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
• Cat -flank site 1  cm behind the last rib and 1 to 1.5 cm below the lumbar vertebra

Flank site

• 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 ovary

• 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 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.

Uuterine horns

• 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.