Lecture 9: Intro to Spay Flashcards
Identify 1-9
- Suspension ligament
- Ovary
- Proper ligament
- Uterine horn
- Broad ligament
- Body of uterus
- Round ligament
- Uterine artery and vein
- Pedicle- ovarian artery and vein
why should you express bladder prior to spay
filled urinary bladder can make it harder to identify uterine body
for spay where should you clip fur
xiphoid to pubis and lateral to mammary glands
where should you make incision in young puppy < 3 months, older puppy and adult
young puppy <3 months: halfway between umbilicus and pubis
Older puppy: between umbilicus and midpoint
Adult: start right behind umbilicus
where should you make incision for cat spay
midpoint between umbilicus and cranial edge of pubis
once you have incised the skin remove the __ with __ to better reveal __
SQ fat, blunt and sharp dissection (scissors) to reveal lines alba
once identified linea alba how do you enter abdomen
grasp linea alba with forceps and elevate, stab incision with blade facing away/dorsal (reverse press cut)
once you made stab incision extend incision with __ or __
scalpel or mayo scissors
describe how you would find first ovary with spay hook
- Use thumb forceps to elevate abdominal wall and pull laterally
- Insert spay hook, aiming diagonally caudally toward stifle
- Push down along body wall until dorsal wall is reached
- Rotate spay hook 180 degrees so open end faces midline
- Sweep spay hook medial and cranial
if you are getting intestine with spay hook you are too far __
cranial
if getting bladder fat you are too far __
caudal
how can you confirm you have hooked the uterus and ovary
follow cranially to ovary or caudally to bifurcation
identify 1-3
- Suspensory ligament
- Vascular pedicle
- Uterine horn
what is the most cranial structure to ovary
suspensory ligament
vascular pedicle travels down __, suspensory ligament more cranially
dorsally
describe the process of breaking the suspensory ligament
Use index finger to rupture suspensory ligament from lateral to medial
t or f: in cats you can use scissors or blade to break suspensory ligament
true
after you break down suspensory ligament what is next step
using hemostats, make a window into your broad ligament, caudal to ovarian pedicle in non-vascular area
describe the three clamp modified technique for ligating pedicle in dog
- Clamp 1: placed as proximal as possible
- Clamp 2: distal to clamp 1
- Move clamp 1 distal to clamp 2 and make first ligature/strangle knot in crush of clamp 1
- Remove clamp 2 and make 2nd ligature/strangle knot in crush of clamp 2
what suture will you use for ligating ovarian pedicle
monofilament absorbable, 3-0 to 0 depending on weight
once pedicle is ligated you can transect where and with what
between clamp 1 and 2nd ligature with scalpel or metzenbaum scissors
since cat pedicles are smaller you can use same ligating technique as dogs or what other technique
Place hemostat right below ovary and place two ligatures below
t or f: you can use autoligation in dog spays
false- never- only cat spays
what are the benefits of autoligation of ovarian pedicle in cats
- Minimize foreign material
- Minimize trauma
- Minimize time
when placing hemostats on ovarian pedicle how should you place them
tips up
be sure to break down __otherwise uterus will remain attached to body wall
broad ligaments
how do you break down broad ligaments
blunt, sharp or digital manipulation
after ligating second ovarian pedicle and cutting, what is next step
ligating uterine body
how do you ligate uterine body
strangle knot proximal and strangle knot distal
when ligating uterine body you want to be mindful not to ligate __
ureters
do not oversew end of uterine stump may predispose to __
stump pyometra
in larger dogs, pregnant animals or those in heat you may need to ligate ___individually
uterine vessels
what should you do prior to closure
- Check abdomen for hemorrhage
- Sponge count
what should you do if concern for bleeding in lab
- Notify instructor
- Extend incision
- Use natural refractors
- left side: colon and mesocolon
Right side: duodenum and mesoduodenum - Soak up pooling blood with sponges
where should you look for bleeding
- Ovarian artery and vein/pedicle
- Aorta, caudal vena cava
- Uterine artery and vein
Other sources:
Broad ligament
Perineal fat and retroperitoneum
Suspensory ligament
Body wall
Spleen
Generalized bleeding/oozing- disorder
what do you do once you find source of bleeding
clamp vessel with hemostats and apply new ligatures
describe closure for spay
- Linea alba/body wall: incorporate external rectus sheet and close with simple continuous, interrupted, or cruciates
- Layer 2: SQ tissue: simple continuous
- Layer 3: skin internal: intradermal
- Skin external: glue, cruciates
what suture do you want to use for linea alba closure
monofilament long lasting absorbable suture- PDS
what is OVH vs PVE
OVH: removal of ovaries and uterus
OVE: removal of just ovaries
what are some peri/post operative spay complications
hemorrhage, infection, dehiscence, ureter ligation
what are some long term spay complications
ovarian remnant syndrome, urinary sphincter mechanism incontinence, obesity
