How to perform a two-portal laparoscopic ovariectomy
Learn more about this laparoscopic procedure, which produces less pain and tissue trauma than a routine open ovariohysterectomy does. Then consider whether you should take the necessary steps to offer it in your practice.
The ideal ovarian tacking position is generally halfway between the portals and far enough laterally to allow easy application
of your endoscopic instruments and avoid interference between the cannulas and the instruments. Once the ideal tacking position
is determined, remove your hand from the endoscopic Babcock forceps, and move the laparoscope (with its light source) toward
the tacking spot to allow transillumination (turn off the room lights) (Figure 9). Use a large needle holder to carefully pass the swaged needle straight into the abdomen at the intended tacking spot from
lateral to medial under direct observation (Figure 10). Alternatively, use a Tankersley ovariectomy hook (Karl Storz) or a large cruciate needle in place of the swaged needle,
armed with No. 2 nylon suture. In cats and smaller dogs, use a regular suture needle and material. Retract the laparoscope
a short distance to avoid damaging it with the needle and avoid inadvertent organ puncture.
Figure 10
Then have an assistant use a sterile towel or paper drape square as a barrier to hold the camera in the selected position,
keeping the needle centered in the monitor's screen. Carefully slide your left hand over to grasp the needle holder from your
right hand. Regrasp the endoscopic grabbers with your right hand, carefully penetrate the mesovarium under and next to the
ovary with the needle, and tilt the needle up to prevent the ovary from slipping off. Avoid passing the needle directly into
the ovarian tissue since this can lead to ovarian tissue seeding and ovarian remnant syndrome.13 Because of the needle's large size, you may want to withdraw it partially as you keep the point close to the abdominal wall
and then force the point through the abdominal wall.
Figure 11
Once the mesovarium is on the needle, remove your hand from the endoscopic forceps. Take the needle holder with your right
hand and use the widely spread fingers of your left hand to help pass the needle point back out through the abdominal wall.
Carefully unclick the forceps, and remove them from the ovarian suspensory ligament to prevent incorporating them in the ligature.
Then use a double throw in the suture, and draw the ovary up snuggly against the body wall and remove all slack from the suture.
Do not tie a knot, but grasp the suture material securely with the needle holder next to your double throw to temporarily
tack the ovary to the abdominal wall (Figure 11). Remove the endoscopic graspers from the portal.
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