Hi guys, and thanks for joining me for this webinar on how to surgically neutral rabbits. So intended learning outcomes for this session are why should we be advising neutering of rabbits? How do I personally, anaesthetize rabbits, the surgical step by step surgical procedure for construction.

And the step by step surgical procedure for the hysterectomy, and as we go through the presentation and I'll touch on any potential complications that we can see. Many of the drugs that we are going to be talking about in this presentation are unlicensed for use in rabbits, and it's informed consent is always required and. Each listener should check the regulations in whichever country they're they're joining me from, but certainly in the UK, the BMD are happy with the lifetime cascadeon signed for, any rabbits.

So why should we be neutering rabbits? Well, the human-animal bond isn't species specific, and it can be any type of animal, and, you know, that much life span for rabbits these days is 8 to 12 years. So if you're going purely on longevity, you know that that's a great thing, so.

I, I think the days of rabbits being seen as purely a child's pet should be confined to the history books, and most of the, thankfully, most of the rabbits that I see are owned by adults, and they're much beloved members of the family. So we advise neutering rabbits for exactly the same reason we advise neutering any species. Neuter, we neuter them for population control, hormonal control for behaviour and disease prevention, and I'll briefly go expanding each of those topics.

So population control, there is a reason why they're so bad, breeding like rabbits, and that's because of the gestation. Rabbit is 28 to 32 days. And once the dog gives birth, she actually comes into a postpartumistress so she can get pregnant again within a few hours of giving birth.

But that actual pregnancy goes into stasis, until she knows the, the current litter that she has. And because they are a prey, a social prey species and if you've evolved to be food, to set sizes make predators should make you feel better than than one, the minimum grouping, advisable if you're gonna be keeping pet rabbits is 2. It's an absolute minimum, and reportedly the best combinations in neutered male and a neutered female.

However, I've seen every combination work and I've seen every combination fail. So I'm actually a firm believer that sometimes it's the personality of the rabbits that's most important when a factor when picking a companion. So moral control for behaviour.

In my experience, it's actually the those that are much more territorially aggressive than than the males, which is contrary to some of the things you'll read in the books, but in over 20 years of working, with rabbits, I've castrated one buck due to territorial aggression, yet territorial aggression is so, so comically based. And female rabbits, think about his PMS on steroids, he's getting Monty Pythonesque rabbits for murder and the eyes and shark who should point the teeth and attack their owners for having the acity of feeding them because they put their hands into their territory. I mean think about how these animals evolved, because we should be remembering that rabbits have actually only been domesticated for about 500 years.

So behaviorally, they're still wild and in the wild, the boy's job is basically to eat, mate. And chase off the odd interloper, but the the female's job is to dig the warren. Have the cats, protect the cats, protect the nest, and the most dominant doe, in a warren has the deepest nest because the deepest nest is the most protected nest because the predators are going to come into the warren, they're gonna need somebody else's babies before they get to yours.

So not only is she protecting her nest against predators, she's protecting against every other doe who wants that as well, so. If we think about it from that point of view, it, it kind of makes sense why the door is much more territorial aggressive. In the bus, scent marking with urine, they, they like to do that, the way cats do.

In fact, a highly bonded rabbit will run around the male or female will run round the owner's legs and spray urine up their legs as they're doing it. And that's the rabbit going, love you, you belong to me, you're important to me. But the owner's not very impressed by that, so, we need to.

Make some owners aware that not to, to try not to take it personally because some owners will interpret it that a rabbit doesn't like them when actually the complete opposite is true. And mounting behaviour, so not all mounting behaviour is sexually motivated, those and bucks will do it. However, certainly entire bucks are much more likely to mount and mount aggressively.

I have a friend who's rabbit burst a football by mounting it so aggressively. And if the other rabbit, if the, the object of the the buck desires isn't a willing participant, then that's gonna cause fights. And if the if the rabbit is mounting the owner's leg or the pet chicken, things are are gonna go wrong.

So mountain behaviour would be the the next most common behaviour I see that I would be advising you to drink for. And if they're already displaying these behaviours premium, then we need to reassure owners it will take 6 to 8 weeks for the hormone levels to fall. Therefore, you're looking at 6 to 8 weeks for these behaviours to dissipate.

I just need to throw in spring fever here because fighting between con specifics can have a hormonal influence. So neutering will definitely reduce that, but even neutered rabbits are being known to succumb to spring fever and owners will sometimes notice that the rabbits might or just squabble or just be a bit more irritable with each other during the during spring. And Gwen Bradbury does a lovely bit on it in her book here, the a clinical approach to behavioural problems and rabbits, and I actually have a lot of my rabbit owners that I get to buy this book, because it gives them a real insight and it's an an easy to read book, so I would strongly recommend that.

The age that I tend to recommend neutering at is 3.5 months of age for your average and inverted comma rabbits, but if you're continental giant rabbits, I will, will want to mute them a little bit older, so 5 to 6 months of age because they take a little bit longer to mature. So disease prevention, well, if a species has a uterus, it can develop the same conditions as more familiar species because it's just a uterus and a different wrapper.

That's how I think of things and I'm very much a, I look at things as a body system as opposed to a species. So, rabbits can get pyometers, they can get mcuometers, but one of these kind of species specific things that. They do get up to 80% of those over 4 years of age will develop uterine adenocarcinomas.

And here's a postmortem picture of the, the rabbit died to something else, which is incidental finding here, having a very abnormal uterine horns with the, the masses in it. I have seen a uterine adenocarcinoma in a one year old rabbit before, and unfortunately, a lot of the time these tumours have already metastasized before you diagnose them. But also neutering, yes, the massive saving and the cancer spreading effects in the uterus, but they can get mastitis, they can get mammary tumours, it's just less common.

False pregnancy can be quite common indoors. It's got similar signs more fami. Species, including the aggression, and rabbits will often pull far from their ventral abdomen to line the nest, and I tend to try not to spay in a false pregnancy.

