Safe Spay Hook Use: Four-Step Technique; LAB

Step 1: Insert the Spay Hook Flat Against the Body Wall

• Use the hook to capture and lift the caudal end of the incision.

• Using thumb forceps, grasp the incision edge on the same side as the uterine horn you intend to locate.

• Re- direct the hook to the side of the incision you are holding with the opening of the hook facing toward and against the body wall edge.

• Introduce the hook through the abdominal incision while keeping it flat against the ventral body wall as you slide down the inside of the abdominal wall.

• Advance the hook along the inside of the body wall rather than directing it into the abdominal contents until you reach the bottom of the abdomen.

What are the Safety Points for Insert the Spay Hook Flat Against the Body Wall

Maintain contact with the body wall.

Keep the hook facing the body wall at all times.

Do not blindly probe into the abdomen.

Do not direct the hook toward abdominal organs.

Step 2: Twist hook 180 degrees and bounce to midline

• Rotate the hook 180 degrees so the open hook now faces midline

• Do not move the hook until the full rotation is complete

• Move the body wall laterally so that you can keep the hook fully perpendicular to the table as you rotate.

• Bounce gently along the dorsum of the abdominal cavity until you come to midline

o This is when the uterus will come onto the hook

▪ Use small, gently movements toward midline

Step 3: Lift and slightly twist

• Gently elevate the hook toward the incision.

• Do no tilt or pull excessively and keep the hook fully perpendicular.

• Bring the captured tissue into view at the surgical field while twisting very slightly back and forth to allow unneeded tissues such as omentum and intestine to fall off the hook as you rise to the incision.

What are the safety points for Lift and slightly twist

Lift slowly and evenly.

Expect occasional retrieval of non-reproductive tissue.

Do not pull forcefully if resistance is encountered.

Why: Excessive traction can damage tissues or tear the broad ligament.

Step 4: Identify Before You Commit

Before proceeding, confirm that the structure is truly a uterine horn.

Look for:

• The characteristic tubular shape of the uterine horn

• Associated broad ligament

• Tracking the structure toward the ovary or uterine body

• Distinction from bowel, omentum, or fat

What are the safety points for Identify Before You Commit

Always visually identify tissue before clamping or exteriorizing further.

Follow the structure to verify anatomy when uncertain.

Never assume anything brought up on the hook is a uterine horn.

Why: Omentum, fat, bowel, and other tissues can be inadvertently hooked and must not be mistaken for reproductive tract structures

Use smooth, controlled movements.

Avoid excessive force.

Never dig or stab with the hook.

If You Retrieve Omentum

• Release it into the abdomen and try again.

• Do not continue pulling in hopes of finding the uterine horn.

If You Retrieve Fat

• Verify whether it is falciform, broad ligament, or periovarian fat.

• Follow the tissue before proceeding.

If Resistance Is Encountered

• Stop. Release the tissue.

• Reposition the hook at the beginning of the process facing the body wall.

• Reattempt using a gentle sweep.