Good afternoon everyone. My name is Charlotte and I'll be, sharing today. We have a fabulous presentation on rabbits and neutering, specifically rabbit reproduction disease and how to neuter.

We have a lovely speaker who is Doctor Sophie Jenkins. And I'll be handing this seminar over to her shortly. So Doctor Sophie Jenkins is an advanced practitioner in zoological medicine and is a veterinary surgeon based in South Wales.

Sophie graduated from the Royal Veterinary College in 2008. She went on to follow her passion for exotic animals and gained a general practitioner certification in exotic animal practise in 2011. And in 2016, Sophie completed a postgraduate certification in exotic animal studies and also was subsequently granted status as advanced practitioner in zoological medicine.

Sophie gives CPD talks and lectures to vets and nurses on exotic medicine and surgery. Sophie is a gold member of the Rabbit Welfare Association and fund. Sophie was recently awarded the Burgess XL winner of Rabbit Vett of the Year in 2020.

So we are blessed today. Sophie owns and runs Origin Vets Clinic in South Wales, and Sophie offers 1st and 2nd veterinary opinion, as well as referrals for reptiles, rabbits, small mammals, birds, amphibians, and fish. Sophie's exotic vet work covers rabbits to rhinos, sugar gliders, to skunks, chameleons to camels, as well as birds, such as African greys, owls, falconry species, and also amphibians, fish, and in birds.

So quite a range there. Loss under your belt. Sophie has also 25 years' experience of keeping and breeding various reptiles, and this includes bearded dragons, multiple species of chameleons, and several species of geckos.

She's also got. A rescue cats. Two large fish tanks, including a discus setup and a kami setup, a rescue horse filled tortoise, and a rescue bearded dragon.

Quite the, quite the farm we've got going there. You've also got a big soft spot for rabbits and currently has 5 rescue lion heads. So, lots, lots on your plate there as well.

So, yeah, so today we're obviously going to be covering the basis of why we neuter rabbits. We've got a photographic guide on how to neuter, the reproductive diseases that can occur in rabbits. So we have a lot to cover, so hopefully we can get through as much as possible.

There'll be some time hopefully for some quite. At the end, so please do write your questions in the box. So we'll get to those at the end, but we'd like to say a massive thank you for Sophie joining us today, and also a massive thank you to the Rabbit Welfare Association as well for sponsoring today.

So I will hand over to you now, Sophie. Oh, thank you, Charlotte. That's a, that's a, a lovely introduction.

Thank you. I hope everyone's, having a nice lunch and learn today when we get started. So this is gonna be basically on, on rabbits and nutrient.

These are my 5 lion head rescues. I think most people are sort of signed in for the live session now, so if we're ready, we'll get started. If there are any problems, Charlotte, with the slides, please just let me know.

OK, will do. If anybody wants any contact details, you can see them in the bottom right of the screen. You're welcome to ring, or email with any questions regarding this particular webinar or other webinars you've seen.

Also, in regards to any cases, we, we do a support with, with our vets, and nurses, you know, not just in the area, but, but, but, well, worldwide. So you're welcome to, to send any cases, please, if you do that, please send the full history and X-rays that we can, or any other imaging and bloods that we can have it all to hand before we have a little look. And we'll get started.

OK, so our objectives today understand companionship in rabbits, we're gonna talk briefly on this. Understand why we're neutering rabbits and not just neutering one, but neutering all of the, of the group or or or the bonded pair. Understand how we need to a male rabbit and how we need to female rabbit.

I've got pictures to go through that as well. And understand the reproductive diseases that can be associated in both male and female rabbits when they are left entire. OK, so companionship, rabbits are incredibly social animals.

They will live in the wild with up to 900 strong in a warren, split down into multiple groups, so often 1 to 2 males with anywhere between 5 and 15 females within that group. It is a very, very, tight social network, and there will be a ranking hierarchy as well. So this does need to come down into how we're keeping these animals.

The rabbits should never be kept on their own. They, rabbits need rabbit friends. It's not great to be bonding them to, to other sort of mammals because the, the, how, how they work together, it is very different from, from other species.

Having a bonded companion will increase their activity. It'll help reduce boredom, helps to reduce obesity as well, keeps them moving, and, and they generally, will live a lot longer, you know, being kept together. You do also see a lot more of natural activity, the more rabbits you generally have in a group.

I have 5. I'm watching them outside, when there's 5 of them all out together, you just see, generally about sort of 3 to 4 of them are always eating, and you'll have like 1 to 2 looking around and stuff. A little bit like meerkats, but not quite as, as extensive as, as a full-on upright, pose for meerkat.

It does help to reduce stress, therefore, the more rabbits that are in together, as long as they are well bonded, then the, the stronger the, the, the, bond between them. The less stress they have about things like predators that may come into the garden because they've got that security of, of, of their bonded partners. And remember, it is part of the five freedoms, you know, to have natural companionship, we must ensure that we are talking to our rabbit owners about this, but they really need to be neutered, otherwise we're gonna end up with unwanted rabbit litters and, and other problems as well.

We can sex them from 6 weeks old, and the females are reproductively active from around about sort of 16 weeks upwards. So they can have a litter quite young, and they can also be pregnant again within 24 hours, which does mean if you, you've got a male and female that have come in, and they've been incorrectly sexed as two females, then it, it could be a major, major problem, for, for those owners within a several weeks. And this is where it's important to know how we're going to do sex.

And so we will talk about that as well. So these are two images. These are young rabbits, approximately 8 weeks old.

So the typical sort of age, you'd be getting these in, coming in for vaccinations and this sort of health check. It's really important to check the sex of these guys, because, as I say, so many are incorrectly sexed, I mean by by the shops particularly and sometimes by breeders as well. So the easy way to I remember this.

Is a boy has got a circle, like an O, which is where the penis sort of comes out, and whereas the girls have got a slit. So a girl has an I in it, so it's a slit, and a boy has an O in it, so it's an O. So that's one of the easiest ways I remember.

