The Lap Spay – the new normal, by Rob Hamilton
Most people either have had, or know someone who has undergone keyhole (laparoscopic) surgery. The vast majority would suggest this is a far superior method in preference to open surgery. Interestingly, the first medical doctor who introduced keyhole to 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 be considered in any other way apart from keyhole.
Within veterinary medicine, the bitch spay is undergoing a transition. Keyhole surgery offers huge post operative advantages for dogs, and owners are now seeking this technique out with increasing frequency. The post-operative pain is vastly reduced, backed up by post-operative comparative studies that show blood glucose and cortisol levels at significantly lower levels from 30 mins to 2 days post-operatively. Pedometers attached to dogs also show a far quicker return to normal movement levels too. It is not uncommon now to suggest only 48 hours rest before returning to full exercise post spay. The open method is 10 days.
The traditional method of opening the abdomen to remove the ovaries and uterus (ovariohysterectomy) has long been practiced, but in the last 15-20 years many researchers and practitioners have argued against the need to remove the uterus. Without the influence of oestrogen, the uterus is dormant and doesn’t need removing. A lifetime study of dogs spayed via keyhole techniques has been published in the US a shows 0% of participants having any uterine complications over their lifetime.
Commonly cited hurdles to introducing the keyhole spay (lap-spay) into a given practice are equipment expense and a reluctance to change – just like the original medics. The tech is quite pricey, with some setups costing tens of thousands. The surgical learning curve is also a little steep and the tech a little off-putting to some. This is fairly quickly overcome with the correct training, and once the lap spay is mastered it opens the door to a plethora of other techniques.
I will find many practitioners who prefer not to break into the area suggest that they both can ‘see more’ and ‘make a keyhole sized incision anyway’, making a lap-spay merely a gimmick. You only need to see one procedure, or watch one video online to see that the images are spectacular in comparison to what is visible through an open hole. The vessel-sealing technology used to dissect and seal the blood vessels means no internal sutures are needed and there is complete confidence that nothing left behind is bleeding, making the keyhole procedure safter. The size of hole created in an open spay is often a badge of honour to practicing vets – the smaller the more impressive. However the size of hole is often inversely proportional to the amount of pulling (and therefore pain) needed to extract the required anatomy.
My hope is that all first opinion practices transition to lap-spaying over the next few years. The interest in the method is on an exponential increase. I hear of anecdotal evidence of long waiting lists for the courses available. I predict a point in the near future where practices will either be doing lap spays or not doing spays at all, as their clients will be seeking the procedure elsewhere, the open spay having gone the way of the open Gallbladder removal in human surgery.
