At Cat Clinic of Cobb, we pride ourselves in providing the very best patient care.  Quickly and cheaply does not always equate with best care.  We invite you to take a virtual tour of Zoe's ovariohysterectomy (that's a cat spay), to see just what we do behind the scenes.

Every surgical procedure at Cat Clinic of Cobb  starts with a complete physical exam.  We like for our little girls to weigh at least 4 pounds for an ovariohysterectomy.

We use an otic thermometer to check temperatures (it doesn't ruffle their dignity nearly as much as using the other end!)

One of our doctors carefully checks the heart and lungs for abnormalities that might make the patient an increased surgical risk.

We always recommend pre-operative blood work for our patients.  Evaluating red and white blood cell counts as well as blood glucose and kidney function help assure that the patient will handle anesthesia well.

After the blood sample is drawn, our licensed veterinary technicians perform in-house diagnostic tests. We are able to run complete blood chemistries in less than 30 minutes.

Once the physical exam and lab work are completed, our patient is anesthesized with an intravenous injection of a short-acting anesthetic

The IV injection relaxes the cat just enough to allow the doctor to pass an endotracheal tube.  This will enable us to maintain an open airway and deliver measured amounts of isoflorane gas anesthetic.

The intubated patient is hooked up to one of our positive-pressure ventilators, a computerized gas anesthesia delivery system that breathes for the cat to insure adequate oxygenation during surgery.

Breaths per minute, oxygen flow rates, Isoflorane gas anesthetic delivery rates, and pulmonary ventilation pressures are all controlled and monitored by the computerized anesthesia machine.

As soon as our patient is anesthetized, she is given an injection of pain control medication, so that it will be in effect when she wakes up.  She will also be given more pain control drugs to use at home after she is discharged.

A protective lubricant is placed in the eyes to keep them moist during surgery, when the blink reflex is surpressed.

In the prep room, the surgical site is shaved with a #40 blade to remove all the hair.

Next the anesthetized patient is transferred to the surgical suite.

In the sterile surgical suite, the patient is placed in dorsal recumbancy on a warm circulating water bed.

Each patient is hooked up to an electrocardiograph (EKG), with one lead clipped to the skin of each leg.

The EKG machine allows us to monitor the heart rate and rhythm throughout the surgery, and it keeps an electronic record of cardiac function.

Our patients are also monitored by a pulse oximeter, which monitors pulse rate, blood oxygen saturation, and temperature during surgery.

The pulse oximeter oxygen monitor clips over the tongue, while the temperature probe goes down the esophagus.  The other tube that you see here is the endotracheal tube attached to the anesthesia machine.

The area shaved for surgery is now washed with a surgical scrub.  The skin is swabbed for one minute with Nolvesan soap, then wiped clean with alcohol.  This procedure is repeated two more times before the site is truly sterile.

After the surgical scrub is complete, the veterinary technicians will remain with the patient, monitoring vital signs, until the surgeon enters the surgical suite.

An autoclaved sterile surgical gown and scrub brush, as well as sterile surgical gloves await the surgeon at the prep station.

Before scrubbing, the surgeon dons a cap to cover all of her hair and a surgical mask to cover the mouth and nose.

Next the surgeon must perform a three minute scrub using a surgical hand soap to sterilize the hands and forearms.

The surgeon dries her hands on a sterile towel that has been autoclaved inside the pack that contains the surgical gown.

Next the surgeon dons the sterile surgical gown, being careful not to touch anything other than the inside of the gown.  An assistant must tie the gown from behind in order to keep the front of the gown sterile.

Next the surgeon dons sterile surgical gloves.  At this point the surgeon must be careful that she does not touch anything outside of the sterile surgical field.

Just before the surgeon enters the surgery suite, the technician monitoring the patient will partially open the pack of sterile surgical instruments.

The surgeon opens the final covering of the pack.

At this point, no one is allowed to enter the surgery suite without a cap and mask, and no one can approach the table without a sterile gown and gloves.

Technicians monitor vital signs displayed by the EKG, pulse oximeter, and ventilator from outside the surgery suite, and record these values on the patient's record.

