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W2168671919 abstract "The technique of transcervical catheterization for artificial insemination has gained practical importance over the last 3 and 1 decades in bitches and queens, respectively. The vagina of both species has a thickening of the dorsal aspect called dorsal medial fold, which restricts the lumen of the paracervix, making catheterization of the cervix difficult both with manual and endoscopic techniques. Manual catheters have been used initially in the bitch and are now gradually being replaced by rigid endoscopy through the adaptation of human cystoscopes and ureteroscopes. Cystoscopes provide excellent imaging of the vagina, but cervical catheterization is more difficult due to the oblique 30° viewing angle of its telescope and may not be long enough to catheterize large size bitches. Ureteroscopes allow an acceptable view of the vaginal mucosa and offer advantages such as the possibility to catheterize the cervix of bitches of all body sizes, manipulate the cervical tubercle when the external cervical os is not visible, offer a better visualization of the cervix using the shunt (a large Foley catheter which allows insufflation and distention of the vagina). Feline cervical catheterization has been achieved with three different types of catheters; the last one, developed following careful anatomical studies of how the feline vaginal lumen changes during estrus, allows cervical catheterization thanks to digital manipulation of the cervix through the rectum. Transcervical catheterization (TC) refers to a procedure, which allows placing an instrument into the uterine lumen in a non-invasive way through the vagina and cervix. This can be performed manually in large animals thanks to the size of the reproductive tract and to the fact that the cervix can be manipulated through the rectum. In small animals, this has been impossible to realize until 25 years ago when Scandinavian investigators reported on the successful adaptation of a fox transcervical catheter to bitches (Linde-Forsberg and Forsberg 1989; Linde-Forsberg 1991). A few years later, the catheterization of the canine cervix using a human cystourethroscope was reported (Wilson 1993). Canine TC was further improved through adaptation to dogs of a human ureteroscope (Lopate 2012), which allows better manipulation of the cervix and faster catheterization. Thanks to increased use of sophisticated equipment, the TC procedure is gradually becoming a routine technique for canine artificial insemination as it provides improved fertility, particularly when using frozen or poor quality semen, as well as overcoming cervical closure, which occurs towards the end of oestrus, at a time when oocytes are still fertilizable. The use of TC has not been applied as extensively to queens as it has been in bitches due to the small size of the feline vagina, making endoscopic investigation hard to achieve. Also, intrauterine semen deposition in cats is not requested as often as in dogs due to difficulties in feline semen collection, making artificial insemination in cats an unusual request for veterinarians. Nevertheless, TC procedures in queens have been reported. This study will review vaginal anatomy and the technique of transcervical intrauterine deposition of semen, describing and comparing manual vs endoscopic equipment in bitches and queens. A thorough understanding of canine gross vaginal anatomy is critical to success with TC procedures. The vagina is very long, extending from 10 to approximately 30 cm depending on breed/body size, while the vestibule is approximately 2–6 cm long (Wilson 2003). The urethral papilla sits ventrally at the vestibulo-vaginal junction (VVJ) and can be easily identified during endoscopy. Some bitches may have strictures, septa or hymenal remnants in the area of the VVJ which can make catheterization difficult, or be missed when passing the catheter and then becoming a potential problem at parturition. The canine vagina has been defined as ‘bottle shaped’, with the external cervical os projecting into the most cranial part of the vagina (the bottleneck, also called the paracervical region) (Lindsay 1983), which is very narrow and begins with a conspicuous fold of vaginal mucosa called the dorsal medial fold (DMF). The DMF arises from the vaginal ceiling and extends cranially from approximately 3–8 cm posterior to the cervix (Pineda et al. 1973). The most anterior point of the DMF is called the cervical (or caudal) tubercle (Roszel 1992). There is usually a narrowing in the vaginal canal adjacent to the DMF (particularly in maiden and small breed bitches) requiring gentle pressure to push through, which can cause the bitch some discomfort. Cranial to this area, there is a slight enlargement of the vaginal lumen and the cervix is easily visible. The most cranial portion of the vagina is called the fornix, and it is a blind-ended region located cranioventrally to the external cervical os where the semen pools following mating or vaginal artificial insemination. The canine cervix sits in a diagonal position at the uterovaginal junction at an upward angle (45–90°) from the vaginal floor. Within the uterine body, the internal cervical os faces