U.S. patent application number 13/229564 was filed with the patent office on 2013-11-07 for surgical spay and neuter assist platform system.
The applicant listed for this patent is Subhakar Patthi Rao. Invention is credited to Subhakar Patthi Rao.
Application Number | 20130296656 13/229564 |
Document ID | / |
Family ID | 49448539 |
Filed Date | 2013-11-07 |
United States Patent
Application |
20130296656 |
Kind Code |
A1 |
Rao; Subhakar Patthi |
November 7, 2013 |
Surgical Spay And Neuter Assist Platform System
Abstract
In accordance with one embodiment a surgical device consisting
of a rigid frame with a spindle straddling the lateral members and
coupled with a ratcheting traction unit for the purpose of
anchoring an organ and, to apply controlled incremental traction to
the tissues connecting the organ to the body enabling exposure of a
working length of the tissue and its associated structures for the
application of ligatures etc.
Inventors: |
Rao; Subhakar Patthi;
(Thousand Oaks, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Rao; Subhakar Patthi |
Thousand Oaks |
CA |
US |
|
|
Family ID: |
49448539 |
Appl. No.: |
13/229564 |
Filed: |
September 9, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61385827 |
Sep 23, 2010 |
|
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|
Current U.S.
Class: |
600/233 |
Current CPC
Class: |
A61D 1/06 20130101 |
Class at
Publication: |
600/233 |
International
Class: |
A61B 1/32 20060101
A61B001/32 |
Claims
1) a surgical device to be used with a pair of operator supplied
forceps to anchor an organ outside a body comprising: (a) a
plurality of elongate members forming a rigid frame adapted to
surround a surgical opening, (b) a set of lateral members of said
rigid frame, each lateral member having a dorsal region, a ventral
region, a cranial portion, a caudal portion, and a mid-section in
between, the said mid-sections have a pair of congruent notches on
the dorsal region, (c) a set of cross members of the said rigid
frame, each cross member having terminal portions and a mid-section
in between, said cranial portions of said lateral members are
fixedly attached to the said terminal portions of one of the said
cross member forming a cranial cross member, and said caudal
portions of the said lateral members is fixedly attached to the
said terminal portions of another said cross member forming a
caudal cross member, and said cross members are contoured to adapt
to the natural curvature of said body, (d) a rigid spindle
straddles the congruent notches of said lateral members during an
anchoring and a traction procedure, (e) a traction unit is fixedly
attached to the mid-section of said caudal cross member, said
traction unit consists of a slidable component and a fixed
housing.
2. (canceled)
3) The surgical device of claim 1 wherein said slidable component
of said traction unit comprises of a body, said body of said
slidable component has a dorsal area, a ventral area, an anterior
surface and, a posterior surface, there is a thumb support on said
dorsal area of said body of said slidable component, said body of
said slidable component also has a set of prongs on said anterior
surface, said posterior surface of said body of said slidable
component has a ratcheting bar with a free end, said ratcheting bar
has a dorsal surface and a ventral surface, a plurality of
cranially raked congruent dentil are disposed on said dorsal
surface of said ratcheting bar, said posterior surface of said body
of said slidable component also has a set of guide rods on either
side of the said ratcheting bar, said fixed housing of said
traction unit has a cranial end, a caudal end, a dorsal area and a
ventral area, a set of congruent openings connect said cranial end
and said caudal end, and said ratcheting bar and said set of guide
rods slide in and out of said fixed housing thru said set of
congruent openings, said fixed housing has a finger support on the
dorsal area, the caudal end of the said congruent opening for said
ratcheting bar has a process to lock the movement of said
ratcheting bar as needed, depressing the free end of said
ratcheting bar releases the capture of said dentil from said
process found on said caudal end of said congruent opening.
4) The surgical device of claim 1 wherein said rigid spindle has a
set of limiting collars near the ends to prevent it from sliding
out of said congruent notches of said lateral members and, said
rigid spindle has a central region in between said limiting
collars, said central region of said rigid spindle has a set of
rings bounding a central annular concavity to guide and contain a
connecting tissue during said traction.
