="Mark Hedberg"]

Transfixing sutures all the way; stitch that suture to the stump and it's NOT going anywhere. :)

[/quote]

Same as with the ovarian bursa thing, it doesn't matter whether it 'goes' any where, if it's not tight enough, whether it's transfixed or other wise, you're still going to get haemorrhage.

Niall

Re: Veterinary videos

Rob Loxley — Thu, 13 Jan 2011 19:44:13 GMT

[quote user="Malcolm Ness"]

Three or four times a year we will see an abdominal bleed following a routine spay.

The last two I have operated supposedly had transfixion ligatures.

Discuss.

[/quote]

A transfixed granny knot or half hitch or loose square knot is not preferable to a non-transfixed well tied knot?

Re: Veterinary videos

Alan Tevendale — Thu, 13 Jan 2011 17:08:58 GMT

[quote user="Malcolm Ness"]

We offer 24/7 surgical service and consequently see quite a few OOH cases from St Elsewhere's.

Three or four times a year we will see an abdominal bleed following a routine spay.

The last two I have operated supposedly had transfixion ligatures.

Discuss.

[/quote]

I take it from your post that you weren't able to find the transfixing ligature that had been supposedly placed - very interesting.

Re: Veterinary videos

Mark Hedberg — Thu, 13 Jan 2011 16:07:30 GMT

[quote user="Malcolm Ness"]

We offer 24/7 surgical service and consequently see quite a few OOH cases from St Elsewhere's.

Three or four times a year we will see an abdominal bleed following a routine spay.

The last two I have operated supposedly had transfixion ligatures.

Discuss.

[/quote] I loved watching St Elsewhere. On topic, however, do you cover OOH for other clinics? If you do, I don't know that 3-4 occasions per year is out of line with plain statistics. Alternatively, were the 3 or 4 cases by one vet or one practice?

If no, then i can see where excessively fat dogs might not let suture be pulled sufficiently tightly on the stump. Or just plain bad luck for some first opinion vet somewhere?

Re: Veterinary videos

Edward Jones — Thu, 13 Jan 2011 15:51:20 GMT

Slipping ovarian ligament ligatures: In my experience the most significant potential complication is accidental trapping of non-ligament material within the ligature (omentum or peritoneum, for example). If not noticed before the ligament is released then the extraneous tissue can act to pull the ligature off the stump as it retracts into the abdomen. Anyone else know what I mean by this?

I've had one bitch of mine bleed. A colleague saw it OOH and used a abdominal bandage with no further problems. I once re-operated on an apparently bleeding bitch (having been spayed by a colleague) - I found a moderate amount of sanguious abdominal fluid and a large clot around an ovarian stump, but no active bleeding.

Does anyone know of a bitch dying from an ovarian bleed?

Re: Veterinary videos

Malcolm Ness — Thu, 13 Jan 2011 15:14:11 GMT

We offer 24/7 surgical service and consequently see quite a few OOH cases from St Elsewhere's.

Three or four times a year we will see an abdominal bleed following a routine spay.

The last two I have operated supposedly had transfixion ligatures.

Discuss.

Re: Veterinary videos

Bob Russell — Thu, 13 Jan 2011 13:13:57 GMT

Transfix, transfix, transfix!

Re: Veterinary videos

Mark Hedberg — Wed, 12 Jan 2011 23:34:54 GMT

Transfixing sutures all the way; stitch that suture to the stump and it's NOT going anywhere. :)

Re: Veterinary videos

arken — Wed, 12 Jan 2011 20:28:27 GMT

Try this....

http://www.vetvideos.com/

Website looks a bit shabby but the content is great and seems OK. (I have only checked out 2 of the clips though)

good luck

Mark

Re: Veterinary videos

vs0u — Thu, 01 Apr 2010 22:53:23 GMT

Don't other people do transfixing ligatures? I thought everyone did them!

On a different topic I have seen a couple of bitches come into us out of hours bleeding heavily from the vulva about 1-2 weeks post spaying - when opened up it seemed that it was caused by an overlong cervical stump which had started to granulate and bleed. Anyone else come across this?

Re: Veterinary videos

stephen sargent — Wed, 31 Mar 2010 15:52:17 GMT

[quote user="Adi Nell"]Involved leaving the ovarian bursa behind to prevent the ligature slipping down and off the ovarian stump. Takes a minute longer to carefully dissect out the ovary (and make sure you've got it all!), but there is no way a ligature can then slip off. You still have to tie them properly, though! The ovary is removed with the rest of the uterus in the usual way.[/quote]

Not sure I understand the advantage of this. Surely if the ligature is loose enough that it would slip off if not restrained by the ovarian bursa, then it will not stop haemorrhage from the ovarian artery either?

Re: Veterinary videos

Adi Nell — Sat, 06 Mar 2010 20:23:29 GMT

Not fail-proof, I'm sure, but advised to a colleague by the VDS after a spay bled badly.

Involved leaving the ovarian bursa behind to prevent the ligature slipping down and off the ovarian stump. Takes a minute longer to carefully dissect out the ovary (and make sure you've got it all!), but there is no way a ligature can then slip off. You still have to tie them properly, though! The ovary is removed with the rest of the uterus in the usual way.

It's amazing the stuff you can pick up at a dermatology congress!

Re: Veterinary videos

Gillian Mostyn — Sat, 06 Mar 2010 20:13:23 GMT

[quote user="Adi Nell"] tips (on how to stop spay ligatures slipping, for example[/quote]

you have a fail-proof system? Please tell....

Re: Veterinary videos

Adi Nell — Sat, 06 Mar 2010 16:12:07 GMT

I am occasionally surprised at how some basic procedures are either not done or very badly performed by vets. What I've often needed to assist with is stuff like how to do a skin scraping and how to do a tape strip exam (with my dermatology background). Having a section on simple, everyday procedures, tips (on how to stop spay ligatures slipping, for example, or analogies that can be used to explain diabetes or thyroid disease to clients) and a searchable database would be really useful to a lot of vets, I think. I'd be happy to help, and I'm sure there are plenty of other members who would be willing to give a little time to this, too.

Re: Veterinary videos

Arlo Guthrie — Fri, 05 Mar 2010 17:53:56 GMT

Hi Agapiev

A number of members have asked for more videos, so it's an area that I'll be working on soon. Hoping I can persuade more members to upload video to youtube and then share in our galleries, and if not, we'll be going out and filming some of our own stuff ...

In fact, while I think of it, it would be helpful if I could have a comprehensive wish list from members of what videos would be particularly helpful, in addition to the ones you asked for above.

Suggestions please everyone ...