And as I said, this is from 8 weeks old, so please don't look at testicles. This little boy did actually have testicles there, and I just put my fingers there just so you don't see them. So now you can see that in place, have a little look at these.

I'm not gonna ask anyone to do a poll. I just just have a mental note of which ones you think's female, which ones you think is male. So this is female on the left with the slit, and that's male on the right with a more of a circle.

And again, these guys are around about 8 to 9 weeks old, so you can sex these guys very, very young and it's important to make sure we're doing that. OK, so why, why do we need to Well, the obvious one, similar to cats and dogs is preventing unwanted litters. The rabbits we've already talked about are really, really social, they need to be kept in that companionship, but we don't need to be breeding rabbits just for the sake of having more rabbits.

So, the other things to talk about with illness would also be reproductive diseases such as ovarian or uterine tumours, reducing the risk of mammary tumours, preventing uterine pathologies. And then in the males preventing testicular tumours, and we'll come into a little bit of depth more as we go through the slides on each, each of those. And then finally, behaviour related, males particularly are quite aggressive, especially if they are kept on their own, and they can be quite aggressive both to humans and to to other rabbits, if they are entire.

Females will often be very aggressive during the Easter phase, and bearing in mind that they sort of cycle every 2 of 28 days. So it's quite a regular thing that they can be quite aggressive with. They will also do unwanted necessary nesting behaviour as well.

So it's, it's generally multiple reasons that we are neuter and not just to prevent unwanted litters. It's worth talking about a phenomenon called spring fever, and anyone who's got rabbits, that have got bonded pairs may well know about, about this, but if you don't know about it as a vet or nurse, then definitely keep this in, in your mind. It's stimulated by a change in day length, but it is also affected by that change in temperature, the milder temperatures coming in, and also that young fresh grass that suddenly becomes available as, as the spring starts to take place.

It can occur in any rabbit, and that is whether they are neutered or not. Suddenly they'll become frisky, they'll start mounting each other, they may start chasing and nipping their companion. And I've actually had this this year with my 5, where one female, despite being, they've been bonded for 22 years, this particular group.

One female just suddenly turned on the other, and it, it was some nasty chunks taken out and requiring surgery as well to stitch up a vulva. So not very nice at all, but we get through it because it will pass. Now, it's important to be aware of this because sometimes you have to separate the, the, the group in order to get them back together later, because if you try and bond in, in, in the spring or summer, once they've had this sort of fight, they won't bond again.

So my particular group, I've re-bonded now, now we've gone into the late autumn into winter period, they've now been back together for 3 weeks, and they've had no problems at all, and it is purely down to that hormonal changes that can occur, and they are all neutered rabbits. But just be aware of this, if everyoneers come in saying about it. It's also being aware that spring summers is never a great time to sort of bond new rabbits together because of this, even though they have been neutered.

So if the client's got rabbits and they're looking to get another bonded partner, certainly autumn and winter time would be preferable if that was an option, OK? So let's talk about nutrient. This will be, we're going to sort of go through it a little bit.

So this is your admin day. What do you want to do, so. Your reception, or whoever's booking these appointments in really should be encouraging the owners to bring their rabbit in either their bonded group or partner with them.

They need to be in a predator-free waiting area. So this is a typical sort of our gold standard setup where you've got, chairs, which are blocked off visually from, from other cats and dogs, and if possible, sort of smell wise as well. We use towels that have got pre-sprayed with pet remedies so it keeps the rabbits nice and calm.

And at the moment, clients are waiting in their car, so that's another option as well as the clients waiting in, in their car. When the rabbit comes in, obviously you go through all your consent form, etc. It's really good idea to get the owners to bring in.

A lunchbox, so we, we say bring them a packed lunch. They love it. They bring in some of the food that they, that they like to, feed them during the day, and it gives you a chance to have a little look and see what the owners think is a is is either a normal amount or normal types of food to be given.

We have food with us in, in the practises, of course, as well, but it does really help cos you know that that's their normal food. It's really important that the animal, the rabbits have a full physical examination at the point of admit. You need to take note of their body condition scores, their weight, particularly take a note of dentals.

Sometimes rabbits may not be vaccinated and they're just coming in for, for neutering for whatever reason. They may have been vaccinated by the, the breeders, for example. And this is the first time they're coming in, it's really important to ensure you check them all.

And certainly dental, because, where you've got some of these, these shorter-nosed breeds like the mini lops and, and dwarfs, they can have a, a, a sort of reverse incisors, and sometimes that's not picked up, up, if they're not looked for. So certainly and ensure that that that is checked. Also take a note of previous diseases.

Have they had respiratory problems? Have they had Eicular or any other systemic disease that could affect their anaesthetic, their surgery, and their recovery? And take a note of that, making sure it's written on the on the forms so that you're aware of the situation and obviously they're on any other medications as well.

So in the hospital, we set up a predator-free environment, and we use quietly dim lit, rooms, pet remedy sprays, plenty of hides, normal food, we, as we mentioned, and we never ever starve rabbits. You can see in these photos, these are a selection of some of our setups that we use. They've got plenty of space to jump and, and roam around.

These are sort of 5 ft long kennels by, just about 2.5 ft wide. And they've got plenty of hides, food, water, and they've got their bonded partners.

You could consider early premedicating if you've got a particularly stressed rabbit. So sometimes this does happen where rabbits are very, very stressed and they won't exhibit their normal behaviours. In each of these you can see a rabbit that's stood up in the top right there's sniffing the air, having a look around.

The, the Harlequin behind her is it was having a little sniff on the ground as well. And you can see the ones in the bottom, the, you know, the, the orange, lionhead in the middle is eating hay. They're exhibiting normal behaviours.

But if you do have a stressed rabbit that isn't wanting to come out, then it might not be worth considering early pre-medicating them. Generally do surgery early in the day to allow plenty of time for recovery, particularly to ensure that they are eating and passing faeces as well. So you could do any premedication with something like buprenorphine, plus or minus midazolam if they are particularly stressed.