5) A surgical device to anchor organs, the improvement wherein the
operator can apply incremental traction to expose a working length
of the tissues that connect said organs to the body without tipping
of said device, comprising: (a) a plurality of elongate members
forming a rigid frame of sufficient size to surround a surgical
opening, (b) the lateral members of said rigid frame have a set of
congruent notches that receive a rigid spindle and said rigid
spindle straddles said lateral members during the anchoring and
traction procedure, (c) and said rigid spindle placed under said
connecting tissues and disposed in said congruent notches acts as a
fulcrum between the point of origin of said connecting tissues from
inside the body and said organ that is held by a user supplied
forceps placed in congruent notches straddling the terminal portion
of said lateral members.
6) The surgical device of claim 5 wherein said rigid spindle has
limiting collars near the ends to prevent it from sliding out of
said dorsal notches of said lateral members and, the central region
of said spindle has a set of rings bounding a central annular
concavity to guide and contain said connecting tissues during
traction and ligation.
7) The surgical device of claim 5 wherein said cross and lateral
members are permanently attached to form a rigid frame of a
predetermined shape, said cross members are contoured to adapt to
the natural curvature of the abdomen and the terminal region of
said lateral members converge medially narrowing the bridging span
and, said narrowed region of said lateral members have a plurality
of caudally sloped congruent notches disposed on the dorsal surface
that serve to anchor the user supplied forceps providing a means of
traction by alternatively pivoting and walking the tip and the body
of said forceps that was placed across the proper ligament and to
progressively advance and expose a working length of said tissues.
Where by an operator can efficiently ligate the exposed and
anchored tissues that connect said organs to the body without
tipping of the device or seeking additional help to comfortably
complete the procedure.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] Provisional U.S. Application No. 61/385,827, filed on Sep.
23, 2010 by Subhakar Patthi Rao for a "Surgical Spay and Neuter
Assist Platform System" (`SNAP` system).
BACKGROUND
Prior Art
[0002] (1) Patent # US 2006/0079932 A1 issued to Brian T. Dowling
on Apr. 13, 2006 [0003] (2) The `Hauptman OHE Retractor` available
from Jorgenson Laboratories of Loveland Colo.
FEDERALLY SPONSORED RESEARCH
[0004] None
[0005] Surgical neutering (Ovario-hysterectomy or removal of the
female reproductive organs commonly referred to as `Spaying` and,
Orchiectomy is the removal of the testes in the male is usually
referred to as `Castration`) is one of the most routinely performed
elective procedures carried out by veterinarians. It demands a
working knowledge of regional anatomy, skill and, manual dexterity.
In the case of `Spaying` sometimes an `additional` pair of hands
comes into play to complete the procedure.
[0006] After gaining access to the abdomen of the female dog or
cat, the uterine horn is identified, isolated, exteriorized and
followed cranially to locate the ovary. Once this is done the ovary
is held by the `Proper` ligament (the ligament that attaches the
ovary to the uterus) and adequate traction is applied to identify
the `suspensory` or ovarian ligament (a strong fibrous band that is
attached to the ovary at the distal end and arises as a fan shaped
structure from the vertebral end of the last two ribs) by digital
palpation as a taut band arising from the an area near pole of the
ipsilateral kidney. Holding and maintaining traction on the proper
ligament by the power hand, the index finger of the free hand is
slid along the cranial border of the suspensory ligament (closer to
the kidney) and is either stretched or torn to facilitate
exteriorizing the ovary.
