3/4/2014

Surgery in pet birds Part I Soft tissue surgery

Nico J. Schoemaker, DVM, PhD, Dip. ECZM (small mammal & avian)
Division of Zoological Medicine, Utrecht University
Surgery in pet birds:
Part I Soft tissue surgery

Nico Schoemaker

Internacionalizacevukyveterinrnmedicnyjakocestanaevropsktrhprce
projekt.CZ.1.07/2.2.00/28.0288
Division of Zoological Medicine
Brno, Czech republic
Department of Clinical Sciences of Companion Animals
March 4, 2014
Faculty of Veterinary Medicine, Utrecht University

Introduction Introduction
Preparation & instrument use
Head & neck surgery
Enucleation
Rhinolith & sinus surgery
Ingluviotomy
Tracheotomy
Surgery of the celomic cavity
Airsacculotomy
Ventral celiotomy
Left lateral celiotomy
Cloacopexy & ventplasty
Post-operative care

Patient evaluation Patient preparation

Prevent heat loss: use

Pre-anesthetic evaluation Demarcate betadine or chlorhexidine
History surgical field instead of alcohol
Physical examination with tape
Additional work-up
Stabilize FIRST (if necessary)
Nutritional support
Fluid therapy
Birds are plucked
Fasting prior to surgery and no eye ointment Prevent heat loss: supply
is necessary external heat (see anesthesia)

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(Patient) preparation Instrumentation

Drape patients with
Instruments appropriate to the patients size
light materials Use hygienic
Fine instrumentation, used in ophthalmology
measures just
as in mammals Micro-surgical instruments

Lay out the proper

surgical instrumentation

Instrumentation Instrumentation
Absorbent materials Electro-surgery - Surgitron (Ellmann)
Cotton-tip applicators Monopolar vs Bipolar
Small gauze pads Different probes available
Surgical spears Different modes of action

Instrumentation Instrumentation
Use fine suture materials Light-weight wound retractor
Selection criteria similar to Lone star retractor
dogs and cats
Hemostatic clips (Surgi-clips)

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Instrumentation
Use magnification
Surgical loupes (2.5 3.5 x)
Operating microscope
Surgery of the head and neck

Enucleation Enucleation

Green-winged macaw
Two months later
Ara chloroptera
No improvement
6 weeks old
Found in nest box with
Plan:
perforated cornea
Enucleation
First treated with:
Chloramphenicol / Vit A
TMP/S systemic
Meloxicam

Enucleation Enucleation

Suture the eyelids Suture the eyelids

together together
Circular incision of the
skin around the eyelids

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Enucleation
Suture the eyelids
together
Circular incision of the
skin around the eyelids
Dissect the conjunctiva
lose from surroundings
Enucleation
The eye was collapsed
Enucleation
The eye was collapsed
Removal of the eye from
the socket
DO NOT pull on the eye!!!
Closure of the orbita
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Enucleation
Suture the eyelids
together
Circular incision of the
skin around the eyelids
Dissect the conjunctiva
lose from surroundings
Puncture the eyeball
and remove the lens
Enucleation
The eye was collapsed
Removal of the eye from
the socket
DO NOT pull on the eye!!!
Enucleation
The eye was collapsed
Removal of the eye from
the socket
DO NOT pull on the eye!!!
Closure of the orbita
End-result
A few weeks post-surgery
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Rhinolith Rhinolith
Frequently seen in psittacines Treatment:
Operculum
Causes: Remove rhinolith
Rhinitis Bacterial culture from
behind the lith
Hyperkeratosis
Hypovitaminosis A Flush the sinus
Possible source for culture
Removal by currettage
Systemic antibiotics
TMP/S (100 mg/kg BID)
Amoxycillin (150 mg/kg BID)

Rhinolith Surgery of the infraorbital sinus

The nares will remain Complex anatomy of the
abnormally large infraorbital sinus
Rhinoliths may be seen in
passerines as well

