SURVIVAL SURGICAL PROCEDURES

Survival surgical procedures performed on research, testing and teaching animals must be done by qualified personnel using aseptic technique in appropriate facilities. Pre-procedural and post-procedural care must comply with veterinary medical practices and must be documented in surgical records.

Definitions

• Major Survival Surgery: Any surgical intervention that penetrates and exposes a body cavity, produces substantial impairment of physical or physiologic functions, or involves extensive tissue dissection or transection.
• Minor Survival Surgery: Minor survival surgery does not expose a body cavity and causes little or no physical impairment, (e.g. wound suturing; peripheral-vessel cannulation; per-cutaneous biopsy)
• Multiple Major Survival Surgeries: More than one major operative procedure from which the animal is allowed to recover. Multiple survival surgical procedures should be necessary for the objectives of a single research project. Cost reduction alone is not adequate justification for conducting multiple major survival surgeries on the same animal.
• Aseptic Techniques: The use of practices that minimize the number of microorganisms in the operating environment and reduce any contamination of a surgical wound to the lowest possible practical level. These practices include sanitation of the operating location, preparation of the animal, preparation of the surgeon, and sterilization of instruments and supplies.
• Sterile Only Tip Technique: This method of aseptic technique restricts the surgeon to only using the sterile working ends of instruments to manipulate the sterile field. This practice is only to be used in select species (mouse, rat, hamster) in situations where maintaining sterility of gloves is more problematic than maintaining the sterility of the instrument tips.
• Clean Non-Sterile Field Surgery: Certain standard agricultural or field research procedures may be conducted using clean techniques rather than aseptic procedures. Details and justification for this exception must be provided in the IACUC protocol.

Personnel Qualifications

Qualifications to conduct animal surgery must be described in the IACUC protocol Key Study Personnel section. Qualifications may include one or more of the listed below. Note: hands-on training is obligatory for performing surgery.

• Documented professional training
• In-person training by veterinarian
• Completion of training module on surgery
• Documented hands-on training by an experienced Principal Investigator. The use of animals for surgical training must take place under a separate IACUC protocol, or be included under the Rationale for Animal Numbers and described in the Surgical Procedures sections of the project’s IACUC protocol.

Surgical Facilities

• Rodents and Non-Mammalian Vertebrates: Major survival surgical procedures must take place in a dedicated room designated for aseptic procedures or in a specific laboratory area that provides separation from other activities. The area of the laboratory or facility where surgery is conducted must have been inspected and approved by the IACUC. Work surfaces and storage units must be easily sanitized. The location should include an area for surgery preparation separated from the operative area in space or time.
• Non-Rodent Mammals: Surgery on non-rodent laboratory animals and agricultural animals in biomedical research and teaching must be conducted in a dedicated surgical facility that has been inspected and approved by the IACUC. A dedicated surgical facility is structured to be easily cleaned and sanitized and is managed to ensure cleanliness. Preparation for surgery should take place in a different room or an area separated by distance or timing between activities.

Aseptic Practices

Aseptic practices must be described in the Surgery sections of the project’s IACUC protocol.

1. Preparation of the Surgery Location

• Area must be free of clutter, disinfectants must be used to prepare surfaces.
• When performing surgeries on multiple animals during a single session, the surgical area in contact with the animals must be disinfected between surgeries.

2. Preparation of the Animal

• The animal must be prepared for surgery by removing hair from the surgical site.
• This procedure should be performed in an area separate from where the surgery will be done. Analgesics (preemptive analgesia) should be administered as described in the approved IACUC protocol.
• For animals undergoing general anesthesia, the ophthalmic ointment should be applied to the eyes in order to protect the corneas from drying out.
• The surgical site should be prepared with an appropriate skin disinfectant.
• The surgical preparation of animals should be completed before the surgeon wear surgical attire, including sterile gloves.

