Keyhole or Laparoscopic Surgery


‘Keyhole’ or minimally invasive surgery has been used in human surgery for many years now and has become the standard method for numerous procedures. The benefits are well documented; with quicker recoveries, less tissue trauma and therefore less post-operative pain or wound complications for the patient.

1_Patient_ Preparation.jpg
(1) Patient Preparation

These laparoscopic techniques have more recently been taken up by some veterinary surgeons, thereby affording the same benefits to some of our four-legged friends. Procedures that are routinely carried out using keyhole methods are; Bitch Spay, Retained (Cryptorchid) Castration, Liver Biopsy, Pericardiectomy, Lap-assisted prophylactic Gastropexy, Staging for lung tumour surgery or intra-abdominal tumour surgery.

The ‘Keyhole’ Bitch Spay is perhaps the most beneficial development in recent times. We have now been performing Keyhole Bitch Spays at Ashby Veterinary Group for over a year and have performed some 50+ procedures. Laparoscopic Bitch Spays are estimated to be 62% less painful than the traditional open procedure. At Ashby Vets we certainly see a difference in dogs coming round from a Keyhole Spay and owners report that their dogs are back to normal within a matter of 1-2 days.

What’s the difference from a normal Spay?

With a ‘Traditional’ or open Spay an incision of 5-10cm is made in the abdominal wall near the umbilicus. The ovaries and the uterus are removed to the level of the cervix. The ovaries are accessed by tearing the ovarian ligament off the abdominal wall, which leads to bruising and post-operative discomfort. Your dog will need to be kept restricted for 7-10 days postoperatively to prevent any problems with her surgical wound. Excessive activity during this period can lead to fluid accumulating below the wound (seroma) or in worst case scenarios wound breakdown.

With a ‘Keyhole’ Spay two small incisions are made either side of the umbilicus. The largest one will be 0.5-1.5cm depending on the size of your dog’s ovaries. The cranial (forward) incision will always only be 0.5cm. In very small dogs we can often remove the ovaries through a 0.5-0.75cm opening and as we have both 1cm and 0.5cm diameter Ligasure Vessel Sealers, this is now achievable.

The ovaries only are removed using a vessel sealer as described above. Studies have shown there is no medical benefit to removing the uterus in young healthy bitches and indeed on the continent they have been removing only the ovaries when performing normal spays for years.

We would normally suggest having a keyhole spay done when your dog is young, i.e. between 6-12 months old either before or 3 months after their first season. However older dogs can still be done this way, but if any abnormality is noted in their uterus we may need to either convert to a traditional spay or remove the uterus as well.

You need only keep your dog restricted for 2-3 days following a Keyhole spay.

The downside? – Although this is minimally invasive surgery, it is NOT minimally clipping surgery! Your dog will have a similar or larger area of fur removed for the procedure.

Laparoscopic Assisted Cryptorchid (Retained Testicle) Castration

Another way in which ‘keyhole’ surgery has greatly reduce surgical trauma involved in a common procedure, is in locating and assisting with the removal of un-descended testicles that have remained within the abdomen. These testicles are at a much higher risk of becoming cancerous and do need removing. This normally requires a 7-10cm, para-preputial incision (in-front of and along side the penis) to be made to allow the surgeon to locate and remove the testicle. Because of the position and size of the surgical wound required, it is very prone to post-operative complications such as swelling or wound infections, due to interference from the dog licking or urine soiling of the wound.

Laparoscopic assistance means that a single 0.5cm incision near the umbilicus to be made to allow the endoscope to be introduced into the inflated abdomen. The undescended testicle is then visualised using this and a small incision made in the abdominal wall, directly over it to allow it to be extracted from the abdomen and removed as normal. The resulting wounds are much smaller and positioned such that post-operative discomfort and wound complications are much reduced.

If you would like to arrange or discuss a ‘Keyhole’ procedure for your pet please phone 01724 842655.

2. Gaining Access
(2) Gaining Access 3. Creating Pneumoperitoneum
(3) Creating Pneumoperitoneum 4. Finding the Ovaries
(4) Finding the Ovaries 5. Vessel Sealing
(5) Vessel Sealing 6. Ovary Being Removed
(6) Ovary Being Removed 7. Ovary Removed
(7) Ovary Removed 8. 2nd Ovary
(8) 2nd Ovary 9. Closing up
(9) Closing up 10. Completed
(10) Completed