Laparoscopic ovariectomy.

Re: Laparoscopic ovariectomy.

Christina Smith — Sun, 08 Sep 2013 17:39:17 GMT

[quote user="Julie Innes"]

I've always done OVH, and for some reason, I instinctively would want to stick with that. POssibly because I am a dinosaur, possibly because I feel more comfortable with having better exposure, possibly because I usually do my bitch spays via a 3-4cm incision and am always pleasantly surprised at how well my patients are when I see them for their post-op 2 days later. Not sure how we are evaluating pain, but I use post-op pain relief on an as-required basis (having given plenty at the time of op) and very few owners use it, as they say their main difficulty is trying to keep the bitch from leaping around!

I think you can do an OVH with minimal tissue handling and trauma, which should mean that there is minimal post-op pain. It seems that the most painful part for the animal is the "pulling up" of the ovary, which presumably you would get during OE too. I have also heard from people post laparoscopy about pain and discomfort due to trapped air/ gas, so it may be swings and roundabouts.

I love the way people seem able to precisely assess levels of perceived pain in animals to quantify it! My own beagle used to scream the place down every time she got a booster with a 23g needle, but post OVH behaved as though nothing had happened!

[/quote]

5 stars from me too

Re: Laparoscopic ovariectomy.

Julie Innes — Sat, 07 Sep 2013 12:12:55 GMT

Re: Laparoscopic ovariectomy.

Mark Hedberg — Fri, 06 Sep 2013 08:53:17 GMT

[quote user="robloxley"]

[quote user="Aisling McGrath"]Reading this thread, I feel I want to go back to OVEs again![/quote]

Discuss with the practice; educate them; what is their immovable attachment to removing the uterus?

[/quote]

The same reason that flanks spays are - it's tradition

Re: Laparoscopic ovariectomy.

Rob Loxley — Thu, 05 Sep 2013 23:56:53 GMT

[quote user="Aisling McGrath"]Reading this thread, I feel I want to go back to OVEs again![/quote]

Discuss with the practice; educate them; what is their immovable attachment to removing the uterus?

Re: Laparoscopic ovariectomy.

Aisling McGrath — Thu, 05 Sep 2013 16:55:42 GMT

I worked in Normandy, France for 18 months post graduation.

Every single dog/cat (apart from older ones with funny looking uteri and/or pyo) just removed ovaries - no problems.

Moved to UK, and practice protocol is OVH, so I have followed suit. However now feel that incisions are bigger and surgery takes longer, and have bigger cervical blood vessels to deal with, which weren't an issue before.

Reading this thread, I feel I want to go back to OVEs again!

Re: Laparoscopic ovariectomy.

Rob Loxley — Thu, 05 Sep 2013 15:09:07 GMT

[quote user="Neil Wheadon"]

Her response was in Spain she had seen 4 bitches develop pyometra having had just the ovaries removed.

Is she right and with bitches out there who have been laparoscopically speyed and just the ovaries removed, can they develope a pyo?

[/quote]

I'd be very interested to check repro hormone levels on the spayed bitch with a pyo

Re: Laparoscopic ovariectomy.

Mark Hedberg — Thu, 05 Sep 2013 09:36:40 GMT

[quote user="Martin Atkinson"]

Can we have a vote on here about who performs ovaroectomies and who does ovaro-hysterectomies, and those who do OHEs now but are being swayed towards OEs instead - forget laparoscopic for now. As I'm a Luddite can anyone set up one of those vote thingies on a new thread? Arlo?

[/quote]

By the end of my time in Saudi, I had switched over to doing OEs - I figured if it was good enough for Germany, it was good enough for me. Smaller hole, faster op, smaller vessels, etc, etc.

When I moved to the UK I did OHE - the boss did not like OE and while he was very civil about it and was quite content that I was good at it, I was specifically asked to do OHE instead.

So I did. *shrug*. (I wasn't fussed enough to make a big deal out of it.)

Re: Laparoscopic ovariectomy.

Michael Woodhouse — Thu, 05 Sep 2013 09:22:11 GMT

[quote user="Neil Wheadon"]

Her response was in Spain she had seen 4 bitches develop pyometra having had just the ovaries removed.

Is she right and with bitches out there who have been laparoscopically speyed and just the ovaries removed, can they develope a pyo?

[/quote]

Even the laproscopic surgery I've seen by experts all looks a little 'ham fisted' grabbing and pulling until you get what you want. I'd postulate a fraction of ovarian tissue somehow detaches and manages to achieve a collateral blood supply (a bit like stuffing a parathyroid gland back in).

It was my driver for smaller hole spays when I read that no need to worry about cervix. I usually ligate around the bifurcation and it takes a ligature so much better than the fibrous cervix. On a young, immature dog I don't even always transfix.

Re: Laparoscopic ovariectomy.