[0007] At this stage a `fenestration` or a window is made in the
broad ligament (the structure that comprises of a peritoneal fold
that suspends the uterus) caudal to the ovary and one or two
crushing type of forceps (depending upon the choice of the surgeon)
are placed across the ovarian `Pedicle` (comprising of the tortuous
ovarian artery and vein; the suspensory ligament and its
vasculature) and one across the proper ligament. Once removed, the
most proximal clamp serves to form a groove for the placement of a
circumferential ligature which is applied in a fashion that is
comfortable to the surgeon. The middle clamp assists to hold the
pedicle for ligation. Depending upon the skill of the surgeon, size
of the pedicle and the amount of fat surrounding it a second
ligature may be applied after releasing (and `flashing`) the middle
forceps. The suspensory ligament is held as close to the ovary as
possible by a smaller forceps and the pedicle is transected distal
to this forceps. The stump is checked for any bleeding and is
released back into the abdominal cavity. The contralateral ovary is
removed in the same way. Removal of the uterus is done in a routine
way.
[0008] The preceding paragraph illustrates the steps needed to
complete the procedure (in this instance removal of the ovaries)
after the body wall is opened the ovaries need to be exteriorized
and the pedicle visible and accessible for the application
ligatures. There has to be adequate traction applied to the ovarian
pedicle to keep the ovary in an exteriorized position.
[0009] While maintaining traction, the index finger of the free
hand is used to feel for the taut ovarian ligament and with
controlled traction from the said finger the said ligament is
`tweaked` until it tears or stretched for adequate pedicle
exposure. Since the application of the ligature requires two hands,
the step to hold the traction on the ovarian pedicle lies in the
improvisation of the surgeon using the back or the edge of the palm
to anchor the clamps or seek the assistance from an extra pair of
hands. One method to secure and stabilize the ovarian pedicle (for
a solo surgeon) is to apply a crushing clamp (or two clamps placed
opposite to each other across the opened body wall) proximal to the
intended placement of the ligature, apply the ligature and release
the clamp (or clamps). Since the groove or tract made by the clamp
is left behind in the body, there is a chance that the integrity of
the vascular walls of the pedicle might be compromised leading to
bleeding and subsequent complications.
[0010] At present there are two alternatives that offer relief for
the solo practitioner:
[0011] (a) The `Hauptman OHE Retractor` (available in three sizes
from Jorgenson Laboratories of Loveland Colo.) lets the veterinary
surgeon clamp the proper ligament (using existing clamps like the
Carmalt etc) after stretching or tearing the suspensory ligament
make a fenestration in the broad ligament to pass the lower arm of
the retractor and use the two prongs to secure the clamp. Steady
traction is applied on the pronged arm away from the bottom arm to
stretch, stabilize and pull the ovarian pedicle into view and then
proceed to ligate the same. The taut ovarian pedicle over the
straight bottom arm of the device tends to act as a `fulcrum` and
as such the set up could have a tendency to lift up.
[0012] (b) The `Dowling Retractor` invented by Brian T. Dowling of
Elma Wash., (patent # US 20060079932A1, date: Apr. 13, 2006) is a
much simpler rendition. Before clamping the proper ligament the
surgeon has to secure the ligament using his fingers (and a piece
of gauze for added traction) to wiggle and exteriorize the ovary,
make a fenestration in the broad ligament, pass the fixed lower
curved arm of the retractor through the opening and apply enough
traction to exteriorize the ovarian ligament and then place the
clamp across the proper ligament. Depending upon the amount of
traction that is applied to the ovarian ligament, the tip of the
lower curved arm (if it lacks adequate support from the body wall)
could have a tendency to tip over as the curved arm could act as a
fulcrum. The said retractor is available in two lower arm
sizes.
[0013] The shortcomings of the aforementioned retractors is based
on the laws of physics, specifically that of Class I Levers and the
fulcrum which is placed farther away from the load (here the
attachment of the ovarian ligament and its associated structures)
than it is to the point of force (the forceps clamped across the
proper ligament) and as such a significantly higher tendency for
the device to tip over.
ADVANTAGES
[0014] The described embodiment offers a more stable and elegant
solution to expose the ovarian ligament with a more controlled
traction as the device takes advantage of the fulcrum in Class I
Levers. When the load increases (tension from the ovarian ligament)
so does the stability of the device and prevents any tipping over.
