Current vet students/recent grads - what do you want to learn about spay/neuter?

Cyndia

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Hey guys!

I'm currently assisting with putting together some online training materials on spay/neuter. While obviously it isn't the same as in person, hands on training, we're trying our best to incorporate a lot of related topics, videos, and information sessions that current students who are not getting as much in-person clinical instruction might find helpful to review. I'd love to hear what related topics/general questions you have that you would like to see covered. Ex. pros and cons of early spay/neuter and how to decide on age of spay with an owner, how to do flank spays, extra considerations with pyometras, different knot techniques, etc. Also happy to hear any suggestions on what virtual methods of training you've found most useful, or the worst, so far (ex. interactive zoom discussions, prerecorded lectures with quizzes, etc).

Thanks in advance for any suggestions!! :)
 
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batsenecal

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I would love info on appropriate spay times for different breeds of dogs due to the new info coming out. To me, I dont really know who to "believe" per se since everyone is a professional.

I also just finished an externship at a local hospital and all their spays are laproscopic, which was amazing. They were actually filming a spay for a virtual reality program so that vets could train with it. I know laproscopic isnt common, but it would be cool to see different videos of the different spay techniques. I've watched some on YouTube, but sometimes quality could be an issue.
 
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Cyndia

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I would love info on appropriate spay times for different breeds of dogs due to the new info coming out. To me, I dont really know who to "believe" per se since everyone is a professional.

I also just finished an externship at a local hospital and all their spays are laproscopic, which was amazing. They were actually filming a spay for a virtual reality program so that vets could train with it. I know laproscopic isnt common, but it would be cool to see different videos of the different spay techniques. I've watched some on YouTube, but sometimes quality could be an issue.

Appropriate spay times is a really tough topic that's always changing, and something we'll definitely include! For example, I literally just found this paper earlier today that was recently published and touches on certain breeds/conditions. As for laparoscopic spays, we unfortunately don't have the equipment at our disposal to perform or record those at our facility, but I'll add that to our list of topics to consider discussing. :)
 
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Cyndia

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what, people actually get *taught* this?? Lucky jerks. I was just at a S/N operation and they said, hey, think you can try? and I rolled with it, lol. :laugh:

Lmao, sounds a lot like my first time!! I was at a TNR clinic and one of the vets gave me a 30 second run down on landmarks for my incision, gave me a thumbs up and walked away. Thankfully it went smoothly lol.
 
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I would love info on appropriate spay times for different breeds of dogs due to the new info coming out. To me, I dont really know who to "believe" per se since everyone is a professional.

I also just finished an externship at a local hospital and all their spays are laproscopic, which was amazing. They were actually filming a spay for a virtual reality program so that vets could train with it. I know laproscopic isnt common, but it would be cool to see different videos of the different spay techniques. I've watched some on YouTube, but sometimes quality could be an issue.
I would love if VIN could spearhead this. They already have some really cool useful surgical videos that are filmed from a couple angles, and it would be a nice one stop shop for trustworthy videos.
 
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Trilt

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Lmao, sounds a lot like my first time!! I was at a TNR clinic and one of the vets gave me a 30 second run down on landmarks for my incision, gave me a thumbs up and walked away. Thankfully it went smoothly lol.
"just feel the ribs and the muscle. then cut the skin. then stab it with the hemostats. the ovary should be there. if it's not there, you got your landmarks wrong. good luck!"
 
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itsrocky

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I love flank spays. I almost wish I could do all of my spays through the flank..... taboo?

Edit: pretty sure a flank spay in a large breed dog would SUCK though lol
 

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Anesthesia and pain management protocols for low cost practice?
 
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WildZoo

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Lmao, sounds a lot like my first time!! I was at a TNR clinic and one of the vets gave me a 30 second run down on landmarks for my incision, gave me a thumbs up and walked away. Thankfully it went smoothly lol.
Basically what happened when I did one on our mobile during clinics. And then I had to call for help when I couldn't reach the second ovary :laugh:
 

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Anesthesia and pain management protocols for low cost practice?
Late to this thread, but to add on to this I think considerations for protocols that minimize use of controlled drugs, which can be an issue for certain operations that involve travel/difficulty maintaining a secure drug storage box or people who will practice in places like Puerto Rico where it's a huge PITA to get control drugs. Related to anesthesia, but some consideration for pediatric anesthesia protocols/support /recovery would also be nifty although that would have probably been covered in an anesthesia course.

