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Spay_proceedure

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					Surgeon                                      Assistant
In the dog, the incision is started at the   Control bleeding with digital pressure and
level of the umbilicus and is extended       hemostats.
caudally an adequate distance to allow
exposure of the uterus. The abdominal wall
is opened along the linea alba in the same
area as the skin incision.
A spay hook can also be used to locate the   After opening the body wall, the edges are
uterine horn.                                retracted with hand-held retractors.
A hemostat is placed on the proper (utero-
ovarian) ligament.
Identify the suspensory ligament and break
it down.
A carmalt or mosquito forceps is used to     Stretches mesovarium.
penetrate the mesovarium caudal to the
ovarian artery. A
"window" is made in an area where there is
no fat in the mesovarium.
A carmalt or mosquito forceps is used to     Holds mesovarium during clamp placement
penetrate the mesovarium caudal to the
ovarian artery. A
"window" is made in an area where there is
no fat in the mesovarium.
A ligature of appropriate size chromic gut   The clamp is removed as the ligature is
or PDS is placed in the crushed tissue       tightened.
created by the most
proximal clamp. All ligatures placed on
the ovarian pedicles are placed using
hand ties.
A second ligature is now placed in the       This clamp is also removed as the ligature
same manner as the first in the crushed      is tightened
tissue of the middle
clamp.
The ovarian pedicle is grasped along its     Holds 3rd clamp and retractor.
edge with a hemostat or thumb forceps.
The mesovarium and
ovarian artery are now cut between the
most distal ligature and the third clamp.
The ovarian pedicle is gently placed (not
dropped) back into the abdomen.
The mesometrium is now examined              the assistant fans out the mesometrium
between the ovary and uterine body.
The mesometrium is sharply incised with      Pulls mesometrium away.
metzenbaums to the level of the uterine
body. The tips of the metzenbaums should
be up and visible at all times.
The opposite ovary is located by tracing     Holds hand-held retractor.
the uterine horn up from the uterine body
A hemostat is placed on the proper (utero-
ovarian) ligament.
Identify the suspensory ligament and break
it down.
A carmalt or mosquito forceps is used to      Stretches mesovarium.
penetrate the mesovarium caudal to the
ovarian artery. A "window" is made in an
area where there is no fat in the
mesovarium adjacent to the ovary.
A carmalt or mosquito forceps is used to      Holds mesovarium during clamp placement
penetrate the mesovarium caudal to the
ovarian artery. A "window" is made in an
area where there is no fat in the
mesovarium.
A ligature of appropriate size chromic gut    The clamp is removed as the ligature is
or PDS is placed in the crushed tissue        tightened.
created by the most proximal clamp. All
ligatures placed on the ovarian pedicles
are placed using hand ties.
A second ligature is now placed in the        This clamp is also removed as the ligature
same manner as the first in the crushed       is tightened
tissue of the middle clamp.
The ovarian pedicle is grasped along its      Holds 3rd clamp and retractor.
edge with a hemostat or thumb forceps.
The mesovarium and ovarian artery are
now cut between the most distal ligature
and the third clamp.
The ovarian pedicle is gently placed (not
dropped) back into the abdomen.
If the vessels are widely spaced from the
uterine body, and if they are large (i.e.,
bitch or queen in heat or pregnant), these
vessels are separately transfixed and
ligated before proceeding further. If the
uterine arteries are not enlarged and the
uterus is small, the vessels may be ligated
at the same time as the uterine body.
The cervix is identified by palpation.
Three clamps are placed just above the        The clamps are removed as the ligatures
cervix (on the ovarian side of the cervix).   are tightened.
The uterine stump is double ligated with
chromic gut or PDS suture material. The
ligatures are placed in the crushed tissue
created by the two clamps closest to the
cervix.
The uterine stump is gently lowered back
to its normal location and the hemostat is
removed.
The stump is observed for hemorrhage.
A final examination should be made of         Retract medially with the descending
both ovarian pedicles and the uterine         duodenum and mesoduodenum to
stump prior to closing the                    visualize the right ovarian pedicle and
abdominal cavity.                             retract medially with the descending colon
                                              and mesocolon to visualize the left ovarian
                                              pedicle. The uterine stump will be found
                                              between the neck of the bladder and the
                                              colon.
Multifilament nonabsorbable suture            Cuts simple interrupted knots
material (such as vetafil) should not be
buried. The fascia of the rectus abdominus
muscle is the strongest and most important
tissue layer in the closure. A monofilament
absorbable suture, such as PDS is used
for closing the linea.
The middle layer can be a subcuticular or     Cut knots at ends of simple continuous
subcutaneous pattern                          pattern.
Skin closure: Simple interrupted pattern      Cut knots in simple interrupted pattern.

				
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posted:1/12/2012
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