So if I notice that there's lots of milk in the mammary glands, then I will treat the cabergoline. For a week just to help settle that down because I have worries that just like it's been shown to happen in in the the bitch that if we need surgery during a false pregnancy that we could end up having behavioural problems later in life. Now that is just a fear of mine that has not been proven, but that's my approach.

So disease prevention in the box, so why, you know what, why, why do we use stuff for disease prevention? Well, species has testicles that can go get orchitis, neoplasia isn't as common in in males, but it does happen. They tend to be slow to metastasize, so at least castration's usually curative.

Cryptoridism isn't common in rabbits. I've seen a couple of cases over the last 20 years, and torsion I've included for, completeness sake. It's incredibly rare.

I've not seen a case of that, but be interested to see if any of you guys have. So the age I've I've actually already touched on that, most rabbits they'll do 3.5 to 4 months of age, but the giant breeds I will wait till they're a little bit bigger.

And what I want to point out, guys, is that there's absolutely no reason why we have to be doing this surgery and overweight or obese dose. In fact, my practise policy is we will not neuter, fat animals. It, it's contrary in my belief that animal welfare, it, it stresses the surgeons out, and it increases the risk, so.

I always advise a pre-op check and ensuring that the rabbits are the ideal body condition before we go ahead, because especially in those, but the primary fat storage site in those is the mesometrium mesoarium, as you're right to find out in these pictures. So if you're trying to . Neuter a dough that is already overweight, so there's already fat on the outsides of the rabbit inside's already chock a block full of fat, and that makes the surgery so much more difficult.

So first things first, sex your rabbit. I know it sounds obvious, but I, you know, I'm not too proud to admit I've been caught out when sexting young rabbits as well. And then you put them in, and you go to, to prep them, and I always routinely check the sex of, the animal again while it's his eyes on the table, and, and said to my nurses, who sexed this, and it's like you Madonna, OK, well I'm a muppet and I've missexed it when it was a baby.

So it happens to the best of us, so just a quick recap, we've got the female rabbit on the left of your screen and you can see cause whether you're when you're a rabbit, I should say something pops out, OK, and so it's not your gent anal distance, you're looking at, it's actually the shape. So in the female, it's slit, hopefully you can see my mouth's here. I'm circling the vulva, and we've got a slit going down the length of the vulva right down to the perineum.

So that's the female. This is the mature male, and what's hard to tell here is that there is actually a dot right at the end of the penis. So, the female's a slat shape, and the male is is a circle, OK, a circle or a doughnut shape.

And what catches some people right is the immature male. And I know as a young vet, this is what caught me out occasionally as well, because the on the far right of the screen is an immature male. And when the males are immature, it's very easy to revert the penis.

So this is an over reverted penis and it can make the centre look like a slit, and that's what can catch some people like, but if you can see that the slit. Here in this immature male penis is still surrounded by a circle of tissue. There, there, you know, there's absolutely no way you can convince yourself that that slit goes all the way down to the perineum like a female does.

So how I teach my vet students or if it's a slit and it goes all the way down to the perineum, it's a female. If it's a circle it's a male, and if it is, if it looks like a a a slit in a doughnut of tissue, so it's still surrounded by a circle. That is a meal, it's just an immature meal.

So we always want to admit our bonded cage mates and the bonding rabbits is scent based so if you split them up. When you're neutering, you only hospitalise the rabbit that you're going to be surgically, altering. Then a couple of things can happen.

One, the rabbit you've left at home can become anorexic through the stress of being separated from bonded mate, but two, because when you put them back together again, they, they smell different, the bond can break down and they can start fighting be very difficult to re bond them. And we all know rabbits that we've got away with that with you get some rabbits that are just so laid back. That it, it almost didn't matter what their pals felt like they would accept them back, but, I have had the experience where owners in the past refused point blank to bring in the cage mate, and when they tried to put them back together again, severe fighting ensued.

So now the policy is if, if they don't want to bring the cage mate in for me, then I can't meet their animal. We remind owners not to starve, really, because owners have to starve themselves before they go in for surgery, and if we've got dogs and cats, they have to starve them too. So although it's obvious to us, we don't starve rabbits, if they've never had a rabbit operated on before, we have to specifically say look, we don't starve rabbits, you feed them as normal.

And I, I tell them, look, bring a packed lunch with their favourite foods, and the owners can get really into this. I've had some absolutely beautifully decorated, lunch boxes. They come into the clinic with the rabbit's name on them and and sometimes they have a better looking lunch than me, but that way, as soon as the rabbit's awake, it's provided with familiar foods and its favourite foods it's tempted to eat.

Provide hides minimise stress. Now it doesn't need to be something fancy guys, it can be a cardboard box, it can be a large paper bag, it can be that half the kennel is covered up with a blanket. To give the illusion to the rabbit they can hunt.

We want to keep the ward warm and quiet. And if you aren't lucky, like myself, to have a prespecies ward, that's fine, it doesn't mean you can't do a good job with rabbits. What I would advise is that you just have a clip, classical kennel that you can put in a quieter area of the practise somewhere ideally that it's easy to keep warm.

So suture material when I'm operating rabbits, don't use cat up. They lack the isoenzymes to break it down so it can cause severe granulation, granuloma formation, and it, it makes adhesions much more common. My preference is viral, that's my suture of choice in rabbits, and I tend to use, for, I use the metric.

For my luggages, sorry, 2 or 3 metric for ligatures for my tuturing of abdominal muscles, and I use 2 metric and I use 1.5 metric for my subcutaneous and intradermal layer because of course we shouldn't be using skin sutures and rabbits because their incisors are based by sors and we do not use buss. So some species specific adaptations for surgery, we don't starve.

We've said that before, but the other thing is to remember is that rabbits have a really high surface area to volume ratio. So what does that mean? Well, that means they, they, they are more predisposed to developing hypothermia.

