MSU Equine Summer Fellowship Blog: Follow the Fellows...: Week 2 in Surgery RREH!

It has been a busy week 2 in surgery at Rood and Riddle! I have started to learn the ropes which has made it one of the best 2 weeks of my life! This week was filled with incredible surgeries and I was able to help in many ways, including with dropping horses (safely allowing the horse to fall to the floor) and prepping them for surgery! The week started off with an ovariectomy on a 5 year old thoroughbred mare. She had a tumor on her left ovary and it needed to be removed. The horse was under heavy sedation and local anesthetic for the procedure. She was placed in stocks with a table to rest her head on. Her left paralumbar fossa (left flank) was blocked with lidocaine to numb the area for the local anesthesia where the surgery would take place. The first picture is of Dr. Woodie and Dr. Broyles making the incision to locate the ovary. The incision is made in the center of the paralumbar fossa (right in the middle of the last rib and point of the hip) going in a dorsal to ventral (top of back toward belly) motion only cutting through one layer of muscle at a time in clean smooth strokes. An ovariectomy can also be completed with a horse under general anesthesia in a dorsal position. This approach is beneficial because the horse can have a faster recovery time and less anesthetic risks because they are not placed under general anesthesia. Once the incision is made and the ovary is located it is important regardless of the approach of the surgery to ligate the ovary pedicle which is the connective stalk of the ovary containing the ovarian artery and vein, connective tissue and nerves. This stalk must be ligated to prevent fatal hemorrhage of the ovarian artery post-surgery. The equine ovarian artery is a major blood supplier to the ovaries and related structures and it branches directly off of the aorta, therefore it is very important to make sure this is successfully ligated! After the ovary is removed the surgeon can then close the incision and the horse will be placed on post-operative pain medications. The next surgery that I wanted to share with you the elective caesarean section on a thoroughbred mare. The surgery was performed by Dr. Embertson, Dr. Broyles (Surgical Resident) and Dr. MacDonald (Hospital Intern). The owners had elected to do a c-section because of past foaling problems with the mare. The mare was placed in dorsal recumbancy under general anesthesia and intubated. Everyone had to work extremely fast to deliver both a healthy mare and foal. An incision was made on the linea alba of the ventral midline. The incision is cutting through skin and fascia then muscle layers making up the rectus sheath, the external abdominal oblique, internal abdominal oblique, and transversus abdominis. The rectus sheath is a sheath that surrounds the muscle the rectus abdominis due to the ventral aponeurosis of the previous muscles mentioned running superficial or deep to the rectus abdominis. The incision will also be cutting through the transversalis fascia and peritoneum lining the abdominal cavity. Then the uterus is located and an incision is made in the uterus near the foals hock to allow the surgeon room to remove the foal. A set of Carmalt forceps are used to crush the umbilical cord. Once the umbilical cord is cut then the foal is pulled from the uterus and a crew is waiting to revive the foal while the surgical team stays to finish the surgery on the mare. The uterus is checked and placenta was manually separated from the uterine wall and in this surgery the placenta was left in for the mare to expel on her own. She was given oxytocin to stimulate uterine contraction and milk let-down. The uterus is then closed and the abdomen is lavaged with sterile saline and suctioned to remove all of the fluid. There is a final sponge count and then a final check to see if there is any areas still bleeding. Then the cecum is decompressed of air and the incision is closed. A filly was successfully delivered!!!! I have never moved so fast in my life and it was an incredible experience to be a part of!! I am so thankful to all of the people at Rood and Riddle for teaching me and it has been a great week 2! I can’t wait to see what next week has in store! Thanks for reading! Jackie Tobias