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Laparoscopic Ovariectomy: A Safer Alternative to Traditional Spaying

April 14, 2011 | 59,178 views
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Woman with her PetAn ovariectomy differs from an ovariohysterectomy in that only the ovaries are removed, leaving the uterus in place. According to reports comparing the two techniques, it was found that ovariectomy is less invasive and eliminates the risk of ureter ligation at the uterine body. All other known risks are comparable between the two procedures.

According to dvm360:

“Laparoscopic procedures have become increasingly available and demanded by our clientele because of the benefits of decreased patient morbidity (less postoperative pain and quicker return to normal activity).”

Ovariectomy has been the preferred surgery for years in many European communities. In the U.S., ovariohysterectomy (spaying) is by far the most commonly performed sterilization procedure on female pets.

Dr. Becker's Comments:

If your female dog or cat is intact and you’re starting to plan for her sterilization surgery, you might want to consider an alternative to traditional spaying.

Laparoscopic ovariectomy is a less invasive procedure than open abdominal surgery, and it involves removing only the ovaries, leaving the uterus in place.

Laparoscopic Surgery

Laparoscopy goes by a number of names, including minimally invasive surgery, video surgery, endoscopic surgery and ‘keyhole surgery.’ Laparoscopy used on humans for abdominal procedures is also called ‘belly button surgery.’

In a laparoscopic ovariectomy, two small 5 mm to 10 mm incisions are made. A slender video scope is inserted into the abdomen through one of the incisions. The other incision is for the surgical instruments that will be used to detach and remove the ovaries, and then seal the tissues and blood vessels in the area of the removed organs.

The final step is to close the incisions with absorbable sutures and tissue glue.

In a traditional spay procedure, one 40 mm to 70 mm incision is made in the abdomen to expose the reproductive organs. The ligaments holding the ovaries and uterus in place are torn, the organs are tied with sutures and removed, and the incision is closed with sutures.

Laparoscopic procedures often take a bit longer than traditional surgeries, primarily because they demand more precision and less aggressive manipulation of tissues and organs.

Benefits of Laparoscopic Ovariectomy

The benefit for veterinarians who perform the procedure – and therefore their patients -- is enhanced visualization of the abdominal cavity thanks to the magnification properties of the scope. Enhanced visualization during surgery leads to safer procedures and better outcomes.

For your dog or cat, the main advantages of the procedure as compared to a traditional spay include:

  • Less stress and trauma
  • Dramatic reduction in pain (up to 65 percent less)
  • Smaller incisions
  • Less bruising
  • Fewer complications

Removing the uterus in addition to the ovaries carries some inherent surgical risks. It requires more complicated ligations (tie-offs) of large blood vessels and tissue. A ligation that isn’t tight enough can result in bleeding into the abdominal cavity. This is a very serious complication that can necessitate a second surgery and blood transfusions.

The ureters, which take urine from the kidneys to the bladder, are in very close proximity to the uterus. It’s easier than you might think to damage a ureter in the process of removing the uterus. This complication can also result in a second surgery, and in some cases damage to the ureter and affected kidney is irreversible.

Surgical removal of the uterus leaves a small portion of the organ behind, referred to as the ‘stump.’ An additional potential complication of the traditional spay procedure can be the development of a ‘stump granuloma,’ which is inflammation of the retained portion of the uterus. This complication also typically requires surgical correction.

Ovariectomy Accomplishes the Same Goal as Ovariohysterectomy

The primary aim of spaying is to render your pet unable to conceive.

Secondary objectives are to eliminate 1) the mess and inconvenience of heat cycles, and 2) future risk of diseases of the reproductive organs.

Removing just the ovaries accomplishes all these goals, while at the same time being a minimally invasive, much less painful procedure with fewer complications than a traditional spay.

