Another better way to spay (that you probably never heard of)

March 17, 2011

I was pleased to see Dr. Nancy Kay’s recent blog post on ovariectomy vs.ovariohysterectomy. I have been promoting ovariectomy as the preferred technique for several years now, but from a different perspective.

I started performing laparoscopic ovariohysterectomies about 20 years ago, and then shifted to laparoscopic ovariectomies about 10 years ago.

When I first started performing laparoscopic surgery, I decided that trying to sell the idea of minimally invasive surgery was enough of a challenge in itself. Trying to overcome what Dr. Kay referred to as the “tradition” of removing the uterus was going to significantly increase the difficulty of promoting this technique so I left it for a later time.

Fortunately, Dr. Ty Tankersley in Denver took on this challenge, successfully developing, documenting, and promoting the technique of laparoscopic ovariectomy in his general practice.

Additionally, ovariectomies have been the standard of care in Europe for as long as we have been performing ovariohysterectomies in the United States.

The first question that I usually get when I start discussing ovariectomies vs ovariohysterectomies is, “What about uterine stump pyometras?”

Uterine stump pyometras are not a uterine remnant problem but an ovarian remnant problem. If the ovaries are adequately removed, uterine stump pyometras do not occur.

As veterinarians we are hammered with the “new” concept of evidence based medicine, and yet when there is overwhelming evidence we still tend to stick with “tradition” over science. We need to change.

When I watched my first spay in about 1958, it was rather primitive by
today’s standards. Since that time we have incorporated better
anesthesia, better pain management, better suture materials and better
aseptic techniques.

Despite accepting those changes, we are still using the same primitive blind tissue handling technique to rip the ovarian attachments away from the abdominal wall.

With laparoscopy, we can see the ovaries in their normal location and remove them under direct observation. The video camera systems used for minimally invasive surgery also magnify the tissues making the ovaries bigger than life. There is far less tissue trauma, far less pain because there is less tissue trauma, and far less risk because we can see what we are doing.

The incisions for the procedure are smaller, too, which also reduced the pain and risk.

In fact, all aspects of this technique are better, except for the cost of the equipment. And in my view, the cost is reasonable when compared with other commonly used sophisticated medical equipment like ultrasound, digital radiography systems and lasers. The cost is far less than other equipment, like CT and MRI.

The improvement in surgical technique afforded by this instrumentation far outweighs the cost.

Also, a  significant cost modifier in acquiring the equipment needed for laparoscopic ovariectomies is that it opens the door for a long list of diagnostic endoscopy, interventional endoscopy, and minimally invasive surgery procedures that are performed with the same instrumentation.

Training for minimally invasive surgery is needed, but is also very reasonable when compared with the training needed to advance our techniques in other areas of medicine and surgery.

Bottom line: This is the future, and will become the standard of care.

Photo on bottom is the ovary lifted up away from the surrounding tissues so that it can be seen and removed.

Filed under: pets, connected,veterinary medicine — Dr. Timothy C. McCarthy @ 4:02 am

13 Comments »

  1. Here’s a random question that occured to me as I was reading your post: I have a cat whose intact status was missed until we biopsied her for mammary lumps and – as long as we had her open – I asked my vet to also do an exploratory incision to confirm whether she had been spayed or not (Surprise! The answer was “NOT”!)

    Ignoring for the moment the cost of the equipment, would a laparascopic approach make the process of confirming a female dog or cat’s reproductive status easier? Easier enough that – again ignoring the cost for the moment – this could potentially be considered as a fairly “routine” check that rescues and shelters could utilize for intake animals?

    What physiological factors (that I am probably completely unaware of! G!) would come into play here?

    Comment by The OTHER Pat — March 17, 2011 @ 5:11 am

  2. TOP, your comment made me wonder how a laparascopic “look-see” would work with a spay that only removed the ovaries – if they find a uterus, then what?

    Is there no convention for marking an animal that clearly states “Hey, I can’t reproduce!”? Because the same issue would arise for males that keep their testicles, but have a vasectomy.

    The last thing we need is unnecessary surgery to perform an operation that has already been done.

    Comment by K.B. — March 17, 2011 @ 5:55 am

  3. Thank you Dr. McCarthy!

    Comment by Dr. Nancy Kay — March 17, 2011 @ 6:10 am

  4. I just have to say, that is a really beautiful picture! (Probably something only someone with a strange sense of beauty would say!) I am interested in improving my skills using a rigid endoscope. Currently, we only have a small (2.7 mm) rigid endoscope for use in exotics and other small orifices. Where can one get practical training/experience?

    Comment by J.C. Burcham, DVM — March 17, 2011 @ 7:15 am

  5. By the way, my comment about the beautiful picture was in reference to the ovary, not Dr. McCarthy (no offense). :)

    Comment by J.C. Burcham, DVM — March 17, 2011 @ 7:16 am

  6. Dr. Burcham, I personally loved that photo! Only just now did I stop think think, “Hmmm. Is that going to gross people out?” I hope not!

    Comment by Christie Keith — March 17, 2011 @ 7:22 am

  7. I think we’re all good with the picture. I did stand at our booth at a vet conf though endlessly watching the most ghastly photos circulate on the tvs at the opposite booth – good diet technique!

    Comment by Laura B — March 17, 2011 @ 7:31 am

  8. This less invasive form of spaying would be much, much better for shelter kittens who get spayed at a very young age order to get them adopted as quickly as possible.

    And I would think it would be a no-brainer for low cost spay-neuter programs since it would less expensive and faster than the traditional surgery.

    Comment by Susan Fox — March 17, 2011 @ 7:59 am

  9. Well, put me down as among those who think the “interior look” photo is WAY cool!

    Comment by The OTHER Pat — March 17, 2011 @ 9:01 am

  10. Love the photo ! I don’t think any of we “tiny readers” gross out too easily. My son has a 5 1/2 month old chihuahua puppy who is only 2 lbs 4 oz, I wonder if a laparoscopic ovariectomy who be better for her. We are very worried about anesthesia & overall effect of major surgery on her.

    Comment by original Leslie K — March 17, 2011 @ 5:05 pm

  11. At the Toronto Humane Society, we spay/neuter feral cats (as part of a TNR program) and they get “ear tipped” to show they’ve been sterilized. Not sure how well adopters would react to that, though!

    On a related note, we’re hoping to build a low-cost spay/neuter clinic and are currently competing to win $100,000 in an online voting project. We sure could use your “clicks”!

    http://www.refresheverything.ca/thsspayneuter2011

    Comment by Lisa Gibbens — March 18, 2011 @ 8:33 am

  12. AWESOME! I remember the disaster my Golden went through with her spay. She was in obvious pain, chewed out her stitches, and it took weeks of medicine to heal the wound. She didn’t eat for two days straight. By contrast, I see lap OE dogs up and playing within hours. Just because they don’t talk, doesn’t mean they don’t feel pain.

    Comment by Mike — March 21, 2011 @ 7:54 pm

  13. After a long search, I only found 2 vets that offer lap spay within a day driving distance. One is near Atlanta and one is above Memphis. I will have to drive 200 miles to access this procedure

    I called MS State Vet School. They do not offer lap spay nor will they do just a ovariectomy. Only traditional spay is offered at our vet school. Sad to know the schools are not even all teaching a procedure less invasive and less painful as an option.

    Comment by khills — February 12, 2014 @ 12:21 pm

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