Surgery of the infraorbital sinus Ingluviotomy

Penguin with infraorbital sinusitis
(Infraorbital diverticulum)
Indications

Surgery is the only Removal of foreign body

treatment option Obtaining crop biopsy for diagnosis of PDD

Proventricular Dilatation Disease
The sinus contains
Repair of damage due to trauma
necrotic material
Barb wire in pigeons and raptors
It is not necessary to
Burnt crop wall due to overheated handfeeding formula
close the surgery site

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Ingluviotomy Ingluviotomy

Pluck feathers just cranial to sternum Use betadine to sterilize surgery

Insert cotton swab into crop to facilitate
Tape feathers out of surgery field field localization of the crop

Ingluviotomy Ingluviotomy

Cover patient with Carefully cut skin with scissors until cotton
sterile paper drape Place stay- Cut crop wall with scissors to open crop
swab is visible sutures
& Crop biopsy for diagnosis of PDD should
Notice how thin the crop wall is (Monocryl 4-0) include blood vessel!
cut opening in drape

Ingluviotomy Cockatoo with crop lesion

Blue eyed cockatoo
12-week-old female bird
Thick lesion on ventral surface
crop since a couple of days
Anorexia
Close crop wall and skin in two separate layers using Vomiting
Monocryl 4-0 in a continuous pattern Bird is still handfed with formula
PDS results in less tissue reaction compared to Vicryl.
Monocryl was not tested

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Cockatoo with crop lesion
Massive lesion with necrosis
in the neck area
Skin torn proximally
Crop mucosa necrotic along a
large portion of the crop wall
Plan
Healing by second intent due
to the severe loss of viable
crop mucosa
Cockatoo with crop lesion
One week later
Crop mucosa starting to heal
Huge inflammatory lesion at
the distal area of the crop
Plan:
No surgical intervention
Continue with supportive care
Cockatoo with crop lesion
Another two week later
Large necrotic area has
disappeared
The crop healed for a large
part by second intent
Plan
Closure of crop with simple
interrupted sutures
Duoderm to cover wound
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Cockatoo with crop lesion
Placement of an esophageal feeding tube
Cockatoo with crop lesion
Another two week later
Large necrotic area has
disappeared
The crop healed for a large
part by second intent
Cockatoo with crop lesion
Conclusion
Surgery may be postponed by
placing an esophageal tube
The crop heals well by second
intent
In some birds it may be wise to
use a collar to prevent chewing on
the tube (www.aviancollar.com)
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Tracheotomy Case description

Indications 3-year old Hybrid macaw
Removal of foreign body/granuloma Fracture of tibiotarsus

Presence of strictures Type II External fixator

May be result of improper tracheal tube placement Two weeks post-surgery

Part of the trachea may be resected Acute dyspnea
Up to 15 tracheal rings have been succesfully removed in a Open beak breathing
macaw diagnosed with a tracheal stricture
Stridor present

Anorexia since one day

CT-imaging Tracheotomy
Confirmed presence of stricture halfway the neck Dorsal recumbency
Transverse tracheotomy
<50% of circumference
Place stay sutures
Endoscopic removal FB
Use suction tip or forceps
Closure of trachea
Preplace 1-2 sutures
1-2 tracheal rings
incorporated in suture
Plan: tracheal resection and anastomosis Tie knots on outside

Tracheal resection Therapy & Follow-up

Similar technique to tracheotomy Tracheal resection
Complete separation of trachea, removal of affected portion
Create anastomosis between ends, with slight overlap In total 5-6 rings removed
Closure with 4 preplaced simple interrupted sutures Post-operative treatment
Itraconazol 1dd 10 mg/kg PO
Synulox 2dd 125 mg/kg PO
Carprofen 2dd 2 mg/kg PO

Tracheoscopy upon recheck

1 week postoperatively

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Airsacculotomy

Indications
Emergency treatment for tracheal obstruction
Compare with tracheotomy in mammals
Surgery of the coelomic cavity Airsac perfusion anesthesia
To facilitate tracheal surgery / endoscopy
To provide a sufficiently large working space when
performing surgery of the head / eye

Airsacculotomy Air sac tube placement

Right lateral recumbency a

Left caudal thoracic airsac

Abdominal airsac c

b d

Ventral celiotomy Ventral celiotomy

Ventral midline
Indications
Liver biopsy
Intestinal surgery
Proventriculus is approached from left side
Removal of egg End of pubic bones