Now, midazolam will probably wear off by the time you're about to induce, but it does help to maintain a calmer rabit. This is one of our vet students who's placed an IV catheter. Generally you put amyla on them and clip them about 40 minutes before placing a cannula.

Normally we'll use either, the little purples or yellows, so sort of 2026, 27, or, or, or 25s. And just, we just use a little la class, or Durapo wrapped around. We don't generally put in heavy materials like, rat wrap or anything like that anymore.

They sort of shine and pulled away from it because generally the more you put on the rabbit's ear, the more they it annoys them. There's lots of locations. This particular one is a marginal ear vein.

You can use the lateral saffius, the cephalic, medial safines, and you could do interociates if you've got particularly young, young rabbits or anything like that, . Particularly things like the tibia, so if you've got very, very small rabbits, but I mean we rarely manage, a struggle to get any sort of IVs in, you know, we'll normally use one of one of the IV posed into ashes when it comes to neutering. Generally we set up everything in advance.

It's really important to ensure the full anaesthetic is all ready, the surgical equipment's all ready. We calculate our doses for emergency drugs in advance and write them all down. If we have any cases that we are worried about, for example, previous respiratory disease problems, or anything that might indicate a problem with an anaesthetic, then we physically draw the drugs up as well.

We also have oxygen ready from the point of induction so that it's all ready to go when we pre-oxygenate before we're inducing. So again, just talking about canons, it's important to do these routinely and where better to do them than Neutrin, because this is a really good, skill to have and it makes an emergency much easier. We've mentioned the various veins that you can use and how it will, by using AMLA will really help.

It vasodilates as well as numbs the, the skin, so that's a really good advantage. And as you've mentioned, you can use midazolamma as well, which may calm them if you've got a particularly sort of stressed rabbit. Another option is Eyal if you've got it.

It is cold, so it may constrict the ear veins. It may not be so good in some very, very small veined rabbits, but it is good to use where you can get an IV in quite quickly. As you mentioned, you use light, but it's quite secure taping and with the lightweight buns.

I put plus or minus butter collar, because people always ask me, I don't use butter collars on them at all. I mean, we never had a problem with the rabbit pulling the, the cannulas out. So you can see here a lovely marginal ear vein, and this one is it isn't a giant rabbit in all honesty, but it's a very nice sample of where you're looking for your ear veins.

This has just got a lightweight bung and lala got secured in place. This is your safness. I hope you can sort of see it on there if if my arrows coming out on the screen, then your, your stifle is here and your hock is here and you can just see it running down the leg there.

So again, we sort of just place in the IV catheter, do a little figure 8 around it and then you can put an extension set onto it and for fluids, or you could just cap it off if you, if you just need it for vein access as well. OK, so moving on to how we actually do the procedure. So the male is orchiectomy, we do from around about 1214 weeks onwards.

I do a little bit later in giants, just to allow that growth phase, and similarly with larger breed dogs as well. I use local anaesthetic instilled after the clip, and I'll show you in a second how to do that. Generally, I would do pseudo clothes.

So a close would be you don't open the tunic, but the difficulty with that is they have got very long, heads of the epididymis. And so you could potentially leave a small bit of testicle. If you do open, of course, you've got to close the tunic over, open over because they have open inguinal canals.

So I do a technique called pseudoclose, which is where I open, the tunic and, then ligate underneath the. And then I'll show you how that's done in a second. You can do scrutiny or pre-scrotially.

Prefer preference for me is scrotal, just because I can roll the skin afterwards, from the scrotal incision, rather than, than pre-scrotially where you really should be suturing it closed. You can use 30 or 4 knot PDS, or viral with a non-cutter needle would be preferable. You may or may not need tissue glue or intradermals afterwards.

I don't use tissue glue at all. I'll just roll it, this, the scrotum back together and we'll use laser after as well, so I'll show you those pictures. An alternative approach to this certainly works really well with older rabbits where sometimes it can be a little bit tougher doing scrotally.

You can use the abdominal approach. I haven't actually got pictures of that, so I'll quickly talk about it now, but it's very simple. You go in, sort of lower, lower causal abdomen in between the two last, the sort of nipples, it'd be on a female, and some males do have nipples as well, so you can use that area.

But if you were gonna do a cystotomy effectively. You go in and either side of the bladder, there's two little fat pads, and you just pull gently up, on one, and I will pop the testicle and you close it all off. And then you do the same the other one, and then you just close the abdomen, like you would for a standard cystoomy closure or anything equivalent.

Do we really get cryp orchids? Very, very rarely abdominally, but yes, we do get some inguinalline and I'll show you some pictures of that. It must be noted, and this is really important to ensure the owners are aware of this, that it can take 6 to 8 weeks for the sperm to be expelled from all of the glands in a male.

And therefore they need to take care if they are still with an entire female, for whatever reason she's not being neutered at that point in time. So this is a typical sort of setup in our prep area. Our rabbit's intubated, held in correct position with the head elevated and the chest above the abdomen to aid respiratory.

We've got an ECG in place, we've got an SPO2 in place, we've got an IV cannula, and we've got K laser ready in the prep room for, for post-operative healing as well. So this is how we do the local anaesthetic. We use a 23 gauge needle with a 1 mil syringe or we use an insulin needle, 2 MB per kilo, the cane with equal parts saline, and you basically just split half and half, going along just the tip of the .

The most proximal part of the scrotummy either side, basically trying to block up that, that canal. So after we've prepped and we've put our drapes on, this is what we're getting, so we've got our scrotal skin here, we've made that incision, but we haven't gone through the tunic at this point. Now, I've put this, the slide at the bottom here, and it's borrowed from a colleague, but this is a closed castrate in the bottom here.

You see the tunic's not been opened. But I prefer to open this, as you'll see in this picture here. And this is now the open, the test at the top, and the tunic has opened at this point here.

All we want to do at this point is very gently, with a little swab, just break down this fascia here. And this is where in young rabbits it's super easy to do. But in older rabbits, that becomes a little bit tougher and sometimes if you pull too hard, you will end up with a hematoma, in, in that scrotal region.