The surgeon takes a sterile surgical drape from the instrument pack and cuts an opening appropriate for the anticipated surgical incision.

The surgical drape is clamped to the skin of the patient, because it is essential that it does not move during the surgery.

Here the surgeon is making the initial incision through the skin.  The incision is 2-4 cm long, depending on the size of the patient, and it will be extended through the subcutaneous tissues, through the abdominal wall musculature and through the peritoneum into the abdominal cavity.

A snare is inserted through the incision to locate the left horn of the uterus and bring it outside of the abdominal cavity.

By following along the uterine horn, the surgeon locates the left ovary at the cranial end of the horn, and lifts it out of the abdomen.

Here the left ovary has been exteriorized.  It is attached to the left uterine horn, and it is being clamped off from the artery and vein that support its blood supply.

After the vessels are ligated, the ovary is cut away from its blood supply.  The clamp prevents any bleeding from the direction of the uterus.

After the ovary is excised, the surgeon holds the ligated stump for a few moments to be sure that there is no bleeding.  Then the stump is released back into the abdomen.

Here the left ovary has been detached from its blood supply.  The surgeon follows the left uterine horn back to the body of the uterus, then lifts up the right uterine horn to locate the right ovary.

Here the second ovary is being clamped at its connection to the uterine horn.

The artery and vein supplying the second ovary is ligated using two ligatures of absorbable 4-0 vicryl suture.

After the ovary is cut away from its blood supply, the surgeon holds the ligated stump for a few moments to be sure that there is no bleeding around the sutures.

Here both detached ovaries and their respective uterine horns are displayed, and the surgeon has clamped off the uterine body to begin ligating it at the level of the cervix.

With three ligatures around the body of the uterus, it is now ready to be removed.

This shows both ovaries and the uterine horns completely excised and removed from the abdomen.

The abdominal wall muscles are then closed using a series of simple interrupted sutures using absorbable 4-0 vicryl.  These sutures will slowly be absorbed by the body and disappear completely after the incision has healed.

Three to six sutures are necessary to close the incision, depending on its length.

Finally the skin is closed using simple interrupted non-absorbable sutures.  The ends are cut short to keep the patient from chewing on them.  These sutures will have to be removed in ten days after healing is complete.

At this point the drapes are removed and the surgical site is sponged clean.  The gas anesthesia is cut off and the patient will breathe pure oxygen until she is awake.

After the anesthetic gas has been turned off, a staff member stays with the patient until she is breathing and swallowing on her own.  Her vital signs are still being monitored, and she is breathing pure oxygen.  She is wrapped in heated towels and rice bags to keep her warm.

Once the patient is breathing on her own, the endotracheal tube and monitors are removed and she is taken into recovery.

In recovery, our patient is monitored by a registered veterinary technician until she is wide awake and on her feet.  She will stay in our hospital overnight, receiving pain control medications in the evening and again the next morning before she goes home.

Think we are finished?  Not yet.  The surgery suite must be cleaned and disinfected.  All of those instruments, and the drapes and surgical gown must be washed and repackaged.

Everything has to be autoclaved so that all will be sterile for the next surgery.

Do you think all spays are the same?  Take a look at this photograph from a spay/neuter clinic that was featured in an American magazine.  The surgeons are not wearing gowns.  The closest kitty is clearly not getting any gas anesthesia.  The second kitty does not appear to have even rated a surgical drape.  There are volunteers in the surgery room without caps and masks.  There are no laws dictating how surgeries are performed on cats.  In Georgia, we do not even have hospital inspections, unless the practice is American Animal Hospital Association accredited (the Cat Clinic of Cobb has been AAHA accredited since 1995).  Many veterinarians still do not think that a cat needs any pain control medications following an ovariohysterectomy.  Just ask any woman who has had that surgery if she would agree!  All spays are not the same.  Ask questions, and know exactly what you are signing your kitty up for!

Cat Clinic of Cobb 2440 Sandy Plains Road Marietta, GA 30066	Phone: 770-973-6369 Fax: 770-973-5772