Laparoscopic or traditional bitch spay? A comparison of surgical technique, associated risks and benefits

ABSTRACT:

In the bitch, surgical sterilisation can be achieved by a number of different methods. Ovariohysterectomy via a midline coeliotomy is the method traditionally used in the UK. An alternative to ovariohysterectomy, which is being used more widely, is laparoscopic ovariectomy (LapOVE). Laparoscopic surgery involves the introduction of a camera and specialised instruments into the abdomen through small incisions, and is routinely used in human medicine.

The benefits of laparoscopy include a faster return to normal activity and decreased post-operative pain, as well as a lower risk of haemorrhage and other recognised complications. Some complications, such as gas embolism and increased arterial CO₂ levels, are specific to laparoscopy.

Laparoscopy requires specialist equipment which carries a high start-up cost; this can deter many practitioners from offering it to their clients. In addition, significant increases in surgical time are documented with LapOVE.

Due to the risk of complications and the specialist equipment required, it is imperative that veterinary nurses have complete and up-to-date knowledge regarding laparoscopic neutering in order to provide the best possible patient care.

Keywords:

• neutering
• spay
• keyhole
• minimally invasive surgery
• ovariohysterectomy
• ovariectomy
• gonadectomy
• sterilisation
• nursing

Multiple Choice Questions

1.	Traditional ovariohysterectomy is normally performed via which of the following incisions? a. Flank laparotomy b. Ventral midline coeliotomy c. Lateral coeliotomy d. Median sternotomy
2.	Which of the following is a disadvantage of routine ovariohysterectomy compared with laparoscopic ovariectomy? a. Higher risk of haemorrhage b. Shorter procedure times c. No specialist equipment required d. Lower pain scores observed post-operatively
3.	Which of the following may be a more likely complication of laparoscopic ovariectomy when compared with traditional ovariohysterectomy? a. Air embolism b. Haemorrhage c. Reduced surgical visibility d. Distal ureter ligation
4.	Laparoscopic ovariectomy is associated with lower pain score postoperatively than routine ovariohysterectomy:

TRUE or FALSE

5.	Informed consent and the RCVS code of professional conduct means that advice given to owners regarding neutering should be up-to-date and include all surgical options available:

TRUE or FALSE

6.	Which of the following is a disadvantage of laparoscopic ovariectomy compared with routine ovariohysterectomy? a. Increased surgical visibility b. Increased haemorrhage c. Longer procedure times d. Higher levels of post-operative activity in the patients
7.	The ‘Trendelenburg position’ is which of the following? a. Ventro-dorsal recumbency b. Ventro-dorsal recumbency with the pelvis raised by 30° c. Lateral recumbency d. Dorsal recumbency

For the answers to the MCQs, please go to: http://www.bvna.org.uk/publications/veterinary-nursing-journal

Additional information

Notes on contributors

Laura Rosewell

Laura began nursing in 2007 and qualified in 2010. Following three years as Clinical Nurse Manager at a busy hospital, Laura is now Deputy Lead Nurse at Lumbry Park Veterinary Specialists in Hampshire. She completed her DipAVN in 2014 and is currently studying for a BSc(Hons) degree at Harper Adams University.