Also, I think it would helpful to just mention the difference in mobility/flexibility of various tissues in dogs vs cat spays. For example cat ovaries are a lot more mobile than dog ovaries, but you really need to be careful with the uterine horns/body because it's much easier to tear in cats than dogs

I think different knot techniques would be cool to learn (especially some of the neat stuff like autoligation of the ovarian pedicle in cats, figure 8 ties, Aberdeen knots, etc)

I actually just finished my first week of a spay/neuter rotation and one of the things I found helpful was a combination of written details about the procedures with lists of complications and tips (e.g. estimating incision placement, considerations for cat vs dog) and videos of the procedures being performed in cats and dogs with narration were really helpful prep before I actually did them.

Do y'all teach OVEs or OHEs more commonly? Our instructor prefers OVEs here so that's largely what we've done but I was curious
 
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itsrocky

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Late to this thread, but to add on to this I think considerations for protocols that minimize use of controlled drugs, which can be an issue for certain operations that involve travel/difficulty maintaining a secure drug storage box or people who will practice in places like Puerto Rico where it's a huge PITA to get control drugs. Related to anesthesia, but some consideration for pediatric anesthesia protocols/support /recovery would also be nifty although that would have probably been covered in an anesthesia course.

Also, I think it would helpful to just mention the difference in mobility/flexibility of various tissues in dogs vs cat spays. For example cat ovaries are a lot more mobile than dog ovaries, but you really need to be careful with the uterine horns/body because it's much easier to tear in cats than dogs

I think different knot techniques would be cool to learn (especially some of the neat stuff like autoligation of the ovarian pedicle in cats, figure 8 ties, Aberdeen knots, etc)

I actually just finished my first week of a spay/neuter rotation and one of the things I found helpful was a combination of written details about the procedures with lists of complications and tips (e.g. estimating incision placement, considerations for cat vs dog) and videos of the procedures being performed in cats and dogs with narration were really helpful prep before I actually did them.

Do y'all teach OVEs or OHEs more commonly? Our instructor prefers OVEs here so that's largely what we've done but I was curious

Oooo yes to all of this! As far as I know, CSU is the only school stateside that teaches ovariectomies. I might be wrong though.
 
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Cyndia

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Late to this thread, but to add on to this I think considerations for protocols that minimize use of controlled drugs, which can be an issue for certain operations that involve travel/difficulty maintaining a secure drug storage box or people who will practice in places like Puerto Rico where it's a huge PITA to get control drugs. Related to anesthesia, but some consideration for pediatric anesthesia protocols/support /recovery would also be nifty although that would have probably been covered in an anesthesia course.

Ooh this is a super interesting idea!! Minimizing controlled drugs isn't an angle I've thought about at all. I'll have to bring that up and try to get that incorporated into our anesthesia lectures. The pediatrics stuff is actually getting covered in a separate pediatrics only lecture, and it'll definitely have anesthestic, intra-op and recovery considerations. :)

Also, I think it would helpful to just mention the difference in mobility/flexibility of various tissues in dogs vs cat spays. For example cat ovaries are a lot more mobile than dog ovaries, but you really need to be careful with the uterine horns/body because it's much easier to tear in cats than dogs

I think different knot techniques would be cool to learn (especially some of the neat stuff like autoligation of the ovarian pedicle in cats, figure 8 ties, Aberdeen knots, etc)

I actually just finished my first week of a spay/neuter rotation and one of the things I found helpful was a combination of written details about the procedures with lists of complications and tips (e.g. estimating incision placement, considerations for cat vs dog) and videos of the procedures being performed in cats and dogs with narration were really helpful prep before I actually did them.

We've luckily incorporated a lot of that info already, though we don't use some of those knots you mentioned (figure 8, aberdeen). I actually am a big fan of aberdeens when I have procedures requiring long incisions, so I'll have to bring that up. Are a lot of schools using aberdeens frequently these days?

Also I like that you mentioned written details.. up till now we've just been making videos/ppts, but I might bring up the idea of creating a printable surgery cheat sheet if that's something you guys would find useful? It would likely be extremely basic and no longer than a page long for each type of surgery, containing info on incision placement/types of knots and ties we use/extra tips like suture selection? Would you guys actually print out and use something like this as you first start out, or would that be too basic if it was kept to a page or less?

