Ovariohysterectomy Flashcards
Surgical Approach used for a Ovariohysterectomy
Ventral Midline Approach
*6-8cm Incision Immediately Caudal to Umbilicus (Red Circle)
When Performing the Ventral Midline Approach, Sharply Incise the Subcutaneous Tissue and Watch for Separation of the Subcutaneous. Make a Blunt Dissection through the Subcutaneous Tissue ____mm from Linea Alba
10mm
When performing the Blunt Subcutaneous Dissection Create a Window _____ to Midline using Metzenbaum Scissors. You will hear a Gentle “Pop” when you have Entered the Subcutaneous Pocket. Reorient Scissors Parallel and Bluntly Dissect along Midline (Extend Pocket)
Perpendicular
When Making a Ventral Midline Incision for Ovariohysterectomy, cut where the _____ Tissue and Fascia Meet, to make the Fascia as Clean as Possible
Subcutaneous
*Do NOT Lacerate Fascia- Too Deep
When Making the Abdominal Wall Incision during Ovariohysterectomy, you want to Tent the Linea Alba, Rest your Hand on the Patient for Improved Control and make a Stab Incision at a _____Degree Angle
45
*Tenting Linea Alba- Prevents stabbing Abdominal Organs with Scalpal
_____ Are located at the Caudal Pole of the Kidneys and the Uterine Horns are Dorsolateral in Body Cavity (Bottom of Abdomen)
Ovaries
During Ovariohysterectomy, Locate the Uterine Horn and Follow it cranially to the Ovary. Clamp the _____ Ligament to Manipulate the Ovary
Proper
Review Card: Anatomy
Proper Ligament- Uterine Horn to Caudal Pole of Ovaries
Suspensory Ligament- _Cranial Pole of Ovaries to Body Wal_l
Round Ligament- Uterine Horn to Vaginal Process
When Performing Ovariohysterectomy, Clamp the _____ Ligament, but Hold the Ovary or Uterine Horn
Proper
When Ligating the Ovarian Pedicle, make sure to Ligate the ____ Arteries because they Branch from the Aorta
Ovarian Arteries
*Extremely Important to Ligate the Ovarian Arteries
The Right Ovarian Vein Empties into the _____
The Left Ovarian Vein Empties into the _____
Vena Cava
Renal Vein
When Ligating Ovarian Pedicles, the _____ Technique is most Suitable for Most Patients
Modified Triple Clamp Technique
*Tips of Forceps MUST stay Outside the Body Cavity!! If the Tips of the Rochester Carmalts slip inside the Abdomen they can Poke holes into Organs and Structures- Ex. Spleen, Kidney, Intestine
*Kelly Hemostat placed on the Proper Ligament
When Ligating the Ovarian Pedicle:
Place Circumferential Ligature in _____ of Proximal Clamp (Millers Knot)
Place 2nd Ligature Proximal to Middle Clamp and Flash Clamp
Crush
*2nd Ligature can be Either a Surgeons Knot or Transfixation Ligature- Generally Transfixation is Perferred
Suture Type used to Ligate the Ovarian Pedicles
2-0 Monofilament Absorbable
*Absorbable Suture is Essential
Check the Bursa after you Transect the Ovarian Pedicle to Make sure you have Removed the Whole _____
Ovary
When Ligating the Uterine Body, Ligate and Transect Uterus ____ to Cervix
Cranial
*DO NOT exteriorize Cervix from Abdomen
Breakdown of the _____ Ligament is Necessary for Ligation of the Uterine Body
Broad Ligament
When Breaking down the Broad Ligament for Ligation of the Uterine Body, Start _____ near the Uterine Body due to Lessened Risk to Vessels
Caudally
The Broad Ligament Breakdown starts _____ and goes Laterally away from the Vessels
Caudally
When Ligating the Uterine Body:
Use ______ Clamp Technique
Place Circumferential Ligature in Proximal Crush (Millers Knot)
Place Modified Transfixation Ligature
3-Clamp Technique
After Performing Ovariohysterectomy, prior to Closing:
Check the Left Pedicle by Retracting the ____
Check the Right Pedicle by Retracting the ______
Descending Colon- Left Pedicle
Duodenum- Right Pedicle
If there is Hemorrhage/Bleeding during Ovariohysterectomy, what is the First Thing you should do?
Extend the Incision
Holding Layer when Closing the Body Wall/Linea Alba after Ovariohysterectomy
External Rectus Sheath
Common Suture Pattern used when Closing the Abdominal Wall after Ovariohysterectomy
Simple Interrupted Closure
*5mm Spacing between Sutures!
Ideal Suture Type for Closing the Abdominal Wall
2-0 PDS
*PDS is Ideal because it is an Absorbable Monofilament Suture
Best Suture Type and Pattern for Closure of Subcutaneous Tissue following Ovariohysterectomy
3-0 or 4-0 Synthetic Absorbable
Simple Continuous with Burying the Knot
Best Suture Type and Pattern for Closure of Skin following Ovariohysterectomy
Cruciate Pattern
3-0 or 4-0 Nonabsorbable Monofilament (Ex. Nylon)
Most Common Postop Complication of Ovariohysterectomy
Hemorrhage
*usually comes from Incomplete Ligation of Ovarian Pedicle
Three Common Postop Complications following Ovariohysterectomy
Hemorrhage- Most Common
Dehiscence of Abdominal Incision
Ligation of Ureter- Abdominal Pain, Hydroureter
When Performing an Ovariohysterectomy on a Cat, the Uterus is much more Friable so remember NOT to Clamp the Uterus until after _____
Ligation
*In Felines- Ligate the Uterus Prior to Clamping
