Recently a lovely lady with a super young female dog appeared in my consult room wanting to know about laparoscopic spaying or neutering. She was a client at another practice but her vet, a friend of mine, had suggested she seek us out! It was great to speak to someone who had done a lot of research herself so I thought I’d write an article based around that conversation.
It has long been accepted that we should consider spaying or neutering female dogs. However, as it is a choice that we, as pet owners have to make, we should ask ourselves what the reasons for this are. Population control, avoidance of unwanted pregnancies is an obvious reason. Social reasons, the prevention of signs of a bitch coming in to heat – vaginal bleeding or being chased around the park by overly enthusiastic male dogs – again is straightforward. There are health benefits to your bitch which for some reason, we often forget about. The Royal Veterinary College (RVC) in London have a detailed disease surveillance programme, involving many veterinary practices and hence literally thousands of dogs. One of the simplest statistics to come from this is simply that neutered dogs live longer than entire or un-neutered ones. In the female dog we prevent ovarian and uterine cancers. Mature bitches who have never bred or who haven’t had a litter for many years can commonly develop a serious and potentially life-threatening womb infection, called a pyometra. Pyometra can be treated surgically but surely this is best prevented. If a bitch is spayed earlier in her life there is a dramatic reduction in the incidence of mammary carcinomas (breast cancer) in her later years. We see this in practice – many years ago, surgery for mammary tumours was frequently performed in the surgery, but now, with the majority of older females being spayed, we perform significantly fewer procedures. So we can argue that spaying your female dog is an important part of preventative health care.
So, we have decided to neuter our lovely female dog. What does this actually entail?
The traditional spay performed in the U.K. would be an ‘open’ surgical procedure. This means that the surgeon creates a wound in the abdomen, large enough to allow direct access for the fingers, hands and surgical instruments to the contents of the abdomen. The operation would usually involve the removal of both ovaries and the uterus. This is called an ovariohysterectomy (OVH). The alternative surgery involves the removal of only the ovaries (an ovariectomy or OVE). Surgical procedures can involve complications, however rare, and studies have shown no difference between OVH and OVE regarding the incidence of womb infections or incontinence.
Now we know just a little about what the neutering surgery entails do we have any other considerations? Well, yes!
Nowadays the choices available are further broadened by the development of Minimally Invasive Surgery (MIS) or laparoscopic assisted surgical techniques, sometimes called ‘keyhole surgery’. The range of surgeries we can perform laparoscopically mirrors that of human surgical practice. Neutering a female dog and removing retained abdominal testicles (which have a high risk of undergoing cancerous change) in a male dog, are surgeries that lend themselves to MIS. Rather than completely opening the body cavity we place surgical tubes (or cannula) between 5.5mm and 10mm in diameter through the abdominal wall to gain surgical access, using special scissors, forceps and sealing devices. The patient’s abdomen in inflated with carbon dioxide gas to create a space in which to perform the surgery. The whole procedure is viewed via a digital camera on a high definition monitor.
Is laparoscopic surgery better than open surgery? This is a question I am often asked. There is nothing wrong with traditional open surgery. It is safe and surgeons are well practiced with techniques and in fact when performing an MIS laparoscopic procedure we are always prepared to convert to an open procedure. What else could we do if our camera broke? However many studies in both the human field and Veterinary surgery have demonstrated lower complication rates with wound infection or haemorrhage, lower pain levels and a more rapid return to normal activity. A study in 2009 showed that female dogs undergoing OVH via an open procedure were 62% less active in the 24 hours after surgery, while those undergoing OVH laparoscopically were only 25% less active. Typically our patients are exercising normally a week after surgery.
Are there any disadvantages to laparoscopic surgery? Learning laparoscopic surgery has a steep learning curve but as with all things with experience the procedure become straight forward. The procedure is more expensive performed laparoscopically because of the high cost of equipment and the extensive training required. However for reasons of reduced post operative pain and a much reduced return to normal activity, laparoscopic surgery offers a good alternative to traditional open surgical neutering.
Dugie Gemmill is the Clinical Director, and principal surgeon in his own Veterinary practice on the Wirral, with an interest in laparoscopic surgery and orthopaedics. He has been performing laparoscopic surgery for over eight years and as well as offering the procedures in his own practice, also operates at certain practices in North Wales.