So we want to keep the deer to really warm, and I, I believe in keeping the ambient temperature up rather than direct heat, because I don't want to accident inadvertently cook the rabbit. So I tell my students if the sweat isn't running down our backs, my theatre isn't warm enough. You can bubble wrap the extremities should you wish.

Usually because my theater's kept so warm I don't do that. But if I'm doing an emergency surgery and I haven't got time to, to adequately heat my theatre, then I will do that. And I put towels down on the, the table, and the rabbit was on top of the towel, because again that keeps them warm.

Another thing that we should be aware of is that rabbits have a smaller volume of blood per unit of body weight than dogs do. So 60 mL per kilogramme that's versus 90 mL per kilo in dogs. What's that mean?

Well, really, it means that we need to be careful with our hemostasis, and I don't know if you're aware of this product that, I became aware of it last year. Co alot in the UK you can get it through IMS. If you're out with the UK if you contact me, I can let you know who your local supplier is.

And Cololo is an avian, . Colagen sponge, and rather than allowing a clot to form to the sponge, I actually activate the platelets at the blood vessel, and I love it. I absolutely love it.

It's got a long storage life, so it's like 5 years, it's cheap as chips, I think it's like 8 quid or a small bit of it, . So it was priced and designed to be used and to be kept for emergency, yes, and, it will stop a reportedly stop a femoral artery bleed. I, I have used it when I accidentally transected a part of a jugular and a rabbit doing a a tumour removal and, and it saved the rabbit's jugular, and so I always keep one in the theatre.

OK, so preemptive analgesia, rabbits have the same anatomical and physiological pain pathways that we do. So just because we can't necessarily understand their behaviour or their method of communicating that they're ill or they're in pain because they hide it so blinking well, I tend to think along the lines, well, if I'd find it painful, then they're gonna find it painful. So multimodal analgesia is always the best way to go.

I tend to use meloxicam, as part of my pre-medicine, and I use 0.6 mg per kg twice a day. I don't tend to go up to 1 mg per kg twice a day because I'm using multimodal analgesia.

I'll use paracetamol syrup, and I, I go for the, 15 mg per kg twice daily. Mirropotin I've added for completeness. I very rarely use that, when I'm used to ring, I just wanted to add it in there because it has been, shown to have some useful advantages for visceral as pain in rabbits.

But as you're about to find out, my preferred anaesthetic technique, and also all three agents provide analgesia. So all of my anaesthesia is done intravenously in rabbits, and I use the marginal air vein, and it's so much easier and you think, guys, vets haven't done it before, students haven't done it before, I always think it's really scary because it's a rabbit. And in my experience, the hardest thing about putting an IV line in when you first start learning to IV lines in is that the rain bounces.

Yeah, but the arch in there again, guys, it's super glued down by the skin. It cannot bounce. It is a thing of beauty.

OK, it's absolutely fantastic. And Elaine is your friend. It's, a local anaesthesia cream and the literature state you have to put it on for 20 minutes, half an hour wrapping cling film.

My experience less than 5 minutes. So what I tend to do is I put them on, I shave up both ears because just like in more familiar species, there's always one being bigger than another. I put in one both and then go and calculate all my drugs and pull up my drugs, and then the time I come back from doing that, I can place my ID like.

The added bone, another added benefit of MLA apart from the fact it causes local anaesthesia. Therefore, it's the rabbit doesn't struggle getting IV lining is it also causes venal dilation, so it facilitates it. Here's a video.

Here I tend to use wind catheters. Because I use them to bend right, you can actually see that this vein already was, was standing sharp and slightly proud for being veodilated. OK, it's very superficial and so you have to go in a much shallower angle than you would with a dog or cat.

You can actually see the catheter run up the vein. I mean, look at that, beautiful. And then what I would do is I would bend the wing, the catheter around the edge of the penny, and then I take it in with micropo above and below, just like I would if it was a dog's leg.

I don't put a bandage in, I, I don't put anything inside the penny to straighten it out. I tend to find that less is more because they're more likely to try and pull it out postoperatively or even preoperatively if the ear weighs too much. So I, I, I very rarely get problems with it if I do it that way.

The rabbit is burritoed as well. OK. So my preferred G cocktail is tropical moon rabbits, that's dormitory and ketamine, so meatomidine pitoph and ketamine.

I've been using that cocktail for about 22 years in rabbits, and the only thing that I've changed is the, the dose and the root. Cos I used to give it, subcutaneously as a new grad, much higher doses, and it took ages to go to sleep and then changed it to intramuscularly for a year until I read a couple of papers where rabbits had self-mutilated and partially chewed off their own hind legs after ketamine injections I am, so I've not given an intramuscular injection or a rabbit for about 16 years now. So, for about 15 years now I've been given IV.

To effect, so I mix, if the, the bottle of metamidine is 1 mg per mL, I put 0.1 mL per kilo. So I've literally worked it out for you guys here.

So, and I've got the strengths of the drug behind the drug name. So 0.1 mL per kilo, metamidine, 0.05 mL per kg meal, 0.05 mL per kilo ketamine mixed together in a syringe and I give it slowly IV to effect.

And that usually the vast majority of rabbits is anywhere between 25% and 1/3 of the total volume. But what we need to also remember is that this triple combo is really good analgesia as well because metamidine, butorphenyliketamine all have an analgesic effect in different ways. To intubate or not to intubate, whether I intubate is really dependent on why I anaesthetizing the rabbits.

I do not intubate for a rabbit castration, purely because I've been doing this so long I can get straight at a rabbit in less than 5 minutes and it takes me longer to intubate than it just straight. That's me personally, so I only actually intubate rabbits for head surgery, not dentals, but if I'm doing eucations, or ear surgery, . If I do abdominal or thoracic surgery in rabbits, I will intubate, or if I'm doing a procedure that I think's gonna an amputation that's gonna last longer than 15 minutes, then I'll intubate.

