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Spay neuter

QuestionAnswer
(OHE) What is your first step after draping and clipping the patient? Following appropriate clipping and draping, I will use my nondominant hand to tense the skin and perform a midline celiotomy with a #10 scalpel blade, starting at the umbilicus and extending over the cranial third of the abdomen.
(OHE) How do you dissect to expose the linea alba? I will change my #10 scalpel blade and sharply dissect the subcutaneous tissue to expose the linea alba. In dogs, I may perform a push-cut elevation with Metzenbaum scissors to improve visualization.
(OHE) How do you enter the abdomen? I will tense the linea with Brown-Adson thumb forceps and perform an inverted stab incision using a #10 blade. Once a finger fits, I will digitally sweep for adhesions and extend the incision with Mayo scissors or a #10 blade.
(OHE) How do you locate the first ovary? Using my dominant index finger or a spay hook, I will follow the inner right or left abdominal gutter to identify and exteriorize the uterine horn.
(OHE) How do you handle the suspensory ligament? I will place a mosquito hemostat halfway across the proper ligament, then strum or press the suspensory ligament dorsocaudally to break it down, stopping once enough pedicle is exposed for a 3-clamp technique.
(OHE) How do you create a window for ligation? I will create a window in the broad ligament caudal to the ovarian artery with a hemostat to prepare for ligation.
(OHE) How do you apply the three-clamp technique? I will place three hemostatic forceps perpendicular to the incision line across the ovarian pedicle, alternating clamp directions for stability.
(OHE) How do you place your first ligature? I will pre-place a strangle or Miller's knot at the most proximal aspect of the pedicle, have my assistant remove the first clamp, and seat the ligature into the crushed tissue.
(OHE) How do you place your second ligature? I will place a second ligature distal to the first but proximal to the second clamp. Before tightening, I will ask my assistant to flash the second clamp to ensure proper tissue crushing, then finish my knot.
(OHE) How do you transect the ovarian pedicle? I will transect tissue between the second and third clamps with Metzenbaum scissors or a #10 blade, grasp the distal pedicle avoiding sutures, release the second clamp, confirm hemostasis, and replace the pedicle into the abdomen.
(OHE) After ligating the ovary, what's next? I will trace the uterine horn caudally to the uterine body, visualizing the uterine artery with assistance for exposure.
(OHE) How do you manage the broad and round ligaments? I will create a window cranial to the uterine artery and carefully tear or fray the broad and round ligaments using fingers or Metzenbaum scissors, monitoring for hemorrhage.
(OHE) How do you ligate the uterine body? I will apply a 3-clamp technique cranial to the cervix, place a strangle or Miller's knot in the crushed tissue after clamp removal, then a second ligature between the first suture and second clamp with flashing.
(OHE) How do you transect and inspect the uterine stump? I will transect between the second and third clamps, grasp the uterine pedicle with Brown-Adson forceps, release the second clamp, monitor for hemorrhage, and replace the stump if hemostasis is adequate.
(OHE) How do you check for bleeding and close? I will check both gutters and the caudal abdomen for hemorrhage, perform a sponge count, and close in three layers: linea alba (simple continuous), subcutaneous tissue (simple continuous), and skin (intradermal simple continuous).
(Castration) What is your first step after draping the patient? Following clipping and draping, I will digitally manipulate the testicle into the prescrotal region and stabilize it with my nondominant hand.
(Castration) How do you make your skin incision? Using a #10 scalpel blade, I will make a single smooth full-thickness incision over the testicle.
(Castration) How do you expose the testicle? I will change blades and dissect the subcutaneous tissue to expose the testicle, then elevate it from the incision using digital manipulation.
(Castration) How do you prepare the spermatic cord? I will use sterile gauze to strip fat and fascia from the spermatic cord until it is clean and ready for ligation.
(Castration) How do you apply the three-clamp technique? I will apply three hemostatic forceps across the spermatic cord perpendicular to the incision, with assistance for elevation and visualization.
(Castration) How do you place your first ligature? I will pre-place a strangle or Miller's knot along the most proximal aspect of the cord, have my assistant remove the first clamp, and seat the ligature in the crushed tissue.
(Castration) How do you place your second ligature? I will place a second ligature distal to the first but proximal to the second clamp. Before tightening, I will request a flash of the second clamp, then finish my knot.
(Castration) How do you transect and check for bleeding? I will transect between the second and third clamps with Metzenbaum scissors or a #10 blade, grasp the distal cord, release the second clamp, confirm hemostasis, and return the cord into the abdomen.
(Castration) What do you do for the other testicle? I will repeat the procedure on the contralateral testicle using the same technique.
(Castration) How do you close the incision? I will close subcutaneous tissue with size-appropriate suture in a simple continuous pattern and the skin with an intradermal simple continuous pattern.
Suture decisions for a cat or dog less than 7kg (15lb)? 3-0 PDS for pedicle and body wall and monocryl 4-0 for sq/intradermal.
Suture decisions for a dog that is 15 lbs - 40 lbs ( 7 -18kgs) 2-0 PDS for vascular pedicle and body wall. 4-0 moncryl for SQ/intradermal
Suture decisions for a dog that is over 40lbs or 18kgs> 0 PDS for pedicle and body wall. 3-0 monocryl for SQ/intradermal
Created by: awahay
 

 



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