Minimally Invasive Surgery Laparoscopic Spay


Key Points

Laparoscopic spays have been shown to be 62% less painful versus traditional spay procedure

Smaller incision with laparoscopic spay means less risk for herniation of abdominal contents if the patient removes sutures prematurely

Faster return to normal activity with laparoscopic spaying

 

Introduction

Minimally invasive surgery has been used in man for years and has proven to be less painful, frequently being performed on an outpatient basis, decreased total cost to insurance companies or the patient, and returning the patient back to work sooner. Take for example a gall bladder removal…typically a patient would be off work for 6 weeks, but now with laparoscopic gall bladder removal, patients will only need to take a few days off work. Does this mean that animals should also have laparoscopic surgery? Based on a blinded study performed by Dr. Chad Devitt, laparoscopic spaying was found to be 62% less painful than traditional surgery in dogs. This fact alone is grounds for clients to want the best for their furry companions.

Laparoscopy is a procedure in which the surgeon only makes one or two small incisions in the abdomen. The first incision is utilized to insert a camera, which provides the surgeon for a view within the abdomen. the abdomen must be inflated with carbon dioxide, to allow the surgeon to have a “working space within the abdomen. If the surgeon utilizes an operating scope, instruments can be inserted down a channel within the telescope, thus avoiding an additional incision.

 

Candidates for laparoscopic spaying

With the advent of smaller telescopes, even dogs under 10 pounds can have laparoscopic surgery. Patients that have laparoscopic spaying should be healthy, which almost all of these patients fall in this category, as they are young. Preoperative blood work is typically performed to ensure that the pet is in good health to undergo anesthesia. In addition. the surgeon will perform a physical examination to rule out any other problems.

 

Preparation for surgery

Make sure that your pet is fasted, as instructed by your pet’s surgical team. Water is usually permitted up to the time of admission to the hospital. Your pet’s surgeon may prescribe an antacid such as Pepcid AC, which should be administered by 6 AM on the day of surgery; this treatment will help reduce the risk of esophagitis (heartburn) in the postop period. Inform the surgical team of any medications that your pet is currently receiving. Your pet should not receive any aspirin within 1 week of surgery, as this medication will thin the blood and increase the risk of bleeding. Prior to surgery, your pet will receive a sedative, have an intravenous catheter placed for the administration of intravenous fluids and intravenous medications, be induced under general anesthesia with medication(s), and have a breathing tube (endotracheal tube) placed to allow delivery of oxygen and gaseous anesthesia. The surgical site will be clipped and cleansed with an anti-septic solution in preparation for surgery. While under general anesthesia, your pet’s breathing will be assisted with a ventilator and vital parameters such as heart rate, respiratory rate, core body temperature, blood pressure, oxygenation of the blood (pulse oximetry), exhaled carbon dioxide (capnography), and heart rhythm (EKG) will be monitored to ensure your companion’s well being. Pain will be controlled both during and after surgery with analgesics (pain-controlling medication).

 

Surgery

Laparoscopic spay can be done with either a single port (one small incision) or two incisions. I have performed lap spay using both methods and prefer the single port. Intuitively a single port should be less painful for the patient; however, one recent study indicated that the two port technique was less painful than the single port. I suspect that the investigators that compared the two techniques likely were more experienced with the double port surgery, thus the single port procedure might not have gone as smoothly….hence more pain.

The single port lap spay involves making a single small incision about 2 inches behind the belly button (umbilicus). A camera is inserted into the abdomen. Forceps are passed through the channel of the laparoscope and the ovary is grasped and pushed up to the body wall. A suture is passed through the skin and body wall and through the tissues surrounding the ovary, thus suspending the ovary and reproductive tract. The forceps is released from the ovary and the a cautery forceps is passed down the channel of the laparoscope. The tissues and blood vessels of the ovaries are cauterized with this instrument, thus freeing the ovary from the uterus. A grasping forceps is then used to pull the ovary out of the body via the port (see video below that depicts the description above).

Aftercare and expectations

To allow for a very smooth recovery at home, your pet should have a soft bed in a quiet room to encourage rest. Although laparoscopic spay results in much less pain than experienced with traditional surgery, the prescribed analgesic medication(s) should be administered for a day or two. About half of a normal meal should be fed after your pet gets settled at home. Do not allow consumption of excessive amounts of water the evening after surgery (or vomiting likely will ensue). If your pet does not eat the regular diet, offer a cooked meal consisting of a 50:50 mixture of lean meat and a carbohydrate source such as rice, potato, or pasta. During the first evening, walk your dog outdoors three times for elimination purposes; your pet may need to urinate more than normal, as intravenous fluid were administered during the procedure (note: a full bladder can may your pet whine and seem in pain). Bowel movements might not be seen for a day or two after surgery. Do not allow your pet to lick the incision. Check the incision daily for signs of infection. Schedule an appointment to return to the surgeon two weeks after surgery for another evaluation of the healing process.

 

Prognosis

The prognosis following laparoscopic spay is typically excellent with an uneventful recovery. Frequently the laparoscopic spay involves only removal of the ovaries, as this procedure is faster and less traumatic to the patient versus removal of the ovaries and the uterus. Research studies have not found any ill effects when the uterus is not removed. Medications that contain progesterone or progesterone-like substances should be avoided, as they could cause and infection in the remaining uterus (pyometra).


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