Minimally Invasive Surgery
In 2009 The Parkway Veterinary Hospital embarked on a journey to improve upon one of the most common surgeries veterinarians perform in nearly all female canine patients, the spay or ovariohysterectomy (OVH for short). A spay is the surgical removal of the ovaries and uterus to prevent heat cycles and pregnancy (aka traditional spay). Since the early days of spay/neuter programs, few advancements has have been made to this surgical procedure, but gratefully, leaps and bounds have been made with regards to perioperative and postoperative pain management.
In making every effort to carefully plan and control pain resulting during this necessary procedure, the veterinary staff at Parkway not only wanted to control pain but also to minimize the pain and tissue trauma caused by the surgery itself. It was with that goal in mind that we teamed up with Dr. Tim McCarthy, a local veterinary surgery expert, and Karl Storz veterinary endoscopy to train and offer laparoscopic spay surgery, a minimally invasive approach to spay your pet.
The primary aim of spaying is to render your pet unable to conceive. Secondary objectives are to eliminate the mess and inconvenience of heat cycles and to minimize future risk of diseases of the reproductive organs. Removal of the ovaries accomplishes all these goals, while at the same time being less invasive, much less painful procedure with fewer complications than a traditional spay. Removal of the ovaries brings an immediate halt to the reproductive cycle. Your pet will no longer go into heat nor will she attract male dogs. Likewise, she cannot conceive and the risk of ovarian disease is eliminated.
In a laparoscopic ovariectomy, two small 5 mm to 10 mm incisions are made. Sterile carbon dioxide is used to ‘inflate’ the abdomen which allows incredible visualization of all structures. A slender video scope is inserted into the abdomen through one of the incisions. The other incision is for the surgical instruments that will be used to seal the tissues and blood vessels in the area of the ovary and to remove the tissue from the abdomen. Given the small incision size and since the ovaries are able to reside in their normal anatomic location until their removal, there is far less tissue trauma and thus, less pain during and after the procedure.
By contrast, during a traditional spay, a 4-7 cm incision is made into the abdomen to expose the reproductive organs. The ligaments holding the ovaries and uterus in place are blindly torn (a significant source of abdominal pain), the ovaries are mobilized to the skin incision and tied with sutures, then cut and removed. Likewise, the uterine horns and body are removed at the level of the cervix.
The benefit for veterinarians who perform laparoscopic spays – and therefore their patients — is enhanced visualization of the abdominal cavity thanks to the magnification properties of the scope. Enhanced visualization during surgery leads to safer procedures, less inadvertent ligation of other structures (ie ureters) and better outcomes. Some of the many advantages of the procedure as compared to a traditional spay include less stress and tissue trauma, dramatic reduction in pain (up to 65 percent less, JAVMA 2005), smaller incision size which results in less bruising, less incisional complications, and faster return to normal function. Most importantly, laparoscopy and cautery ligation of the ovarian and other vessels lowers the risk of intraoperative or postoperative bleeding which can be fatal or minimally require a second surgery to repair loose sutures placed during traditional spay.
The biggest technical difference of a traditional ovariohysterectomy (OVH) and a laparoscopic ovariectomy is that in the latter only the ovaries are removed and the uterus is left in place. Many question whether this is safe to do and we can assure you that yes it is.
Uterine disease in dogs whose ovaries have been removed is almost nonexistent. The disease called pyometra, which is infection in the uterus, is the most common uterine problem in intact dogs. It is the result of the influence of the hormone progesterone, produced by the ovaries. When the ovaries are removed, hormone production stops and it becomes impossible for pyometra to occur naturally. Malignant uterine tumors in dogs with or without ovaries are an extremely rare occurrence at 0.003 percent of all canine tumors. Additionally, thanks to our veterinary counterpart in Europe where ovariectomy surgery (ovary removal only) has been performed since the early 1980’s, we know that there is virtually no increase risk of the uterine disease if the ovaries are removed properly.
At Parkway Veterinary Hospital, we offer other laparoscopic services that may benefit your pet. In male dogs, it is not uncommon to find an undescended testicle that remains within the abdomen. The laparoscopic procedure to remove this abdominal testicle is the same as for a laparoscopic spay, with all the benefits of a small incision and avoiding a large abdominal incision necessary to find the testicle during a traditional surgery. Additionally, for breeds at risk for gastric dilatation and volvulus, or GDV, we offer laparoscopic assisted gastropexy for both male and female dogs. A gastropexy is the surgery where the stomach is ‘tacked’ to the abdominal wall using minimally invasive surgery as opposed to a large ‘open’ incision. By tacking the stomach, we prevent the stomach from twisting in the event of gas dilation. Breeds considered at risk are all giant breeds, poodles and labrador retrievers.
One of the only disadvantages of laparoscopic ovariectomy is the increased cost. We have to account for the additional and ongoing training of our doctors and staff to perform the procedure safely and correctly, and the equipment purchase and maintenance cost is much greater than traditional surgical instruments. That said, our laparoscopic ovariectomy is typically $300 additional to the cost of a traditional spay. In summary, there are many advantages, and no medical disadvantages save the training and specialized instrumentation and technology needed to accomplish this form of minimally invasive surgery. The Parkway Veterinary Hospital is proud to be a leader in this advanced and more pain-free surgical technique.
If you are considering a laparoscopic procedure for your pet or want more information, please contact us at The Parkway Veterinary Hospital.