dorsal, while within the vagina, the external os faces the vaginal floor. The appearance of the cervical lumen and caudal tubercle varies greatly from bitch to bitch, most commonly appearing like the head of a cauliflower or like the surface of the brain. Identification of the cervical lumen during endoscopy requires some degree of practical experience as it is not always pointed in a caudal direction. The cervical lumen may be located directly in the centre of the tubercle with a clear opening visible or it may be located deeper in the tubercle with a ventral slit and ‘ramp’, leading to the lumen, which requires manipulation of the cervix with the catheter/scope to enter. It is helpful to have the bitch empty her rectum and bladder just prior to TC as both structures, when full, may cause the cervical lumen to be difficult to identify and/or catheterize. Activity (walking or running) may stimulate defecation. Fasting is not necessary. Enemas are not recommended as they may result in dripping of faecal secretions down the perineum, thus increasing vaginal/uterine contamination. The bitch should be restrained in a standing position on a table. The use of a hydraulic table is quite helpful as the bitch can be raised or lowered to a comfortable position and adjusted as needed during the procedure. Either a wide belt around the abdomen or an assistant can help hold the bitch in position. No pressure should be applied to the abdomen during the procedure as this can alter/obscure the view through the endoscope. Sedation is normally not necessary, especially when using the ureteroscope, because its small size places no pressure on the paracervix (the most sensitive area). If the bitch is reactive, which may be more likely when the TC procedure is performed outside of oestrus (i.e. in dioestrus or anoestrus for uterine lavage or biopsy), mild sedation can be administered with either acepromazine, butorphenol or dexmedetomidine. Care should be taken not to sedate the bitch so much that she will want to sit down or rest on the abdominal belt or the assistant's arm. Most bitches tolerate this procedure well during any stage of the cycle, particularly when using the ureteroscope (Lopate 2012), although mild discomfort can be observed in some cases (Hayashi et al. 2013). Warming the end of the scope with a hot-water bottle or warm rice bag, so that the bitch does not startle when the cold metal is introduced into the vaginal canal makes the procedure less frightening for the bitch. General anaesthesia is typically not needed for TC artificial insemination while it is normally used for hysteroscopy regardless of stage of cycle as it is easy to perforate the uterus with any sudden movement of the bitch. This catheter (jan@basbergdata.no) has a hard nylon outer cannula (which comes in four different sizes depending on body weight) with a 20- to 50-cm-long steel catheter ending with 0.5- to 1.0-mm-diameter rounded and slightly enlarged tip (Fig. 1) (Linde-Forsberg 1991). The operator has to stabilize the cervix through the abdominal wall applying a cranial-downward traction so as to change the main axis of the cervix from a 45° angle to a horizontal one. The outer cannula is advanced until it stops in front of the cervical tubercle, at which point the tip of the steel catheter is then gently moved forward searching for the opening of the cervical canal, which is described as a sensation of ‘roughening or cobblestone-like’ as the catheter passes over the surface of the cervix and then as a ‘crispy’ sensation as the catheter passes through the cervix (Linde-Forsberg 1991). This technique can be performed in most small, medium and large breed dogs and is inexpensive, and conception rates of 51–84% have been reported when it is performed by skilled inseminators, particularly in Scandinavian countries and Northern Europe (Linde-Forsberg and Forsberg 1989, 1993; Linde-Forsberg et al. 1999). However, it requires significant practice to master, including practicing on canine reproductive tracts as well as infusing saline in oestrous bitches; also, the cervix may be difficult to palpate in bitches that are very fat or have deep or tense abdomens, making this catheter difficult or impossible to use in such cases. Catheterization of the canine cervix was initially described using a cystourethroscope (Karl Storz Veterinary Endoscopy – America Inc. Goleta CA, USA) (Wilson 1993; Pretzer et al. 2005; Davidson and Eilts 2006). This type of endoscope (Fig. 2) normally employs a telescope with a 30° oblique viewing angle, a 22 Fr (7.3 mm) diameter outer sheath, a bridge, a cold light source and a working length of 29 cm. Polypropylene catheters as large as 9 Fr can be used, and a smaller version of the same endoscope will accept catheters as large as 6 Fr. The 30° angle view allows for very good visualization of the entire vagina, making this an excellent endoscope for vaginoscopy. Manipulation of the cervix can be difficult, particularly in maiden and small/toy breed bitches (due to a small paracervix and fornix, and an occasional difficulty in stretching these tissues). In some giant breed bitches, the cystourethroscope may not be long enough to reach the cervix. A human ureteroscope (Karl Storz Veterinary Endoscopy – America Inc. or Minitube of America, Inc. Verona, WI, USA) has recently been adapted for canine TC techniques. This ureteroscope is thinner (9.5 Fr = 3.15 mm) and longer (43 cm) and has a telescope with a 5° viewing angle, an instrument port, a sealing system and a cold light source (Fig. 3). It does not accept standard urinary polypropylene catheters because they are too short. Catheters designed for the ureteroscope (Karl Storz Veterinary Endoscopy – America Inc., Goleta CA, USA; or Minitube® TCI catheter, Minitube of America Inc.) are made of a sturdier plastic and have a mandrel for extra stability (these catheters can also be used with the cystourethroscope). Their small size (3, 4, and 5 Fr) and an extended length (up to 56 cm) allow them to be passed up to 6–10 cm into the uterine lumen. Air or fluid can be administered through side ports of the scope. The main advantages of the ureteroscope are its small diameter (allowing it to be used on the smallest of bitches, regardless of their parity), its length (allowing it to be used on the largest of bitches) and the angle view, which allows positioning right in front of the cervix, making catheterization easier and significantly reducing the time needed to perform a TC procedure. This scope can be used to manipulate the cervix when the lumen is pointed in an awkward direction, and the scope can be ‘walked’ up the external os of cervices with a ‘ramp’ allowing catheterization of these more difficult cases. Because of the above, the ureteroscope has some clear benefits over the cysto-urethroscope. Intrauterine insemination as well as most other techniques (uterine culture, cytology, biopsy, lavage and hysteroscopy) can be performed with either scope but are easier to perform with the ureteroscope. Vaginoscopy and cystoscopy can also be performed with both instruments, although vaginal and bladder visualization are better with the cysto-urethroscope. Disadvantages of the ureteroscope include less light from the camera; a narrower angle of view (which makes it insufficient for vaginoscopy) and the small size of the tip, making it easier for the vaginal wall to be perforated if the bitch moves suddenly; however, the small size of any perforation will likely heal quite uneventfully without any surgical intervention. Using the largest size of catheter that will pass through the cervical lumen is desirable. The benefits of the polypropylene (PP) catheters include the ability to watch the semen (or fluid) enter the uterus; the rigidity of the 8 Fr PP catheter when trying to catheterize a highly mobile cervix; the ability to heat the end of the catheter at a slight angle facilitating entry into the cervix (see below); and the ability to cut off the end of the catheter and aspirate fluid that is pooling in the fornix when it obscures the view of the cervical lumen. The disadvantages of these catheters include the flexibility of the smaller catheters (≤5 Fr), resulting in them bending rather than threading into the cervical lumen, the need to ‘burp’ the catheter of air before threading it all the way into the uterus (this can result in the catheter slipping out of the cervix if the bitch moves suddenly and the need to re-catheterize) and the relatively large amount of residual fluid left in the catheter after insemination (up to 0.5 ml in an 8 Fr). When using the cysto-urethroscope, it may be helpful to heat the end of the catheter (about 5 cm from the tip and bending the catheter slightly upwards) when trying to catheterize a difficult cervix. This allows the tip of the catheter to pass upwards instead of straight out of the end of the sheath (Fig. 4a and b). Curved catheters with an olive tip can be purchased; however, manipulation of the PP catheters is simple and easy and can be performed in less than a minute, so it makes sense to adapt the PP catheters when needed. Another method is to cut the end off (last 7–10 cm) of a 8 Fr catheter and then pass a smaller 5 Fr catheter that has been bent upward (as described above) through it (Fig. 5a and b). The rigidity of the 8 Fr catheter and the upward angle of the smaller catheter will allow catheterization of some cervices. Ureteroscope catheters have either one or two side ports, which allow fluid to flow proximally from the openings (up the uterine horn), thus helping to prevent backflow as long as the liquid is injected slowly. These catheters come with a removable metal mandrel that makes them more rigid and are marked every cm on the outside, which is helpful in determining how far into the uterus the catheter has passed. They also have a double or triple mark every 5–10 cm. Because of the small luminal size, these catheters empty almost completely, leaving no residual fluid in the catheter, assuming air (0.2 ml) has been injected to empty them. They are, however, significantly more expensive than polypropylene catheters. The endoscope is introduced as one would introduce a cotton swab for vaginal cytology, at a steep angle to the vulva (60–80° down from the horizontal plane), so that the clitoral fossa and the urethral papilla are avoided, then it is raised to a horizontal plane once beyond the pelvic rim. The tip of the catheter is used as a guide to manoeuver the scope down