Evaluation of completeness of resection of the glandular portion of the uterus with hysterectomy in dogs – A pilot study

WSAVA guidelines for the control of reproduction in dogs and cats

“…Several methods of ligation can now be used with success, but regardless of technique, it is critical that all uterine tissue be removed to prevent increased risk of future cystic endometrial hyperplasia complex. Studies indicate that remnant tissue is most likely at the proximal ligation site, so particular caution is advised in this location (Mejia et al., 2020). The surgeon needs to recognise the close proximity of the uterine horn to the ovary; only a few millimetres of mesosalpinx separate the structures.…”

“…Using a knot design that has inherent resistance to slippage on the first throw such as a miller's knot may be advantageous, especially in large breed dogs. If proximity of the cranial uterine hormone and ovary prevent definitive separation with multiple forceps, a single transfixing suture should be considered to minimize risk of leaving residual uterine glandular tissue after surgery (Mejia et al., 2020). Vessel‐sealing devices, bipolar electrosurgical forceps or vascular clips can also be used for ligation and decrease surgery times.…”

“…The broad ligament is then cut or bluntly dissected lateral to the uterine artery to the level of the vagina. Studies indicate the presence of glandular tissue responsive to gonadal hormones within the cervix, so transection should be at the level of the cranial vagina rather than cervix (Mejia et al., 2020). Several methods for ligation and transection can be used with success, but regardless of technique the uterine arteries should be individually transfixed.…”

“…While many veterinary textbooks describe the OHE procedure with ligatures placed and subsequent transection made at the level of the uterine body, it is important to recognise that this is both anatomically and physiologically incorrect. Some portion of the uterus will inevitably remain in the patient and therefore what is being performed, is a SOHE (Mejia et al., 2020). SOHE should be avoided as it exposes the female to the risk of developing a uterine stump condition should an ovarian remnant be present, or a progestogen treatment administered at a later date.…”