Laparoscopic, or keyhole, surgery is already widely used in human medicine, but it is also changing the way some veterinary procedures are performed.
In this article, Southwater Veterinary Group vet Rob Hamilton shares his professional perspective on laparoscopic spaying, its potential benefits for dogs and why he believes it could become the preferred approach for veterinary practices and pet owners.
Learning from human keyhole surgery
Most people have either undergone keyhole surgery themselves or know someone who has. The vast majority would suggest that it is a far superior method to open surgery.
Interestingly, the first medical doctor to introduce keyhole surgery into human medicine for gall bladder removal was ridiculed by his colleagues. When he refused to stop pursuing the method, they also tried to have him sectioned on mental health grounds.
Now, the complete converse is true – a routine gall bladder removal procedure would not normally be considered in any way other than keyhole surgery.
A changing approach to spaying
Within veterinary medicine, the bitch spay is undergoing a transition. Keyhole surgery offers significant post-operative advantages for dogs, and owners are now seeking this technique with increasing frequency.
Post-operative pain is considerably reduced. This is supported by comparative studies showing significantly lower blood glucose and cortisol levels from 30 minutes to two days after surgery.
Pedometers attached to dogs have also shown a much quicker return to normal movement levels. It is now not uncommon to recommend only 48 hours’ rest before returning to full exercise following a laparoscopic spay, compared with around 10 days for the traditional open method.
Is it necessary to remove the uterus?
The traditional method involves opening the abdomen to remove the ovaries and uterus, a procedure known as an ovariohysterectomy.
This approach has long been practised, but over the last 15–20 years, many researchers and veterinary practitioners have questioned the need to remove the uterus.
Without the influence of oestrogen, the uterus becomes dormant and does not necessarily need to be removed. A lifetime study of dogs spayed using keyhole techniques has been published in the United States, with none of the participating dogs experiencing uterine complications during their lifetime.
The challenges for veterinary practices
Commonly cited barriers to introducing laparoscopic spaying into a veterinary practice include the cost of the equipment and a reluctance to change – much like the response of the original medical practitioners.
The technology can be expensive, with some setups costing tens of thousands of pounds. There is also a fairly steep surgical learning curve, and the equipment can initially seem off-putting.
However, these challenges can be overcome relatively quickly with the correct training. Once laparoscopic spaying has been mastered, it can open the door to many other minimally invasive techniques.
Better visibility and vessel-sealing technology
Practitioners who prefer not to move into this area sometimes suggest that they can “see more” during open surgery or that they already make a “keyhole-sized incision”, making laparoscopic spaying little more than a gimmick.
However, you only need to observe one procedure – or watch a video of one – to see that the images produced during keyhole surgery are spectacular compared with what can be seen through a small open incision.
The vessel-sealing technology used to dissect tissue and seal blood vessels means that no internal sutures are required. It also gives the surgeon confidence that nothing left behind is bleeding, helping to make the keyhole procedure safer.
The size of the incision made during an open spay can sometimes be regarded as a badge of honour among practising vets – the smaller the incision, the more impressive it appears. However, the size of the opening is often inversely proportional to the amount of pulling, and therefore pain, required to extract the relevant anatomy.
Could laparoscopic spaying become the standard?
My hope is that all first-opinion veterinary practices will transition to laparoscopic spaying over the next few years. Interest in the method is increasing exponentially, and I hear anecdotal reports of long waiting lists for the available training courses.
I predict that we will reach a point in the near future when practices will either offer laparoscopic spays or stop performing spays altogether, as their clients seek the keyhole procedure elsewhere.
The traditional open spay may eventually go the same way as open gall bladder removal in human surgery.
If you are a veterinary professional looking to refer for Laparoscopic surgery, you can find out more about our referral service here.