the vaginal canal. When the DMF is identified, the scope is passed along its left or right side. Keeping the tip of the catheter out a few mm helps to clear the way for the endoscope (Lopate 2012). When the cervical tubercle is identified, the endoscope is moved underneath it while trying to locate the external cervical os. The endoscope may need to be oriented at a steep angle opposite to the one used to enter the vulva, that is 40–60° up from the horizontal plane. If the fornix is reached, the scope should be pulled caudally 1–2 cm to locate the cervix and then moved underneath it from one side of the external os to the other until the lumen is located (Lopate 2012). Watching for bloody discharge or for air bubbles coming from the lumen can sometimes assist in its location. As soon as the cervical opening is identified and the catheter lined up with its opening, it can be slid in and advanced forward (Wilson 2001; Makloski 2012). When attempting to catheterize the cervix, using a rapid twirling or twisting motion of the catheter is very helpful as it prevents the catheter from getting caught on cervical or endometrial folds (Wilson 2001; Lopate 2012; Makloski 2012). If the catheter passes into the uterus for a few centimetres and then stops, simply backing it up a centimetre and starting to twirl again while moving forward helps the tip of the catheter pass down a horn rather than getting stuck on the uterine tissues at the bifurcation. Alternatively, if the catheter cannot be advanced, beginning to inject a small amount of fluid will wet the tip of the catheter and will expand the uterine lumen enough to allow the catheter to continue advancing. The ureteroscope may be used to physically manipulate the cervix when it is not pointed directly caudally. Because of the narrow angle of view, the end of the scope is exactly what is seen on the screen, making it easier to use it to move the cervix in the direction desired. Normally up to 80% of bitches can be inseminated without any difficulty in catheterization, while in the remaining 20% of cases varying degrees of cervical tubercle manipulation with the endoscope and the catheter may be necessary (Macedo et al. 2012). The mean time necessary to catheterize the cervix can be as short as 7.5 min (Hayashi et al. 2013). When trying to manipulate the cervix into a postero-central location, pushing the tip of the catheter into the fornix on the side opposite the direction of the lumen and then beginning a rapid twirling in the same direction as one would like the lumen to move will often bring the cervix around to a better position (Lopate 2012). When the cervical lumen is angled so steeply that the catheter cannot be easily threaded, a combination of initially forward catheter movement to ‘grab and hold’ the cervix and then backward to allow the scope to be ‘rested’ on the cervix while the scope is reoriented will allow the catheter to be ‘walked’ up towards the cervical lumen thus reaching the uterus. If the scope is being passed during dioestrus or anoestrus, it is very important to remember that the vaginal wall is much thinner during these stages and so perforation is much more likely to occur with sudden movement or excessive pressure. Poor visibility may occur due to pooling of blood in the fornix or from epithelial cells sticking to the end of the telescope. With the cysto-urethroscope, the only way to clear debris off the telescope is to remove it and clean it. With the ureteroscope, the end of the telescope can simply be tapped against the vaginal mucosa to clear debris off the fibre optics. Blood pooling in the fornix may be suctioned out using an 8 Fr PP catheter with the end cut-off (open ended). Transcervical insemination (TCI) involves concentrating the semen sample into a pellet and then reextending it to a small volume. Traditionally, canine TC insemination volumes have been very small, 1.0 ml for toy breeds, 1.5–2.0 ml for small–medium size breeds, 2.0–2.5 ml for large breeds and 2.5–3 ml for giant breeds (Macedo et al. 2012). However, it has recently been observed (Mason and Rous, 2014) that pregnancy rates and litter size may be increased by increasing the volume of the inseminate. The new volumes are double to triple those previously reported. When using these larger volumes, insemination should be performed over 20–30 min to minimize backflow. If backflow into the vaginal fornix occurs, the insemination is stopped for a few minutes until the fluid has an opportunity to wick back up into the uterus via the cervix. The site of deposition within the uterus does not affect the distribution of sperm into the uterus. TCI is recommended for fresh semen with poor quality or a low count to introduce an acceptable breeding dose into the uterus. It is recommended for all breeds, but particularly for large and giant breed bitches when using either fresh or chilled semen to ensure an adequate breeding dose reaches the oviductal reservoirs. It is recommended if the bitch owner can only do one insemination using any type of semen (although it is always advised to inseminate twice). TCI is particularly beneficial for bitches over 25 kg body weight compared with vaginal AI where large numbers of sperm may be lost in the vaginal