OVH

Question 1

What is the attachment of the proper ligament?

Answer 1

Uterine horn to caudal pole of the ovary.

Question 2

What is the attachment of the suspensory ligament?

Answer 2

cranial pole of the ovary and the body wall.

Question 3

What three tissues make up the Broad Ligament?

Answer 3

Mesovarium + Mesometrium + Mesosalpinx

Question 4

What are the components of the Broad Ligament?

Answer 4

Ovarian & Uterine vessels, +/- fat

Question 5

What is the Round Ligament?

Answer 5

Remnant of the gubernaculum.

Question 6

Where do right & left ovarian arteries branch from?

Answer 6

Aorta

Question 7

Where do right & left ovarian veins drain?

Answer 7

Right Ovarian v.= vena cava

Left Ovarian v. = left renal v.

Question 8

What instrument is used to clamp the proper ligament?

Answer 8

Mosquito forcep

Question 9

T/F: The mosquito forcep clamped to the proper ligament should be used to manipulate the ovary during OVH.

Answer 9

False! Clamp the proper ligament, but hold the ovary or uterine horn for manipulation

Question 10

Should the suspensory ligament be cut or digitally broken down?

Answer 10

Digitally broken down to exteriorize the ovary.

CAUTION: Complete breakdown of the suspensory ligament can tear into the pedicle causing hemorrhage

Question 11

Which surgical technique is appropriate for most patients when ligating the ovarian pedicle?

Answer 11

Modified Triple Clamp Technique.

Question 12

What ligatures are used in the Modified Triple Clamp technique?

Answer 12

1st Ligature: Circumferential Miller’s Knot in the proximal crush
2nd: Transfixation or surgeron’s knot; must flash clamp (why?)

Question 13

What suture type & size are you going to use to ligate in most OVH procedures?

Answer 13

Absorbable, monofilament, 2-0

Note: Giant breeds you can use size 0

Question 14

T/F: The uterine body is ligated and transected caudal to the cervix, thus requiring complete exteriorizing of the cervix.

Answer 14

False. The uterine body is ligated & transected CRANIAL to the cervix, thus you do NOT need to exteriorize the cervix.

Question 15

All vessels of the uterine body are located in what part of the broad ligament?

Answer 15

Mesometrium.

Question 16

The uterine artery arises from where?

Answer 16

Internal pudendal artery

Question 17

Breakdown of the broad ligament should be conducted in this fashion in an effort to reduce the risk to vessels & thus reduced risk of intra-op complications.

Answer 17

Begin caudally near the uterine body & work laterally.

Question 18

T/F: Uterine vessels should be ligated individually.

Answer 18

True.

Question 19

The left ovarian pedicle can be located using the ‘colonic maneuver,’ what is it?

Answer 19

Retracting the colon medially; the mesocolon will retract the jejunum, thus revealing the approximate location of where a dropped left pedicle may be.

Question 20

How would you locate a dropped right ovarian pedicle?

Answer 20

“Duodenal Maneuver”–retract the duodenum medially; mesoduodenum will retract the jejunum.

Question 21

What is the first step when uncontrolled hemorrhage is encountered during OVH?

Answer 21

Extend the incision.

Question 22

What is the holding layer during OVH closure?

Answer 22

External rectus sheath/fascia

Question 23

Why should suturing muscle be avoided?

Answer 23

It does not add strength to the closure and increases inflammation

Question 24

What two suture patterns can be used to close the holding layer?

Answer 24

Simple interrupted & simple continuous

Bonus Question: why is simple continuous the least preferred pattern?

Question 25

What is the ideal suture type for closing the external rectus fascia?
BONUS Question: why?

Answer 25

PDS, 2-0

Bonus Answer: because PDS takes ~60days to lose 50% of it’s tensile strength and the fascia takes ~6 weeks to heal.

Question 26

What is the most common immediate post-op complication of OVH?

Answer 26

Hemorrhage

Question 27

What are two other important immediate post-op complications assoc. w/ OVH besides hemorrhage?

Answer 27

Dehiscence of abdominal incision & ligation of a ureter.

Question 28

T/F: The uterus should not be clamped until after ligation when performing OVH in felines due to friable tissues.

Answer 28

True.

Question 29

What are some differences between OVH in canines vs. felines?

Answer 29

Incision: middle 1/3 of caudal abdomen
SQ tissues separate easily
Single ligatures usually sufficient (Miller’s Knot)
Ligate closer to the bifurcation