And the hardest thing about intubation is, is ensuring your assistant is holding the rabbit properly because I'm gonna teach you the technique that I use for. Direct visual intubation and, and again sounds scary, but I shouldn't do it, and, and they do it really well. So as long as you're sitting and holding the rabbit properly, then you'll be fine.

Once the rabbits anaesthetized, then we hold the rabbit square on with the basically dangled by its head, extend the head so that the nose is pointing vertically and you lift the rabbit by its head until the front 2 ft are just off the table, OK? And then I use, an orthoscope, I use the long cone. I always have a sterile cone, and I, if your assistant isn't holding the rabbit straight enough, then you're not gonna get it in.

I'm A 2.15 uncapped the vast majority of rabbits, some of them are continental giants. I'm looking at a 3.5 or a 4, I think it's the biggest one I've used.

But you judge the size of the tube required based on the size of the glos, so I usually have at least 2 or 3 tubes. You're gonna go down vertically and you are going to feel that this is completely wrong when you put your corn in because almost the whole length of the long cone cone will be in and sometimes the tongue can go blue because you're pressing on the tongue. And once you've pushed it in vertically, then what you're going to do is pull the handle up a little bit and what that does is it tilts the the cone towards you.

And Because they have a really sensitive larynx, we do want to spray with some in bees, and I just literally move the magnifying lens out the way and spray in bees down the scope. And we know that they're all the nasal breathers and epiglottis articulates with the soft palate, so this is what you would see, that's your, your. Cartilage is at the entrance to the here, the reason it's kind of blurry is because the epiglottis is over it and see if you just touch it with the endoscope or with your ET tube it disarticulates.

And the reason I prefer direct vigilation over blinding situation is this. This is a rabbit that there's the epiglottis here, this is here, and that is the grass seed or the seed that another vet had almost accidentally pushed down into the trachea when I got asked to come into theatre to intubate because they tried to do it blind and couldn't get the tube. Bin and now I've successfully managed to remove that before I went into the trachea, but, that's why I, I, and I know plenty of vets that I respect, and they're excellent vets that, do blind intubation and do it really, really well, and I haven't had a problem, but this is why I don't do it because of my fear that this could happen and that is a, as you say, a photograph of an actual case.

And then we would tie the tube in securely just like in a dog or cat, and I do have a 3 strikes in your right roll, and we can all have bad tube days, and repeated, repeated attempts can cause trauma and you can get laryngeal edoema or spasming. So if I can't get the tube in, then mass maintenance is acceptable and I just have to accept the fact that if, Something goes wrong if this animal crashes, then I'm not gonna have the control, over the, the respiratory system as well because if I'm trying to artificially ventilate this animal then I could actually just be pulling up the stomach. So here is a video of intubation.

And you can see how that I've got the rabbit d off table and that's me using gravity to help straighten out the neck of this animal and I've got all of that scope in. Spree And often as I'm I'm because you can see. I can actually see the ET tube going into the trachea.

Sometimes I find just twisting it slightly just to go in. I should have said make sure you take your connector off cos the first time I tried this, I didn't take the connector off, which was silly. So you can get it done.

OK. OK. So give it a go next time then.

For complete list of instic early devices like your Egel rabbits, my opinion personally, I think they're really expensive. I think the, the advanced one that's come out, it's a single use, so for me that's, it's kind of wasteful, if we're looking at, at, environmental impact point of view, I've been told that they can't disarticulate, I have. Spoken at several conferences where anecdotally vets and RBNs have told me that in their clinic they did disarticulate and you know, if, if they're being used, if they, if they advise that you should really be using them with a catnograph, well, that's to ensure that they're not, they're in the right place, OK, because, just checking that carbon dioxide is coming out.

And personally I think they descale vets and, and I will, I will, . Explain why I'm saying that in a minute. I will admit they are useful in an emergency situation and to get quick control, so I can understand why practises use them completely.

I don't, I don't have any in the clinic, but I, I do want to put in, I can't understand why people use them. But what I mean by descale is that I have to intubate many species, so this is a rat that I was had in Tropien, so, which is relatively common in Rex type coats. And because I was doing an eyelid surgery, then I could not do it using a mask, and that is a 16 gauge IV catheter that I used to integrate the rat with, but if I hadn't been used to.

Doing direct visualisation and intubation, then I would have found that way harder. So it does increase your confidence and increases your ability because if you're used to giving it a go and having a look down, then you're much more likely to do it with other species. So you connect to oxygen minimum 1 litre per minute.

I tend to use an ATPs, lubricate the eyes, we've got large canass and the, the eye's gonna stay up because we've got ketamine in there and you're not gonna blink, so we want to ensure that we're protecting the canneas. And for maintenance, well, you've got the rest of your solution, your cocktails, so you could just inject more do ketamine as needed, or you can connect to isoflurane. Or see the flu, but I would hasten to add that see flura would be used off licence because it's no isoflurane that is actually licenced for rabbits.

Positioning, they have a really small thoracic cavity compared to a large abdominal cavity, but also rabbits are mainly diaphragmatic breathers, so they rely on movements of their diaphragm to breathe and because of the weight of the abdominal organs, if you've not elevated the chest, it does actually make it much harder for them to breathe. So I tend to fold a wee towel up, just have it under the thorax, and that allows gravity to shift the abdominal organs off the diaphragm, making it easy. Surgical prep, this was actually a rage rabbit, but we want to clip minimally because we're trying to reduce air loss, sorry, heat loss.

We don't want to over wet them again, we're minimising heat loss and don't use surgical spirits, so I tend to use only one scrub agent and that's, that's still hi for me. Surgical spirit d drives by evaporation, so that increases their, their heat loss. I use transparent plastic drapes because you can actually see your patient through them, and you can see them breathing, but not only that, or with your bigger rabbits, I use app alert so I can hear them breathing anyway, but not only that, it keeps the heat in.