folds. It is preferred for frozen semen over vaginal AI (which has a very poor success rate). TCI has a comparable (or higher) success rate with frozen semen compared to surgical insemination, depending on the experience of the operator. When using the ureteroscope, an insufflation bulb is attached to the side port of the scope to allow expansion of the vaginal canal with air. Insufflation should begin once the scope is passed over the pelvic rim. With the cystoscope, minimal insufflation is needed, while with the ureteroscope, repeated or continuous insufflation is necessary. If the cervix cannot be manipulated into position with catheter manipulation alone, a commercially available shunt (TCI Shunt System, Minitube of America, Inc.) can be used to keep the vaginal canal insufflated continuously. Use of the shunt system, along with air insufflation, may lift the cervix up slightly, making the cervical lumen more accessible. The shunt is basically a large (36 Fr) Foley catheter, which comes in two lengths (16 and 21 cm) (Fig. 6). The shunt is introduced through the vestibule, and the Foley balloon is inflated with up to 100 cc of air, after which the shunt is pulled backwards against the VVJ giving the bitch the same feeling of a copulatory lock. Once the shunt is in place, the ureteroscope is passed into and through it. When one is learning how to use this scope, using the shunt may improve visualization. Disadvantages of the shunt are loss of control to move the scope quickly because it is snuggly fitted in the O ring in the centre of the shunt, so if the bitch moves suddenly, there is less control over the end of the scope and a greater risk of perforating the vaginal canal; if the bitch has a stricture, hymenal remnant or septum, the shunt may be too large to be introduced. The scope also tends to stick to the O ring if the procedure takes more than a few minutes because lubrication applied to the scope dries quickly. This may result in the O ring popping out of the metal holder, resulting an abrupt loss of air from the vagina and possibly frightening the bitch. The feline vagina has been an object of interest for veterinary anatomists only recently with the first detailed report on anatomical patterns of urogenital sinus, vagina and cervix published in 1993 (Watson and Glover 1993). In adult queens, the total distance from vulva to cervix is approximately 4.0–4.5 cm, with the area of the external urethral meatus (or urogenital sinus) being located approximately half way through (Fletcher 1974). There is a thickening of the medial dorsal vaginal wall caudal to the cervix, which is equivalent to the DMF in bitches (Swanson and Godke 1994). The longitudinal axes of cervix and vagina form an obtuse angle, and the vaginal fornix is located ventrolateral to the cervix (Watson and Glover 1993; Swanson and Godke 1994). The total distance from the vulva to the end of the vaginal fornix has been reported to be as long as 6.0 cm (Chatdarong et al. 2002). During the last decade, feline vaginal anatomy has been elegantly studied by Zambelli and his co-workers using silicon moulds obtained in different oestrous cycle stages (Zambelli et al. 2004; Zambelli and Cunto 2005a). In adult queens, the inner diameter of the feline vestibular lumen is normally ≥2.0 mm, but it decreases to <2.0 mm in the vagina and to approximately 1.3 mm at the level of the fornix (Zambelli and Cunto 2005a). However, these diameters decrease even further during the follicular phase, when rising oestrogen concentrations cause the DMF to become more prominent and longer, the vaginal fornix to be longer and flattened and the cervical axis to have a greater slope (Zambelli et al. 2004; Zambelli and Cunto 2005a). Stimulation of the more cranial aspect of the vestibulum causes intense vocalization of the queen, similar to what is observed during coitus (Watson and Glover 1993). Therefore, queens need to be anaesthetized prior to performing a TC, otherwise their sudden movement may jeopardize the success of the procedure. Anaesthesia has been induced using different protocols, such as injectable ketamine HCl/acepromazine and halothane (Howard et al., 1992), or xylazine HCl and ketamine HCl with or without halothane (Chatdarong et al. 2007; Villaverde et al., 2009). A detrimental effect of anaesthesia on ovulation has been claimed (Howard et al., 1992) although no alteration of the ovulatory process was reported in more recent studies (Tsutsui et al. 2000; Chatdarong et al. 2007; Villaverde et al., 2009). The presence of a full bladder and/or rectum may make the TC procedure more complicated, and an empty rectum is definitely an advantage if the Zambelli technique is being used, which requires transrectal palpation of the cervix with a forefinger (see below) (Zambelli and Cunto 2005b). During the TC procedure, the queen is maintained in ventral recumbency and may be held with her hindquarter elevated for 10 min once the procedure is over (Zambelli and Cunto 2005b; Chatdarong et al. 2007). Three different types of catheters have been used for the TC procedure in queens. Hurlburt et al. (1988) used a modified 18 gauge, 9.4-cm-long ball-tip stainless steel needle, which was introduced using a 2 × 8 mm glass speculum. Because the