So. What I would suggest you do is sort of judge it and see how you're getting on with the ages, and you might find that for an older rabbit, abdominally may be an easier approach, or, or you could do a closed cash rate and just be very careful that you make sure you get the whole, epididymis there. So now we've opened it, you can see this is being broken down a little bit, the fascia.

You can see the blood vessels here, we can see the spermatic cord and the cremaster muscle and everything as well. So what we're gonna do is I generally just put one ratchet clamp on just to keep it up or out of place to stop all the testes slipping back into the tunic. But I just do it on the one ratchet, I don't do a full crush cos I don't want to cause any potential sort of trauma, more than we need to.

I'm using a round bodied, 3 knot PDS and I'm just going behind the spermatic cord and the blood vessel, in the middle of the tunic, underneath my clamp. So I know I've got all the head on my epididymis, and the, so the whole testicle is out completely. We're gonna then tie it off on the, the upper side here, and then I literally just flip the testy over and do a circumvential around.

So this is called a transfixing. Circumferential ligature and it's going underneath my clamp and then all I do is cut off the testy above there. It's the easiest way to ensure you've got the whole testicle, but it means you don't have to go and close that tunic off after as well.

If you don't want to do that and you do want to close the tunic, then you would just basically ligate these here and remove this completely, and then you just close that tunic off with a simple cruciate suture. This is post-operative K laser to aid healing. We use this routinely for all of our ops really.

And it's really, really good. It just helps heal everything. But all you want to do is just roll the scrotal skin together and just hold it for a few seconds and then let it go, and it will generally stay in place.

You don't need to be using tissue glue or doing any intradermal sutures. OK, so moving on to Iguly retained testicles. You can see on this picture you've got the normal testicle which would be on the rabbit's left hand side.

And you've got that inguinal retained one on the right. Now, you can't really see it, there, but I could feel that it was there. So we prep our animal, and we're gonna do a pre-scrotal incision in this place.

So this would be where you would do your pre-scrotal incision if you were going to do it for both testes anyway. . The tester you can just see just, it's just underneath there, the the tunic, and that's gonna come out here and we just remove it.

And when you compare it to the other side, it's very, very small. You can see here, we've taken both the testes out from that one incision, but you do need to really be closing that incision back off, so you do need to do some intradermals in that case. And then again, if you've got OK laser, then use it for healing.

OK, so moving on to neuter and females. So normally 16 weeks, but I will do them from 12 weeks, and sometimes even younger if we need to, if needs must. They are generally very, very easy to do from around about 14 weeks upwards.

Remembering they've got a double cervix, so you need to make sure you, you remove the whole cervix, because you've got these really nasty tumours called adenocarcinomas. These occur in around about 50% of of entire females and as high as 80% of New Zealand whites. Not only do we have adenocarcinomas, with the, the uterus, we also have got very nasty mammary tumours, so adenocarcinoma and fibrosarcomas and mammary tumours.

And if you're new to the rabbit before they're 6 months old, you're reducing the risk of developing a mammary tumour by 80%. So it's really worth noting that when you've got, clients coming in for their vaccines, trying to get those rabbits in around about 4 months old is spot on. Not only do we prevent tumours, but we also prevent things like pyometers because yes they do occur in rabbits, myometris, hematometris and hydrometers as well, and I've got some pictures of some of those later on.

And then as you mentioned earlier, we really does help to prevent behavioural issues, particularly nesting and aggression between females and even from female to owner as well, it can become quite nasty, they can give quite a nip when they're cycling. OK, so we've talked about how to castrate males. We're gonna talk about ovarian hysterectomies in females.

So the easiest way to remember the location is you go between a a 2 to 3 cm incision. That's, that's been quite generous. Normally my incisions are around about 1 to 1.5 centimetres.

So you, but you, you've got some leeway there. Go between the causal pair of nipples. You'll often see, and you can see in this picture, the uterus body, right there, we've got the uterine horns and the round, round ligament there.

If you don't see it straight away, then it probably means that your incision's just slightly out for future reference. So, all you need to do is go cordially, find the bladder, and then you'll find the cervices just around the bladder and you can gently pull, pull, pull them on the uterus there. You really need to be careful to avoid the secu.

So this is where I say I use a much smaller incision than what's written up there. This is a 3 centimetre incision, roughly. And you can see the yum is there.

So you really need to be careful. So if you go, if you do a small incision once you're used to doing them, you won't even see that secum in the way at all. We need to be careful of the large broad ligaments as well, because it's, especially in the older females, some of the broad ligaments are very, very, engorged, and there's a lot of fat around them, so it can be a little bit tricky sometimes.

But once you're used to doing them, that will become second nature. So for ligate in the ovary, you could use a 3 knot, or 4 knot PDS ligature. You could also use a liger clip as well.

It's important to note that, especially in young rabbits, their blood vessels are very, very small around the ovary. So if it, if it, if you, if it does tear, I, I wouldn't worry too much because the bleed that you get around there is, is, is minimum. However, when you get a little bit of an older rabbit, it can be more.

And so you do need to be careful with use of things like archery forceps, because if you crush it too much, then you're gonna tear that fat and it's just gonna tear straight through the blood vessel, OK? For the services, you want to make sure you ligate below the two of them, and then question whether you need to oversse the vagina vestibule. So I normally use like a 3 knot PDS or the smaller rabbits, a 4 knot PDS round body.

For the very young ones, I'll just do a circumferential once around the vagina vestibule, and that's it. I'm confident my sutures are absolutely fine. You don't need to over sew it.

If you've got an older rabbit. Or a fattier rabbit, then you generally find that you, you may need to do, sort of two ligatures and a transfixion might work quite well. So you'll pop the needle through the vaginal vestibule around the broad ligament and blood vessel on one side, tie it off and then it feels circumferential, and then the same for the other side if they are particularly fatty.