Do y'all teach OVEs or OHEs more commonly? Our instructor prefers OVEs here so that's largely what we've done but I was curious

We teach OVH here, though on rare occasions we will technically perform an OVE if we can't fully remove the uterus. Just curious, but do you happen to know why your instructors prefer OVE?
 
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WildZoo

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Are a lot of schools using aberdeens frequently these days?
We learned it in the context of the more traditional spay techniques, since we did have longer incisions there but still did a continuous subq to intradermal closure. I find it to be quite magical lol but didn't use it in my shelter rotation at all
 
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Cyndia

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We learned it in the context of the more traditional spay techniques, since we did have longer incisions there but still did a continuous subq to intradermal closure. I find it to be quite magical lol but didn't use it in my shelter rotation at all

Lol magical is a great word for it :laugh: Most of the shelter vets I know don't use it since it's pointless with the keyhole incisions they're achieving, but definitely think it's a good one to have in your back pocket when you need it.
 
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vetmedhead

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Ooh this is a super interesting idea!! Minimizing controlled drugs isn't an angle I've thought about at all. I'll have to bring that up and try to get that incorporated into our anesthesia lectures. The pediatrics stuff is actually getting covered in a separate pediatrics only lecture, and it'll definitely have anesthestic, intra-op and recovery considerations. :)



We've luckily incorporated a lot of that info already, though we don't use some of those knots you mentioned (figure 8, aberdeen). I actually am a big fan of aberdeens when I have procedures requiring long incisions, so I'll have to bring that up. Are a lot of schools using aberdeens frequently these days?

Also I like that you mentioned written details.. up till now we've just been making videos/ppts, but I might bring up the idea of creating a printable surgery cheat sheet if that's something you guys would find useful? It would likely be extremely basic and no longer than a page long for each type of surgery, containing info on incision placement/types of knots and ties we use/extra tips like suture selection? Would you guys actually print out and use something like this as you first start out, or would that be too basic if it was kept to a page or less?



We teach OVH here, though on rare occasions we will technically perform an OVE if we can't fully remove the uterus. Just curious, but do you happen to know why your instructors prefer OVE?
The written instructions just sort of outlined a step by step of what you're looking for/doing, which I found helpful to run through to help me remember steps before watching a video where they did everything but didn't always explain what exactly they were looking for/feeling/etc. It did also include things like suture selection, incision placement, considerations for closure etc that I found really helpful. I'd definitely use a cheat sheet if only to refresh quickly the night before or morning of if I want fast clarification on something.

We don't really do the funky knots here (though they'd largely be fine with us trying them), I'm interested in shelter medicine and they come up a lot in those arenas and think they're just fun to mention lol

Re: OVEs, I'm not totally sure why they prefer them so much here. I think there was a paper a few years ago showing that so long as you get all of the ovaries out it's fine to leave in remaining uterus, and students tend to find it somewhat easier to do, so I think that's why they focus on it. Hoping to do some OHEs next week since it's certainly a necessary procedure in many cases and I should know how to do one lol
 

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I was reading about this recently! There is a paper from way back in 2006 that promoted OVE as superior to OVH in healthy dogs for many reasons mostly related to the morbidity of surgery (pain and invasiveness and such), with long-term outcomes being pretty much the same between the two surgeries. Van Goethem B, Schaefers-Okkens A, Kirpensteijn J. Making a rational choice between ovariectomy and ovariohysterectomy in the dog: a discussion of the benefits of either technique. Vet Surg 2006;35:136-143.

OVE allows for smaller incisions even in large patients, less trauma/pain due to not messing with the broad ligament/uterine body, and shorter surgical times (mostly owing to the smaller incisions). Probably less of a difference in pediatrics but likely a large difference in those adult, fat dog spays that everyone hates.

Of course it is still important to know how to do an OVH because of pyometras and such.
 
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batsenecal

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I wonder how the comparison of OHE vs OVE would be for laproscopic OHE vs traditional or laproscopic OVE. The clinic I'm hoping to go to post-graduation does everything laproscopically now and the top two reasons are pain and surgical duration.
 
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WildZoo

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I wonder how the comparison of OHE vs OVE would be for laproscopic OHE vs traditional or laproscopic OVE. The clinic I'm hoping to go to post-graduation does everything laproscopically now and the top two reasons are pain and surgical duration.
From what I've read OVE is even more preferred for laparoscopic procedures because it's more difficult to reach both the ovaries and the uterine body.
 
