VSUR 143

SMALL ANIMAL SURGERY

SURGEON: ETHELINE P. CAÑERO DATE: 17 April 2023 2023

ASSIST. SURGEON: TRISHA MAE MARZO PRE-OPERATIVE GRADE:
NURSE: LYKA SOBREVILLA OPERATIVE GRADE:
ANESTHESIOLOGIST: VLADYS CLAIRE CARIASO POST OPERATIVE GRADE:

SURGICAL EXERCISE #7:

OVARIOHYSTERECTOMY (OHE) / SPAY

I. Indication/s:
Spay refers to ovariohysterectomy (OHE), the surgical removal of the ovaries and
uterus is done to limit reproduction or to prevent unwanted reproduction of puppies or
kittens. Other reasons for OHE include prevention of mammary tumors or congenital
anomalies; prevention and treatment of pyometra, metritis, neoplasia (i.e., ovarian, uterine, or
vaginal), cysts, trauma, uterine torsion, uterine prolapse, subinvolution of placental sites,
vaginal prolapse, and vaginal hyperplasia; and control of some endocrine abnormalities (i.e.,
diabetes and epilepsy) and dermatoses (e.g., generalized Demodex).

II. Signalment:
Patient Name: QUEENIE
Species: CANINE
Breed: ASPIN X BEAGLE
Age: 1 YEAR OLD
Sex: FEMALE
Weight:
Color/Markings: CREAM
III. Surgical Anatomy:
The female reproductive tract includes the ovaries,
oviduct, uterus, vagina, vulva, and mammary glands. The
ovaries are located within a thin-walled peritoneal sac; the
ovarian bursa is located just caudal to the pole of each
kidney. The uterine tube or oviduct courses through the
wall of the ovarian bursa. The right ovary lies further
cranially than the left. The right ovary lies dorsal to the
descending duodenum, and the left ovary lies dorsal to the
descending colon and lateral to the spleen. Medial
retraction of the mesoduodenum or mesocolon exposes the
ovary on each side. Each ovary is attached by the proper
ligament to the uterine horn and via the suspensory
ligament to the transversalis fascia medial to the last one or
two ribs. The ovarian pedicle (mesovarium) includes the
suspensory ligament with its artery and vein, ovarian artery
and vein, and variable amounts of fat and connective tissue.
Canine ovarian pedicles contain more fat than feline
ovarian pedicles, making it more difficult to visualize the vasculature. The ovarian vessels
take a tortuous path within the pedicle. Ovarian arteries originate from the aorta. The left
ovarian vein drains into the left renal vein; the right vein drains into the caudal vena cava.
The suspensory ligament is a tough, whitish band of tissue that diverges as it travels from the
ovary to attach to the last two ribs. The broad ligament (mesometrium) is the peritoneal fold
that suspends the uterus. The round ligament travels in the free edge of the broad ligament
from the ovary through the inguinal canal with the vaginal process. The uterus has a short
body and long narrow horns. The uterine arteries and veins supply blood to the uterus. The
cervix is the constricted caudal part of the uterus and is thicker than the uterine body and
vagina. It is oriented in a nearly vertical position with the uterine opening dorsally. The
vagina is long and connects with the vaginal vestibule at the urethral entrance. The clitoris is
broad, flat, vascular, infiltrated with fat, and lies on the floor of the vestibule near the vulva.
The clitoral fossa is a depression on the floor of the vestibule that is sometimes mistaken for
the urethral orifice. The vulva is the external opening of the genital tract. The vulvar lips are
thick and form a pointed commissure. ss
Prior to surgery, the operating room should be ready and aseptically cleanse.
Instruments, towels, drapes, scrubs etc. must be autoclaved for sterilization. As for the
patient, food and water intake should be restricted 8 to 12 hours before the surgery. Animal
should be encouraged to defecate and urinate before induction of anesthesia. Bath and
remove matted or soiled hair for prevention of contamination to the operative site. Vital signs
of the patient such as its pulse rate, respiratory rate and rectal temperature must be recorded,
followed by the administration of pre-anesthetics (ATS). Administer general anesthetics
(Zoletil) then Clip and surgically prepare the ventral abdomen from the xiphoid to the pubis.
The surgical team should also be prepared before transferring the animal to the operating
room. The IV fluid should also be administered according to the computed drop rate.
IV. Operative Technique: Midline Ovariohysterectomy
Clip and surgically prepare the ventral abdomen from the xiphoid to the pubis.
Identify the umbilicus, and visually divide the caudal abdomen into thirds. In dogs, make the
incision just caudal to the umbilicus in the cranial third of the caudal abdomen. More caudal
incisions make it difficult to exteriorize canine ovaries. In deep-chested dogs or in those with
an enlarged uterus, extend the incision cranially or caudally to allow exteriorization of the
tract without excessive traction. In prepubertal puppies, making the incision in the middle
third of the caudal abdomen facilitates uterine body ligation.

