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15Soft 9 Dental Tissue Equipment Surgery & Instrumentation www.vetinst.com Ovariohysterectomy Ovariohysterectomy Because ovariohysterectomy is the procedure most commonly performed in practice there is an expectation that all qualified veterinary surgeons have high level of competency in the technique. Ovariohysterectomy is not a simple technique and things can go badly wrong despite surgeons following what appears to be a straightforward step by step approach. Many young surgeons have been badly traumatised by the learning curve involved in becoming adept at this fundamental procedure. ‘Cannot even spay a bitch’ is a heavy burden. Calling in the senior partner to deal with a bleeder does not add to one’s self confidence. Spay Hooks Use to atraumatically lift uterine horns. SPAY HOOKS This was confirmed by a paper by Tivers etal (JSAP 46, 430-435) which reported that 50% of graduates no longer used the technique in which they were trained. The standard 3 clamp technique for tying off the ovarian pedicle is very effective when performed correctly. However it is often the case that the clamps are applied with the ovary under significant tension so that the clamps are placed very close together. Once the central clamp is removed in these circumstances, because of the tension and the limited space, the crushed pedicle cannot be pulled into a tight circle by the ligature. Instead the pedicle is often tied off as an oval. In that the circumference of an oval is greater than that of a circle with similar area, as soon as the outer clamps are released the pedicle reverts to a circle and the once tight ligature becomes loose and the artery bleeds. 014320 014325 Spay Hook Small 130mm Long Spay Hook Large 170mm Long £33.48 £33.48 Spay Forceps ‘Sturdy’ type. Atraumatic spay forceps-tips have fine toothed DeBakey type form. This can be managed by reducing the tension on the pedicle by breaking down the round ligament, loose tight exteriorising the ovary and applying the clamps slightly further apart. These subtleties are best learnt by practical training. Supervising surgeons have developed the ‘knack’ but may not be aware of the issues. SPAY FORCEPS 014211 014218 Spay Forceps 5” 125mm Long Spay Forceps (DeBakey Type) 5” 125mm Long £26.27 £35.54 Spay Clamps Angiotribes Included in this section are two aids which assist in the exposure and ligature of the ovarian pedicle. The new Howard ‘B’ clamp and the well established Hauptman retractor.Videos of both instruments may be viewed or downloaded from www.vetinst.com/ovariohysterectomy. Howard ‘B’ Ovariohysterectomy Clamp Feline spay showing ovary exteriorised and ovarian pedicle ‘collected’ ready for ligation. The jaws of this instrument are designed for maximum crushing by serrated longitudinal grooves. ANGIOTRIBES 014304 014305 014301 014302 Designed and developed in practice by Howard Taylor who recognised that ovariohysterectomy was far from straightforward, particularly but not exclusively for recent graduates. The Clamp has a number of features which assist the surgeon in the exposure and ligature of the ovarian pedicle. • The ligature material is preloaded onto the forceps which takes it through the broad ligament. • Longitudinal grooves in the jaw minimise slippage • As the forceps are rotated the ‘B’ shaped extension ‘collects’ and brings together the structures of the pedicle ready for tying. • The forceps sit outside the incision to exteriorise the pedicle The ligature is tied without precrushing but is retained by a small haemostat to check for bleeding prior to closure.Visit www.vetinst.com to view a surgical video. These Clamps are curved with longitudinal grooves in the jaws to minimise tissue slippage. More reasonably priced than Angiotribes. HYSTERECTOMY CLAMPS HOWARD ‘B’ OVARIOHYSTERECTOMY CLAMP Howard ‘B’ Ovariohysterectomy Clamp 160mm Long £65.41 £65.41 £65.41 £65.41 Hysterectomy Clamps (Carmault) Case: Howard Taylor 546470 Angiotribes Straight 6.5” 160mm Angiotribes Curved 6.5” 160mm Angiotribes Straight 8” 200mm Angiotribes Curved 8” 200mm 014307 014309 £71.59 240 Hysterectomy Clamp (Carmault) 200mm Long Hysterectomy Clamp (Carmault) 160mm Long £40.69 £40.69