Ovariohysterectomy

Question 1

Surgical Approach used for a Ovariohysterectomy

Answer 1

Ventral Midline Approach

*6-8cm Incision Immediately Caudal to Umbilicus (Red Circle)

Question 2

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

Answer 2

10mm

Question 3

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)

Answer 3

Perpendicular

Question 4

When Making a Ventral Midline Incision for Ovariohysterectomy, cut where the _____ Tissue and Fascia Meet, to make the Fascia as Clean as Possible

Answer 4

Subcutaneous

*Do NOT Lacerate Fascia- Too Deep

Question 5

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

Answer 5

45

*Tenting Linea Alba- Prevents stabbing Abdominal Organs with Scalpal

Question 6

_____ Are located at the Caudal Pole of the Kidneys and the Uterine Horns are Dorsolateral in Body Cavity (Bottom of Abdomen)

Answer 6

Ovaries

Question 7

During Ovariohysterectomy, Locate the Uterine Horn and Follow it cranially to the Ovary. Clamp the _____ Ligament to Manipulate the Ovary

Answer 7

Proper

Question 8

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

Answer 8

Question 9

When Performing Ovariohysterectomy, Clamp the _____ Ligament, but Hold the Ovary or Uterine Horn

Answer 9

Proper

Question 10

When Ligating the Ovarian Pedicle, make sure to Ligate the ____ Arteries because they Branch from the Aorta

Answer 10

Ovarian Arteries

*Extremely Important to Ligate the Ovarian Arteries

Question 11

The Right Ovarian Vein Empties into the _____

The Left Ovarian Vein Empties into the _____

Answer 11

Vena Cava

Renal Vein

Question 12

When Ligating Ovarian Pedicles, the _____ Technique is most Suitable for Most Patients

Answer 12

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

Question 13

When Ligating the Ovarian Pedicle:

Place Circumferential Ligature in _____ of Proximal Clamp (Millers Knot)

Place 2nd Ligature Proximal to Middle Clamp and Flash Clamp

Answer 13

Crush

*2nd Ligature can be Either a Surgeons Knot or Transfixation Ligature- Generally Transfixation is Perferred

Question 14

Suture Type used to Ligate the Ovarian Pedicles

Answer 14

2-0 Monofilament Absorbable

*Absorbable Suture is Essential

Question 15

Check the Bursa after you Transect the Ovarian Pedicle to Make sure you have Removed the Whole _____

Answer 15

Ovary

Question 16

When Ligating the Uterine Body, Ligate and Transect Uterus ____ to Cervix

Answer 16

Cranial

*DO NOT exteriorize Cervix from Abdomen

Question 17

Breakdown of the _____ Ligament is Necessary for Ligation of the Uterine Body

Answer 17

Broad Ligament

Question 18

When Breaking down the Broad Ligament for Ligation of the Uterine Body, Start _____ near the Uterine Body due to Lessened Risk to Vessels

Answer 18

Caudally

Question 19

The Broad Ligament Breakdown starts _____ and goes Laterally away from the Vessels

Answer 19

Caudally

Question 20

When Ligating the Uterine Body:

Use ______ Clamp Technique

Place Circumferential Ligature in Proximal Crush (Millers Knot)

Place Modified Transfixation Ligature

Answer 20

3-Clamp Technique

Question 21

After Performing Ovariohysterectomy, prior to Closing:

Check the Left Pedicle by Retracting the ____

Check the Right Pedicle by Retracting the ______

Answer 21

Descending Colon- Left Pedicle

Duodenum- Right Pedicle

Question 22

If there is Hemorrhage/Bleeding during Ovariohysterectomy, what is the First Thing you should do?

Answer 22

Extend the Incision

Question 23

Holding Layer when Closing the Body Wall/Linea Alba after Ovariohysterectomy

Answer 23

External Rectus Sheath

Question 24

Common Suture Pattern used when Closing the Abdominal Wall after Ovariohysterectomy

Answer 24

Simple Interrupted Closure

*5mm Spacing between Sutures!

Question 25

Ideal Suture Type for Closing the Abdominal Wall

Answer 25

2-0 PDS

*PDS is Ideal because it is an Absorbable Monofilament Suture

Question 26

Best Suture Type and Pattern for Closure of Subcutaneous Tissue following Ovariohysterectomy

Answer 26

3-0 or 4-0 Synthetic Absorbable

Simple Continuous with Burying the Knot

Question 27

Best Suture Type and Pattern for Closure of Skin following Ovariohysterectomy

Answer 27

Cruciate Pattern

3-0 or 4-0 Nonabsorbable Monofilament (Ex. Nylon)

Question 28

Most Common Postop Complication of Ovariohysterectomy

Answer 28

Hemorrhage

*usually comes from Incomplete Ligation of Ovarian Pedicle

Question 29

Three Common Postop Complications following Ovariohysterectomy

Answer 29

Hemorrhage- Most Common

Dehiscence of Abdominal Incision

Ligation of Ureter- Abdominal Pain, Hydroureter

Question 30

When Performing an Ovariohysterectomy on a Cat, the Uterus is much more Friable so remember NOT to Clamp the Uterus until after _____

Answer 30

Ligation

*In Felines- Ligate the Uterus Prior to Clamping