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). Following is an overview of how to perform a laparoscopic ovariectomy.
The instrumentation required to perform a laparoscopic ovariectomy includes a laparoscopic tower (monitor, endoscopic camera, xenon light source, CO2 insufflator and image recording device); a 5-mm, 0- or 30-degree telescope; 6-mm trocar-cannula components; a vessel-sealing device and laparoscopic instruments (a blunt probe, Kelly or Babcock forceps).
Important considerations for laparoscopic procedures include contraindications, such as diaphragmatic hernia and septic peritonitis, in addition to anesthetic considerations. During insufflation, intra-abdominal pressures should not be greater than 12 to 15 mm Hg or cardiovascular or respiratory compromise could occur during anesthesia. End-tidal CO2 should be monitored to avoid hypercapnia.
Place the anesthetized patient in dorsal recumbency in such a way that allows the ability to tilt the patient to the left and right after port placement to facilitate visualization of the ovaries. This can be accomplished either by using a specially designed tilt table or by having staff manually move the patient during the procedure.
Once this procedure has been performed on both ovaries, remove the ovaries through an enlarged instrument port incision. Finally, inspect the abdomen for evidence of hemorrhage, and close the port sites routinely.
After surgery, monitor patients for signs of hemorrhage, and manage them appropriately for pain (hydromorphone 0.05 mg/kg IV every six hours or buprenorphine 0.01 mg/kg IV every eight hours). Even though the incisions are much smaller (less than 2 cm) than with the traditional procedure, discharge instructions for owners include keeping incisions clean and dry. Incisions are usually closed in two layers—a linea/fascial layer and subcuticular—without skin sutures, so owners don't need to return for suture removal. Activity restriction requirements are less strict than with the traditional procedure—patients should be kept quiet for only five to seven days after surgery, and, generally, only a two-day course of an anti-inflammatory medication is needed.
Dr. Buote was awarded Diplomate status in the American College of Veterinary Surgeons in 2010 after completing a residency at the Animal Medical Center in New York City. She is a published author on the subject of laparoscopy and heads the minimally invasive surgery department at VCA California Animal Hospital Veterinary Specialty Group in Los Angeles, Calif.
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.