Lecture 9: Intro to Spay

Question 1

Identify 1-9

Answer 1

1. Suspension ligament
2. Ovary
3. Proper ligament
4. Uterine horn
5. Broad ligament
6. Body of uterus
7. Round ligament
8. Uterine artery and vein
9. Pedicle- ovarian artery and vein

Question 2

why should you express bladder prior to spay

Answer 2

filled urinary bladder can make it harder to identify uterine body

Question 3

for spay where should you clip fur

Answer 3

xiphoid to pubis and lateral to mammary glands

Question 4

where should you make incision in young puppy < 3 months, older puppy and adult

Answer 4

young puppy <3 months: halfway between umbilicus and pubis

Older puppy: between umbilicus and midpoint

Adult: start right behind umbilicus

Question 5

where should you make incision for cat spay

Answer 5

midpoint between umbilicus and cranial edge of pubis

Question 6

once you have incised the skin remove the __ with __ to better reveal __

Answer 6

SQ fat, blunt and sharp dissection (scissors) to reveal lines alba

Question 7

once identified linea alba how do you enter abdomen

Answer 7

grasp linea alba with forceps and elevate, stab incision with blade facing away/dorsal (reverse press cut)

Question 8

once you made stab incision extend incision with __ or __

Answer 8

scalpel or mayo scissors

Question 9

describe how you would find first ovary with spay hook

Answer 9

1. Use thumb forceps to elevate abdominal wall and pull laterally
2. Insert spay hook, aiming diagonally caudally toward stifle
3. Push down along body wall until dorsal wall is reached
4. Rotate spay hook 180 degrees so open end faces midline
5. Sweep spay hook medial and cranial

Question 10

if you are getting intestine with spay hook you are too far __

Answer 10

cranial

Question 11

if getting bladder fat you are too far __

Answer 11

caudal

Question 12

how can you confirm you have hooked the uterus and ovary

Answer 12

follow cranially to ovary or caudally to bifurcation

Question 13

identify 1-3

Answer 13

1. Suspensory ligament
2. Vascular pedicle
3. Uterine horn

Question 14

what is the most cranial structure to ovary

Answer 14

suspensory ligament

Question 15

vascular pedicle travels down __, suspensory ligament more cranially

Answer 15

dorsally

Question 16

describe the process of breaking the suspensory ligament

Answer 16

Use index finger to rupture suspensory ligament from lateral to medial

Question 17

t or f: in cats you can use scissors or blade to break suspensory ligament

Answer 17

true

Question 18

after you break down suspensory ligament what is next step

Answer 18

using hemostats, make a window into your broad ligament, caudal to ovarian pedicle in non-vascular area

Question 19

describe the three clamp modified technique for ligating pedicle in dog

Answer 19

1. Clamp 1: placed as proximal as possible
2. Clamp 2: distal to clamp 1
3. Move clamp 1 distal to clamp 2 and make first ligature/strangle knot in crush of clamp 1
4. Remove clamp 2 and make 2nd ligature/strangle knot in crush of clamp 2

Question 20

what suture will you use for ligating ovarian pedicle

Answer 20

monofilament absorbable, 3-0 to 0 depending on weight

Question 21

once pedicle is ligated you can transect where and with what

Answer 21

between clamp 1 and 2nd ligature with scalpel or metzenbaum scissors

Question 22

since cat pedicles are smaller you can use same ligating technique as dogs or what other technique

Answer 22

Place hemostat right below ovary and place two ligatures below

Question 23

t or f: you can use autoligation in dog spays

Answer 23

false- never- only cat spays

Question 24

what are the benefits of autoligation of ovarian pedicle in cats

Answer 24

1. Minimize foreign material
2. Minimize trauma
3. Minimize time

Question 25

when placing hemostats on ovarian pedicle how should you place them

Answer 25

tips up

Question 26

be sure to break down __otherwise uterus will remain attached to body wall

Answer 26

broad ligaments

Question 27

how do you break down broad ligaments

Answer 27

blunt, sharp or digital manipulation

Question 28

after ligating second ovarian pedicle and cutting, what is next step

Answer 28

ligating uterine body

Question 29

how do you ligate uterine body

Answer 29

strangle knot proximal and strangle knot distal

Question 30

when ligating uterine body you want to be mindful not to ligate __

Answer 30

ureters

Question 31

do not oversew end of uterine stump may predispose to __

Answer 31

stump pyometra

Question 32

in larger dogs, pregnant animals or those in heat you may need to ligate ___individually

Answer 32

uterine vessels

Question 33

what should you do prior to closure

Answer 33

1. Check abdomen for hemorrhage 2. Sponge count

Question 34

what should you do if concern for bleeding in lab

Answer 34

1. Notify instructor 2. Extend incision 3. Use natural refractors - left side: colon and mesocolon Right side: duodenum and mesoduodenum 4. Soak up pooling blood with sponges

Question 35

where should you look for bleeding

Answer 35

1. Ovarian artery and vein/pedicle 2. Aorta, caudal vena cava 3. Uterine artery and vein Other sources: Broad ligament Perineal fat and retroperitoneum Suspensory ligament Body wall Spleen Generalized bleeding/oozing- disorder

Question 36

what do you do once you find source of bleeding

Answer 36

clamp vessel with hemostats and apply new ligatures

Question 37

describe closure for spay

Answer 37

1. Linea alba/body wall: incorporate external rectus sheet and close with simple continuous, interrupted, or cruciates 2. Layer 2: SQ tissue: simple continuous 3. Layer 3: skin internal: intradermal 4. Skin external: glue, cruciates

Question 38

what suture do you want to use for linea alba closure

Answer 38

monofilament long lasting absorbable suture- PDS

Question 39

what is OVH vs PVE

Answer 39

OVH: removal of ovaries and uterus OVE: removal of just ovaries

Question 40

what are some peri/post operative spay complications

Answer 40

hemorrhage, infection, dehiscence, ureter ligation

Question 41

what are some long term spay complications

Answer 41

ovarian remnant syndrome, urinary sphincter mechanism incontinence, obesity