This device can accommodate anatomical variations as reproductive
anatomical parts come in different sizes and lengths. There is no
need to break the ovarian ligament for a working exposure of the
ligament and the veterinarian has both the hands free to ligate the
pedicle in a more comfortable manner. The procedural time is
shortened since this device eliminates the step of breaking the
ovarian ligament and there is no `fumbling`of the instrumentation
to complete the application of the ligatures. This device is to
augment the standard set of instruments that are routinely used in
spay and neuter procedures.
[0015] In a neutering procedure the `cord` is clamped and anchored
between the two prongs and adequate traction applied to stretch the
same. A second clamp is temporarily applied across the cord to
`crush` the cremaster muscle and provide a track for the
application of the ligature.
SUMMARY
[0016] The `SNAP` System addresses the need to a more secure,
controlled, and confident method of exposing and anchoring
reproductive tissues when performing one of the most common
surgical procedures (spaying and neutering) in a veterinary
hospital.
[0017] In accordance with the described embodiment (the `SNAP`
system) consists of a rigid frame and a spindle straddling the
lateral members. The traction unit resembles a `three-tined
pitchfork` or a `trident` shape with a flat stump for a handle. The
stump is attached to a set of prongs cranially and the central tine
is shaped in the form of a flat ratcheting bar that slides into a
channel located in the ratcheting housing that is located on the
rear cross member. The rear opening of the channel has a partial
height beveled end plate attached at a predetermined height to act
as a rigid pawl to control the movement of the ratcheting bar. The
traction system has a pair of guide rods on either side of the
ratcheting bar that slide in and out the corresponding open sleeves
found on the traction housing. This set up will help align the unit
and prevent the same from racking during operation. To impart
traction, the thumb support on the traction unit and the finger
grip on the traction unit housing are squeezed together. To release
the ratcheting bar, downward digital pressure is applied to the
caudal tip of the ratcheting bar to disengage the ratcheting teeth
and slide the bar out cranially.
[0018] In accordance with another simpler rendition of the device
the mechanical traction system is eliminated and instead the caudal
portion of the rigid lateral members of the main frame sports a
plurality of caudally raked congruent notches on the dorsal
surface.
[0019] The proper ligament is cross-clamped with the power hand
using user supplied forceps; the thumb and fingers of the free hand
are placed on either side of the central annular concavity of the
spindle to stabilize the frame and to apply downward pressure. The
tip of the forceps is maneuvered into the first notch on the far
side and this is used as a pivot to maneuver the body of the
forceps into the corresponding first notch on the near side. This
operation of `walking` and alternately pivoting the tip and the
body of the forceps is progressively advanced till a working length
of the ovarian ligament is exposed.
DRAWINGS
[0020] FIG. 1 is the one of the embodiments of the `SNAP`
system.
[0021] FIG. 2 is an exploded view showing the parts of the `SNAP"
system.
[0022] FIG. 3 is the sliding components of the traction unit.
[0023] FIG. 4 is the caudal view of the traction unit housing
[0024] FIG. 5 is the cranial view of the traction unit housing
[0025] FIG. 6 is the rigid spindle.
[0026] FIG. 7 is another embodiment of the `SNAP` system.
[0027] FIG. 8 is an exploded view of the second embodiment.
[0028] FIG. 9 is a variation of the `SNAP` system.
[0029] FIG. 10 is yet another variation of the `SNAP` system.
REFERENCE NUMERALS
[0030] 101 is the cranial cross member of the rigid frame. [0031]
102L & 102R are the two lateral members of the rigid frame.
