By Dr. Timothy C. McCarthy
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
todayâ€™s standards. Since that time we have incorporated better
anesthesia, better pain management, better suture materials and better
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, aÂ 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.