Today I took a uterus out of a dog! As you may remember, when I did my spay lab, my dog unexpectedly arrived pre-spayed. I expected to have to repeat the entire lab, but it turned out that a member of my class, Minerva, couldn’t remove her spay dog’s uterus for religious reasons. We asked the course head if I could take out the uterus for Minerva, while she would do the rest of the surgery (basically opening and closing the dog). The course head agreed, so it was a go.
I showed up at a decadent 8 am. The spay lab students already had been in the clinic for two hours; the dogs had received their premedication, anesthesia had been induced, and they were on the tables, already clipped, scrubbed, and draped. It was a little disconcerting to meet this dog, whose uterus I was going to remove, as just a bare belly under a window in the drapes. I can’t even tell you for sure what color her fur was.
Minerva made the incision and found the uterus. I confess to a moment of nervousness: maybe I was cursed. Maybe this dog would also be uterus-free. (Minerva noted that the dog had apparently had puppies recently, so this seemed unlikely.) And then came time for the uterus removal.
Dog uteruses are a little different from the human variety; they are Y-shaped, with a small body and two long uterine horns, where the puppies would grow. (I don’t know why it is adaptive for them to have such a different uterine shape. I don’t think it has to do with number of offspring in a litter, because horses have twins no more often than humans do, but their uteruses also have long horns, just like cows, cats, sheep, and goats.)
So what Minerva found was the left uterine horn, with the ovary at the end. At that end, the whole structure attaches to the body wall in two places. The suspensory ligament is a small ligament running from near the ovary to the body wall; it can just be broken manually, no big deal. Then the pedicle connects the uterine horn to the body wall more extensively.
The pedicle is the bit that is harder to separate. First it must be clamped twice, using carmault forceps, which are long curved forceps which I am told are special for spays. Then you double ligate the pedicle — tie it off twice so that when you cut, it does not bleed. I placed a loop of suture material around one clamp, removed the clamp, tightened the suture very very tight, and made a very secure knot. (Knot tying was a skill we had to learn before being allowed in the door.)
I did the same for the second suture, but for that one, I just moved the clamp up a little, so that I had a clamp to cut against. I made sure to have hold of the pedicle with a smaller forceps, below the ligatures, so that when it was cut it wouldn’t jump back into the abdomen before I had a chance to look at it. Then I cut above my ligatures. I looked carefully at the stump: any extra bleeding? No, it looked good. So I let go of it and watched as it fell back into the abdomen. Now one horn of the uterus was free.
I did the same thing on the other side. The right side is a little harder. All the organs on the left side are pushed down a little towards the dog’s tail to make room for the heart, which means that the uterine horn is a little easier to get hold of on that side. On the right side, the horn was closer to the dog’s head (“more cranial”). I cut it away, and now the entire uterus could be pulled out of the abdomen (“exteriorized”). Minerva and I looked carefully to make sure nothing had come out with it that needed to stay in.
Finally, the uterus is (obviously) attached at the tail (“caudal”) end of the dog — where the babies come out! I double clamped the uterine body above the cervix, and tied it off twice. I cut and inspected and released. And then the dog was spayed.
At that point I stepped back and let Minerva take over. I wrote up a detailed surgery report, using somewhat different words than I have used here, and then I was done, even with some free time before my lunch meeting to do things like write this up. It feels so good to have actually taken out a uterus! (If you'd asked me a few years ago if I'd ever write that sentence, I would have thought you were insane.)
[How to learn how to spay a dog, part 1: Basic skills]
[How to learn how to spay a dog, part 2: Anesthesia]
[How to learn how to spay a dog, part 3: Surgery]