[0032] 103 is the spindle seen in an operational position. [0033]
104L & 104R the set of prongs that support the user supplied
forceps. [0034] 105 the body of the traction unit with the dorsal
thumb support. [0035] 105A the thumb support on the body of
traction unit. [0036] 106L & 106R are the lateral guide rods of
the traction unit. [0037] 107 is the finger support that is on the
top of the traction unit housing. [0038] 108 is the ratcheting bar
of the traction unit. [0039] 109 is the caudal cross member of the
rigid frame. [0040] 110 is the rigid platform that rests on the
prepped and draped abdomen of the pet. [0041] 111L & 111R are
the two congruent cranially raked notches that receive the spindle
[0042] 112 is the sliding traction unit. [0043] 113 is the housing
for the sliding traction unit. [0044] 115L & 115R are the
tubular channels for the movement of the lateral guide rods. [0045]
116L & 116R are the openings of the tubular channels. [0046]
117 is the beveled fixed pawl to stop the cranial movement of the
ratcheting bar. [0047] 118 is the cranial opening of the channel
that receives the ratcheting bar. [0048] 119A & 119B are the
ends of the spindle that will rest in the notches of the rigid
frame. [0049] 120A & 120B are the collars that prevent the
lateral movement of the spindle while seated in the notches of the
rigid frame. [0050] 121A & 121B are rings that guide the
connecting tissues to the center of the spindle. [0051] 122 is the
central annular concavity that channels the connecting tissues.
[0052] 123 is the rigid frame of the second embodiment. [0053] 124
L & 124R are a set of caudally raked congruent notches to trap
the user supplied forceps.
DETAILED DESCRIPTION
[0054] FIG. 1 is a perspective view of the device showing the
embodiment in an assembled state that is ready for use. The two
prongs 104R and 104L helps anchor the forceps that is clamped
across the proper ligament. The squeezing together of the thumb
support 105A and the finger support 107 helps the application of
necessary traction to expose a working length of the ovarian
ligament and its associated structures. Other parts are the spindle
103, the main rigid frame 110.
[0055] FIG. 2 is an exploded view of the embodiment. The cross
members 101 and 109 to be permanently attached to the lateral
members 102R and 102L of the rigid frame 110. The pair of cranially
rake notches 111R and 111L located on the dorsal surface of the
lateral members receives the ends of the spindle 103 during
operation. The raised fixed vertical member 105A behind the prongs
serves as a support for the thumb and the upright raised member 107
which is located at the entrance of the traction housing 113 serves
as resting place for the fingers of the surgeon during the act of
applying traction to the connecting ovarian structures. The
ratcheting bar 108 of the sliding part of the traction unit helps
maintain traction on the ovarian structures during operation and
can be disengaged by the surgeon as needed.
[0056] FIG. 3 shows the sliding traction unit 112, the body 105,
the thumb support 105A and, the centrally located flat ratcheting
bar 108 shows a set of cranially raked elongate teeth 116 on the
dorsal surface. The two guide rods 106R and 106L located laterally
prevent the sliding unit from racking during operation. The two
prongs 106R and 106L in front of the body 105.
[0057] FIG. 4 shows the caudal view of the traction unit housing
located above the caudal cross member 109. The lateral channels
115R and 115L show the two hollow tubes 116R and 116L that receives
the two guide rods during operation. The fixed beveled rigid pawl
117 located at a predetermined height above the caudal opening of
the central channel serves to lock the sliding ratcheting bar as
needed.
[0058] FIG. 5 shows the cranial view of the traction unit housing
located above the caudal cross member 109. The cranial opening of
the central channel 118 receives the flat ratcheting bar of the
sliding traction unit. The lateral channels 115R and 115L show the
two hollow tubes 116R and 116L that receives the two guide rods
during operation.
[0059] FIG. 6 shows the spindle 103. The two collars 120A and 120B
prevent the spindle from sliding out of the dorsal notches 111R and
111L located on the lateral members 102R and 102L. The central
annular sulcus 122 is bounded by a set of annular rings 121A and
121B that help guide the ovarian structures to stay confined within
the concavity of the annular sulcus 122.