Dagmar Steele — Thu, 05 Sep 2013 08:44:43 GMT

In contrast to the UK in Germany many vets do OEs on young healthy bitches. I do as well (not laparoscopically) but in one case I did it on a five yo bitch which had some previous hormonal problems reported. Two weeks later she was in with a ruptured pyo, fortunately survived. Lesson learned: If the uterus looks slightly active (it did in this case and I'm still beating myself up for not taking it out anyway!) or the bitch is older than 3yo I take it all out. Most of my spays are performed at six to seven months though and here I always do OEs, never had a pyo on one of them.

Re: Laparoscopic ovariectomy.

Neil Wheadon — Thu, 05 Sep 2013 00:47:48 GMT

I've resurrected this discussion as discussing spaying with a Spanish graduate today.

I take a tiny bit of cervix, she takes the lot.

My justification was that it made no difference as wouldn't get a pyo and a little safer/easier.

Her response was in Spain she had seen 4 bitches develop pyometra having had just the ovaries removed.

Is she right and with bitches out there who have been laparoscopically speyed and just the ovaries removed, can they develope a pyo?

Neil

Re: Laparoscopic ovariectomy.

patrick murphy — Mon, 19 Nov 2012 12:40:33 GMT

very interesting.

1. habit

2. I stayed at friends house for LVS and spent a morning in laparscopic theatare at St. Marks of which he is the director. at the moment he is trying, with difficulty, to prove an advantage that is EBM, and statistically valid for people!

although all of the advantages are intuitive, proving it has been problematical. as I have had personal experience of major laparoscopic surgery, I am most defintiely a fan, but I do have difficulty bridging the gap to our patients, for loads of reasons

Re: Laparoscopic ovariectomy.

Rajat — Thu, 15 Nov 2012 04:14:34 GMT

[quote user="robloxley"]Am pretty au fait with the literature[/quote]

Kewl :)

[quote user="robloxley"]My experience has been however with have-a-go laparoscopists[/quote]

Everyone starts by having a go I suppose. We started 5 years ago. Now we do on average 3-4 lap spays a week. So quite experienced with it.

[quote user="robloxley"]I also contend that the recovery from conventional surgery is good, at somewhat lower cost to the client. [/quote]

No-one said recovery is bad from conventional surgery. Just tht laparoscopic recoveries are better.

[quote user="robloxley"]Why OVH for charity cases and OVE when paid-for[/quote]

Because that is our contract with the charity- its what they expect, and these ops are not linked to animal specific cards on the computer. So it cannot be made as clear as it otherwise could be, on the animal card, that it has had an OVE. I kind of disagree with this approach but its not my decision so I do what the rules say.

But I prefer doing OVEs.

Re: Laparoscopic ovariectomy.

Rob Loxley — Wed, 14 Nov 2012 22:31:07 GMT

[quote user="Rajat"]To avoid guesswork I suppose one could always make a tentative foray into reading the literature which supports better recoveries more mobile pets following lap surgery and lower pain scores post op...[/quote]

Am pretty au fait with the literature. My experience has been however with have-a-go laparoscopists who surely would have made a better job with a conventional approach, who didn't make it clear to the clients that the theory behind the benefits might be sound but in their inexperienced hands the reality was different. I also contend that the recovery from conventional surgery is good, at somewhat lower cost to the client.

[quote user="Rajat"] OVHs for the charity cases[/quote]

Why OVH for charity cases and OVE when paid-for (unless I am reading your post wrong)?

Re: Laparoscopic ovariectomy.

Martin Atkinson — Wed, 14 Nov 2012 19:12:32 GMT

Re: Laparoscopic ovariectomy.

Rajat — Wed, 14 Nov 2012 15:43:18 GMT

[quote user="robloxley"]The cynic in me wonders whether the rise in lap spays is as much motivated by the need to pay off a new shiny laparoscopy stack?[/quote]

Not us - the extra charge for lap spays is very low - cf extra charge for lap asissted biopsies pericardectomies etc. This allows us to encourage people to have their bitches done this way, we get to use and get better with the equipment (as we have over the last yrs) and the bitches benefit from it too!

Similar situation to OVH - we all charge less for surgical time for this than say for another op and similarly we charge a small amount for lap OVEs over a normal spay charge (or thats my understanding anyways - neuters are somewhat discounted to encourage neutering in the general public)

[quote user="robloxley"]How many people are doing conventional ovariectomy - as opposed to OHE.[/quote]

Moi - where possible. Client factors often come into it. But I usually recommend OVEs over OVHs. Quicker and easier and less trauma and probably less pain.

Re: Laparoscopic ovariectomy.

Rajat — Wed, 14 Nov 2012 15:39:36 GMT

[quote user="Clive Ansell"]Why? Mine almost always go home the same day.[/quote]

Convention at our practice- allows also for post op analgesia - we give bupe again 6-8 h post morphine and bupe/tramadol t night. I am quite happy to send OVEs home. And as I do both midline OVEs and lap OVEs and OVHs for the charity cases, some comparisons can be made between these groups, altho I'd be the first to admit its guesswork. But I'd wager it is better guesswork than those of you not doing both procedures inhouse so you can at least compare the outcomes!

