Ligation and Neutering

Question 1

97% of UK practices spay cats via which approach?

Answer 1

Flank

Question 2

What are some advantages of a flank vs midline approach?

Answer 2

Flank:
- Quicker
- Smaller incision 
Midline
- Relevant anatomy is all visible
- Can identify that the cat has already been spayed

Question 3

What are some disadvantages of a flank vs midline approach?

Answer 3

Flank: 
- Uterus has to be found blind
- Cannot identify that a cat has already been spayed
Midline:
- longer recovery period
- larger incision

Question 4

When entering a midline incision which structures need to be displaced?

Answer 4

Bladder caudally

Small intestine cranially

Question 5

Which forceps would you use to grasp a uterine horn?

Answer 5

Dressing forceps

Question 6

How is the suspensory ligament different in dogs and cat?

Answer 6

In the cat the suspensory ligament is long and loose and easily allows the ovary to be exteriorized.
In the bitch the suspensory ligament is short and tight, and must be broken in order to allow the ovary to be exteriorized

Question 7

Which structure needs to be ligated first in a spay?

Answer 7

Ovarian/suspensory ligament

Question 8

Describe the 3 clamp ligation technique for an ovarian ligament

Answer 8

1. place the bottom clamp first as low down to the ovarian ligament as possible
2. place the top clamp as high up the ovarian ligament as possible
3. place the middle clamp immediately below the top clamp

Question 9

Why is it important to leave a gap between the middle and bottom clamps?

Answer 9

There needs to be a sufficient stump to prevent the ligature rolling off the end of the ovarian pedicle

Question 10

Once the three clamps have been placed, how do you ligated the ovarian ligament?

Answer 10

• place the first throw of ligature loosely above or below the bottom clamp, and then release the bottom clamp
• Push the ligature into the groove created by the bottom clamp and tighten it very well before completing the knot
• transect the ovarian ligament by cutting between the middle and top clamps

Question 11

Once ligated, what should you do to the ovarian ligament?

Answer 11

Securely hold with tissue forceps and release the clamp to check that no haemorrhage occurs

Question 12

Once both ovarian/suspensory ligament have been ligated, what is the next step?

Answer 12

• place both ovaries caudally to expose the uterine body
• 2 clamps should be placed immediately below the bifurcation
• place a uterine body ligature using a transfixing ligature

Question 13

How do you place a transfixing ligature around the uterine body?

Answer 13

• Using a needle pass the suture material through the wall of the uterine body, and secure with a single surgeons knot (double then single throw)
• bring both ends of the suture material around and complete the surgeons knot with multiple throws

Question 14

What position should a cat be in for a flank spay?

Answer 14

Right lateral recumbency

Question 15

Once the initial flank spay incision has been made, what are the next steps?

Answer 15

• using dressing forceps, grasp the uppermost uterine horn and exteriorize it
• pull the rest of the uterine horn until its suspensory/ovarian ligament has been exteriorised
• clamp using the 3 clamp technique