OHE trouble

[Bearby]

This is my first time posting on the Veterinary side of the forum, but I feel like my problem is more suited for this one.

Today was my first OHE ever (it was on a cadaver dog).

I've been in the surgery suite during dozens of them, but have always been running anesthesia and never really saw what was happening at the level of the incision.

I had a lot of trouble. I know it's expected to not be a brilliant surgeon when you do your first procedure, but I feel as though I had more trouble than I should have. I was able to locate the uterine horn using the spay hook, but when I tried to exteriorize the ovary by breaking the suspensory ligament, I had no idea what I was doing. I had 3 people trying to explain to me how to "strum" it, but I can't seem to understand the procedure without being able to visualize what's going on while I'm "strumming." Does anyone have any suggestions on what to do? This is the only practice we get before our live surgeries starting next week. Each person only gets one and there's no telling whether the one I get will be a male or female. If I end up getting a male, that means I may never get another chance to do a spay before graduation without doing a spay/neuter externship. This scares the crap out of me because I want to be proficient when I graduate.

Please help!

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[cowgirla]

Videos.
There are some pretty helpful ones on Youtube. Our school has videos for our use, but in addition to those, I watched a few online the night before my first live surgery and read through the procedure a few times as well.

I will say cadaver =/= live animal in terms of tissue feel. Cadaver surgeries just felt "wrong" in that it didn't feel natural. No stretch, no blood, etc. My spays went relatively smoothly - I've done 5 as primary surgeon and a few "halves" at this point, so I'm nowhere near an expert and I'm not going to attempt to explain the strumming of the ligament without being able to gesture. Basically, when you hold the ovary, the suspensory lig forms a tight band in a wad of soft tissue/vessels/nerves. That band should stretch relatively easily with some light pressure (strumming) and allow you to exteriorize the ovary without breaking the vessels. I know there are quite a few different methods for how to stretch/break it down so hopefully you'll find one that works for you!

Good luck.

 

[No Imagination]

I know this doesn't really answer your specific question; but if you do end up with a male, and want/need more experience, Mississippi State has a mobile spay/neuter unit (two actually) and they allow externships from other schools.

Typically they are two week externships, you go out 4 days a week, and do between 8 - 12 spays a day (and who knows how many neuters).

Also, i know most people are taught to strum it, but I was shown an alternative method which I prefer. Basically, if you can visualize the ligament, you can go in with some metz and give it a little snip (partial), making it much easier to exteriorize.

PS: Like Cowgirl said... working on a cadaver is nothing like the real thing! Probably will find it easier when you actually get in there!

 

[cuitlamiztli]

Basically, if you can visualize the ligament, you can go in with some metz and give it a little snip (partial), making it much easier to exteriorize.

👍 I prefer this as well. Much easier/quicker than manually breaking the suspensory (at least for me).

I found a good article on vetlearn.com that walks you through the "strumming" technique last year... I can find the info and PM it to you if you're interested.

 

[david594]

I know this doesn't really answer your specific question; but if you do end up with a male, and want/need more experience, Mississippi State has a mobile spay/neuter unit (two actually) and they allow externships from other schools.

Typically they are two week externships, you go out 4 days a week, and do between 8 - 12 spays a day (and who knows how many neuters).

I'm actually starting that elective next monday! Pretty excited about it.


Trying to "strum" the suspensory ligament drove me crazy early on and really made me dislike dog spays. I would just keep strumming and make no progress, really frustrating. Then on a recent externship someone showed me how to do it using constant pressure in more of a rolling motion with your hands outside the abdomen and its made it immensely easier for me. So I'd say dont get too frustrated early on, and ask different people to show you how they do it and see if you can find a way that your more comfortable with.

 

[Minnerbelle]

I have a really hard time strumming it til it breaks too. But during the second suspensory lig of my first spay, I realized that I can easily snap it using the thumb and index finger of both hands as long as I stretch it enough first to get a good visual. It gives me more control on the break too, which I like.

The dr watching me was giving me advice on how to strum it as the lig kept stretching longer and longer into a thin tough cord, and when i just brought in my other hand to snap it, she was like, "...or you can just do that I guess."