For closure, I would use a 30 or 4 knot, depending on the size continuous muscle closure. So normally, especially for young rabbits, I'll just use the 14 knot PDS for everything and that'll include the closure as well. And we do an intradermal sutures, with, that you can use that same round bodied, and you don't need to use a reverse cut at all.

The rabbit skin is so thin, a round body would be absolutely fine. And then an Aberdeen knot which will hide your knot underneath the skin. And that would mean that they, they can't be pulling anything out, and again we use K laser over that skin suture there.

So, the other option that you do is just an ovarectomy, and this is very popular, particularly when they're doing them in the labs and things like that. It absolutely must be done before 8 months old, as we've mentioned earlier, things like adenocarcinomas can come into play. Now, why were you just do the ovary?

Well, it's same, similarly with with dogs and to the lapse space now as well. It will still prevent adenocarcinomas, pyometris, and other uterine pathologies because you're removing the, hormonal content of it. So as long as they're done young, you can, you can still prevent all those.

Generally, I, I just do a full over, of, of hysterectomy, just because I'm just so used to doing it. And it gives me a chance just to check everything out on the reproductive tract that there isn't any problems, or so. But in theory, you could do laparoscopically or you could go over the spine.

So to go over the spine, you just go in, around about L7, and you make one incision over L7. You move it across just behind the ribs, and then you incise, over the muscle there. You go through and you'll find there's a little fat pad.

Bring that fat pad up, the ovaries in there, and you can just remove the ovary. Again, you don't need to worry too much about the bleeding with such young, rabbits because it's the, the blood vessels are minimum around the ovary. It's the broad ligament ones you need to watch.

So once you've done the one side, you, you bring your skin suture back across and you go the opposite side then, and you just go in through the muscle, find the the fat pad, bring it up, remove the ovary. And then to close, just put a little, suture through the muscle each side, and then you close the skin. That's how we do a lot of our rat space as well, particularly those that are under 90 days old.

OK, so do some pictures, I talk through so this is where we say we've got this little incision here between the two causal nipples. You can see the sum there and you can see the uterine horn, and this is a little bit of a large incision, but it's literally just a show of the anatomy. So this is me doing some surgery here.

This is the incision size that we're making, so we're going through the skin here and then through into the abdomen and this one here. And this is a very young rabbit, so, I'm pointing out here the ovary, and this is the bladder underneath. So here's our bladder, 1 ovary and 2 ovary at the top there.

And you can just see here's our double cervix here, and this bit here is the vagina vestibule. So we're gonna suture around this area here, and this size rabbit, I would just do a one circumvential and that'll be absolutely fine. So this is going into an older rabbit who's sort of from 24 weeks on upwards again, similar size incision, but you can see now this sort of creamy colour and as soon as you go in.

And that's actually our a broad sort of broad ligament just creeping in. So if we start to pull it up, you can see it all here. This is now having it exteriorized, so we've got our ovaries are sort of hidden underneath here at the moment.

And you can just see how much difference it makes in 10 weeks, from a 14 week old to a 24 week old. If you go into the giant breeds, I mean, I've needed some of these giants that are hitting 8 9 kg, and actually when we weigh the uterus after, it's almost 2 kg worth of, of, of weight there. And it's in here that you'll have your really big juicy blood vessels.

So it's this, it's the under the cervix ligatures you need to be careful of that you're gonna make sure you get those blood vessels there, OK? And then you can see here we've got this is a transfixing circumferential ligature here that's gone round underneath it's just a slightly different angle, but it's the same rabbit from up there. So let's just to recap between the two sizes.

So we've got a 12 week old ish, and a 66 month old-ish, sort of sizing, and you can see the huge difference that's made just by allowing them to go that little bit, bigger in, in an older in age. Personally, I actually prefer doing them much younger. It's just so much easier and so much quicker.

And also you, you know, you're gonna be preventing hormonal related, diseases and pregnancies. So just to go through the bit of the anatomy again, just to make sure, because this is the one that you just need to be careful of. So we've got our ovaries up here.

We've got, our uterine horns coming right down with the two cervices either side. This is our vaginal vestibule. And why you just need to be careful is you don't accidentally catch the your ute uterus from the, kidneys to the bladder, because they do lay very, very close.

So just to ensure you don't catch it. Where I'm talking about going through and doing a circumferential, it's, this is the, the vaginal vestibule is here, and, and we're sort of going through the, the middle section of that and around the one side. I'm hoping you can see my arrow here.

And then we, we do the same on the other side. So. That, that allows us to encompass the blood vessel coming, coming down.

As I said, for younger younger rabbits, liger clips work really well. If you haven't got a set of liger clippers, they're great. Epicon makes them, and they just mean you can just put a little liger clip instead of a suture, and it means minimum tissue handling.

They're fantastic for young, young rabbits or small things. OK, so these are all rabbit uterus or uterine horns. There is a normal one on there, and there are some abnormal ones on there, as you can hopefully tell.

So, I can't do a pull, as I, I, so I have a mental think of what we could be doing here. And bearing in mind that these rabbits could come in with no symptoms whatsoever, or they could come in with multiple symptoms. So this is our normal.

This is the picture that I just showed just reversed round from the the other side. The top right is adenocarcinoma. It's really quite nasty.

Bottom left is hematometra, which is where it's full of blood. And then we've got hydrometri where it's more full of any other fluid other than blood or, or infection. But my, the, the sort of thing you see coming from these is that if you felt all this, they could feel just like a tumour, but they're not always that tumour.

So if we've got an older rabbit that you palpates in a mass, it may not be the end of the road because it may not be adenocarcinoma. It might be that you've got one of these other diseases or even a yo coming into place. And so it's always worth scanning, and then where possible, doing chest X-rays to ensure there's no sign of any spread of anything and then doing surgery to remove but submitting for histopathology as well.

Do we use cat gut? I don't know what you guys are doing with cats and dogs. I don't do cat and dog work anymore.

It's been about 8 years since I've done it. But why do we not use it in rabbits? I still do get cases of rabbits having intermittent gut stasis, and when we look back on the notes from the previous vet's referral, we can see that they were spayed 2 years ago using cat gut.