[0060] FIG. 7 shows a simpler rendition of the surgical device
without a built-in traction unit. The caudal portion of the
modified lateral members of the rigid frame 123 have a set of
dorsally placed caudally raked congruent notches in areas 124R and
124L. These notches help in pivoting the tip and the body of the
forceps to advance caudally and incrementally expose the ovarian
ligament and its associated structures. Other parts are the spindle
103, the modified main frame 123 and the rear cross member 109.
[0061] FIG. 8 shows an exploded view of the simpler version of the
device. Cranial cross member 101, caudal cross member 109, lateral
members 102R and 102L to be permanently fused in the predetermined
configuration. Dorsal notches 111R and 111L receive the spindle
103.
[0062] FIG. 9 shows the embodiment with a variation of the traction
unit with an articulating pawl and a modified spindle.
[0063] FIG. 10 shows yet another embodiment with a variation of the
traction unit showing an unassembled floating roller pin instead of
a pawl and another variation of the spindle.
Materials, Ramifications and Conclusions
[0064] The embodiment to be made with a metal that is light weight,
can withstand thermal stress that typical surgical instruments
undergo during the sterilization process, be resistant to body
fluids and chemicals in the cleaning solutions, be resistant to
corrosion or oxidative damage, be adequately hard to withstand
routine surgical handling and occasional mishandling, retain
surface integrity for ease of use and cleaning etc. Options would
include 316L or 904L type of surgical grade stainless steel or,
production costs permitting Titanium could also be considered.
[0065] The top contact surface of the raked dentils on the
ratcheting bar and the lower beveled edge of the fixed pawl could
be laminated with tungsten carbide inserts to extend the longevity
of the device.
[0066] The anterior face of the thumb support on the ratcheting
body and the posterior face of the finger support on the ratcheting
stop housing unit could have a milled cross-hatched or reticulated
surface to increase frictional grip during the traction
process.
[0067] The lateral members of the frame, the sliding traction unit,
the traction housing of the embodiment to be `bead` blasted (glass
bead #10 size with a mesh of 100/170) or other similar process to
give it a soft satin luster thereby reducing any reflections from
the lights in the operatory and marginally increase haptic
properties. For purely aesthetic reasons, the two cross members to
have a polished satin finish.
[0068] In accordance with another variation of the device a larger
sliding ratcheting platform travels in a open channel located in
the ratcheting pawl housing and the movement of the ratcheting
platform is controlled by an articulating pawl that is secured atop
the housing. The sliding platform has an articulating stop at the
caudal end that prevents the platform from sliding completely out
of the housing during a surgical procedure. The pawl can be engaged
or disengaged depending upon the different stages of the surgical
procedure. The pawl housing unit is attached to the rear cross
member of the metal frame.
[0069] In accordance with another variation of the articulating
pawl would be to replace the articulating pawl with a roller pin
with capped ends that travels in caudally raked embrasures located
in the side walls of the housing. The pin mates with the raked
teeth on the sliding ratcheting platform and it moves up in the
opening when the platform is pushed caudally into the housing and
drops in front of the teeth thereby locking the platform.
[0070] In accordance with yet another embodiment of the device
provides the necessary traction via a horizontally placed gear that
is attached to a lever at the top. The gear meshes with a
ratcheting bar that bears dentils on the lateral side facing the
gear and, the bar bears a set of prongs at the cranial end. The
movement of the gear is controlled by an articulating spring loaded
pawl with a thumb grip to facilitate the engagement or
disengagement of the pawl. To impart the necessary traction to the
ovarian ligament the lever is moved in a radial direction till the
ligament is in a position to be ligated
[0071] With all the variations shown, the reader will see at least
one embodiment of the surgical device to be more effective and easy
to operate. These embodiments are simple in design, light-weight
and economical to manufacture. The specificities of the description
should not be construed as limitations of the scope of the
embodiments but rather as an exemplification of several variations.
In keeping with the principle of the class-1 levers, the embodiment
can be designed to adapt to other organs that need to be secured
when exteriorized outside the body.