They're actually relatively inexpensive, 50 pounds, something like that, which can add to the, the cost of your general anaesthesia, and I use an adhesive spray to hold in place. Monitoring, it's mostly the same as other species, we can use jotto and hind limbedo and ear pinch and they should all be absent and and the rabbit, and some of the texts will say that they should have a full limbedal very faint. To be honest, I've never been convinced by that, and I tend to prefer it without, pulse symmetry, yeah, .

It can cause compression of the tongue in some of the smaller rabbits, so what I tend to do is just stick a cotton bud in between it. So the sensors here and I've got cotton bud to help alleviate some of the pressure on the tongue and it works beautifully. And a lot of the texts will say that you can get unreliable readings and methamidine, I've not actually found it to have an issue.

If I'm getting unreliable readings on the ear, I'll change to the tongue, or if I'm getting no if I'm not getting readings on the tongue, I'll change the ear. Most texts that you'll read will say the people reflexes remain, but we've got to remember the fact that we're using ketamine, so that's gone. Doppler, I've put in for completeness cause I tend to use my Doppler just to listen to their heartbeat, although I do have an ECG machine now that I use as well, but for completeness, I'll put that in there for you.

And Broadbelt 2006 found that 64% of perioperative deaths in rabbits actually occurred during the post-op recovery period. So we're just going to talk very briefly about the recovery period before we move on to the step by step surgical techniques. So recovery, the metomidine is reversible, so I use antirazole, 0.1 mL per kilo, so same dose or up to 5 times higher dose.

And what we need to be cognizant of is that if we reverse the metomidine, we're also reversing the analgesic effect of the meatomidine. But that's fine guys. I never delay my recovery.

An anaesthesia to just keep that extra analgesia on board because I've already got analgesia on board from the meloxicam. I've got analgesia on board from the paracetamol, from metorphinol, from the ketamine. So that's 4 different analgesics and the metaone means the analgesics.

So if I just that, that's fine. We intubate them when we start to get increased jaw tone just the with cats and. Because we don't want to wait till they're coughing because of the sensitive larynx, and if they're starting to shiver, so shivering thermogenesis is, is, it's a sign of recovery signs that they're starting to come in from the anaesthesia.

We want to monitor and recover ideally in an incubator. We don't all have incubators, so what, what can I use then? Well, I really want about 26 degrees, until the rabbit is up and it's moving about.

Once it's up and it's moving about, you can reduce down to our temperature. And what's fully awake, syringe feed, and my rule of thumb for syringe feeding is 10 to 20 mL per kilogramme per feed. So we're gonna talk aboutration night.

What do we need to remember about rabbits? What's different about rabbits is construction. Well, they've got open ankle knock canals.

What does that mean? Well, that means that if you do not restrain the testicle adequately during the surgical procedure, it will disappear back into the abdomen. And it also means that if we do not find a method of closing over the canal, then you are leaving a space which could potentially result in herniation of abdominal organs into the total sack.

So there are 3 main techniques. I'm gonna teach you the close technique, I, I'll just briefly tell you about them. You've got the open technique, which involves cutting into the vaginal tunic, removing the Tesco, ligating, and then ligating the.

Vaginal separately removing it there by convert it back into post. You've got the semi open technique where you Take the vaginal tunic out of the scrotal sac, you nick it to ensure that you've got all the testicles, so that's your semi-open, and then you do the rest of the surgeries as if it's a closed, castration. And then the third technique, which is the complete closed technique, which is the one I'm going to teach you.

So for the, because they've got open inguinal canals, what I do is when I'm frustrating them I hold the testicle. Between my ring finger, so this my palm is facing up, my hand is at the cranial edge of the testicle. So I, I clamp the testicle between my ring finger and my middle finger, and I'm holding that really tightly here, OK, because otherwise what can happen is that any pressure that's on that testicle, it just shoots back into the abdomen.

So then what I'll do is I will use my. Thumb and forefinger to stretch the skin into the testicle, but you can see I've still got the base clamped between these two fingers. Holding my pen, my scalpel in a pen like that, I, I incise carefully through the skin because it is quite thin.

And if you're too eager, you can sometimes accidentally go through the skin, straight through the vaginal tuning straight into the Tesco. So at the end of the day, if that happens, it's not the end of the world, it just makes it a bit more fiddly. So whilst ensuring that we've clamped the testicles still between these fingers at the base, now that incised through the skin, I'm going to use my blunt blunt scissors, to, undermine to blunt dissect between scrotal sac and the vaginal tunic, and I do this in all four quadrants, OK, so there, left, that way, that way, that way, and that way, OK.

So once I've, I've bluntly dissected then, and while still maintaining my hold in the testicle, I'm gonna use my other hand to gently squeeze the caudal pole of the testicle and what that does is that it causes the testicle within the vaginal tunic to to pop through the scrotal incision. So once I've done that, I will put a pair of artery forceps on the epididymis through the vaginal tubic before I've let go, OK, which isn't that ob in that picture, but that's what I've done before I've let go. And don't worry about damaging the testicle case causes some vets will say to me, but Donna, I'm really worried that that I'll damage the tests within the vaginal check.

It doesn't matter because we're gonna be cutting it off and put in. Incineration anyway, what I want is that you have hold of the Tesco within the vaginal generic so that it can't disappear into the abdomen when you let go. There's often, so now here we've got your testicle inside your vaginal tunic, your artery forceps across the epididymis through the vaginal tunic, scrot sac is in in my right hand here and there's a ligament or a soft tissue attachment between the head of the vaginal tunic and the scrot sack, and that can be quite tough, OK, especially in mature box.

I need to break that down, sometimes I've even had to cut it with a pair of scissors here. So what I am now doing is I'm holding the actually goes it vertically, I'm not pulling up. I'm not pulling up, I'm just literally holding it vertically and I'm using my other hand to strip the scrotal sac down away something and that's breaking down any leftover soft tissue attachments.