The sole job of the uterus is to house a developing litter of puppies or kittens. It is the ovaries that run the reproductive show. They have a number of duties, including:

  • Housing the eggs
  • Ovulation
  • Controlling when your pet goes into and out of heat
  • Sending messages to the uterus during gestation

Removal of the ovaries brings an immediate halt to the reproductive cycle. Your pet will no longer go into heat nor will she attract male dogs. She cannot conceive, and the risk of ovarian disease is virtually eliminated.

Is It Safe to Leave the Uterus Behind?

Yes it is.

However, there are still plenty of veterinarians who continue to warn pet owners of the dangers of uterine infection and uterine cancer.

To be blunt, this is nonsense.

Uterine disease in dogs whose ovaries have been removed is almost nonexistent. The disease called pyometra, which is pus in the uterus, is the most common uterine problem in intact dogs. It is the result of the influence of the hormone progesterone, produced by the ovaries.

When the ovaries are removed, hormone production stops and it becomes impossible for pyometra to occur naturally.

Malignant uterine tumors in dogs with or without ovaries are an extremely rare occurrence at 0.003 percent of all canine tumors.

Above All, Do No Harm

Proponents of ovariectomy contend the U.S. preference for removing a healthy uterus rather than just the ovaries of a dog or cat flies in the face of medicine’s ruling principle to ‘do no harm.’

The majority of veterinarians continue to perform ovariohysterectomies because that’s what they were taught. It’s tradition.

In addition, not many vets are trained in laparoscopic surgery or own the expensive equipment required for this type of procedure.

As a profession we need to ask ourselves if we truly do no harm when we risk the possible complications involved in removing a healthy uterus – especially when removing that uterus serves no useful purpose.

From a report published in 2006 in the journal Veterinary Surgery:

Since 1981, after introduction of OVE [ovariectomy] as the standard technique for canine neutering at Utrecht University, no increase in short-term complications has been observed. With respect to long-term urogenital problems, including endometritis/pyometra and urinary incontinence, it has been clearly established that they do not occur more frequently with either technique. The overall chance for development of malignant uterine tumors is very low (0.003 %), and, in our opinion, does not warrant performing a potentially more traumatizing surgical procedure, OVH [ovariohysterectomy], that might be associated with more postoperative complications.

Without benefit of more prospective studies comparing surgical complications between OVE and OVH, most evidence extracted from the literature leads us to the conclusion that there is no benefit and thus no indication for removing the uterus during routine neutering in healthy bitches. Thus we believe that OVE should be the procedure of choice for canine gonadectomy.

What to Do If You Want Your Pet to Have a Laparoscopic Ovariectomy

While European vets have been doing OVE’s for years, the procedure has been slow to catch on in the U.S.

Fortunately, some veterinary schools are now teaching the procedure to students, and there are a growing number of veterinary hospitals offering laparoscopic OVE’s. However, it’s hardly a widespread practice at this time.

I recommend you call your own vet first to inquire about the procedure. Even if he or she doesn’t provide the service (usually due to expensive equipment costs), it’s worth the phone call to let your vet staff know there’s interest in the community for the procedure.

I also recommend you let your state teaching hospital know of your interest in having the procedure offered locally. Public pressure can be beneficial in helping curriculums evolve to offer beneficial surgical advances like laparoscopic ovariectomy.

You can also try an online search, for example, on the phrase ‘vets who perform laparoscopic ovariectomy in [your town].’ Depending on where you live, there might be none, one, or several vet clinics offering the procedure.

Some vets are offering to perform a gastropexy at the same time for dogs prone to Gastric Dilatation Volvulus, or GDV (bloat). Gastropexy is a procedure which tacks the stomach to the body wall so that it cannot torque (turn on itself) if the dog suffers an incident of bloat.

I’m not really in favor of surgical ‘add-ons’ and would prefer you prevent GDV through a species-appropriate diet, management of all forms of stress and other smart lifestyle choices. That said, if your dog is a breed prone to bloat and eats a primarily dry food diet, gastropexy is a good idea.

Finally, make sure to ask about costs when you call around, because laparoscopic procedures are almost always more costly than traditional surgery. The average cost of a laparoscopic OVE seems to be about $200 more than a traditional spay.

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