Why keyhole bitch spay?
As in human surgery the benefits of carrying out keyhole procedures in the dog are becoming established. This is particularly true when it comes to carrying out neutering in our pets; these benefits include less postoperative pain, lower incidence of postoperative illness, a far better view of the surgical area and a rapid return to normal activity.
Do we need to remove the uterus (womb) and ovaries ?
In the UK (and the USA) the predominant teaching in veterinary schools has been that when carrying out a spay, it is essential to remove the uterus along with the ovaries to prevent any uterine disease developing. In mainland Europe ovariectomy (OVE) alone has long been advocated as a safe alternative ovariohysterectomy (OVH). With the advent of laparoscopic spay procedures it is now accepted in the both the UK and the USA that OVE is a safe procedure.
The two questions I get asked regularly are, will they develop pyometra (womb infection) or will they get uterine (womb) tumours as they get older?
The answer to the first question is a straightforward no. It is currently understood that progesterone ‘priming’ of the uterus leads to development of a pyometra. The only natural source of progesterone in the bitch are the ovaries. If the ovaries have been removed pyometra cannot occur. There is no evidence that bitches have ectopic ovarian tissue and in all reported cases of ‘stump’ pyometra, there was either ovarian tissue left behind post spay or they had been treated with oral progestagens.
Will my bitch develop uterine cancer?
The overall reported risk of uterine neoplasia in intact bitches is 3 in 10,000 (0.003%) and almost all the reported tumours have been benign leiomyomas. These are slow growing, non invasive masses which can be cured by hysterectomy, and there are no reports of tumours developing in bitches spayed under 2 years of age, which suggests a strong hormonal influence to their development. The answer to this question is that it is highly, highly unlikely.
When should I spay my bitch?
Two concerns which relate to timing of a spay procedure are the possibility of increased risk of urinary incontinence after a spay but also minimising the risk from development of mammary tumours. Many of the actual numbers often quoted on this subject are not very scientific as they were based on reports written before veterinary surgeons appreciated the necessity for robust statistical analysis.
It is likely that the risk of development of mammary tumours significantly increases after the first season and then continues to rise slightly with each subsequent season thereafter for at least the first few years. Therefore, in order to minimise the risk from development of mammary tumours, bitches should be spayed before the first season, but there is some benefit from spaying after later seasons.
The risk of urinary incontinence is present following any neutering procedure (around 5% of cases), and unfortunately some bitches will become incontinent whether they are spayed or not. Recent reports suggest that there is no greater risk of young bitches developing incontinence. It is clear that urinary incontinence is the result of a complex interaction of many factors and therefore it cannot be simply attributed to an effect of sexual maturity or spaying alone.
What should you expect?
Though the incisions made for keyhole spay are very small (5 or 10mm), we do need to clip a large enough area to ensure that the skin around the wound is clean before surgery is carried out. The technique that we carry out involves making 3 small incisions so that the instruments and camera can be inserted into the abdomen. In larger bitches we make use of 2 ports that are 5mm and one that is 10mm; in small bitches we will use 3.5mm ports. Some surgeons prefer to use a 2 port technique but when this is done the flanks have to be clipped as well. It is our experience that most owners prefer the less obtrusive clipping associated with a 3 port approach.
When you collect your pet the wounds will be covered with light Primapore dressings, to help keep the wounds clean. These can be removed in 2 days time. We recommend that skin sutures are removed after 10 days. Your pet will also be given 5 days of anti-inflammatory drugs to make her comfortable.
The biggest issue we have is that most owners find it very difficult to keep their pet calm and quiet after the first 24 hours! We do however recommend lead exercise only for the first week after surgery, to allow the internal wounds to heal.
Do you own a large or giant breed dog?
Gastropexy reduces the risk of occurrence of GDV and as such it is logical to offer prophylactic gastropexy in those breeds that are most at risk from bloat (gastric dilatation volvulus; GDV). In bitches, such a procedure could be readily carried out at the same time as a routine laparoscopic spay. A gastropexy is the suturing of the right side of the stomach to the body wall so that it is fixed and cannot twist. Some concerns have been expressed that gastropexy may significantly alter gastric motility due to the repositioning of the stomach. Recent research showed that there was minimal disruption to gastric motility and emptying 10 weeks post surgery. Prophylactic gastropexy is an underused technique and many large and giant breed dogs run the risk of GDV.
Laparoscopic-assisted gastropexy is a procedure which is readily carried out at the same time as keyhole spay and involves making a small (3 – 5 cm) incision on the right flank; the stomach is sutured to this and the skin then closed. This minimally invasive technique has been shown to have minimal effect on pain scoring and recovery is as rapid as for a normal spay. The only difference is that lead exercise is recommended for 4 weeks after surgery to ensure that the stomach fuses to the body wall. Of course this is not limited to female dogs! Northwest Surgeons also performs prophylactic gastropexy on male dogs!
Ok. I want my dog to have a keyhole spay.
Northwest Surgeons is one of a few centres performing these procedures and the only practice in the area backed by a team of specialists. The surgery is performed by Professor John Williams, a European Specialist in Small Animal Surgery and the anaesthesia for these cases is handled by our dedicated veterinary anaesthetists, who are either European & RCVS Specialists or residency-trained. To arrange for your dog to have this procedure, you will need to ask your vet to refer you to us. It’s that simple. Once they give us authority to treat your pet, we will call you and arrange everything. Your pet will be admitted on the morning of surgery and will be ready to go later that day. If you have several dogs, we can help. Just ask. The cost of a laparoscopic spay is only £500, with or without gastropexy.
What do other clients say?
Our specialist in cardiology Simon Swift, who had his only dog Millie spayed using the keyhole technique, has written his account of her procedure here for you to read.Full Article >