Some people find the snapping kind of scary, but to each his own I guess.

 

[Angelo84]

Not sure if this will make sense but I'll try. When you put tension on the proper ligament (caudally) you will tension the suspensory ligament. It will be the tense band of tissue running cranial from the ovary--follow this tense band as far dorsocranially as you can--then push on it from lateral to medial (you need to use quite a bit of pressure especially in a large deep chested dog. By pushing this direction when it gives you loosen the vessels making it less likely to tear the pedicle (vs if pushing medial to lateral when it gives you tension the vessels and are more likely to tear the pedicle). Sometimes it will just stretch and not truly break as long as you can visualize your pedicle well it doesn't matter if it doesn't fully break. Also make sure your initial incision is in the right place if you are too caudal to start it will be really hard to get to the ovaries! You can always extend your incision so you can see what you are doing!

 

[skittles12]

I'm in a spay/neuter elective right now and I agree that this is often one of the most frustrating parts of spaying. I have a problem with the strumming technique because I feel like I could sit there and strum it all day and never make any progress. If you can see part of the suspensory, you can use Metzenbaums to snip it a little and make it easier to break. Another way to do it is to grasp the cranial end of the suspensory between your thumb and index finger, then rotate your index finger around your thumb toward midline to twist the suspensory and stretch it across your index finger. Sometimes I get lucky and just applying caudally directed traction on the ligament stretches it enough to expose the ovarian pedicle and it doesn't actually have to be broken down completely. It's definitely different in the cadaver, because things aren't as pliable. I think a problem too (with me at least), is that I tend to be too gentle. It actually takes a little bit of force to break the suspensory (especially for big dogs that have had a litter or two), which can be scary in the live animal!

I agree with the idea to ask about different opinions on how to do things--sometimes someone will have a little tip that makes things much easier!

 

[Nekkid]

I don't strum or break the ligament at all. I just put gentle pulling pressure on it to stretch it out. You do not have to break it; it will stretch to the point where you can see what you need to see. Just expect to have to wear out the ligament. It takes 30 seconds to a minute and this way you don't have to risk tearing any vessels. They don't tell you that in vet school, but an excellent surgeon taught me that one and it works great (of course I've only done a handful of spays on my own so far). Good luck!

 

[Lissarae06]

I don't strum or break the ligament at all. I just put gentle pulling pressure on it to stretch it out. You do not have to break it; it will stretch to the point where you can see what you need to see. Just expect to have to wear out the ligament. It takes 30 seconds to a minute and this way you don't have to risk tearing any vessels. They don't tell you that in vet school, but an excellent surgeon taught me that one and it works great (of course I've only done a handful of spays on my own so far). Good luck!

Actually, Dr. Staubus told me that if I could get the ovary out of the abdomen enough, that I didn't need to actually break it so they do teach it in school 😉 I was much more comfortable not breaking than sitting there trying to.

 

[Bearby]

Thanks everyone. I really appreciate your advice and what works well for you. Hopefully my real one goes well.

 

[dyachei]

I don't strum or break the ligament at all. I just put gentle pulling pressure on it to stretch it out. You do not have to break it; it will stretch to the point where you can see what you need to see. Just expect to have to wear out the ligament. It takes 30 seconds to a minute and this way you don't have to risk tearing any vessels. They don't tell you that in vet school, but an excellent surgeon taught me that one and it works great (of course I've only done a handful of spays on my own so far). Good luck!

I was taught this as well. The problem? Not all dogs have easily stretched/exposed ovaries.

 

[Nekkid]

I was taught this as well. The problem? Not all dogs have easily stretched/exposed ovaries.

Patience and they apparently always stretch enough. At least that's what I've been told. Sometimes you have to give it 3 or 4 min for the big mastiffs, etc

 

[dyachei]

Patience and they apparently always stretch enough. At least that's what I've been told. Sometimes you have to give it 3 or 4 min for the big mastiffs, etc

In my experience, sometimes they don't stretch enough. Granted it is anecdotal, but I have had 2 dogs that I could not stretch the ligament on.