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I was reading about this recently! There is a paper from way back in 2006 that promoted OVE as superior to OVH in healthy dogs for many reasons mostly related to the morbidity of surgery (pain and invasiveness and such), with long-term outcomes being pretty much the same between the two surgeries. Van Goethem B, Schaefers-Okkens A, Kirpensteijn J. Making a rational choice between ovariectomy and ovariohysterectomy in the dog: a discussion of the benefits of either technique. Vet Surg 2006;35:136-143.

OVE allows for smaller incisions even in large patients, less trauma/pain due to not messing with the broad ligament/uterine body, and shorter surgical times (mostly owing to the smaller incisions). Probably less of a difference in pediatrics but likely a large difference in those adult, fat dog spays that everyone hates.

Of course it is still important to know how to do an OVH because of pyometras and such.

Most vets I know eventually get their incision size down to 1-2" for a spay regardless if OHE/OVE.... I watched one spay/neuter vet who even in big fat dogs could have the entire uterus out of a 1" incision and be done with surgery in 5 minutes.

So I find it interesting incision length was considered, though I get why. I mean...don't ask me to spay anything, I'm not getting it done with even a 2" incision. :laugh:

The big reason I don't like OVE vs OHE is because we currently don't have a system to differentiate a patient that has had one over the other....we only know "they were spayed"... but knowing a patient only had an OVE is important medically as you're going to think of that remaining uterus for certain issues, more so than you would in a dog with a full OHE.
 
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Trilt

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I wonder how the comparison of OHE vs OVE would be for laproscopic OHE vs traditional or laproscopic OVE. The clinic I'm hoping to go to post-graduation does everything laproscopically now and the top two reasons are pain and surgical duration.
See and I'm a bit of a lap spay skeptic. The vet clinic I hung out with most during school did all their canine spays lap, and while I see the benefit for really large dogs, in smaller dogs... my single incision is usually an inch or less. I usually close my linea in a cruciate or two. Having two to three smaller incisions and a bunch of gas in the abdomen just doesn't really feel like a dramatic improvement and they were definitely a slower process.

With that said, they were really fun. :laugh:
 
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batsenecal

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See and I'm a bit of a lap spay skeptic. The vet clinic I hung out with most during school did all their canine spays lap, and while I see the benefit for really large dogs, in smaller dogs... my single incision is usually an inch or less. I usually close my linea in a cruciate or two. Having two to three smaller incisions and a bunch of gas in the abdomen just doesn't really feel like a dramatic improvement and they were definitely a slower process.

With that said, they were really fun. :laugh:

I dont know if it's this clinic specifically, but their times are consistently faster across doctors/dogs. They dont have new trainees do small breeds for about 20-25 procedures.
 

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Most vets I know eventually get their incision size down to 1-2" for a spay regardless if OHE/OVE.... I watched one spay/neuter vet who even in big fat dogs could have the entire uterus out of a 1" incision and be done with surgery in 5 minutes.

So I find it interesting incision length was considered, though I get why. I mean...don't ask me to spay anything, I'm not getting it done with even a 2" incision. :laugh:

The big reason I don't like OVE vs OHE is because we currently don't have a system to differentiate a patient that has had one over the other....we only know "they were spayed"... but knowing a patient only had an OVE is important medically as you're going to think of that remaining uterus for certain issues, more so than you would in a dog with a full OHE.
Yeah, always the chance that dog could be the weirdo who ends up with a uterine tumor. Though the theory is that those are hormonally driven so shouldn't be a problem (unless they happen to be estrogen driven and the dog is on estrogen supplementation???). It would be nice to have a different identification system though!

It's the prevailing method in Europe according to what I've read and they haven't seemed to have any issues. Honestly most of the data seems pretty equivocal. One of those things where you can probably just do whatever you're most comfortable with.
 

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Apparently. I haven't done it myself so again just from reading things but it's supposedly easier to just go for the ovaries than to try to get to the uterine body as well through the same port.

Weird. Between my junior surgery spay and my lap spay, the lap spay was 100% easier just cause I could see what I was doing. Lol. But does junior surgery count since it's so crazy town? :laugh:
 

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I'm pretty sure I don't remember how to spay a dog. Like, I mean, obviously I remember the generalities. But all that "make your incision 1/3 of the way blah blah blah."

If I had to spay something now, guaranteed the incision would run from stem to stern.

Maybe the next pyo I get I'll do myself just for a refresher. Hrm.
 
