The female on the operating table was under anesthesia and prepped for the procedure, while the two attending UCHealth obstetrician-gynecologists had scrubbed up and were ready to proceed.

Their patient was suffering from perimenopausal symptoms, including prolonged periods with heavy bleeding. The hormone therapy she had been undergoing had helped but had not resolved her issues or discomfort.

An ultrasound of her uterus had shown a worrisome mass. So, after weeks of planning and consultation among various medical colleagues who were dedicated to her care and well-being, the team decided that the best option was a hysterectomy.

Despite having performed many such procedures, the two physicians from the UCHealth Women’s Care Clinic – Anschutz Medical Campus were in uncharted territory.

For starters, she was a little smaller than their typical patient, at about three feet tall and weighing 30 pounds, and a bit younger, at 20 years.

And there was another big difference.

Pressed against the glass of the hospital where the surgery was taking place were the faces of parents and children, wanting to see what was going on with one of their beloved friends:

It was Saba, a 20-year-old African mandrill, who was born and raised at Denver Zoo.

The Zoo partners with experts in obstetrics and gynecology (OB-GYNs) who treat humans for surgeries like Saba’s to blend the expertise of both physicians and veterinarians, especially when the patient is a primate whose anatomy so closely resembles that of a human.

“Part of the reason the Zoo reaches out to GYNs is that the primate anatomy is essentially identical to the human female anatomy since we are primates as well,” said Dr. Shawna Tonick, who typically does surgeries at UCHealth University of Colorado Hospital on the Anschutz Medical Campus, where she is an assistant professor of OB-GYN and obstetrical health at the University of Colorado School of Medicine.

When Tonick was asked whether she wanted to be involved in the surgery, her answer was quick and firm.

“I said, ‘Absolutely.’ I love primates, especially African primates. I’ve been on safaris a few times, and I just find them fascinating.”

She asked her OB-GYN colleague, Dr. Amy Markese, to join her in the procedure.

“I am an animal lover too and was excited to be involved,” said Markese, who is also an assistant professor of OB-GYN and obstrectical health at the CU School of Medicine.

Both women donated their time.

Threatened in the wild, Saba faces another challenge

Typically inhabiting the rainforest of west central Africa, mandrills are one of the largest and most colorful of the monkey species, with wonderfully expressive faces that can look wise, playful, inquisitive and irritated within moments.

Mandrills face many foes in the wild and are a vulnerable species. Their habitat is being destroyed through deforestation and logging. They are also killed by hunters for bushmeat and to fuel an international export market.

Saba was born at Denver Zoo and lives with a group of other, mainly female, mandrills. Last winter and into early spring, her caretakers noted her worsening bleeding issues. They conducted a series of tests, including a CT scan, an ultrasound, hormone analysis, and vaginal and uterine endoscopy, which led them to seek out the assistance of UCHealth doctors to perform the necessary hysterectomy.

To prepare for the procedure, Tonick and Markese collaborated with their OB-GYN colleagues, including one who had previously performed a hysterectomy on a white-cheeked gibbon from Denver Zoo. In the days leading up to the surgery, they visited the facility, toured its Helen and Arthur E. Johnson Animal Hospital, which opened in 2020, spoke with the vets and other staffers who knew and cared for Saba and looked over the surgical supplies they would be using.

“A lot of planning and discussion took place before the surgery,” Tonick said. “And it ended up being very similar to what we are accustomed to.”

For Dr. Spencer Kehoe, a clinical veterinarian at Denver Zoo, working with UCHealth physicians makes a lot of sense, especially if other medical complications arise during the surgery that they would be more familiar with, such as endometriosis.

“We combined our expertise with their expertise,” he said. “It was a great collaboration and a good example of two fields coming together to give this species the best care possible.”

Patient is different; surgery is the same

Saba was anesthetized and brought into the Zoo’s hospital operating room. The surgery, which took about 90 minutes, included the removal of her ovaries, uterus and fallopian tubes. An endocrinologist who works with Saba to help manage her diabetes was on hand. (She receives daily insulin injections.) Also there for the surgery were human and veterinary radiologists and a veterinary dental specialist.

A lot of thought went into Saba’s post-operation recuperation. Kehoe, who assisted with the procedure, used an “intradermal” suture pattern where the stitches are hidden under the skin. This was important so Saba wouldn’t be able to pull them out.

To keep her attention even more diverted from the incision, he placed “distraction sutures” in random places, including on her arm, which would be harmless when she poked or pulled them, along with tabs of tape attached to her hair to keep her busy. Saba also got a manicure and pedicure – in neon green nonetheless – as another way to keep her focus away from her healing wound.

The entire procedure went off without a hitch. Saba spent one week in her own habitat (away from the prying fingers of her family) and then re-joined the group. Aside from some pain medication, she has convalesced without any complications.

“She recovered great. She seems very comfortable,” Kehoe said. He added that pathology results showed that the mass was of a pre-cancerous nature, underscoring the importance of Saba having the hysterectomy.

Both Tonick and Markese agreed that the day’s collaboration between the Zoo and UCHealth was a great success.

“Everyone involved at the Zoo was so caring and took such care with Saba. It was a high-achievement moment for us,” Markese said.

For Tonick, the day was one she will always remember.

“We were so happy to help,” Tonick said. “It’s such an amazing thing to have lent our expertise. Both of us were in awe. She was so beautiful. It was one of the best days of my life,” Tonick said.

In the months since her operation, Saba has thrived.

“She’s a really independent, smart and wonderful animal,” Kehoe said. “She’s very much her own lady.”