Sometimes I will have to use a swab to do that, especially if it's a mature buck. The testicles are quite long and this rabbit has a really obvious testicle within the vaginal check. They aren't always that obvious and the fat pad can be visualised through the vaginal check, so that's the fat pads, got the testicle and we've got the epididymis here, OK.

So I've traced my clamp cranial to the testicle and I don't pre-crush, in rabbits because their soft tissues are quite delicate. So place my clamp and we use a transfixing ligature. And that we, we, we're showing that we're catching everything, so I use my transfixing ligature, and tie that and what we need to be careful of is when we're tying our ligatures that we don't accidentally pull up because you can rip things out of the abdomens, when you're, when you're dealing with these more fragile tissues.

So all of the movements should be coming from our wrists, the tissues should be moving early, and when we're, we're tightening up our legs really her wrists should be moving naturally, . I am a paranoid android surgeon. I like to double ligate everything.

So I will perform a circumferential ligature as well as a transfixing. It's just the way I am. And I prefer hand ties because I feel that I've got a better feel for the tissues, and I can feel when I'm bedded my ligatures down better than using instrument ties.

Once I've done both my ligatures, I then put a second set of artery 4 sets directly above the first set. That's so that the artery four sets are touching, and I hold the bottom set still and we take the, we take the top set away while twisting at the same time. And that'll often just cause the tissues to rip, which allows some bottle ligation.

But if they don't come away cleanly, then I will just use scissors being cut between. I hold the testicular stump and my rapped tooth forceps and release the forceps and I'm checking for any bleeding. Don't put tension on it cos if you're holding it up, then you could be artificially preventing a bleed.

So I will relax it down so that I'm ensuring if there is any bleed. I'm aware of it and then say bye bye guys. As vets, we're superstitious lots.

OK, if you're anything like me, and I say bye bye to every single one of my stumps because the one stump I don't say bye bye to is the one I'm gonna have to open an animal back up for because something's slipped. I put the stump back into the scrotum. I then hold the scrotum skin together and actually the sages don't sack until they come into alignment in a straight line, and I use tissue glue.

The skin's very thin, so intradermals I find incredibly difficult to place in them. And I don't leave them completely open because I don't want shavings or other debris going in. And then apply Ela to the wound once the wound flue is healed, cos that's yet another form of local anaesthesia.

Post-operative care, you keep warm, we give the antiramazole, syringe recovery, monitor the faecal output and continue on with analgesia at home for a week. Usually with constraints it'll be blockam 0.6 mg per kg twice daily for a week.

So we'll move on to the hysterectomy, so what are the species specific adaptations for an OVH and a rabbit? Well, they've got a really large sum and it's in close proximity to the abdominal wall, which is scary biscuits. If you do not take that abdominal wall properly because you run a real risk of of inadvertently punctioning that, which is, is, is difficult to get come back from.

Their soft tissues are verifiable, and they're visceral soft tissues, the muscles aren't, you can actually put a lot of tension on the muscles, but their visceral soft tissues are. Rabbits don't have a uterine body, they have two uterine horns and two cervices, which we'll go into more detail. And I tell my students that you have to get a train and a bus and sometimes a taxi to find an ovary and a rabbit because it's, whereas we're a more familiar species and dogs and cats, though these are right beside the end of the uterine body.

It's a horn, not in the rabbit, it's like 1 to 2 inches a week, OK, so we need to be aware of that so that we're not inadvertently leaving these ovaries behind. And rabbits form adhesions really easy. You look at easily, you know, they are actually used in the human side of things for adhesion studies and any any of you that have either unfortunately had abdominal adhesions or have a friend that has will tell you it's incredibly painful, OK?

So. We will, if you're using gauze swabs in a rabbit's abdomen, it should be pres soaked with sterile saline to minimise the risk of a dehesions, and that is also why we will postoperatively before we close the abdomen, rinse that now with worse. So hopefully this picture, these pictures will adequately demonstrate to you why, another reason why I like neutering at 4 months, 3.5 to 4 months of age, OK, because this is the young do on the left-hand side, and this is a mature on the right hand side.

The mature dough, the memetrium, the mesoarium are completely full of fat and that dough was not overweight. OK, that is normal. But once there's a lot of fat there, it makes it much more difficult to operate, and, the, the fat melts when you're handling it, it's like operating a chip pan, increase the risks of bleeds.

So that's why I, I, I do not, I will not neuter an overweight animal. I will put them on a restricted calorie diet, see a safe restricted calorie diet to get the weight first. OK, so we've got an ovary there.

Or uterine horn, look at the difference between the the distance between the ovary and the uterine horn, and uterine horn ovary. Make the wounds as large as you need to guys, . It's wounds heal side to side, not end to end.

Yes, of course, a smaller abdominal wound will mean you're losing less heat in the rabbit, OK, I get that, and I get that a smaller abdominal wound could potentially mean that this that you're holding the scum in better. When you first start learning to do rabbits space, you need to see what you're doing. And it's completely unrealistic to expect a vet who's newly qualified to spay through the same size wound as a, a 2 qualified vet.

It's, it's, and sometimes it's us, sometimes it's us that put the pressure on ourselves that we need to do it. But most of the vets that I, that I know of that run into problems per often cos they're trying to operate through a room that's too small for their level and they can't visualise properly, OK. So my attitude is to in Spain, any species is, first you learn how to do it properly, then you learn how to get faster, and then you learn how to do it through a smaller home.

Landmarks are the Belkus. Now, this rabbit here actually has a fairly obvious umbilicus. It's highlighted by this blue arrow.

Most rabbits do not have an obvious umbilicus, OK, so my, my landmarks, if I can't see the umbilicus are the last two nipples, causal two nipples. I usually I'm going to start my incision, about 1 inch caudal to the umbilicus, or where I imagine the umbilicus is, and I, I extend that caudially to halfway between the teeth nipples. I bluntly dissect any subcutissue to expose the abdominal muscles.

