Weeks 3 and 4 at RREH surgery

Weeks 3 and 4: Getting the Hang of it

               Week three marked the transition for me from what seemed like a learning whirlwind to establishing a greater comfort level that has helped me feel more helpful as a surgery tech. I’m starting to develop more of a routine; which horse to bring up to surgery, where to clip and prep based on the surgery being done, how to set up the surgery room and how to be a helpful when in surgery. By the end of week 4 I had even acted as the primary tech on a couple simple surgeries! Interesting surgeries I’ve seen in the past two weeks include a post-foaling uterine tear, a foal with a ruptured bladder, two colic surgeries, an ovariectomy, a fractured cervical vertebrae neck plate, and of course the more typical orthopedic repairs, among other things.

               The mare with the uterine tear came in as a colic case and was immediately operated on after standard colic workup. Upon opening her abdomen, all of her intestines appeared normal, but a tear could be felt in her uterus. Uterine tears often occur during foaling when the sheer size of the foal being born is enough to stretch the tissue of the uterus- the foal being in different, odd positions can serve to make this stretching worse to the point where the tissue tears. What was different about this tear is that it involved multiple layers of serosa (the outer layer of uterine tissue) and possibly some myometrium (middle muscular layer) without tearing all the way through to the inside of the uterus (through the endometrium). Most uterine tears are seen when they are entirely torn through or only one small tear through the first layer of serosa.

The tear!

In the middle of suturing the tear back together.

               The foal with the ruptured bladder came up to surgery as a case from medicine. Ruptured bladders are emergencies as the urine in the bladder has different electrolyte concentrations from the rest of the body as a result of the filtering capabilities and electron pumps in the kidneys. When the abdomen fills with urine from a ruptured bladder the electrolytes equilibrate with the electrolytes in the blood, creating life-threatening electrolyte imbalances that can severely depress the function of the heart. Medicine had worked on this foal in an attempt to deliver fluids and electrolytes to correct the imbalances to a point where the foal could survive surgery. When the foal arrived it was in critical condition and required careful anesthesia planning, a heating blanket, and immediate surgery to repair the bladder. The goal of the surgery is to find the torn area of the bladder and suture it closed to a point where it can heal on its own. The anesthetist’s role involves keeping the foal under anesthesia (“asleep”) while continuing to correct for electrolyte imbalances and keep the foal alive by administering fluids, anesthetics and additional electrolytes. This particular foal’s electrolyte values improved greatly by the end of surgery and ultimately the repair was a success. The difficulty that this foal presented to the surgeon is that the tear in its bladder was on the dorsal aspect of the bladder (closest to the top of the foal’s back) which made it difficult to access and repair!

Suturing the bladder tear.

               One of the colic surgeries was a simple intestinal volvulus (the intestine flipped around 180 degrees and essentially rolled over on itself) that was caught early enough to be a simple repair. The surgeon simply had to rotate it back to its original location and close the abdomen back up. The other colic was a foal that had an intussusception. This is where one length of intestine gets sucked inside another piece like when you roll up a sock. The tubular structure remains and is not cut off, but the vessels to and from the intussuscepted piece of intestine are blocked and that piece of intestine can die because of its lack of blood supply. In this case, there was a length of intestine that had died and some surrounding it that was relatively unhealthy. The solution in this case was to remove 6-8 feet of this compromised intestine and suture the surrounding healthy portions together-an intestinal anastomosis.

Performing the anastomosis!

 The horse that underwent the ovariectomy had her ovary removed because it simply wasn't functional any longer and had the potential to cause serious problems. An ovariectomy is not uncommon for various reasons across veterinary species.

 The removed ovary (huge!).