Removal of oviduct and testis via lateral approach Pluck feathers Tape feathers out of Incision may need to
Attachment of cloaca to ribs and abdominal wall surgery field be expanded in lateral
Feathers originating on
direction to allow for
In case of cloacal prolapse sternum can be bent in Disinfect with betadine more abdominal
cranial direction
access

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Ventral celiotomy Ventral celiotomy

Make skin incision A lone star retractor can aid in creating Expand incision in A better overview of the
with scissors a larger field of view by retracting the lateral direction abdomen is now achieved
wound edges

Ventral celiotomy Ventral celiotomy

The liver can be approached by
opening the ventral hepatic peritoneal
cavity just dorsal of the sternum
Liver
The liver is difficult to see
when not enlarged. Endoscopy
is advised in those cases
For closure of the
The abdominal wall and skin are then
wound FIRST bring
closed in two separate layers using
the corners of the
Monocryl 4-0 in a continuous pattern
incisions together

Left lateral celiotomy Left lateral celiotomy

Indications
Approach of the proventriculus and ventriculus
Proventriculotomy
Approach of the genital tract
Salphingectomy
Orchidectomy
Approach of the left kidney
Place bird in right lateral recumbency
Kidney biopsy Tape wings together Use betadine to disinfect
surgical field
Retract left leg dorsally and caudally

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Left lateral celiotomy
Drape surgical field
Cut opening in drape
Left lateral celiotomy
Extend incision to pubic bones
Left lateral celiotomy
The incision is extended cranially
to the ribs dorsal to the uncinate
process
With Ellmann forceps skin incision
Cut skin fold (knee web) in groin
Open the body wall caudal to the ribs
The 7th and 8th rib may be cut
after the intercostal vessels have
been coagulated
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Left lateral celiotomy
Scissors can be used to
can be extended extend the incision
Left lateral celiotomy
the airsac lining is seen
After incising the muscles,
and can be opened
Left lateral celiotomy
Good visualization of the organs
Using the lone star retractor
is achieved
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Left lateral celiotomy Proventriculotomy

Lung Left testis Kidney

A stay suture is placed on the and another one on the

Proventriculus Liver Ventriculus ventriculus, proventriculus

Proventriculotomy Proventriculotomy

The proventriculus is closed with Opposition of the cartilageous

Gauze is used to prevent leakage The proventriculus is opened on
a monofilament continuous ribs is achieved by placing a
of gastric contents into the wound the junction with the ventriculus
suture (Monocryl 3-0 / 4-0) suture through the ribs

Proventriculotomy Salpingohysterectomy
Indication
Persistent egg laying
Approach
Left lateral celiotomy
Anatomical consideration
The oviduct and uterus are located ventral
to the caudal vena cava
Risky surgery
The body wall is closed with a continuous suture
The skin is then also closed with a continuous suture

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Salpingohysterectomy Cloacal prolapse

Surgical procedure Particularly cockatoos are prone
Locate oviduct and uterus dorsal to proventriculus A variety of causes have been
Dissect ventral ligament to stretch oviduct and uterus reported, e.g.
Ligate (hemoclip) infundibulum and vessel Persistent tenesmus due to
Gastroenteritis, cloacitis
Dissect suspensory ligament with electrosurgery
Extra- or intraluminal masses
Place hemoclip at entrance of cloaca
Sphincter problems
Neuromuscular deficits
Behavioural, hypersexuality
Idiopathic

Therapeutic options Cloacopexy

Temporary relief Types of cloacapexy
Use of transverse stay sutures
Percutaneous cloacapexy
Pursestring suture?!
Rib-cloacapexy
Permanent reduction
Ventral incisional cloacapexy
(Incisional) cloacapexy
Percutaneous, rib or ventral midline
Ventplasty
When sphincter atony is present
+/- Medical and/or behavioural
intervention

Ventplasty Post operative care

General guidelines
Keep warm
Keep hydrated
Provide food a.s.a.p.
Provide sufficient analgesia
Closely monitor the patient
Only consider a collar in
mutilating patients

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Questions???

Thank you for your attention!

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