What I should have, there's a slide missing there potentially guys, because when you expose the abdominal muscles, the line albas and that obvious in rabbits. And if you go right down to the muscles, what you will find is that there are 3 lines. There are 3 lines.

And if you can only see two lines, it means your rabbits, skew with, so it's, it's not completely straight, so try and straighten up because it's the middle line that's the line alba, so you go for the middle line, and it's the way that their fascial layers come together with their muscles that that makes it look like they have three line albas, but they don't, the the the proper linear alba is the middle line. This postmortem picture I put in just to show you how large the scum is and how it is literally just below the muscle in this radiograph, you wouldn't normally expect gas like that, that's completely pathological, but it does highlight how how closely in a position the sequence sits of the abdominal muscles. So, there's one of those lines, and if you can just see here I'm highlighting with my mouse.

The other line is the line elbow which is holding, pulling up, and we've got a line that you can't see on the other side of the rabbit which looks exactly the same as the line closest here, so 3 lines, pick the middle one. Look at how much I'm pulling these muscles up, so I'm tempting them to ensure that the sum is falling down, and we're gonna do a reverse stab incision, and I, I literally just put the tip through my muscle. Those close eagle-eyed eager beavers along you will notice that this is a this is a rabbit.

I didn't have any pictures that showed any cutting the muscles with my scissors pointing up the way. and I, I wanted to point out that we always need to ensure that our scissors are pointing up the room when we're cutting because I extend my wounds and in the abdomen using my scissors, because if we're not, if scissors aren't pointing up, you could inadvertently nick something that you shouldn't. And remember you're an anatomy guys.

The uterus is always gonna sit between the bladder and the descending colon, always, OK. So when I get into an abdomen, first thing I do is I look for the bladder every single time. And more often than not, to be fair, when I open into the abdomen, the bladder's sitting there and then the, the uterus is going, hi Madora, but if you can't find it, look for the bladder.

Bind your uterus and follow your uterine horn. OK, and the ovary is coddle to the kidney, and you can see that the uterine horn and then it goes into the incondibuum which actually goes cranial to the ovary and then comes back around the ovary. And some rabbits' ovaries have got cysts in them like this one, some have black melanistic dots in it, and other ones don't.

Some of them, some ovaries and rabbits are more fawn, some are more creamy, they're all, they're all different. OK. The remembering our anatomy helps because here's the uterine the uterine horn in my right hand, here is the ovary, that is the ovarian ligament and running perpendicular from the ovary which I'm highlighting with my mouse is arian artery.

So this is me ligating the the vaing artery. So I'm using my thumbs, my fingers to break down the vascular window. We do not pre clamping rabbits.

So that's internal plastic vagina, that's one uterine horn and that's other uterine horn and there's two services. I'm ensuring that I don't have anything in my clamp that I shouldn't have. Just speak through this a little bit because I seem to take an age to get my suture material for my ligature.

There we go. Pass my ligature through. Shooting again, I've not got anything in there that I don't want to have in there.

I had ties or tree. I don't she. Which is harder and The tighter I'm pulling it, the more fingers I can get in.

And I'm pulling it as tight as I can, to be honest, I pulled my ligatures until I hurt myself, because when I can feel it nipping my fingers, then I know that I've got my ligature tighten up and I've I've bed it dying. And I'm assuring that I'm not pulling up at any moment there because you actually not only do you loosen off your ligature, you can actually rip organs out of their abdomen because they're fat, you look at the fat and blood. OK, so that's number one ligature.

And I go to. 2 ligature. Which sometimes will bed down into the crash.

I'm not tying it on top of the other one, it's beside it. When I get my statements or for it. It's The above just touching.

With the bottom sets still and turn and twist set away. I've left a little bit of infodibuum there, which I will remove. That's just what to say.

Because I noticed I left it there was no blood by bye. OK. So we're ligating the we're moving on to ligating tri vessels we've taken both we've ligated both her ovaries.

They look at our anatomy here guys, in case we've got our ovaries, we've got them clamped off here and here. We've got our internal las vagina. Our services.

And highlighted with our white arrows or uterine arteries. Now think of the uterine arteries as a tree. So this is the trunk of the tree and then it starts to branch out into the, the branches and rather than liate all the different branches, it's better to write .

Like it the Trump. We need to be really careful, guys, because if You go too deep into the animal and and too deep into the rabbit, you do, that's where you run the risk of inadvertently tying off the ureter. OK, so you don't want to like get uterine artery.

To eventually. What where I tend to like get to ensure I'm as far away from your choice as possible is just before it branches, just before it branches, then I know I'm absolutely nowhere near it, and you can see that there are there's an avascular window here and there is actually one on the other side and the same here. So this is me.

So there's your, your uterine artery here and it's just starting to branch out. So I'm, I'm using the coursecept to break down the vascular window just. At the trunk just as it starts to to branch out.

The reason I've changed, I was getting some ooze blood here, which is why I, I . Coming through one of the blood vessels and the fat, which is why I, I altered where my for my arter forcep was. OK.

And we don't see clamp. Minimal movements, soft tissues, you just can't see them because my hands are in the way. Some like.

And I tend to, as I'm, I, as I'm tying each one, I, I'm pushing down and I've trained myself to do that cos if I'm pushing down the way then I can't inadvertently be pulling up, if that makes sense. I caught COVID twice last year, guys, and sometimes my words go missing, which is why, those of you that I seen before might have found that this time I'm a little bit more hesitant and I'm see it clearly because I reached your word and it's not there. Medicine surgery is all, all still in my brain.

I just can't get it out of my mouth. OK. So, I'm a double light gator by nature, if I have space, I mean I suffer from insomnia anyway guys, so, if I can put two ligatures on then the chances of something slipping is always gonna be reduced.

Secondary. And those eagle eyed ones amongst you will be looking there going, Donna, that's shocking. You a curved horseset and then a straight.

