Major Survival Surgery

From the Guide for the Care and Use of Laboratory Animals, page 60-

"Appropriate attention to presurgical planning, personnel training, aseptic and surgical technique, animal well-being, and animal physiologic status during all phases of a protocol will enhance the outcome of surgery (see Appendix A, "Anesthesia, Pain, and Surgery"). The individual impact of those factors will vary according to the complexity of procedures involved and the species of animal used. A team approach to a surgical project often increases the likelihood of a successful outcome by providing input from persons with different expertise (Brown and Schofield 1994; Brown and others 1993).

"A continuing and thorough assessment of surgical outcomes should be performed to ensure that appropriate procedures are followed and timely corrective changes instituted. Modification of standard techniques might be desirable or even required (for instance, in rodent or field surgery), but it should not compromise the well-being of the animals. In the event of modification, assessment of outcomes should be even more intense and might have to incorporate criteria other than obvious clinical morbidity and mortality.

"Presurgical planning should include input from all members of the surgical team, including the surgeon, anesthetist, veterinarian, surgical technicians, animal-care staff, and investigator. The surgical plan should identify personnel, their roles and training needs, and equipment and supplies required for the procedures planned (Cunliffe-Beamer 1993); the location and nature of the facilities in which the procedures will be conducted; and preoperative animal-health assessment and postoperative care (Brown and Schofield 1994). If a nonsterile part of an animal, such as the gastrointestinal tract, is to be surgically exposed or if a procedure is likely to cause immunosuppression, preoperative antibiotics might be appropriate (Klement and others 1987). However, the use of antibiotics should never be considered as a replacement for aseptic procedures.

"It is important that persons have had appropriate training to ensure that good surgical technique is practiced, that is, asepsis, gentle tissue handling, minimal dissection of tissue, appropriate use of instruments, effective hemostasis, and correct use of suture materials and patterns (Chaffee 1974; Wingfield 1979). People performing and assisting in surgical procedures in a research setting often have a wide range of educational backgrounds and might require various levels and kinds of training before they participate in surgical procedures on animals. For example, persons trained in human surgery might need training in inter species variations in anatomy, physiology, and the effects of anesthetic and analgesic drugs, or in postoperative requirements. Training guidelines for research surgery commensurate with a person's background are available (ASR 1989) to assist institutions in developing appropriate training programs. The PHS Policy and the AWRs place responsibility with the IACUC for determining that personnel performing surgical procedures are appropriately qualified and trained in the procedures to be performed.

"In general, surgical procedures are categorized as major or minor and in the laboratory setting can be further divided into survival and nonsurvival. Major survival surgery penetrates and exposes a body cavity or produces substantial impairment of physical or physiologic functions (such as laparotomy, thoracotomy, craniotomy, joint replacement, and limb amputation). Minor survival surgery does not expose a body cavity and causes little or no physical impairment (such as wound suturing; peripheral-vessel cannulation; such routine farm-animal procedures as castration, dehorning, and repair of prolapses; and most procedures routinely done on an "outpatient" basis in veterinary clinical practice).

"Aseptic technique is used to reduce microbial contamination to the lowest possible practical level (Cunliffe-Beamer 1993). No procedure, piece of equipment, or germicide alone can achieve that objective (Schonholtz 1976). Aseptic technique requires the input and cooperation of everyone who enters the operating suite (Belkin 1992; McWilliams 1976). The contribution and importance of each practice varies with the procedure. Aseptic technique includes preparation of the patient, such as hair removal and disinfection of the operative site (Hofmann 1979); preparation of the surgeon. such as the provision of decontaminated surgical attire, surgical scrub, and sterile surgical gloves (Chamberlain and Houang 1984; Pereira and others 1990; Schonholtz 1976); sterilization of instruments, supplies, and implanted materials (Kagan 1992b); and the use of operative techniques to reduce the likelihood of infection (Ayliffe 1991; Kagan 1 992a; Ritter and Marmion 1987; Schofield 1994; Whyte 1988).

"Specific sterilization methods should be selected on the basis of physical characteristics of materials to be sterilized (Schofield 1994). Autoclaving and gas sterilization are common effective methods. Sterilization indicators should be used to identify materials that have undergone proper sterilization (Berg 1993). Liquid chemical sterilants should be used with adequate contact times, and instruments should be rinsed with sterile water or saline before use. Alcohol is neither a sterilant nor a high-level disinfectant (Rutala 1990)."