Surgery Rounds 2 Flashcards
Before going to scrub…
- what do we do with:
- instrument and gown pack
- lap sheet
- glove pack
- suture materials
- scalpel blades
- Instrument and gown packs are opened
- Lap sheet is opened
- Gloves for surgeons are opened
- Suture material is planned and obtained
- Scalpel blades are opened
What is the cause of Ovarian Remnant Syndrome?
- Improper surgical technique
> Decreased visualization – limited incision
> Surgeon inexperience - Ovaries can revascularize if dropped
- Estrogen creams?
Ovarian remnant syndrome Dx
- Physical examination with history of spay
- Vaginal cytology during heat (estrogen dominance)
- HormoneAssays:
> Serum estradio l>15pg/mL
> Serum progesterone >2ng/mL
> Single low luteinizing hormone (high usually consistent with gonadectomy but false positives)
> Anti-Mullerian hormone - Abdominal Ultrasound
considerations when Dx ovarian remnant syndrome for cats
- Subtle vaginal cytology changes
- Increased plasma estrogen = ovarian remnant or adrenocortical problems
- Progesterone analysis requires previous luteinization
Ovarian Remnant Syndrome occurs most commonly on: left or right? why? cats or dogs?
Right
Dogs have a higher likelihood of developing ORS as compared with cats and the right ovary is more likely to be involved given its cranial location
SUSPENSORY LIGAMENT RUPTURE
- steps
- Identify proper ligament
> Place hemostat - Identify ovary and grasp with dominant hand
- Identify suspensory ligament with non-dominant hand
- Use thumb and forefinger to trace suspensory ligament as close to the body wall as possible
- Controlled rupture between thumb and forefinger
TREATMENT FOR OVARIAN REMNANT SYNDROME
- Surgical removal of tissue located at both ovarian pedicles
- Laparotomy or Laparoscopically
- WATCH URETERS!!!
- Visualization is important (estrus)
- Always send for histopathology
> Confirm ovarian tissue has been removed
you drop a pedicle on the left during a spay, what do you do?
- grab colon, pull it over > pulls all intestines up in a ‘basket’
> look for left kidney, will see pedicle just caudal
> watch out for ureter when picking up
why do we like to rip vs cut suspensory ligament?
small vessel that will bleed less if ruptured vs cut
ovariectomy - how surgery differs?
- pros and cons?
- more cranial incision to focus on ovary
- risk of uterine tumour development, but very low
- some say its faster
- some say there are less complications
<><> - but papers have found not much difference, but pretty much no risk for cancer or pyometra since the ovaries are gone
- more common in europe and with laparoscopic techniques
ovary sparing spay
- rationalle
- Removal of the entire uterus while leaving the ovaries
- LH receptors present in normal tissues and neoplastic tissues
- Gonads may be critical to endocrine, musculoskeletal, behavior and anti-neoplastic health
<><> - possible relationship between long term adverse health effects of gonad-removing surgical sterilization and LH in dogs
- a tougher surgery
