If you needed surgery – which would you prefer?
1. More pain or less pain?
2. Higher complication rate or lower complication rate?
3. Two weeks of activity restriction or two days?
What would your pet want?
We believe the best option for your pet is a procedure with less pain, less chance of complications, and faster recovery. This is why we now offer Laparoscopic Surgery, a minimally invasive pet surgery option! Read on to learn more about what laparoscopy is and the benefits of this versus regular surgical procedures.
What is Laparoscopy?
Laparoscopy, or minimally-invasive surgery, is a way to explore the organs of your pet’s abdomen using only tiny key-hole incisions. Using these incisions (generally 3/16”), we can insert a camera and our surgical instruments to perform surgery. Laparoscopy is a safer method of surgery because everything that is done is under direct magnified visualization. Organs, such as your pet’s ovaries, do not need to be pulled out of the body to allow the surgery to be performed so there is less trauma to the internal structures of your pet’s abdomen. Recent studies have shown the use of laparoscopy to be a less traumatic and less painful alternative to traditional procedures, such as a spay.
With traditional spays, a 1-4” incision is made in the abdominal wall. The ovaries are then blindly hooked and the ovarian ligament is torn from the body wall. This tearing causes pain and can cause bruising. In traditional spays, most vets also unnecessarily remove the uterus. Due to the location of the uterus and the attempt to minimize the surgical incision, significant tension is placed on the body of the uterus which may cause trauma and bleeding.
A LAP spay is short for a Laparoscopic OVE (ovariectomy). This is a minimally-invasive spay that removes the ovaries from healthy dogs and has been shown to be a less painful alternative to traditional spays. With this technique, 2 small keyhole incisions are made into the abdomen and our laparoscopic equipment is used to perform the surgery. The ovarian ligament is not torn from the body but carefully cut and cauterized with virtually no bleeding or pain. No tension is placed on the uterus (which is not removed). Because of the enhanced visualization, there is less of a chance of leaving ovarian tissue behind. Laparoscopic spays have been shown to offer 65% less pain than traditional spays which means a faster recovery and less trauma to their body. Activity restriction is only recommended for the first 2-3 days after a LAP spay versus 7-14 days for a traditional spay.
Laparoscopy is also a less invasive alternative for preventative gastropexy. This surgery is the only proven method for preventing Gastric Dilatation-Volvulus, or GDV, which is common in deep-chested dogs such as Great Danes, German Shepherds, Irish Setters, Bernese Mountain Dogs, Saint Bernards, Weimaraners, and Boxers, to name a few. This is a rapidly fatal condition where the stomach flips over on itself and compromises the blood flow to the stomach and heart. If not corrected quickly, your pet can die within a few hours. A preventative gastropexy anchors the stomach to the body wall which will prevent torsion. Normally this surgery requires a long incision of at least 8-12 inches but with laparoscopy-assisted surgery the incision is less than 2 inches.
Laparoscopy is also a less invasive alternative for a cryptorchid neuter. A cryptorchid male is an animal whose testicles (one or both) have not descended into the scrotum. Finding these testicles in the abdomen can be difficult and requires a large incision to safely perform the surgery. Laparoscopy is an ideal manner to find these “hidden” testicles because it affords great visualization and magnification of the internal organs without the need for a large incision.
What are the Advantages of Laparoscopy?
- Laparoscopic spays have been found to be 65% less pain compared to traditional open spays.
- The entire surgery is performed through two tiny incisions (generally 3/16”). Smaller incisions are less painful, reduce recovery time, and are less likely to have major postoperative complications.
- A magnified view of internal organs allows for precise cauterized incisions with none of the tearing or bruising normally associated with traditional spays.
- Laparoscope-assisted gastropexy can be performed at the time of the spay with a 1.5-inch incision compared to an additional 8-12 inch incision normally needed with a traditional open gastropexy.
Will my pet need a Elizabethan collar (E-collar, cone of shame, lampshade, etc) after the procedure?
Yes, even though the incisions are tiny, it is still an incision. If your pet licks at this small incision it could still become infected and require at minimum antibiotics and at worst a second surgery. However, we find that pets are generally less interested in these incisions (most likely due to the reduced pain) than the larger incisions from traditional spays. All incisions – regardless of their size, require a minimum of 7 days to heal, so plan on having your pet wear the cone for a minimum of 7 days.
This is one of the biggest benefits of a LAP spay. We only recommend 2-3 days of activity restriction after a LAP spay versus 7-14 days with a traditional spay. The risk of a complication such as a hernia is very low and if it does occur, would not be a life-threatening emergency like a hernia could be with a traditional spay. NOTE: Your pet cannot go swimming for 7-14 days. The skin needs to heal to prevent the surgical site from getting infected from potentially contaminated water. Also, if your pet is also having a preventative gastropexy performed at the same time, then they will need to be activity restricted for 3 weeks to allow the stomach time to properly heal.