Now, cat gut is absorbed by a protelytic enzymatic digestion, which what that creates is an inflammatory response. That creates adhesions. Now, rabbits are excellent at formal adhesions, and they're actually used as a human model in the study for adhesions.

So why would we use cat guts, in, a rabbit that's that's great for form adhesions? Just don't use it. So just never ever use it in rabbits.

You can take home one thing, it'd be that as well. OK, so postoperative care, we've gone through how to do the rabbits, neutering, we just need to now make sure we be providing the best care to go home. Pain relief, generally I'll use meloxicam, 0.6 to 0.8 mg per kilo, twice a day for about 5 days, starting the following day after surgery.

Sometimes I use paracetamol, remembering things like rabbits have got, previous, I generally have that a slightly heightened, sensation. So sometimes they may require a bit of extra pain relief. Paracetamol, 10 per kilo, every, twice a day for 3 to 5 days would be spot on.

And I'll just get them to use, human, human paracetamol, suspension. Ensure we syringe feed in the hospital before they leave the premises and ideally you want to be seeing them eating on their own. There's lots of different syringe feeds out there.

These are great aspects for, for your nurses, particularly your trainee nurses or vet students to, to get on to doing for you. You can continue to syringe feed at home if you're in any doubt how well they're eating. In all honesty, our rabbits, when they go home for nutrient, are normally eaten before we even get a chance to syringe feed them.

Part of it will come down to anaesthetic protocol, and to speed the surgery and potential pain, making sure it's been recovered properly with proper analgesia and multimodal. You must ensure they're passing urine faeces within 12 hours. It's really important to put this on postoperative forms that the owners get to look not only that they're eating, but they are actually passing urine and faeces.

There is no need for antibiotics. This is a sterile surgery, antibiotics can cause huge problems with with rabbits if they're not required, and there's, there really is no need, need to producing them. Depending on your anaesthetic protocol as well, you really don't need any metoclopramide being added in.

You need to take care with, keep with their companions all the time. So this includes when they're recovering, generally, once they got their head up, they'll go straight back into their companions. The smell of, of their other, rabbits, and also their normal food being around them will stimulate them to, to wake up quite quickly as well.

OK, so we're sort of coming towards the end now in the summary, companionship is an absolute must for rabbits, they really need to be kept together, but they really should be neutered, and that includes all of them in the group. We should be avoiding cat guts to avoid adhesions. We should be neuturing to prevent unwanted litters, preventing multiple, diseases, and also preventing unwanted behaviours.

So thank you for listening. We've gone quite, quite soon quickly through all that. I appreciate there might be some questions.

I may have answered them as we've gone through, but quite happy to, to answer any questions. You can also email me, that's fine as well. I hope you've enjoyed, and, I believe the webinar is available after as well, so you can go back and, and have a little look and, and, and check on things.

But I'll pass it back to Charlotte. Thank you so much, Sophie, that was a fabulous and informative webinar there. I really enjoyed seeing actually the, the 12 week to 6 month difference between, the growth and and how amazing that is.

So it's really informative to obviously see that and actually let owners know, well, visually the difference on what it can make, and obviously with surgery itself as well. And also the bonded, pair in hospital, which was really nice as well to see them how, and how relaxed they were. So, thank you.

We have quite a few questions, so we'll hopefully get through as many as we can. So our first one that we have here, if a client reports that a bonded group pair has broken down, would you suggest screening for illness prior to attempting to rebond? So for example, ECT and haematology, biochemistry, as they tend to kick a sick rabbit out of the warren?

Yes, so that's an excellent question. And I think it's, that's definitely one that needs to be addressed. So I think what I would suggest is that all rabbits are checked over, just to be sure, but particularly the one that may have been picked on.

It could be that they are, ill, as you say, quite rightly, that they will get kicked out from warrens, and you go back to natural wild behaviour, they're not gonna want to keep a sick rabbit in with the group. But sometimes that's, that's not the case and it is down to just someone's trying to take over and, and maybe, a matriarch female is getting a little bit older, so one of the younger females is trying to come out and take over. So it's definitely important to be examining the ones that are fighting, definitely.

Where possible, one in bloods and considering checking for Eiculi, certainly ensuring body condition scoring and dental work, etc. Is addressed as well. Perfect, thank you for that one.

The next one we have, what is ELA, so I'm thinking that's in accordance to the Ela cream, but I'll pass it over to you. Yeah, that's right, yeah, so Elo is basically just a local anaesthetic cream that you can use. It's really, really good.

It comes in a little tube. You need to wait minimum 20 minutes for a property to take effect, but ideally 40. And it's a really good one to just do at the time, .

So we try to minimise how much we're handling the rabbits. So they come in, have a physical examination, make sure everything's OK. At the point of them going to go towards the canals, then they'll have the ear prepped where the the ears clipped, put Ala on and they'll have their buprenorphine.

They then go into the canals, so they've only need to be handled once. And then the next time they're coming out is because we're doing it, you know, inducing. So it's a really good one to use and it helps to pay late as well.

Perfect, thank you for summing that up. The next one we have is, do you have a preference of route of pre-med? So it's just apologies if you had said and we've we've missed it.

Was that a preference for premedication? Yeah, so the preference routes, yeah, so I guess like I am or subcut, I'm assuming. OK, so buprenorphine will work, subcut or IM bear in mind these guys have got very small muscle mass to try and minimise how much IM you are given to these.

So normally it would just be a buprenorphine, either subcut or IM, and then everything else we pretty much give intravenously. The only other time we may want to give something like midazolam, IM beforehand would be if you've got a very, very stressed rabbit, and we may want to just take the edge off it, while it's coming into the kennels. Thank you.

Next one we've got, which IV catheter sizes do we mostly use in rabbits? I think you might have answered this one, but if we can re go over that one, please. Yeah, so it's generally, 26 gauge, the purples and 19 mLs, you can get 16 mil ones as well for very, very short, eared rabbits, or we we'll use .