3. Surgical attire

Surgeon and assistant are expected to wear appropriate clothing, that should replace or cover street clothes. Standard PPE for most surgeries include:

• Clean surgical gown, overalls, or lab coat
• Mask
• Head or hair cover
• Sterile surgical gloves. Ordinary, non-sterile laboratory gloves are not acceptable for all surgical procedures EXCEPT when using “Only Tip” technique
• Clean, non-sterile laboratory gloves are ONLY acceptable for surgical procedures using “Only Tip” technique or minor standard agricultural procedures

4. Surgical Instruments and Devices

Surgical instruments and devices must be sterile. For surgical procedures using “Only Tip” technique, whole instruments must initially be sterilized using an appropriate method for the material (e.g. autoclaving, gas sterilization, chemical sterilization). Any item that comes into contact with the surgical site (suture, suture needle, instrument tips, etc.) must be sterile. Instrument tips and devices must be maintained on a sterile surface to prevent contamination of the surgical site. “Only Tip” technique must be described in the animal use protocol if it is planned for use.

Special consideration for procedures on multiple animals (rodents and non-mammals):

Surgical procedures may be performed on multiple rodents and non-mammals during a single session using one sterile surgical pack, providing instruments are re-sterilized in a hot bead sterilizer for a minimum of 15 seconds between animals. A new set of sterile instruments must be used after 4-5 animals. All biological debris, such as blood or tissue, must be removed from the instruments prior to placing them in the hot bead sterilizer. Instruments must be cooled prior to contact with the animal. At any time, if a sterile glove comes into contact with a non-sterile item, the glove is no longer sterile and should be replaced with new sterile gloves in order to maintain aseptic technique.

Surgical procedures performed on non-rodent mammals and agricultural animals, in both agricultural and biomedical research, should use new sterile packs with each major surgery.

Post-Operative Care

• Observation of the animal and, if needed, interventions during recovery from anesthesia are important parts of post-surgical care. Training of personnel, oversight by principal investigator and clear division of responsibilities among PI, project personnel, animal care staff and veterinary staff are required.
• Post-operative monitoring is the responsibility of the research staff and/or surgeon.
• Anesthetized and unconscious animal must be monitored until the animal is conscious and able to walk or maintain itself in sternal recumbency.
• Unconscious animal should not be housed in a primary enclosure with other animals that are fully or partially awake.
• During recovery mammalian and avian species should be kept warm and dry.
• If an animal develops unexpected complications from surgical or post-surgical procedures, appropriate veterinary care must be provided.
• Skin sutures or clips should be removed when the surgical wound has healed and per guidelines described in the approved IACUC protocol. This is typically 7-14 days post-operatively but the timeframe is dependent on the species and procedure.
• Animals must be monitored at the frequency and duration described in the IACUC protocol.
• Surgical records should contain operative and post-operative information (e.g. cage card with procedure and date, body weight on the day of surgery, analgesic administration, wound closure removal, etc.). Daily monitoring of the animal should continue until the animal is stable (e.g. body weight, body condition, activity, etc.).

Postoperative Analgesia

The primary investigator should provide written description of methods used to assess and relieve postoperative pain or distress in animals. Post-surgical analgesia is required after survival surgical procedures unless withholding analgesics is scientifically justified. The justification should include the rationale and evidence that analgesics, if administered, would compromise the scientific validity of the research. Investigators should consult veterinarian at the stage of planning surgical procedures to identify appropriate analgesics.

Surgery Records

It is the responsibility of the PI and/or surgeon to maintain records on surgical procedures, pre-operative and post-operative care. These records must be maintained by the PI for three years beyond the termination date of the IACUC protocol.

Surgical records performed under an approved IACUC protocol must be reviewed by the veterinarian. Surgery records must be submitted electronically using the online protocol system.

Animals that undergo surgical procedures will be monitored in accordance to their IACUC protocol, monitoring frequency will be established in consultation with the veterinarian. Surgical records should include documentation of the monitoring.