LAPAROSCOPIC-ASSISTED OVARIOHYSTERECTOMY: AN OVERVIEW
If uterine disease was found during the initial part of the procedure, you must either remove the entire uterus through a
third portal placed just cranial to the pelvic brim (laparoscopic-assisted ovariohysterectomy2 or complete laparoscopic ovariohysterectomy) or convert to an open procedure. To perform a laparoscopic-assisted ovariohysterectomy,
the third cannula-trocar unit should be 5 mm in cats or small dogs and 10 to 14 mm in medium and large dogs.
Proceed as described earlier to coagulate and cut through the ovarian suspensory ligaments and mesovarium, but do not sever
the ovaries from the uterus. Avoid the uterine arteries and veins and be careful to avoid the ureters since they course close
to the bladder in this area. After both ovaries have been coagulated and cut, use the endoscopic Babcock forceps to pull one
ovary along with its horn through the newly added, most caudal third portal. Once the uterine bifurcation has been reached,
remove the other horn and ovary by simply using outside traction. Then perform an extracorporeal ligation or LigaSure seal
and cut of the uterine arteries, veins, and body at the area between the bifurcation and the cervix. When using the LigaSure
extracorporeally, place a clamp below the LigaSure to prevent the uterine stump from retracting, and perform the seal and
cut distal to the clamp. Replace the uterine stump, and close this portal in the same way the other portals were closed.
Give owners routine written discharge instructions as for an open spay, but advise them in writing that because the uterus
is still intact, no progestational hormones (e.g. megestrol acetate) or estrogens should ever be used in the patient as this could increase the risk of pyometra or induce
signs of estrus. Instruct owners to return in 10 to 14 days for a recheck and suture or staple removal and to return sooner
if any problems are encountered. Also dispense a postoperative analgesic for three days. As with traditional ovariohysterectomy,
potential postoperative complications include infection, dehiscence, and herniation at the portal sites.
Two-portal laparoscopic ovariectomy provides a viable alternative to conventional ovariohysterectomy and can be performed
by most practitioners already performing rigid endoscopy. It not only sterilizes bitches or queens, but it does so less invasively
and helps to minimize postoperative pain. The disadvantages are the initial cost of the equipment and the time and training
involved to acquire the needed skills. Once a veterinarian is trained, this procedure can be performed in 30 to 60 minutes,
depending on the case and the surgeon's skill. Equipment setup and patient preparation require more time than with a conventional
Tom McCabe, DVM
Northeast Veterinary Clinic
9405 Dyer St.
El Paso, TX 79924
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