OVARIOHYSTERECTOMY CN

  • Check patient alignment on table - - must be straight!
  • Drape: medial to teats, from umbilicus to pubis
  • Count sponges!!
  • Lay-out and organize instruments!!

INCISION

  • Make skin incision #10 blade from umbilicus to pubis
  • Dog: cranial 1/3 to ½ distance (Make long enough!)
  • SubQ incision #15 until see linea alba.
  • *Clear SQ 1-1.5 cm laterally with metzenbaum scissors making tunnels and cut along separated SQ to clear linea alba

CLEARLY ID LINEA ALBA

  • Linea Alba incision #15
  • Elevate linea alba with brown adson forceps and incise with #15 scalpel blade. Elevate area from inside with forceps and continue incision.

OVARIAN PEDICLES

  • (LEFT side first)
  • Snook hook enter laterally and move medially at 45o towards caudal end of incision
  • Rupture suspensory ligament
  • Grasp proper ligament with hemostats apply pressure
  • with non dominant hand up away from body
  • dominant hand strums the suspensory ligament with forefinger
  • from lateral to medial as cranial as possible and tear medially
  • ID vascular pedicle
  • Create fenestration caudal to the last artery (vascular pedicle) with hemostats and extend parallel to the vessels
  • 3 clamps placed deep to the ovary (deepest clamp for crushing)
  • mediolateral direction with access to the assistant
  • Perform 3 clamp technique with 2(or 3 if large) ligatures. 2-0 PDS
  • 1st ligature – circumferential – placed above & below deepest clamp
  • remove deepest clamp & seat ligature into crushed area
  • flash deepest clamp before tightening 1st throw (surgeons)
  • 2nd throw – close hemostat – 2 more throws
  • Ears 3-4 mm long
  • Large or obese – place Transfixation ligature in between deepest ligation and clamp
  • flash with 1st two throws (transfix and circumf)
  • 4 throws encircling pedicle with flash
  • 2nd Ligature – circumferential – just below last clamp (surgeons)
  • Flash before tightening 1st throw (surgeons)
  • Incise between last two clamps (against top clamp) TIGHT!
  • Grasp pedicle with thumb forceps and check for hemorrhage

GET INSTRUCTOR BEFORE RELEASING PEDICLE.

  • ID ovary (incise ovarian bursa) before releasing pedicle!!!
  • Repeat onRIGHT side - Right ovary is located more cranial
  • ID branches of uterine artery – exteriorize and retroflex uterus to visualize

BROAD LIGAMENT

  • Ligation of the broad ligament - 3 clamp technique with one circumferential ligature
  • Create fenestrationlateral and parallel to uterine artery
  • 3 clamps placed across entire broad ligament(deepest clamp for crushing)
  • mediolateral direction with access to the assistant
  • Circumferential ligature placed in crushed area of deepest clamp (2 if large)
  • Incise between last two clamps (against top clamp) TIGHT!
  • Repeat on contralateral side

UTERINE PEDICLE

  • ID cervix
  • Plan to incise uterus in btwn top 2 clamps at least 1cm cranial to cervix
  • Uterine ligation: 3 clamp technique with 2 transfixation ligatures
  • 3 clamps placed across (deepest clamp for crushing)
  • 1stTransfixation ligature– placed above & below deepest clamp
  • remove deepest clamp
  • take bite and seat ligature in crushed area
  • Bite part of mesometrium and encircle uterine artery – 2 throws
  • flash deepest clamp beforetightening 1st throw
  • 2nd throw – close hemostat
  • Pass free suture end around pedicle (or flip uterus cranially)
  • Place 4 throws around entire pedicle with flash in first throw
  • 2ndTransfixation Ligature– just above first ligature
  • Contralateral bite part of mesometrium and encircle uterine artery
  • 2 throws
  • flash deepest clamp beforetightening 1st throw
  • 2nd throw – close hemostat
  • Pass free suture end around pedicle (or flip uterus cranially)
  • Place 4 throws around entire pedicle with flash in first throw
  • Incise body of uterus in between the two clamps (>1 cm cranial to cervix)
  • Grasp with thumb forceps and check for hemorrhage

GET INSTRUCTOR BEFORE RELEASING PEDICLE.

CHECK FOR HEMORRHAGE

  • Compress abdomen with hands
  • Insert sponge with needleholders and check for excess blood
  • Count Sponges

CLOSURE

  • Linea alba Simple continuous pattern. 2-0 PDS
  • TIGHT!!
  • 5 throws beginning and 7 throws at end.
  • Maintain tension
  • hold end of last suture with nondominant hand while making next suture
  • TIGHT!!

HAVE INSTRUCTOR CHECK BEFORE MOVING ON!!

  • SubQ continuous pattern with buried knots (deep to superf, superf to deep)
  • Begin: deep to sup, sup to deep (make knot deep to deep) Pull parallel to incision
  • Like closing a book! SMALL BITES
  • Can include a bite of rectus fascia
  • Bites enter and exit as close to skin as possible.
  • DO NOT TAKE LARGE BITES OF FAT.
  • End: Sup to deep, deep to sup;
  • Make deep-to-deep loop loose
  • Sup to deep;
  • tie to deep-to-deep loop
  • Cutaneous interrupted cruciate pattern 3-0 Nylon
  • LOOSE!! Must fit needleholders underneath!
  • Pull up on 2nd throw to keep loose
  • Don’t use forceps on skin
  • Big bites, ~1cm in btwn sutures
  • LOOSE!!