OVH Flashcards
What is the attachment of the proper ligament?
Uterine horn to caudal pole of the ovary.
What is the attachment of the suspensory ligament?
cranial pole of the ovary and the body wall.
What three tissues make up the Broad Ligament?
Mesovarium + Mesometrium + Mesosalpinx
What are the components of the Broad Ligament?
Ovarian & Uterine vessels, +/- fat
What is the Round Ligament?
Remnant of the gubernaculum.
Where do right & left ovarian arteries branch from?
Aorta
Where do right & left ovarian veins drain?
Right Ovarian v.= vena cava
Left Ovarian v. = left renal v.
What instrument is used to clamp the proper ligament?
Mosquito forcep
T/F: The mosquito forcep clamped to the proper ligament should be used to manipulate the ovary during OVH.
False! Clamp the proper ligament, but hold the ovary or uterine horn for manipulation
Should the suspensory ligament be cut or digitally broken down?
Digitally broken down to exteriorize the ovary.
CAUTION: Complete breakdown of the suspensory ligament can tear into the pedicle causing hemorrhage
Which surgical technique is appropriate for most patients when ligating the ovarian pedicle?
Modified Triple Clamp Technique.
What ligatures are used in the Modified Triple Clamp technique?
1st Ligature: Circumferential Miller’s Knot in the proximal crush
2nd: Transfixation or surgeron’s knot; must flash clamp (why?)
What suture type & size are you going to use to ligate in most OVH procedures?
Absorbable, monofilament, 2-0
Note: Giant breeds you can use size 0
T/F: The uterine body is ligated and transected caudal to the cervix, thus requiring complete exteriorizing of the cervix.
False. The uterine body is ligated & transected CRANIAL to the cervix, thus you do NOT need to exteriorize the cervix.
All vessels of the uterine body are located in what part of the broad ligament?
Mesometrium.
The uterine artery arises from where?
Internal pudendal artery
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.
Begin caudally near the uterine body & work laterally.
T/F: Uterine vessels should be ligated individually.
True.
The left ovarian pedicle can be located using the ‘colonic maneuver,’ what is it?
Retracting the colon medially; the mesocolon will retract the jejunum, thus revealing the approximate location of where a dropped left pedicle may be.
How would you locate a dropped right ovarian pedicle?
“Duodenal Maneuver”–retract the duodenum medially; mesoduodenum will retract the jejunum.
What is the first step when uncontrolled hemorrhage is encountered during OVH?
Extend the incision.
What is the holding layer during OVH closure?
External rectus sheath/fascia
Why should suturing muscle be avoided?
It does not add strength to the closure and increases inflammation
What two suture patterns can be used to close the holding layer?
Simple interrupted & simple continuous
Bonus Question: why is simple continuous the least preferred pattern?
