SL1 - Ovariohysterectomy

Question 1

T/F ovariectomies are not used in the US and UK because there is still a risk of pyometra

Answer 1

False

removes source of progesterone so no worry about pyometra

Question 2

indications for OHE

Answer 2

elective sterilization

treatment of ovarian or uterine disease

prevention of mammary neoplasia

prevention/treatment of pyometra

prevention/treatment of vaginal hyperplasia/prolapse

Question 3

ovarian and uterine disease

Answer 3

pyometra

metritis

uterine torsion

neoplasia

trauma

Question 4

advantages of OHE

Answer 4

prevention of mammary tumors

possible prevent other conditions - idiopathic epilepsy, diabetes mellitus

Question 5

disadvantages of OHE

Answer 5

obesity

orthopedic problems

urinary incontinence

neoplasia

Question 6

how should quarter drapes be placed

Answer 6

long

from xiphoid to pubis, 2-3 cm off ventral midline

Question 7

where shoudl final drape be placed

Answer 7

umbilicus to pubis

Question 8

approach

Answer 8

cranial 1/3 of caudal abdomen

extend 4-6cm (based on patient size)

longer if pathology

Question 9

why do you not want to create too much dead space when bluntly dissecting the SQ tissue from the fascia

Answer 9

seroma formation

Question 10

fascia appraoch

Answer 10

identify the linea alba

tent abdomen and perform reverse stab incision (45° angle to level of blade lock - cranial with scalpel, caudal with scissors)

Question 11

where are the ovaries and uterus located in the abdomen

Answer 11

ovaries - caudal pole of kidney

uterine horns - dorsolateral abdomen

uterine body - between bladder and colon adjacent to the ureters

Question 12

how are the uterine horns retrieved

Answer 12

use spay hook - place in incision with hook facing abdominal wall, reach dorsal gutter, turn hook 180° and toward midline

Question 13

where is the proper ligament located

Answer 13

between ovary and uterine horn

Question 14

where is the suspensory ligament

Answer 14

cranial pole of ovary to body wall/last rib

usually must be broken down to exteriorize ovary in dogs

Question 15

where should the suspensory ligament be ruptured

Answer 15

toward the insertion

apply gentle traction, isolate suspensory ligament dorsally, strum, avoid ovarian pedicle

Question 16

T/F the ovian veins drain directly into the vena cava

Answer 16

False

the right ovarian vein drains into the vena cava, the left drains into the renal vein

Question 17

ovarian arteries branch directly off _______

Answer 17

the aorta

Question 18

in order to place your ligatures you need to create a window…how are you going to do this

Answer 18

spread out broad ligament

identify the avascular area of mesovarium

make a window with Rochester-Carmalts

open forceps to widen

Question 19

tips of clamps need to stay _______

Answer 19

outside the body cavity

Question 20

what should not be clamped

Answer 20

tissues you dont want to ligate

SQ, ovary

Question 21

why should non-absorbable suture be avoided when ligating pedicles

Answer 21

risk of developing fistulous tracts

Question 22

where should the window in the broad ligament be placed when ligating uterine body

Answer 22

make window/hole lateral to vessels near uterine body

extend hole digitally craniocaudal manner (aids in hemostasis of small vessels)

may need to ligate broad ligament

Question 23

what should you always do

Answer 23

check ovarian bursa to ensure you have removed entire ovary

remove ovaries and uterus from surgical field

remove blood from dorsal gutters

look for active hemorrhage

Question 24

how can you check left pedicle

Answer 24

move mesocolon medially

Question 25

how can the right pedicle be check

Answer 25

move mesoduodenum medially

Question 26

how to check uterine stump

Answer 26

located between the colon and bladder

exteriorizing bladder helps with exposure

Question 27

what 3 layers should be closed

Answer 27

external rectus sheath

subcutaneous tissue

skin

Question 28

what is the most common cause of death in OHE

Answer 28

hemorrhage

Question 29

causes of hemorrhage in OHE

Answer 29

tearing of pedicle while strumming

incomplete ligation (window in wrong place)

loose ligatures

increased risk in dogs > 25kg

Question 30

what should you do if you notice hemorrhage intra-op

Answer 30

dont panic!

extend the incision

identify source of bleeding → exteriorize vessel → calmp and re-ligate

Question 31

complications of OHE

Answer 31

hemorrhage

infection

dehiscence

ligation or clamping injury of ureter

Question 32

postoperative care

Answer 32

exercise restriction

elizabethan collar

dogs in estrus - males may still try to mate early post-op, uterine tearing → castastrophic hemorrhage, peritonitis

Question 33

how does the approach differ in a cat

Answer 33

middle 1/3 of caudal abdomen

usually shorter incision (3-4cm)

less SQ tissue - less dissection, separates from rectus sheath

don’t need to break down suspensory ligament

Question 34

T/F you dont need to clamp uterine body until ligated in feline OHE

Answer 34

true