Make a 4- to 8-cm incision through skin and subcutaneous tissue to expose the linea
alba. Grasp the linea alba or ventral rectus sheath, tent it outward, and make a stab incision
into the abdominal cavity. Extend the linea incision cranial and caudal to the stab incision
with Mayo scissors. Elevate the left abdominal wall by grasping the linea or external rectus
sheath with thumb forceps. Slide the ovariectomy hook (e.g., Covault or Snook) with the
hook against the abdominal wall, 2 to 3 cm caudal to the kidney.
Turn the hook medially to ensnare the uterine horn, broad ligament, or round
ligament, and gently elevate it from the abdomen. Anatomically confirm the identification of
the uterine horn by following it to either the uterine bifurcation or ovary. If the uterine horn
cannot be located with the hook, retroflex the bladder through the incision and locate the
uterine body and horns between the colon and bladder. With caudal and medial traction on
the uterine horn, identify the suspensory ligament by palpation at the taut fibrous band at the
proximal edge of the ovarian pedicle. Stretch or break the suspensory ligament near the
kidney without tearing the ovarian vessels to allow exteriorization of the ovary. To achieve
this, use the index finger to apply caudolateral traction on the suspensory ligament while
maintaining caudomedial traction on the uterine horn.
Make a hole in the broad ligament caudal to the ovarian pedicle. Place two or three
Crile or Rochester-Carmalt forceps across the ovarian pedicle proximal (deep) to the ovary
and one across the proper ligament of the ovary. The proximal (deep) clamp serves as a
groove for the ligature, the middle clamp holds the pedicle for ligation, and the distal clamp
prevents backflow of blood after transection. When using two clamps, the ovarian pedicle
clamp serves both to hold the pedicle and to make a groove for the ligature.
Place a figure-eight ligature proximal to (below) the ovarian pedicle clamps. Choose
an absorbable suture material for ligatures (i.e., 2-0 or 3-0 polydioxanone [PDS],
polyglyconate [Maxon], poliglecaprone 25 [Monocryl], glycomer 631 [Biosyn], or
polyglactin 910 [Vicryl]). Begin by directing the blunt end of the needle through the middle
of the pedicle, loop the suture around one side of the pedicle, then redirect the needle through
the original hole from the same direction and loop the ligature around the other half of the
pedicle. Securely tie the ligature. Remove one clamp or “flash” a single clamp while
tightening the ligature to allow pedicle compression. Place a second circumferential ligature
proximal to (below) the first to control hemorrhage that may occur from puncturing a vessel
as the needle is passed through the pedicle. Some surgeons prefer to place the circumferential
ligature or Miller’s knot before the transfixing ligature to eliminate hemorrhage if a vessel is
punctured during transfixation.
Place a mosquito hemostat on the suspensory ligament near
the ovary. Transect the ovarian pedicle between the Carmalt and
ovary. Open the ovarian bursa and examine the ovary to be certain
that it has been removed in its entirety. Remove the Carmalt from the
ovarian pedicle and observe for hemorrhage. Replace the Carmalt
and religate the pedicle if hemorrhage is noted. Perform the identical
procedure on the other side.
For ovariectomy, place one or two encircling ligature of
absorbable suture material just caudal to the proper ligament at the tip
of the uterine horn. Transect the mesovarium and proper ligament
and remove the ovary. Open the ovarian bbursa and examine the
ovary to be certain that it has been removed entirely.
For ovariohysterectomy, trace the uterine horn to the uterine
body. Grasp the other uterine horn, and follow it to the opposite
ovary. Place clamps and ligatures as just described. Make a window
in the broad ligament adjacent to the uterine body and uterine artery
and vein. Place a Carmalt across the broad ligament on each side and
transect (Fig. 27-5, G). Apply a ligature around the broad ligament if
the patient is in estrus or pregnant, or if the broad ligament is heavily infiltrated with vessels
or fat. Apply cranial traction on the uterus, and ligate the uterine body cranial to the cervix.
Place a figure-eight suture through the body using the point of the needle and
encircling the uterine vessels on each side. Place a circumferential ligature nearer the cervix.
Place a Carmalt across the uterine body cranial to the ligatures. Grasp the uterine wall with
forceps or mosquito hemostats cranial to the ligatures. Transect the uterine body, and observe
for hemorrhage. Religate if hemorrhage is observed. Some surgeons place one to three
Carmalt across the uterine body before ligation. In cats, clamps may cut rather than crush a
friable or engorged uterus and cause transection before ligature placement. An alternative to
ligatures is to use an ultrasonic scalpel, vascular sealer, or staples. Replace the uterine stump
into the abdomen before releasing the hemostats or forceps.
Close the abdominal wall in three layers (fascia/linea alba, subcutaneous tissue, and
skin).
V. Post-operative Management:
After the surgery, the operative site should be clean with hydrogen peroxide and
povidone-iodine. Antibiotic should be administered intramuscularly immediately after
surgery. The patient should be monitored directly until fully awake and monitor for the
presence of pain. Position the animal in a clean and comfortable area. An E-collar may be
necessary short term to prevent the patient from licking its wound. Postoperative medications
such as antibiotic, analgesic, etc. must be given. Suture is removed when the wound is fully
healed.
VI. Complications:
 Internal bleeding can occur if a ligature around a blood vessel breaks or slips off after the
abdomen has been closed.
 Post-operative infection
 Suture reaction or sinus formation,