To avoid guesswork I suppose one could always make a tentative foray into reading the literature which supports better recoveries more mobile pets following lap surgery and lower pain scores post op...

Re: Laparoscopic ovariectomy.

Clive Ansell — Wed, 14 Nov 2012 14:47:47 GMT

[quote user="Rajat"]

the vast majority of our OVH/OVE patients stay in overnight anyways.

[/quote]

Why? Mine almost always go home the same day.

I have referred a handful of bitches for laproscopic OE, and I can't say the recoveries are mush better/different to traditional speys. More to appease clients i think

Re: Laparoscopic ovariectomy.

Rajat — Wed, 14 Nov 2012 14:40:26 GMT

[quote user="robloxley"]

[quote user="Rajat"]the private clients who have had bitches before lmost always commenbt on the speed of recovery compred to bitches in the past[/quote]

Are you sure they're not comparing speed of recovery from propofol vs. thio in the past?

[/quote]

Pretty sure. Thio doesn't last all that long and the vast majority of our OVH/OVE patients stay in overnight anyways.

Re: Laparoscopic ovariectomy.

Dagmar Steele — Wed, 14 Nov 2012 13:52:29 GMT

[quote user="robloxley"]

How many people are doing conventional ovariectomy - as opposed to OHE.

[/quote]

I do (in young and healthy dogs). Never had a problem, apart from one 5yo bitch with a suspicious looking uterus. I had a severe brain fart and didn't take it out, had to open up 2 weeks later for ruptured pyometra. So: OE in young healthy dogs under three, after that OHE for me.

Always do OEs in cats if no problem visible, but then they almost always come at six months anyway.

Re: Laparoscopic ovariectomy.

Rob Loxley — Wed, 14 Nov 2012 13:41:44 GMT

[quote user="Michael Woodhouse"]Loads of people say that - I'm sure it's a combination of newer anaesthetics and better attention to pain management.[/quote]

Possibly, I wonder.

I've not lots experience of client's dogs going for lap spays - but one had a postop SSI and the other required further followup analgesia beyond what had been dispensed. Given good modern anaesthetic and analgesics and a good surgical technique I find the postop recovery for conventional spays to be good.

The cynic in me wonders whether the rise in lap spays is as much motivated by the need to pay off a new shiny laparoscopy stack?

How many people are doing conventional ovariectomy - as opposed to OHE.

Re: Laparoscopic ovariectomy.

Chris Geddes — Wed, 14 Nov 2012 08:17:35 GMT

[quote user="David Mills"]

I've met several women who've had laparoscopic surgery and they say it bloody hurts- not the cuts in the muscle but the dissipation of the co2 post-surgery and the bloatedness afterwards. I would suspect this is something difficult to quantify in animals.

[/quote] Interesting. Not my experience. I have had both and pain was lot less after laparoscopic.

Re: Laparoscopic ovariectomy.

Michael Woodhouse — Wed, 14 Nov 2012 01:32:37 GMT

[quote user="robloxley"]Are you sure they're not comparing speed of recovery from propofol vs. thio in the past?[/quote]

Loads of people say that - I'm sure it's a combination of newer anaesthetics and better attention to pain management.

Re: Laparoscopic ovariectomy.

Rob Loxley — Wed, 14 Nov 2012 00:07:35 GMT

[quote user="Rajat"]the private clients who have had bitches before lmost always commenbt on the speed of recovery compred to bitches in the past[/quote]

Are you sure they're not comparing speed of recovery from propofol vs. thio in the past?

Re: Laparoscopic ovariectomy.

Stephen Courtney — Tue, 13 Nov 2012 23:45:59 GMT

Ovariectomy rather than ovariohysterectomy is the norm in many countries. It is easier to do and quicker, and leaves somr of the scarier blood vessels alone therefore reduces risk of severe bleeds.

My own dog had an ovariectomy only. I know there is no proof that leaving the uterus behind reduces the risk of later USMI but in my inner self i think that it provides support for the bladder for a reason and is surely better left in place if you have the option. However i still do a traditional spay where everything is removed, out of habit i suppose.

If you don't use progestagens in ovariectomised dogs then there is no risk of pyometra.

At our hospital lap spays have proved popular, the surgeons like using the gear and the clients all feel that the dogs are recovering much faster, and seem much happier in the post op period. Of course they all get post op analgesia for a few days. Would I spend the extra for my dog? Absolutely!

The equipment is of course expensive, and requires a gas sterilizer. The upside is that the gas sterilizer can be used to re-sterilise all sorts of things that cannot go in an autoclave.

Re: Laparoscopic ovariectomy.

Anthony Dennison — Tue, 13 Nov 2012 23:45:02 GMT

At Bristol they would do lap-spays, usually one or two a week, on deep chested breed dogs and do a prophylactic gastropexy at the same time. As I remember used to take AGES