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Having just done my first solo spay... How to find the uterus with your spay hook 101. :laugh:

Swear to god I spent just as long trying to find the uterus in around the fatty omentum as I actually did removing it. Was just about to extend my incision when suddenly it appeared like a mythical being
 
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Having just done my first solo spay... How to find the uterus with your spay hook 101. :laugh:

Swear to god I spent just as long trying to find the uterus in around the fatty omentum as I actually did removing it. Was just about to extend my incision when suddenly it appeared like a mythical being
Hook facing towards the body wall, then trace along the wall to descend down towards the leg/bladder region. Go further backwards than you think you need to. Flip it to hook facing to midline, then wiggle it gently up and down (just a couple mm at a time) while you walk the hook along the bottom of the abdomen to the midline. Lift up gently and see if you've got it!

Works 100% of the time, like 50% of the time. (I probably get the uterus in my first hook like 70% of the time. Thanks Humane Alliance for this one!)

If you don't catch it in the first go, be methodical. I usually try twice on the right side (towards me) then do the same thing towards the left side, then extend the incision a bit to see what's up if I'm not having success. I can't honestly remember the last time I did that and didn't get a uterus within a minute, though, and I remember the struggle being so very real in vet school, haha.

And something that just comes with time is knowing the right "feel" when you snag broad ligament vs. omentum/other stuff in the abdomen. It's tight - but not too tight -and once you know you've got it you can just finagle until you've got the uterus even when the hole is small and you can't necessarily see your success.
 
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Having just done my first solo spay... How to find the uterus with your spay hook 101. :laugh:

Swear to god I spent just as long trying to find the uterus in around the fatty omentum as I actually did removing it. Was just about to extend my incision when suddenly it appeared like a mythical being

I always joke with my tech that it takes me longer to find the uterus than to do the damn spay, but it's almost true except in small, young dogs (or cats obviously). I actually don't use the hook and prefer my finger but maybe I'll give Trilt's method a try :shrug: I find that sometimes I cut a little too high and have to go further back to find it; don't be afraid to extend your incision, especially early on!
 

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I stopped using the hook after seeing multiple people post about accidentally snagging the spleen with the spay hook. Nope, finger works just as well and I can feel things better.
 

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I am consistently amazed by people saying they use their fingers to find the uterus. It all just feels like schmoo in there to me. :laugh: I also have kinda stubby fat fingers so my hole would usually have to be bigger than I like to start.

I purposefully start on the right side to avoid spleen, but honestly if you hook far back enough you shouldn't be in that area. I also feel like there's some spay hooks that are way more stabby/sharp than others...
 
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LetItSnow

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Hook facing towards the body wall, then trace along the wall to descend down towards the leg/bladder region. Go further backwards than you think you need to. Flip it to hook facing to midline, then wiggle it gently up and down (just a couple mm at a time) while you walk the hook along the bottom of the abdomen to the midline. Lift up gently and see if you've got it!

Works 100% of the time, like 50% of the time. (I probably get the uterus in my first hook like 70% of the time. Thanks Humane Alliance for this one!)

If you don't catch it in the first go, be methodical. I usually try twice on the right side (towards me) then do the same thing towards the left side, then extend the incision a bit to see what's up if I'm not having success. I can't honestly remember the last time I did that and didn't get a uterus within a minute, though, and I remember the struggle being so very real in vet school, haha.

And something that just comes with time is knowing the right "feel" when you snag broad ligament vs. omentum/other stuff in the abdomen. It's tight - but not too tight -and once you know you've got it you can just finagle until you've got the uterus even when the hole is small and you can't necessarily see your success.

I'm sure Trilt is better at this than I am by a long shot, but one bit of advice to add that was passed on to me back when I was a student....

When you pull up a bunch of 'random tissue' don't just dump it all back in. Frequently enough to make it worth looking, the uterine horn is buried in all that 'stuff' that you dragged up. Take the time to use your fingers to lift that stuff off the spay hook and go through it before just dumping it back in.

When I was teaching spays I'd see it frequently enough to make me laugh - students were successfully pulling up the horn, but not realizing it because they didn't see it in the other tissue, and they'd pull it up, dump it back, pull it up, dump it back.
 
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I didn't get a cat spay on my first (right) side two times this morning, and literally thought to myself, ****, so much for 70%, this is why I shouldn't give tips...

...but go it on the first time on the left, lol. Sigh of relief. :p
 
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