Spay practical notes

Question 1

Discuss location of the uterus?

Answer 1

• Uterus: y shaped located between the bladder and dorsal colon. The uterus/ovary is the organ closest to the body wall

Question 2

Discuss the use of the spay hook?

Answer 2

• Spay hook: push down the body wall then twist it round and pick up the uterus should feel tensions. Be careful not to damage the ureters and bladder with the hook

Question 3

Discuss the proper ligament?

Answer 3

• Proper ligament: between the ovary and uterine body white and firm. Place a clamp (curved mosquitoes) on it then can use it as a handle so you have something to hold

Question 4

Discuss the suspensory ligament?

Answer 4

Suspensory ligament:

cranial towards the rib. Many ways to break down the suspensory ligament: twanging, scissors or pulling. It releases the tension and allows you to have more room

Question 5

Discuss the pedicle?

Answer 5

Pedicule: dark purple blood vessels that go towards the aorta.

This must be ligated duing a spay procedure

Question 6

Discuss the round ligament?

Answer 6

Round ligament: flappy bit, tough can snap it allowing you to pull ovary out. You can find the round ligament within the broad ligament as it is tougher and more ligament like.

Question 7

Discuss the broad ligament?

Answer 7

Broad ligament: A wide sheet made of peritoneum.

Question 8

Discuss the right uterine horn?

Answer 8

Right uterine horn:

Tighter and harder to exteriorise so bleeding tends to be this side.

Higher up near the right kidney

Question 9

Discuss cutting the suspenosry ligament?

Answer 9

Sometimes need to cut suspensory ligament in bitches to allow ovary to come up. Stretchy in cats so don’t need to cut.

Question 10

Discuss how to deal with complications in neutering the bitch?

Answer 10

• To reduce bleeding use a modified millers knot for ligatures
• To reduce the risk of damage to the bladder express before surgery
• To reduce risk of damage to the spleen lift up/tent before make the incision
• If there is bleeding make a bigger incision and do the Duodenal manoeuvre and colon manoeuvre to pull everything out the way so you can check the ligatures for bleeding. Swab and place another ligature
• Also reflex the bladder back to check the cervix for bleeding
• If bitch is bleeding get someone to take a blood sample so that you have a baseline PCV
• Note a young healthy fit dog can have a pcv down to 20% and can still be fine
• If bleeding a lot put on fluids- Hartmanns

Question 11

What is the duodenal manoeuver?

Answer 11

Duodenum (know it’s the duodenum as it has a pancreas) normally ventrally on right side – use the mesentry to move the structures out the way retract the mesentery across the abdominal cavity, which enables the small and large intestine to be retracted, exposing:

• Kidney, right ovarian pedicle, vena cava and portal system. Photo shows the fingers holding the duodenum and mesentery then can see the vena cava and the right kidney

Question 12

Discuss the Colonic Manoeuver?

Answer 12

Retraction of the descending colon and mesentery to the right hand side provides exposure of the left side of the abdomen. Picture shows this move and you can see the left kidney and left ovarian pedicule to check for bleeding

Question 13

Discuss all the ligaments?

Answer 13

• Suspensory ligament: Runs from the top of the ovary to the dorsal body wall.
• Proper ligament of the ovary: Runs from the bottom of the ovary to the tip of the uterine horn.
• Round ligament of the uterus: Runs from the tip of the uterine horn to the inguinal canal. In bitches it continues through the inguinal canal. Remnant of the Gubernaculum.
• Broad Ligament: A wide sheet of peritoneum supporting the ovaries, uterine tube, horns, body, cervix by suspending them from the dorsolateral body wall, subdivided into 3 structures

Question 14

What can be seen here?

Answer 14

Fingers point at left and right ovaries. Twine tied around descending colon

Question 15

What can be seen here?

Answer 15

Hand beneath and oviarectomy. Where only ovaries have been removed.

Question 16

What does the red arrow show?

Answer 16

Proper ligament red arrow

Question 17

What manoeuvere can be seen here?

Answer 17

Colonic maneuverer to show the left ovary clearly

Question 18

What is show by the red arrows?

Answer 18

Suspensory ligament shown by red arrows

Question 19

What can be seen here?

Answer 19

Duodenal manoeuvere revealing right ovary

Question 20

Discuss Neutering bitches and queens surgery?

Answer 20

• Tie/Pull back legs back in flank approach otherwise you may spay the quadriceps
• Express the bladder before spay to prevent spaying the bladder!!
• If you go too dorsal can be in peritoneal cavity
• American vet schools teach to pull front leg forwards to either side of thorax as apparently it loosens the suspensory ligament

Question 21

Discuss finding the uterus?

Answer 21

• The more caudal you go the closer to bladder the uterus is when you put your finger down just in-front of the bladder the uterus should be felt where it starts to bifurcate.

Question 22

Discuss breaking the suspensory ligament?

Answer 22

• Don’t always need to do it. Depends on age of dog or cat whether you can excise it. It is broken so you can exteriorise the ovary so you can tie the ligature outside of the peritoneal cavity.
• Does not need to be completely broken as adequate exposure can be made by stretching or partial tear.
• Easier to break if it is pulled tight. Like a rubber band.
• Rob finds strumming doesn’t work so well he just pulls caudally and waits for it to give
• Suspensory ligament attaches to cranial edge of the pedicle

Question 23

Discuss safe ligation of the ovarian pedicle?

Answer 23

• 3 clamp: clamp nearest patient (crush clamp clamped to 1st click/ratchet), middle clamp (occlusion clamp clamped to 2nd clip/ratchet) and last clamp (occlusion done to 3rd clamp/ratchet)
• Bed ligature into the crush site

Question 24

Discuss useful retractors for the spay?

Answer 24

Dowling retractor and Haupton retractors

Dowling retractor: aids the single handed surgeon when tissue is trying to fall back into abdomen and holds it in place.

Question 25

Discuss the 4 ligaments again?

Answer 25

* *Suspensory:** you break to exteriorise * *Ovarian ligament:** sits in the bursa between ovary and uterus rarely see * *Proper:** between ovary and body of uterus * *Broad ligament (contains round ligament):** hole must be made in this to produce the pedicle. Pedicle contains more than one BVs; many tiny ones. Ovarian vein and artery are ligated in the pedicle which remains in the animal. Rabbit also has a median broad ligament artery which must also be ligated.

Question 26

Discuss why Stump pyometra/granulomas occur?

Answer 26

Due to exogenous progesterone administration or poor ligature technique or hygiene. Leaving uterus in does not matter it is giving exogenous progesterone or poor surgical asepsis that can cause the granuloma.

Question 27

What is a transfixion suture?

Answer 27

First bite of suture goes through tissue you are ligating.

Question 28

Modified miller's knot?

Answer 28

Ask Anna to send the video