Operation:
[0072] This description follows after the anesthetized patient has
undergone a celiotomy and the uterine horn with the connected
ovarian structures (the side nearest to the surgeon) is
exteriorized. The proper ligament is identified and cross-clamped
with a forceps. The forceps is held above the surface of the
abdomen and the broad ligament is identified and a small (size
adequate for the passage of the spindle) fenestration is made just
below the proximal limit of the ovary. The forceps is now
transferred to the free hand and the power hand secures the uterine
horn. At this juncture the forceps (still cross clamped to the
proper ligament) is let to passively drape on the near side of the
body. The uterine horn is followed caudally towards the bifurcation
and the far side uterine horn is exteriorized, (in younger patients
the body wall incision may have to be extended caudally to reach
the uterine bifurcation) cross clamped with a second forceps and a
second fenestration is made in the broad ligament below the
ovary.
[0073] Both the forceps (that are still securely clamped to the
proper ligaments) are held up vertically with one hand and passed
thru the rigid frame of the device (the prongs of the sliding rack
is set at full extension) which is placed on the draped surface of
the abdomen centering the celiotomy opening. The spindle is now
passed thru the two fenestrations and the ends are placed in the
two notches in the lateral members of the main frame. The forceps
and the uterine horn that is away from the operator are draped over
the farther side of the rigid frame. The forceps that is near to
the operator is held by the power hand, the ovarian ligament and
its associated structures are guided over the central annular
concavity of the spindle and the forceps is secured behind the two
prongs of the sliding rack. The rigid frame of the device can be
repositioned to ensure that the ovarian ligament below the spindle
is in a near vertical position.
[0074] If the forceps cannot be comfortably placed in the prongs, a
little downward pressure on the spindle by the free hand should
achieve the desired objective. Now the thumb grip on the sliding
traction component and the finger support on the traction unit
housing are squeezed together using the fingers of the power hand
alone or with both the hands. This exposes a working length of the
ovarian ligament and the associated structures. The structures are
ligated based the surgeon's choice of material and method. A
smaller forceps is used to clamp the ovarian ligament that is
distal to the placement of the ligature and below the proximal end
of the ovary. The pedicle comprising of the vasculature, other soft
tissue and the ovarian ligament is transected distal to the small
forceps. The cut end of the pedicle is checked for any hemorrhage
and released into the abdominal cavity. The forceps is removed from
the prongs of the sliding ratcheting platform and let to drape on
the side of the body wall nearest to the operator.
[0075] The caudal tip of the ratcheting bar is digitally depressed
and pulled out to the original extended position and digital
pressure released to engage in the rigid pawl. The same steps are
now followed for the second ovary and uterine horn. The spindle is
now removed from its position and set aside. Both the forceps (that
are still cross clamped to the respective proper ligaments) are
held up and checked to ensure that no tissue or small organs are
trapped in the bifurcation. The two broad ligaments attached to the
uterine horns are manually separated making sure any small vessels
are properly ligated. The uterine horns are straightened cranially
and the spindle is now placed on top of the horns and dropped in
the notches. The frame is slid back caudally to a position where
the seated spindle is just above the caudal commisure of the
abdominal incision. One of the forceps that is cross-clamped on the
proper ligament is released and the same forceps is reapplied
across both the exposed uterine horns at a level that is in line
with the two prongs of the traction unit. The forceps with clamped
uterine horns is set in the prongs. Moderate traction is applied to
the uterine structures which are ligated based on the operator's
choice of method and material. The second forceps that is still
attached to the other proper ligament is released and applied
across the uterine structures that are between the applied
ligatures and the prongs of the sliding bar. The uterine structures
are transected just between the applied forceps and the prongs. The
stumps are checked for any hemorrhage and released back into the
abdominal cavity. The embodiment is removed and set aside. The
celiotomy incision is closed based on the choice of the
surgeon.
* * * * *