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Spay Surgery Concerns: Avoiding the Ureters

This is the fourth video in the series on Spay Surgery Concerns. The purpose of this video is to help the veterinarian avoid snagging a ureter during a spay surgery. The prevalence of a damaged ureter at surgery is fortunately very low. It is more prevalent in the cat however. Likely due to its smaller size.

When only one ureter is damaged, the clinical signs are insidious and can be difficult to diagnose. Look for a patient that is not thriving after surgery: takes a long time to recovery from anesthesia and is simply not doing well.

The key to avoiding the ureters at surgery is by simply ensuring that you have only the tissues that intend to ligate and divide in your clamp and nothing else. The best way to do this is to make sure you can see your tissues by maximizing your exposure.

When dealing with the ovarian pedicle you can improve you exposure by completely breaking the suspensory ligament, applying gentle ventral traction on the ovary; you can also push down on the body wall in order to see more of the pedicle; and of course, one can always increase the incision. Removing mesovarium tissues is important and you can do this by ensuring that the window you create in the mesovarium is close to the pedicle itself and then simply tease away excess tissue by gently kneading your finger tips into the fatty mesovarium tissue; making it melt and tear away.

Place your clamps close to the ovary and thus away from the ureter. In smaller patients stick to a 2 clamp technique and consider using smaller hemostats such as mosquitoes.

Improve your exposure of the body of the uterus and cervix: apply cranial traction to the uterine horns; you can elevate the caudal body wall and be sure to adjust the light so that is shines into that caudal abdominal space that you are creating. Finally, you can increase the incision.

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