4 Obstetrics and Gynecology International as possible to the root of the pedicle to ensure haemostasis of the ovarian artery. The broad ligament is then punctured with a clamp to grasp the suture material and a ligature is placed in the ovarian pedicle as close as possible to the lumbar wall. Once this ligature has been placed, the ends of the threads are kept long so that the ovarian pedicle can be found with ease in the event of haemorrhage. A clamp is then placed between this ligature and the ovary, and the pedicle is sectioned between the two. The ovarian pedicle is held throughout this procedure with a clamp. The quality of the haemostasis is checked; the long ends of the suture material on the ovarian pedicle are then cut. In some cases, such as in the event of hypertrophy of the vascular bundle, it may be advisable to place two ligatures, one around the artery and one around the ovarian vein. Never hold the ligature itself with the clamp, as it might slip oﬀ the pedicle when being released back into the abdomen. − Broad Ligament. If the broad ligament is seen to contain large vessels, they should be ligated prior to be being cut. However, if the vessels are invisible and buried under fat, the ligament can simply be torn in the middle above the uterine artery by exerting traction between two swabs with the ﬁngers to tear it from front to back to the level of the cervix, and as close as possible to the lumbar wall. A point of resistance will be encountered within the round ligament; this corresponds to the vaginal process (which corresponds to the scrotum in the male) which explains the risk of inguinal hernia- tion of the uterus in bitches following relaxation of the latter. Another technique for sectioning the broad ligament involves the placement of a row of overlapping mattress sutures along the length of the ligament before making the section with a scalpel or a pair of scissors. Once the ovarian pedicle has been sectioned, the second horn is located and the corresponding ovarian bursa grasped with Babcock forceps. The ovarian pedicle and broad ligament are sectioned as described previously. Finally, the two uterine horns are replaced back onto pelvis. Suturing the Anterior Portion of the Laparotomy Incision. The prolapse of intestinal loops through the incision can cause signiﬁcant heat and ﬂuid loss, which can have very serious consequences, especially if the bitch is already suﬀering from deterioration in general status due to severe pyometria, for example. It is therefore advisable to suture the anterior portion of the laparotomy wound before continuing the surgery. However, if the haemostasis of the ovarian pedicles or broad ligaments is a source of concern, the placement of a few forceps should suﬃce to provide temporary closure of the anterior portion of the laparotomy wound. Sectioning the Cervix [9] − Ligating the Uterine Arteries and Veins (Figure 3). Once both uterine horns have been ﬂipped back onto the pelvis, the uterine cervix is sectioned, following ligation of the uterine arteries and veins. The veins can be visualised passing on either side of the cervix. The arteries run under the veins in the musculosa of the cervix, which is why the haemo- static sutures should transﬁx the lateral walls of the cervix. However, if the uterine artery is perforated during ligation, a wider transﬁxion is needed, more caudal to the previous attempt. − Forcep Placement (Figure 3). Once both of the liga- tures have been placed, the cervix is crushed at their level with an intestinal clamp. Another clamp is then placed just above the ﬁrst and the contents of the uterus are pushed back towards the horns; two other clamps are placed in the same way above the 2nd clamp. The 2nd and 3rd clamps are removed, thus leaving a secretion-free zone. − Sectioning the Cervix (Figure 3). Once both intestinal clamps have been placed, the anterior section of the cervix is performed; the cervix may be normal or pathological. Normal Cervix. The cervix is simply sectioned with a scalpel between the two clamps. Pathological Cervix. For pathological cervixes, the serosa is dissected just caudal to the clamp that is placed on the uterus; the serosa is then retracted caudally. The musculosa is then sectioned cranial to the intestinal clamp placed on the cervix; if the clamps have been placed correctly, no ﬂuid should leak from the cut ends. Dealing with the Stump (Figure 3) − Small, Normal Cervix. The stump is simply replaced in the abdominal cavity. It is however advisable to suture it or bury it in a fold of omentum. − Pathological Cervix. The cut section of the musculosa, mucosa, is cauterised with an iodine-based solution, and then sutured in two phases: Septic Phase. For the septic phase, a simple continuous suture is made in the musculosa with VICRYL N.D dec. 3.