Laparoscopic Surgery
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. The following are benefits of laparoscopy over traditional surgery:
Fewer Complications
Laparoscopy offers a magnified view of internal organs, allowing for precise, cauterized incisions with minimal tearing or bruising. This reduces the risk of post-operative complications compared to traditional procedures.
Less Pain
Traditional surgery involves large incisions, leading to pain, tearing, and bruising. Laparoscopic surgery requires only two or three small 3/16″ keyhole incisions. This minimizes soft tissue trauma, making the procedure significantly less painful for your pet.
Faster Recovery
Traditional surgeries require 10-14 days of activity restriction, while laparoscopic surgeries typically only need 2-3 days. The reduced trauma and pain associated with laparoscopy result in a quicker and less stressful recovery for your pet.
What about spays and neuters?
Traditional Spays
With traditional spays, a 3-8” incision is made in the abdominal wall. The ovaries are then blindly hooked, and the ovarian ligament is torn from the kidney and diaphragm. This tearing causes pain and bruising. In traditional spays, most vets also 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 causes further trauma.
LOVE Spays
A LOVE 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 up to 66% less painful than traditional spays. With this technique, 2 small keyhole incisions are made in the abdomen. The ovarian ligament is not torn from the body but carefully cut and cauterized with specialized equipment, resulting in virtually no bleeding or pain. No tension is placed on the uterus because it is not removed. Enhanced visualization results in a lower likelihood of leaving ovarian tissue behind. Activity restriction is only recommended for the first 2-3 days after a LOVE spay versus 10-14 days for a traditional spay.
Cryptorchid Neuter
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.
My dog is a large or giant breed. Can we do a laparoscopic preventive gastropexy at the time of spay or neuter?
Preventative Gastropexy
Yes, laparoscopy is also a less invasive alternative for a 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 Shephards, 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 the torsion. Normally this surgery requires a long incision of at least 8-12 inches but with the laparoscope-assisted surgery the incision is less than 2 inches and can be performed at the time of a spay or neuter.
Common Questions and Misconceptions
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.
How long do I need to keep my crazy dog confined after surgery?
This is one of the biggest benefits of a LOVE spay. We only recommend 2-3 days of activity restriction after a LOVE spay versus 10-14 days with a traditional spay. The risk of a complication such as a hernia is very low and if it does occur, it would not be a life-threatening emergency like a hernia could be with a traditional spay. NOTE: Your pet cannot go swimming for 10-14 days. The skin needs to heal to prevent the surgical site from getting infected by 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.
Can my dog develop pyometra (uterine infection) if you don’t remove the uterus?
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.
Can my dog develop uterine cancer?
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. 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 it’s not worth it because traditional spay incisions are so small; if you add up the 2 laparoscopic incisions, they would be the same size.
3) Two separate, smaller incisions are less likely to present a major complication than one larger one. If the stitches were to come undone (your pet gets their cone off and licks the stitches out), a life-threatening abdominal hernia could develop. 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.
4) Small incisions are not the main benefit of the laparoscopic surgery. The pain associated with the spay is mainly derived from the traditional surgeon ripping the ovarian ligament off
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 or that it takes less time. Being fast at a spay doesn’t change how much it hurts. 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 that sometimes patients react by trying to wake up! This is a very common in 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 issue of time.
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. Since we started performing laparoscopic spays, we have not needed to convert to an open procedure.
My vet performs a “Laser Spay” so I am already getting a less painful spay, right?
Unfortunately, no. A laser is only used to make the initial skin incision and this doesn’t contribute to 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 true reduction in pain.
Do you perform laparoscopic spays on cats?
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. Also, cats do not tolerate having their belly inflated with the CO2 gas needed to perform the laparoscopic spay.