Subedited by Dr Phil Tucak
Estimated reading time: 5 minutes
The most commonly performed laparoscopic surgery in veterinary medicine is a laparoscopic ovariectomy, or ‘lapspay’. The lapspay is a form of sterilisation where the ovaries are removed through keyhole incisions, leaving the uterus in the abdomen. Laparoscopic ovariectomy has the advantage of causing less pain than a traditional ovariohysterectomy, with multiple studies having shown a decrease in pain scores and cortisol levels in patients.
Provided the uterine tissue being left inside the abdomen is normal there is no increase in the frequency of uterine disease such as pyometra. The incidence of uterine neoplasia is 0.003%, with most of these being benign leiomyomas. The rate of urinary incontinence does not vary between a lapspay and a traditional ovariohysterectomy.
There are several disadvantages to laparoscopic ovariectomy including the need for closer patient monitoring for hypercarbia, which can be caused by the insufflation of the abdomen. Especially at the start of the learning curve, the anaesthetic times can be considerably longer than for a traditional ovariohysterectomy, but with time and practice the difference in anaesthetic times becomes much smaller.
The most obvious disadvantage with this type of surgery is the cost of the laparoscopic equipment. The equipment required includes a vessel sealing device—such as a ‘Covidien Ligasure’ or ‘Aesculap Caiman’, an insufflator for pumping carbon dioxide into the abdomen, and a light source and camera. We use a combined light source and camera produced by Karl Storz called a ‘Telepak’. This also has the advantage of being a mobile unit and it can function as well as the light source and camera for endoscopy. At the time of writing, the cost of all the equipment was in the region of AUD$80,000.
Lola was a healthy seven-month-old golden retriever whose owners were very interested in a minimally invasive sterilisation. I performed Lola’s lapspay using a three-port technique. This involves making a very small surgical incision at the umbilicus to allow placement of the first cannula.
Carbon dioxide is then placed into the abdomen via this cannula to allow insufflation of the abdomen. At the end of the surgery, this carbon dioxide is then let out of the abdomen prior to wound closure. While abdominal insufflation can cause pain in people after laparoscopy, this does not appear to be the case with animals. With the abdomen inflated the laparoscopic camera is then placed into the abdomen, and the second and third ports are placed under direct visualisation. Direct visualisation reduces the risk of accidental damage to any of the nearby internal organs.
The first ovary is identified and a vessel sealing device is then used to cauterise and cut a line from the suspensory ligament through to the uterine horn. This ovary is removed through one of the port holes and then the procedure is repeated with the other ovary. The abdomen is checked for bleeding before removal of all the instruments and cannulas.
All three ports are closed in a similar manner, with the muscle layer being closed with an absorbable suture material of a size suitable for the patient, usually 2/0 or 0. I usually use a cruciate pattern, but a single interrupted or continuous pattern would also be suitable. The subcutaneous layer is then closed with an absorbable suture in a continuous pattern. Skin closure is also personal preference; I use nylon 2/0 for most of my patients, but intradermal sutures can also be used. Bupivacaine is injected around the cannula sites to aid with analgesia, and the patient also receives an injectable dose of NSAID followed by a three-day course of oral NSAID.
Lola had a typical recovery from her anaesthetic and had her skin sutures removed 10 days postoperatively. Her owners were very happy they had the opportunity to sterilise her with a minimally invasive procedure which would minimise the amount of tissue trauma and pain she would experience compared to a traditional ovariohysterectomy.
I have found performing lapspays to be very rewarding; it has been stimulating to learn new skills and exciting to see the difference this procedure can make for our patients. It can also be an exciting challenge for veterinary nurses monitoring and managing different anaesthetic concerns such as hypercapnia, and assisting with the surgery as they learn new skills, and gain experience working with new equipment.
While there are added risks involved with the lapspay procedure, I have found them to be minimal compared to a traditional ovariohysterectomy. There is a steep learning curve involved with becoming adept at performing this type of surgery, and unfortunately there are currently not many avenues available to learn the skills involved. I completed the VetPrac Laparoscopy course in 2020, but haven’t seen any laparoscopy course available in Australia since then.
Dr Chad Marriott
BSc. BVMS MANZCVS (Small Animal Surgery)
Vetwest Animal Hospitals
Veterinarian Dr Chad Marriott graduated from Murdoch University in 1999, first working in Perth for two years and then the United Kingdom and New Zealand for four years.
In 2011 Dr Marriott became a member of the Australian and New Zealand College of Veterinary Scientists (ANZCVS) in Small Animal Surgery.
Dr Marriott is currently the senior veterinarian with an interest in orthopaedics at Vetwest animal hospitals in Perth. As well as performing many tibial plateau levelling osteotomy (TPLO) surgeries, he also has an interest in minimally invasive surgery and the improved patient outcomes this can provide.