A 25 with yellows as well. They're normally the ones we use in the giant rabbits we'll easily put in a 2023, no problem. Perfect, thank you.

The next one we have is, are there any side effects after they are neutered for both male and female? Short term side effects, no, they shouldn't really be, they should be happy eating and drinking, they might be a bit quiet for the 1st 24 hours, just coming round for an anaesthetic, but they really should be eating and drinking and, and, and moving around. You don't need to be keeping them, .

Too, you know, too still. I mean, you need to keep them moving so that their guts keep moving around and they don't get gut status from being shut in. People always ask, should you be bringing them in out from outdoors, I think.

If you're gonna do that, you need to acclimatise them to be coming to come inside for a good couple of days at least before doing the nutrient and then bringing them in because you're gonna stress them out. I mean, whenever I've neutered mine, I always put them back outside, and it's what they're used to. I just make sure that they're not going on any sort of grass areas while the other the sutures are in place.

In regards to long term side effects, no, not normally, males tend to calm right down. You tend to find a, a male, entire rabbit mostly are very, very territorial, they're quite aggressive, sometimes can be quite difficult to handle, whereas neutered males are completely different. And then females, again, similarly, you know, so there aren't really any, .

Downsides to, to, to, to, to doing it once you're taking out your any sort of risk of an anaesthetic. Very briefly on risks, anaesthetic risk in rabbits is between 1 to 3%, depending on your protocols and what you're used to. You couple that against your adenocarcinoma risk, which is 50% in, in, in females, and your behavioural problems, which is very high.

I think it's worth, it's worth explaining that to owners, and I think they may understand a bit more, in regards to that as well. Thank you, the next one we've got is wash the practises to avoid the not good mothering dough. What's the what, sorry?

So it's what the practises to avoid the not good mothering dough. Sorry, I can't quite hear what you're saying there. That's OK.

So what are the practises to avoid the not good good mothering dough? So I'm guessing if, if you've got a dough that's not very mothering, what could you do to avoid er I guess the rejection? I'm thinking potentially.

Sorry, do you mean, do you mean like a, a, a doe that's not looking after the kids? That's, that's the way I've interpreted the question as well, yeah. I mean, if we're talking about like that's going on to breeding, really, but, I mean, if you've got a dog that's not looking after the kits very well, then you're probably gonna have to move the kits off and, and hand rear them, depending on the age of them.

It could be that she's very stressed out. I mean, it's breeding. It's not something that we, we promote.

We're trying to, you know, there's so many, rabbits out there. I mean, the last rescue count, I think, was like 68,000 handed in in one year, in 2019, I think it was. So, I mean, there's a huge amount out there in rescue, so it's not something that we routinely promote.

No worries, thank you. Next one, which actually I, I'm quite interested in your thoughts as well, V gels for rabbits. So obviously I'm aware, you know, quite a few practises don't actually use VGels, so what's your, thoughts on those?

Yeah, so, I intubate all my rabbits, using an altoscope and . Normally, a urinary catheter is a stt, and, and we visualise properly. Now, if you're going to use V jars, there's a couple of things that you need to bear in mind.

They have changed now, so they were multiple use of 99 uses. They've now changed so that they are singularly use. They are meant to be degradable, but thinking about wastage and things, is it something that you really need to be doing or should you look at or intubating?

Intubation is definitely a skill that you really should learn. So because if you've got an emergency situation, you know, it's a good one to be able to do, . It's one thing that we always teach our vet students, you know, and, and vet nurse students to do, and all my nurses can, can intubate the rabbits themselves as well, using a nooscope.

It's one thing we always ensure. They, they learn how to do before they leave practise from their work placements with us. With a V gel, then you need to still ensure that you are clearing the mouth out properly, because the last thing you want to do is put a V gel in and there's a, a strand of grass or hay at the back.

Obviously, with an otoscope and you're looking right back down towards the glottis, you're visualising everything and you'll be surprised how many times I, oh, hang on, got a bit of grass right in the back here that you wouldn't have seen if you hadn't put an otoscope right down. So even if you are going to use a V gal, you still need to visualise right down to that glottis and make sure there's nothing in place before you put your vegal in. You need to make sure it's lubricated and used in the right size.

Go in on a bigger size or so if you've got a 1 kg rabbit, then try maybe for the 1.5 size rather than the smaller one. They do create nice seals.

You can IPV with them. You should always use them with a catnograph to ensure that they are in correct position. And they certainly are, you know, have their place, they are useful, but I would really wouldn't, underestimate the, the, the, the skill and power of being able to intubate a rabbit.

Perfect, thank you. Next one that we have, we've got quite a few actually extra coming in, so I think we might be running out of time, for all of those, so we will obviously email, those answers through. The next one we've got is what age do you recommend in neutering a giant rabbits, and do we have any evidence that this is beneficial?

Yeah, I mean, there's no, as far as we're aware, there's no publications out there, but they do suffer from osteosarcomas more than any other breed of rabbits. So I think if we're going along the lines of, of dogs and later neuring for those reasons, I would look at the same thing with giant rabbits. Also, You know, the hormones do, do help to with their growth.

So the giant rabbits are very slow to mature. They will keep growing for around about sort of 18 months. So generally I'll need them from sort of 67 months upwards unless there's reason to do it earlier.

Thank you, I'm just going through and just picking some ones that there's some that are a little bit similar. What is your oxygen level during the spray and what is your preferred gas anaesthetic? What's our oxygen level?

Yes, so what is your oxygen level during the spray and what is your preferred, like anaesthesia gas that you prefer to use? The oxygen level will entirely depend on what circuit that we're using, and the size and the weight of the rabbit. So it'll vary anywhere between like sort of 0.8 litres up to sort of 2.5 litres depends on the size, but it really just depends on your circuit that you're using.

We generally use isofluorine. We, I don't have se fluorine here. But it depends on again, what your full anaesthetic protocol.

Anaesthetics is a whole other topic. And, I, I, there's, there's so many options you could be using here for them, and I think important is to find something that's working well for you, and where you're not having any problems with recovery. As I said, I don't use metoclopramide with any of my sort of routine things like this at all, and I don't have any problems at all with them.