Yeah, that's why I'm now having to cut the tissue rather than just tear it. All right. OK.

So we've done our uterine artery, that's fine, and we're now moving on to removing the uterus. This, these aren't puddles of blood, it's blood stained fat, because the fat has started to melt, and it's disgusting. But, and it does make life a bit more difficult, but, you know, that's in a rabbit that's in a normal body weight.

So we're removing the uterus, there's 3 schools of thoughts, so you go above, below, or between the services. So if you go below the services, so this is cervix number 1, cervix number 2, internal plastic vagina, there's the cervices here. If you go below the services, then you're removing all of the uterine tissue, but you're going into the internal classic vagina, and what you need to be aware of is and remember is that when the door passes urine, the internal class of vagina fills up the urine.

So if you haven't ligated it properly or if it's quite a lot of tissue and you haven't overseen the stump, then there is a risk of hemolain. So we need to be aware of that. If you like it above the services, then No risk of your abdomen, but you are leaving some uterine tissue behind and if it's a very young doe, then you can't start you get away with it.

But if it's an older doe, then we do need to remember that that uterine tissue has already been sensitised by the hormones, therefore you could still get uterineal carcinoma even when it's been neutered. So I tend to go between the cervices, and the reason for that is if you go between the cervices I should be getting all the uterine tissue. I'm leaving some cervical tissue behind, but actually cervical disease is exceptionally rare in rabbits.

I could not find anything in the literature on it, and I've never seen a case of of it. But again, if any of you have interested to hear, but I go between the shower because I'm, I feel like I've got the best of both works. No risk of uroabdomen and should have no risk of uterine adenocarcinoma.

And I use a transfixing ligature and a circumferential, so I use my transfixing ligature go between the the cervix, the the the cervices, with the needle now. What freaked me out the first couple of times I started doing this is that you put your needle through it and it starts bleeding. Don't worry about it cos it stops once you do your, once you've done your full luggage or now if I get any news of blood cos I've put my needle through the between the services, I, I genuinely don't worry, I, I just keep going and keep tying it, OK?

So I tie my transfixing ligature and then I do circumferential ligature. OK. So that's the internal plastic g here.

I've done both my ligatures, then I put my art sets on. So I'm going right through the surfaces here. You can see where it's joined.

And we don't have the same body, we have to use horns. It's weird watching yourself operate, guys. OK, and I'm stretching the tissues because they're never gonna fully wrap.

I'm just stretching the tissues to give me more space to go in. Sometimes I'll go in with my blades, sometimes I'll go in with my scissors. OK, and then I'll hold it, make sure everything's OK.

And then say bye bye, and I'll then go ahead and check all my sons, make sure I've got no lu no bleeding, there's no clots that, that tell me that, OK, the bleeding's maybe stopped, but there was a bleed there before, therefore, when the rabbit recovers it might be bleed, and providing that's OK, I then, flushed the abdomen out with sterile saline, warmed sterile saline, and. I'll put 500 mLs in, and I'll leave a lot of it in because it helps, rehydrates the the surfaces of the viscera, and of course if they're dried out in the heat and an ambient temperature, then that can cause areas of adhesion when the rabbit wakes up, so we're gonna rehydrate them, but also rehydrates their ambi too. So I hold the muscle aches up.

And then once we're closing, we're almost there guys, you've almost made it to the end of the, the presentation, so well done, we want to really tense those muscles up when we're. When we're sturing the abdomen shut because it'd be a shame to do a beautiful spray and then inadvertently stitch the muscle layer onto the sea cum, and I use cruciate sutures in the abdominal musculature of a rabbit because it counteracts tension at every angle. Rabbits like to do the things like thinking, so I want to ensure that I'm counteracting this tension, and I tend to put my central abdominal suture in first, .

Pure that that actually is a is a personal choice for me. I use that as a stay stitch to keep everything in, and that's a hangover from when I used to be forced to stay or be stitches and, you know, everyone's trying to come out and get me and and and I wasn't allowed an assistant to hold things in so I put started putting my central and my closing my abdominal wounds by putting my central sutures in first and then closing the muscles, . From the inside out, and that's what I have now it actually works quite nicely in rabbits.

So that's why you can see I'm in the centre of my my muscular wound there, tenting up, what I find with cruto then the second throw over tightens and muscles are all bunched up, that's when rabbits can chew through their wound, because it's painful. I, if there's a subcutaneous layer, I will close it. I will close it even though it's, it's thin, using an a simple continuous pattern, and I close it for several reasons.

One, I cut through it, therefore I I think if I cut through things, I'll try and repair them. And 2, it helps keep my knots out of the way when I'm doing intradals, because otherwise what tends to happen is that the ends of your knots keep trying to poke up through the, through the, the skin layer, . I use 1.5 metric if I put on a needle internally and then I applied.

Who self care, keep warm, as we discussed before, I will reverse them, and if the rabbit, it doesn't require reversal, I wouldn't. You know, if, if it's extubated and it's already start lifting its head and it's fine, and I, I don't routinely reversal. It's just like we don't always routinely reverse if we've used Door or metamidine for pre-med and dogs.

It, it's, it's just if required, I will reverse. I'll syringe feed once it's fully awake. I will on to the faeces and I'll continue on with analgesia for at least 10 days.

And I will use Metacam and and paracetamol, and those. 10 days and I will dresslo for a week. I touch you would have not had any issues, but there are cases in which usually the bigger rabbits of them running about and bing up in the air and, breaking down, their abdominal wound because of that with some devastating results.

So because the, because I've read that, it makes me nervous and I tend to tell owners that I want that I'm interested. But cage rested as in not a tiny hutch, cage rested as in I want it inside of its enclosure, so it can still help out because movement is important for gut mentality. I just don't want it running full belt around the garden, or the house doing pinkies.

So hopefully you found that useful. If you've got any questions, as always, feel free to drop me an email that's at the beginning of the presentation and thanks for listening.