How to perform a two-portal laparoscopic ovariectomy - Veterinary Medicine
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How to perform a two-portal laparoscopic ovariectomy
Learn more about this laparoscopic procedure, which produces less pain and tissue trauma than a routine open ovariohysterectomy does. Then consider whether you should take the necessary steps to offer it in your practice.


VETERINARY MEDICINE


LAPAROSCOPIC-ASSISTED OVARIOHYSTERECTOMY: AN OVERVIEW

If uterine disease was found during the initial part of the procedure, you must either remove the entire uterus through a third portal placed just cranial to the pelvic brim (laparoscopic-assisted ovariohysterectomy2 or complete laparoscopic ovariohysterectomy) or convert to an open procedure. To perform a laparoscopic-assisted ovariohysterectomy, the third cannula-trocar unit should be 5 mm in cats or small dogs and 10 to 14 mm in medium and large dogs.

Proceed as described earlier to coagulate and cut through the ovarian suspensory ligaments and mesovarium, but do not sever the ovaries from the uterus. Avoid the uterine arteries and veins and be careful to avoid the ureters since they course close to the bladder in this area. After both ovaries have been coagulated and cut, use the endoscopic Babcock forceps to pull one ovary along with its horn through the newly added, most caudal third portal. Once the uterine bifurcation has been reached, remove the other horn and ovary by simply using outside traction. Then perform an extracorporeal ligation or LigaSure seal and cut of the uterine arteries, veins, and body at the area between the bifurcation and the cervix. When using the LigaSure extracorporeally, place a clamp below the LigaSure to prevent the uterine stump from retracting, and perform the seal and cut distal to the clamp. Replace the uterine stump, and close this portal in the same way the other portals were closed.

POSTOVARIECTOMY MANAGEMENT

Give owners routine written discharge instructions as for an open spay, but advise them in writing that because the uterus is still intact, no progestational hormones (e.g. megestrol acetate) or estrogens should ever be used in the patient as this could increase the risk of pyometra or induce signs of estrus. Instruct owners to return in 10 to 14 days for a recheck and suture or staple removal and to return sooner if any problems are encountered. Also dispense a postoperative analgesic for three days. As with traditional ovariohysterectomy, potential postoperative complications include infection, dehiscence, and herniation at the portal sites.

CONCLUSION

Two-portal laparoscopic ovariectomy provides a viable alternative to conventional ovariohysterectomy and can be performed by most practitioners already performing rigid endoscopy. It not only sterilizes bitches or queens, but it does so less invasively and helps to minimize postoperative pain. The disadvantages are the initial cost of the equipment and the time and training involved to acquire the needed skills. Once a veterinarian is trained, this procedure can be performed in 30 to 60 minutes, depending on the case and the surgeon's skill. Equipment setup and patient preparation require more time than with a conventional ovariohysterectomy.

Tom McCabe, DVM
Northeast Veterinary Clinic
9405 Dyer St.
El Paso, TX 79924

REFERENCES

1. Van Goethem B, Schaefers-Okkens A, Kirpensteijn J. Making a rational choice between ovariectomy and ovariohysterectomy in the dog: a discussion of the benefits of either technique. Vet Surg 2006;35(2):136-143.

2. Devitt CM, Cox RE, Hailey JJ. Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs. J Am Vet Med Assoc 2005;227(6):921-927.

3. Tankersley T, Hampden Family Pet Hospital, Englewood, Colo: Personal communication, 2006.

4. Ternamian A. Recent advances in endoscopic entry techniques. Rev Gynecol Pract 2001;1(2):60-69.

5. Vilos GA, Ternamian A, Dempster J, et al. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can 2007;29(5):433-465.

6. Van Nimwegen SA, Van Swol CF, Kirpensteijn J. Neodymium:yttrium aluminum garnet surgical laser versus bipolar electrocoagulation for laparoscopic ovariectomy in dogs. Vet Surg 2005;34(4):353-357.

7. Austin B, Lanz OI, Hamilton SM, et al. Laparoscopic ovariohysterectomy in nine dogs. J Am Anim Hosp Assoc 2003;39(4):391-396.

8. Bailey JE, Pablo LS. Anesthetic and physiologic considerations for veterinary endosurgery. In: Freeman LJ, ed. Veterinary endosurgery. St Louis, Mo: Mosby, 1999;24-43.

9. Gower S, Mayhew P. Canine laparoscopic and laparoscopic-assisted ovariohysterectomy and ovariectomy. Compend Contin Educ Pract Vet 2008;30(8):430-440.

10. Richter KP. Laparoscopy in dogs and cats. Vet Clin North Am Small Anim Pract 2001;31(4):707-727.

11. Rawlings C, Department of Small Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Ga: Personal communication, 2004.

12. Twedt DC, Monnet E. Laparoscopy: technique and clinical experience. In: McCarthy TC, ed. Veterinary endoscopy for the small animal practitioner. Philadelphia, Pa: W.B. Saunders, 2004;357-385.

13. Root Kustritz MV. Ovarian remnant syndrome in cats. In: Bonagura JD, Twedt DC, eds. Kirk's current veterinary therapy XIV small animal practice. Philadelphia, Pa: W.B. Saunders Co, 2008;1040.


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