They, they're always eating before, they go home. Perfect, which actually brings on to the one of the next questions. Must, rabbits eat prior to having, like NSAIDs like cats and dogs?

Well, a rabbit's stomach's never empty. So you'd have to starve a rabbit very long time to actually empty it. And what actually happens is it it just ends up dehydrating because the stomach is a shock organ.

So there'll still always be food bits in there and so if a rabbit is eating. Well, then there's, there's no problem at what time you give your, your NSAID really. But what you just need to be aware that, that rabbits are prone to stomach ulcers.

So if you've got a stressed, particularly stressed rabbit, it might be worth sort of covering with, I mean, like ranitidine, things like that to help protect the stomach as well. Fab, thank you. And we also have, would you recommend an e-collar for post-op care for rabbits?

Nope. No, I, I rarely ever use any sort of e-collars at all for anything. I mean, I think the biggest thing you need to be looking at is multimodal pain relief.

So if you, you know, I mean neutern meloxicam would be absolutely fine. You know, long, like, sort of, for the short term, you may want to add in paracetamol if you've got a particularly heightened bunny, but e-collars, rabbits aren't great for multiple reasons. They can't groom properly.

They can't eat their secret trophs. It annoys them. So if, if they're bothered by the wound, it's normally because they, they need more pain relief of some description.

Perfect, thank you. We've had quite a few questions on what we would use for induction. For an anaesthetic for rabbits.

Yeah, I mean, anaesthetics is a whole other ball game. It, you know, I think, that really is something that I'd have to talk about in a in a separate webinar. Most of our nutrients, I'm doing buprenorphine with midazolam, ketamine.

And inducing with Alfaxan, very slow dose, 2 kg, but, really, really slowly, like you give a quarter, you wait 30 seconds, you give another quarter, you wait 30 seconds each time trying to check the jaw tone. And once that jaws relaxed enough, you can intubate. Most of the time, we don't need to give the full Alfaxan dose at all.

But it depends again on what, what medication you are giving. Thank you. We've got, what would the complications potentially be in neutering rabbits that are older, so, for example, 5 years of age and older.

Complications, I mean, any sort of older rabbit ones, you know, you, you've got, your anaesthetic becomes a slightly higher risk. If you've had diseases, multiple respiratory problems, or you can or you've got existing dental disease or anything else, you know, that all becomes a risk and unknown rabbits like a rescue, you don't know what age they are. I think anything that that you know, you don't know the full history you treat.

You know, with respect and and and caution about for the anaesthetic point of view. From a surgical point of view, as I mentioned, the testes tend to be a little bit tougher to break that fascia down. So you just watch, you don't pull too hard because you can get hematomas.

So either go abdominally or just be very, very gentle. The space, again, it's that, it's that round ligament, it, it, it becomes very, very fatty, and those blood vessels are generally much larger. So, they just, they're just a little bit, just a bit more fri but you've just got to be very careful with your tissue handling, you know, yeah.

Cheers, and a couple of notes actually just based on you talking about the spay just then, would you normally use fingers to find the uterus or use a spay hook, and also is it possible to use just a with a flank approach? You really don't need to be using spay hooks at all. It's they're very obvious.

Like if you go in the right place, it's literally there every time you go underneath the, through the skin, through the muscle layer, your, your, your uterus is there. You, you, you don't need spay hooks. In regards to flank approach, you could go in and just do an ovarectomy, potentially in the flanks.

Yeah, that's to be similar to guinea pigs, yeah. Perfect. Let's have a look.

Just having a look through now. Quite a few questions on intubation and how you would, I know you were saying it can be quite difficult to practise. We've had quite a, a few, any sort of tips I guess on intubation.

So the easiest way to, to, to intubate is to use an otoscope, the long earpiece, the metal ones, get a full French urinary catheter, cut the end off with, with the, start up bit, the port. And then you use the the rounded end of the catheter will be your induction into the glottis. You need to ensure that you, that the head's in the correct position, so you, your, your rabbit needs to be deep enough to manipulate the head into the correct position, and it's also worth having to flow by oxygen over the nose while you're doing this.

You need to hold the head. I, I generally hold the head and put the otoscope in at the same time. And then you've got to really go over because the base of the tongue sort of does this, where you've got the tongue like that, and then the base of it goes up and over.

So you need to get your otoscope through over the tongue and then looking right round the back of the neck, down the neck, into the throat. You will then see that your glottis like like this and and the and the base is, is wider, so it's sort of like doing that and the, the, the ventral part is the wider section. Well, well, that's in, in place and you can see that you then insert your urinary catheter, which has got a little bit of lubrication on the end of it, KY jelly or la lube, anything like that.

Pop it through the arthroscope. It'll track it right down, right to where you want it to go, and you'll see it enter into your glottis. You then at that point then very gently remove getting someone else to hold the urinary catheter, very gently remove your otoscope.

As soon as the otoscope is out of the mouth, I hold on to the urinary catheter with my hand that's holding the, the head. The scope comes off the urinary catheter and you just slide your ET tube over the urinary catheter. And, even the size 2s will go over a full French without a problem.

And it'll slide right down, holding your head in position, and straight through into the glottis, and you remove your urinary catheter. The whole process takes seconds to do once you've got used to doing it. But the biggest thing is just start looking for that glottis.

Advice, thank you for that. It's not something I guess most practises would do every single day, so, very informative there. So, unfortunately we're gonna have to wrap it up now.

We are getting to, 1:30 on the dot now, but thank you so much, Doctor Sophie, for today. It's been a great webinar to listen and learn, and I'm sure everyone else can agree with me. And, obviously, if any, all the questions that we have got, left over, we will, get them all answered and sent to everyone in an email.

But also we'd just like to say thank you, to the Rabbit Welfare Association as well for sponsoring today. And that is the end of our webinar today, so thank you again, Doctor Sophie. No problem, thank you very much.

Take care, everyone.