Ovariohysterectomy Procedure

Question 1

What do you use a spay hook for?

Answer 1

Introduced into the abdomen with the hook parallel to the body wall

It is then rotated 90 degrees and moved towards the midline

Question 2

Disadvantages of spay hook?

Answer 2

Sometimes GIT structures are hooked and it may be necessary to palpate with a finger

Question 3

Which ovary is more difficult to exteriorise?

Answer 3

The right ovary

Question 4

Which ligament do you break/ stretch first?

Answer 4

The suspensory ligament

Question 5

What do you create a window in in order to be able to ligate the ovarian pedicle?

Answer 5

Window in the mesovarium
Caudal to the ovarian vessels

Question 6

How do you clamp the ovarian pedicle?

Answer 6

Triple clamp with carmalt-rochester forceps

Question 7

Where do you clamp the ovarian pedicle?

Answer 7

Proximal to the ovary (if possible)
otherwise, one clamp between ovary and uterus

Question 8

What does the selection of suture size depend on?

Answer 8

The amount of fat in the pedicle
Your confidence in your ligature

Question 9

2 types of suture material for ovarian pedicles

Answer 9

BOTH ABSORBABLE MONOFILAMENT

PDS (polydioxanone suture)
Polyglyconate

Question 10

Suture size for ovarian pedicles

Answer 10

Dogs 0 - 2/0 - 3/0

Cat 3/0

Question 11

What to do after you transect the pedicle

Answer 11

Hold the pedicle in forceps without tension before releasing into the peritoneal cavity

Question 12

How to transect the broad ligament (2nd)

Answer 12

cut or break with fingers

Question 13

What do you need to avoid when breaking the broad ligament?

Answer 13

The uterine vessels

Question 14

Extra step in multiparous, pregnant or mature dogs?

Answer 14

There may be large branching vessels that require ligation

Question 15

Uterine body clamps

Answer 15

1-2 clamps just cranial to the cervix

Question 16

What is the role of the cervix?

Answer 16

Natural barrier to the exterior

Question 17

How much uterine body tissue should be removed?

Answer 17

As much uterine tissue as possible to prevent complications such as stump pyometra

Question 18

Type of ligature for uterine body

Answer 18

Single, encircling ligature

Question 19

When to use a transfixing ligature for uterine body?

Answer 19

If uterus is enlarged
i.e. pregnant or in season

Question 20

How to ligate the uterine vessels?

Answer 20

Independent to the uterus

Question 21

What do you need to check the abdominal cavity for?

Answer 21

Haemorrhage

Question 22

Linea alba closure material

Answer 22

Monofilament, absorbable
PDS (polydioxanone suture)
Polyglyconate
1 - 3/0

Question 23

Skin suture material

Answer 23

Non-absorbable
Polypropylene or Nylon or Polyamide

Question 24

Intradermal suture material

Answer 24

Absorbabke
PDS or polyglyconate

Question 25

What is the most common ovariohysterectomy complication?

Answer 25

Haemorrhage - 76%

Question 26

3 types of wound healing complications

Answer 26

Suture reaction (most common in cats)

Seroma (fluid accumulation)

Fistulous tracts (abnormal passage)

Question 27

4 causes of stump pyometra

Answer 27

Progesterone produced by remnants of ovarian tissue (or exogenous)

Stump inflammation or granuloma from non-absorbable material

Poor aseptic technique

Excessive residual devitalised uterine body

Question 28

Urogenital complications (2)

Answer 28

1. Accidental ureteral ligation
2. Urinary incontinence (11-20% of desexed females)

Question 29

How to treat post spay urinary incontinence

Answer 29

Stilboestrol or alpha agonists - to increase responsiveness of the smooth muscle of the bladder neck to nerve activity, tightening the muscle and preventing leakage of urine

Colposuspension - when drugs fail - improves pelvic floor and corrects position of the bladder neck to an intra-abdominal position (by cranially stretching the vagina and suturing it to the prepubic tendon on each side of the urethra)

Question 30

In what percentage of patients is weight gain reported ?

Answer 30

26 - 38%

Question 31

Where do you tie into?

Answer 31

The crush