SL1 - Ovariohysterectomy Flashcards
T/F ovariectomies are not used in the US and UK because there is still a risk of pyometra
False
removes source of progesterone so no worry about pyometra
indications for OHE
elective sterilization
treatment of ovarian or uterine disease
prevention of mammary neoplasia
prevention/treatment of pyometra
prevention/treatment of vaginal hyperplasia/prolapse
ovarian and uterine disease
pyometra
metritis
uterine torsion
neoplasia
trauma
advantages of OHE
prevention of mammary tumors
possible prevent other conditions - idiopathic epilepsy, diabetes mellitus
disadvantages of OHE
obesity
orthopedic problems
urinary incontinence
neoplasia
how should quarter drapes be placed
long
from xiphoid to pubis, 2-3 cm off ventral midline
where shoudl final drape be placed
umbilicus to pubis
approach
cranial 1/3 of caudal abdomen
extend 4-6cm (based on patient size)
longer if pathology
why do you not want to create too much dead space when bluntly dissecting the SQ tissue from the fascia
seroma formation
fascia appraoch
identify the linea alba
tent abdomen and perform reverse stab incision (45° angle to level of blade lock - cranial with scalpel, caudal with scissors)
where are the ovaries and uterus located in the abdomen
ovaries - caudal pole of kidney
uterine horns - dorsolateral abdomen
uterine body - between bladder and colon adjacent to the ureters
how are the uterine horns retrieved
use spay hook - place in incision with hook facing abdominal wall, reach dorsal gutter, turn hook 180° and toward midline
where is the proper ligament located
between ovary and uterine horn
where is the suspensory ligament
cranial pole of ovary to body wall/last rib
usually must be broken down to exteriorize ovary in dogs
where should the suspensory ligament be ruptured
toward the insertion
apply gentle traction, isolate suspensory ligament dorsally, strum, avoid ovarian pedicle
T/F the ovian veins drain directly into the vena cava
False
the right ovarian vein drains into the vena cava, the left drains into the renal vein
ovarian arteries branch directly off _______
the aorta
in order to place your ligatures you need to create a window…how are you going to do this
spread out broad ligament
identify the avascular area of mesovarium
make a window with Rochester-Carmalts
open forceps to widen
tips of clamps need to stay _______
outside the body cavity
what should not be clamped
tissues you dont want to ligate
SQ, ovary
why should non-absorbable suture be avoided when ligating pedicles
risk of developing fistulous tracts
where should the window in the broad ligament be placed when ligating uterine body
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
what should you always do
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
how can you check left pedicle
move mesocolon medially
how can the right pedicle be check
move mesoduodenum medially
how to check uterine stump
located between the colon and bladder
exteriorizing bladder helps with exposure
what 3 layers should be closed
external rectus sheath
subcutaneous tissue
skin
what is the most common cause of death in OHE
hemorrhage
causes of hemorrhage in OHE
tearing of pedicle while strumming
incomplete ligation (window in wrong place)
loose ligatures
increased risk in dogs > 25kg
what should you do if you notice hemorrhage intra-op
dont panic!
extend the incision
identify source of bleeding → exteriorize vessel → calmp and re-ligate
complications of OHE
hemorrhage
infection
dehiscence
ligation or clamping injury of ureter
postoperative care
exercise restriction
elizabethan collar
dogs in estrus - males may still try to mate early post-op, uterine tearing → castastrophic hemorrhage, peritonitis
how does the approach differ in a cat
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
T/F you dont need to clamp uterine body until ligated in feline OHE
true