feline vaginal lumen may be smaller than 2.0 mm, as subsequently reported by Zambelli and Cunto (2005b), the technique proposed by Hurlburt et al. (1988) could not reliably allow a successful catheterization and was abandoned. A 3.5 Fr tomcat catheter contained in a 2.7- to 2.8-mm-diameter modified polypropylene urinary catheter (used as a speculum) has been proposed (Swanson and Godke 1994; : Chatdarong et al. 2001, 2002). The speculum has a hole in the side, a few mm before its end, through which the catheter is to be pushed out of the speculum once this is positioned below the cervix. However, also the speculum of this catheter has been demonstrated to be too big to allow repeatability of the TC procedure in all queens (Zambelli and Cunto 2005b). Zambelli et al. (2004) developed a smaller catheter, which appears to be successful and reliable in allowing the feline cervix to be catheterized. This device is made from a 3 Fr tomcat catheter with a rounded tip needle (0.65 mm outer diameter and 30 mm in length) inserted at the cut end and has allowed improvement in the success rate of the TC procedure in the queen when compared to the previously used devices (Zambelli and Cunto 2005b). An endoscopic procedure using a sialoscope has been recently reported as highly successful and reliable (D Zambelli, personal communication). The speculum containing the catheter proposed by Swanson and Godke (1994) and Chatdarong et al. (2001, 2002) is advanced, maintaining the hole on its dorsal aspect; once the end of the vaginal fornix is reached, the internal catheter is pushed through the upper hole allowing its entry into the cervix. The difficulty with this technique is that the size of the speculum (often larger than the queen's vaginal diameter) prevents its tip from reaching the end of the fornix, thus making it impossible for the hole of the speculum to face the internal cervical os, resulting in a failure of catheterization. The catheter proposed by Zambelli and Cunto (2005b) is much smaller and thus reaches the end of the vagina without difficulty. The operator's finger is introduced into the queen's rectum to palpate the tip of the catheter once it is in the vaginal fornix, thereby locating the cervix. Once the catheter has reached the vaginal fornix, it is withdrawn a few mm to reach the cervical opening. At this point, the operator exerts gentle pressure downward with the finger in the rectum, thereby straightening the cervical axis while gently pushing the catheter forward at the same time. When the catheter passes through the cervix the operator feels the typical ‘crispy’ sensation of touching cartilage (Zambelli and Cunto 2005b). Once the tip of the catheter is inside the uterus semen is gently deposited into the uterus approximately 2.0 cm cranial to the cervix. The amount of semen volume used for feline intrauterine insemination is approximately 200–250 μl. Transcervical procedures have been used for many years for canine artificial insemination with good success. Manual catheters are a cheap and good alternative, but are gradually being replaced by endoscopic procedures which, albeit more expensive, allow visualization of the cervix and require increasingly less time to be learned. With the advent of better equipment and with more experienced operators, more TC and less surgical procedures are being performed, reducing the anaesthetic and surgical risks to the female. The use of TC endoscopic procedures has opened up a whole new world of diagnostics for the subfertile bitch and researchers, and clinicians are now considering using endoscopic TC for techniques (such as endometrial culture, cytology and biopsy as well as hysteroscopy) which could previously only be performed surgically (Watts and Wright 1995; Watts et al. 1997; Gerber and Nöthling 2001; ; Fontaine et al. 2009; Groppetti et al. 2010). The same might be true in the future for queens. The learning curve is quite steep with TC procedures but with patience and practice, most bitches can be successfully catheterized. Learning the transcervical procedure in queens requires some time and a finger small enough to be inserted through the anus of the queen. In the bitch, when trying to learn a TC technique, practice should be performed only on females in oestrus until competency is high. This is because the thickened vaginal wall and crenulation seen in oestrus facilitate visualization within the vaginal canal and reduce the risk of perforation. Once the technique is mastered then additional procedures during early proestrus, dioestrus and anoestrus are easily learned. With queens, it is fundamental to use instruments, which are smaller than 1.3 mm in diameter, to gain access to the paracervical area. None of the authors have any conflict of interest to declare. Both authors contributed equally to this review." @default.
W2168671919 created "2016-06-24" @default.
W2168671919 creator A5003502062 @default.
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W2168671919 date "2014-10-01" @default.
W2168671919 modified "2023-10-14" @default.
W2168671919 title "Transcervical Artificial Insemination in Dogs and Cats: Review of the Technique and Practical Aspects" @default.
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