Traditionally in the United States, veterinarians have removed both the ovaries and the uterus when performing a spay. However, there is no real benefit in removing the uterus of a young, otherwise healthy animal. The initial justification came from a belief that it would prevent gynecological problems later in the dog’s life. Many papers have since been published debunking this rationale backed up by data from our European counterparts who only remove the ovaries. We are hoping that even if your veterinarian doesn’t perform laparoscopic spays, that they will start at the very least to perform ovariectomies which are associated with less pain, fewer complications, and is a faster surgery. See the following article for more details: VAN GOETHEM, B., SCHAEFERS-OKKENS, A. and KIRPENSTEIJN, J. (2006), Making a Rational Choice Between Ovariectomy and Ovariohysterectomy in the Dog: A Discussion of the Benefits of Either Technique. Veterinary Surgery, 35: 136–143.
Ovaries are the drivers of pyometra, not the uterus. Pyometra is a hormonally driven process and is an abnormal uterine response to repeated exposure to the hormone called progesterone. If the ovaries of your dog are removed, then a pyometra can’t occur because the source of progesterone has been removed. A lap spay accomplishes this.
Uterine cancer in dogs is not common. The incidence of uterine cancer is 0.03% of all cancers found in dogs. However, most of these uterine cancers are benign tumors, and only 10% of these tumors are malignant (spread to other organs). So overall, your dog has a 0.003% chance of developing a malignant uterine tumor. To look at the equation on the other side, there is a much higher rate of complications, including fatal complications, from the process of removing the uterus during a spay (see the paper cited above). Also, these cancers are thought to be hormonally-driven, so by removing the ovaries at a young age, the likelihood of developing uterine cancer is even more remote. In Europe, they have only been removing the ovaries during spays for decades and they have not found a higher incidence of uterine cancer in these dogs.
My vet told me its not worth it because her incisions are so small, if you add up the 2 laparoscopic incisions, they would be the same size.
While that may be the case, there are 4 major problems with that:
- If you are trying to do the surgery through a tiny hole traditionally, that means you cannot see what you are doing and blindly hooking and grabbing the organs.
- Anatomically speaking, the ovaries are up at the level of the ribs and the uterine body is down by the bladder. To get everything outside of the body to do their surgery through 1 tiny hole – they really have to pull and tug on the ovaries and uterus causing soft tissue trauma and pain.
- If the stitches were to come undone (your pet gets their cone off and licks the stitches out), 2 separate smaller incisions are less likely to present a major complication than 1 larger one. Dogs have literally had their intestines fall out of their body after being spayed in this exact scenario. This is not possible with the incisions from a lap spay.
- Small incisions are not the main benefit of laparoscopic surgery. The pain associated with the spay is mostly derived from the traditional surgeon ripping the ovarian ligament off of the body wall so they can exteriorize the ovary to put their sutures around it.
My vet is so fast and good at doing traditional spays, that the extra anesthesia time is not worth the benefit of less pain and faster recovery.
Spays are the most common procedure that are performed in veterinary hospitals. Most vets are very good at it. However, it doesn’t mean that it is the right way to do it. Both human and veterinary medicine is very slow to change, even when the data clearly shows there is a better way. Being fast at a spay doesn’t change how much it hurts. A small amount of extra anesthesia time isn’t the issue. What creates more anesthetic risk is pain. When a traditional spay is performed and the surgeon is ripping the ovarian ligament off of the body wall, it hurts so much these patients try to wake up! This is a very well-known fact of a traditional spay. To counteract that pain, the anesthetist turns the gas anesthesia way up to get them to a deeper plane of anesthesia. This is the bigger anesthetic risk, not the few extra minutes of stable anesthesia.
My vet told me a high number of laparoscopic procedures get converted to a traditional open surgery, so we should just go straight for the traditional surgery and skip the risk of needing to convert.
The risk and rate of conversion is extremely low and a rare case.
Unfortunately, no. A laser is only used to make the initial skin incision and this doesn’t contribute too much of the pain associated with a spay. The majority of the pain is from the ripping of the ovaries off of the body wall and pulling on the uterus to remove it through the smallest incision possible. A “Laser spay” is more of a marketing gimmick than a true reduction in pain.
While it is possible to perform laparoscopic spays on cats, we do not recommend it. We are still technically performing a “minimally-invasive” surgery on cats – we just don’t need the fancy camera equipment to do it. The incision we normally make to spay a cat is the same size as 1 of the 2 incisions needed for a laparoscopic approach. While small incisions are not the main benefit of lap spays, the ligaments of the cat ovaries are also under a lot less tension and stretch a lot easier. Since we only remove the ovaries (ovariectomy) instead of the ovaries and uterus (ovariohysterectomy), we can make our initial incision closer to the ovaries and minimize the stretching, thus less pain. Also, cats do not tolerate having their belly inflated with the CO2 gas needed to perform the laparoscopic surgery as well as people and dogs do, so the added anesthetic risk is also a factor why we do not recommend this for cats.