Lap-assisted Ovariohysterectomy

Step-by-step

Section 1 of 4

  1. Indication 1: Any uterine abnormality observed when performing the initial laparoscopy during an OV
  2. Indication 2: Open pyometra or small closed pyometra assessed with ultrasound scan
  3. Indication 3: Uterine cysts
  4. Indication 4: Non-infectious fluid in uterus

Section 2 of 4

  1. Clip and surgical preparation as for routine open ovariohysterectomy.
  2. Follow procedure as for routine laparoscopic ovariectomy for: Placement of veress needle Abdominal insufflation Placement of first two ports
  3. For the third and most caudal port select a 6mm or 10mm port. Place this port just cranial to the urinary bladder, in between the pubis and umbilicus.
  4. Tilt the patient with cranial end downwards.
  5. Move the telescope to look caudally to visualize the bladder.
  6. Place port in between pubis and umbilicus or a bit further caudal if you can without the port being located over the bladder.
  7. Visualise the port as it screws in to ensure it does not lie over the bladder.
  8. After placing the port just cranial to bladder return table to normal position.

Section 3 of 4

  1. Place the telescope through the middle port.
  2. Tilt the table to the right and place hook through left ovary ovarian bursa as per routine lap OV.
  3. Place the babcock forceps through the caudal port.
  4. Locate and grasp the uterus. Lock the babcock ratchet on and leave to hang down from port to hold up the uterus.
  5. Cauterise and cut using appropriate instruments from the suspensory ligament along the broad ligament on each side. Do this to close to the level of uterine bifurcation.
  6. Remove the hook and babcock forceps, then turn the patient to the other side. Leave the ovary and cauterised uterine horn in abdomen.

Section 4 of 4

  1. Repeat steps 10-13 for the right side.
  2. Once the uterus has been cauterized and cut, release from the babcock forceps. Placing the babcock forceps in the caudal port grasp the right ovary.
  3. Pull ovary up to port and remove port along with the ovary through the incision. Follow right uterine horn down to bifurcation. Pull out the left uterine horn and then the ovary.
  4. After exteriorisation of the uterus, ligate and tie off outside body at cervix as for an open ovariohysterectomy. Circumferential and transfixing ligatures should be placed.
  5. Replace stump through port incision.
  6. Perform final laparoscopy, desufflate and close all ports as for routine lap OV.