VSR 421: Regional Veterinary Surgery (2+1)

SURGICAL TECHNIQUE

• Incision site
  • Dog: Midline abdominal incision, extending from umbilicus to a point midway between umbilicus and brim of pubis.
  • Cat: 1 cm caudal to umbilicus and extends approximately 3-5 cm caudally
• Ventral midline incision is made on the skin, continued through the linea alba and peritoneum.
• Left uterine horn is easy to reach, as it is located more caudally than the right.
• Left uterus horn is located with ovariohysterectomy hook or index finger.
• Traction of the uterine horn exposes the ovary and ovarian pedicle.
• Suspensory ligament is stretched or broken with index finger.
• The ovarian arteriovenous complex is clamped with two or three haemostatic forceps as per the surgeon’s preference.
• The surgeon should maintain constant digital contact with the ovary when applying the first clamp to ensure the entire ovary is removed.
• A third clamp is placed on the proper ligament between the ovary and the uterine horn.
• Absorbable suture (e.g. chromic catgut or PGA) is preferred for all ligatures.
• A circumferential suture is tightened so that it lies in the groove of the crushed tissue created by the clamp.
• A transfixation suture is placed between the circumferential suture and the cut end of the pedicle.
• Pedicle is grasped with thumb forceps, the final clamp is released and the pedicle is inspected for bleeding.
• If no bleeding occurs, the pedicle is replaced in the abdomen.
• The right uterine horn is isolated following the left uterine horn distally to the bifurcation.
• The ligation procedure is repeated on the right ovarian pedicle.
• Large vessels in the broad ligament are ligated when broad ligament is grasped and torn.
• Uterine body is exteriorized and the cervix is located.
• Three clamps are placed in the uterine body proximal to cervix.
• Circumferential suture is placed around the distal clamp, the clamp is removed and the suture is tightened in the groove of the crushed tissue.
• A transfixation suture is placed between the circumferential suture and the remaining clamp which is removed after severing the uterine body.
• Abdominal incision is closed either in a simple interrupted suture pattern with absorbable suture material or in simple continuous pattern with non absorbable suture.
• Subcutaneous tissue and skin are closed routinely with subcuticular sutures and interrupted sutures respectively.