KINDEST CUP OF ALL
New surgical technique means easier spays, faster healing
By Dr. Timothy McCarthy
The first spaying I ever watched was in a small rural practice in 1958 when I was 13 — the same time I first became interested in veterinary medicine.
The surgery was performed using ether and catgut suture from a spool that had to be manually threaded onto a needle. There was no surgical cap, mask, gown or gloves, and only a postage stamp-sized surgical drape. There was no pain medication, and the ovaries were pulled up to the incision by tearing their attachment to the abdominal wall. This was the state of the art at that time.
Today, nearly all aspects of spaying have improved. We have better anesthetics that have minimal negative effects on the patient. We use individual sterile packages of suture with attached needles made using the same synthetic suture material used in human surgery, which causes minimal tissue reaction and is completely removed by the body with time.
We also use caps, masks, gloves and gowns, and use drapes of adequate size to prevent any contamination of the surgical field. We no longer need to pour antibacterial agents into the surgery site. Aggressive pain management with drug combinations is used before surgery to block pain before it starts, and the medications are continued during the post-operative period.
However, we are still using the same barbaric blind tissue-tearing technique to rip the attachment of the ovaries away from the abdominal wall. This technique does work — because we’ve been spaying dogs and cats this way for more than 50 years. But now there is a better way: laparoscopic spaying. It changes our technique from tearing tissue blindly to cutting tissue where we can see what we are doing, and it is the final step toward achieving modernization of this surgery.
To perform a laparoscopic ovariectomy, we first place a small endoscopic telescope into the abdomen, and the abdominal wall is lifted away from the internal organs by filling the abdomen with carbon dioxide gas so that we have a space to work. Specially designed surgical instruments are placed into the gas-filled abdomen. The first ovary is found and can be seen clearly on a video screen with magnification, which the surgeon uses for the duration of the procedure. The ovary is lifted gently away from the other organs, and its attachments to the abdominal wall are cut with a device that electronically seals the blood vessels. The freed ovary is removed from the abdominal cavity through one of the small incisions made for the telescope or the instruments. The procedure is repeated for the other ovary.
When the surgery is completed, no foreign suture material is left in the abdomen because we have electronically sealed the blood vessels, and we have only two small incisions in the abdominal wall.
The equipment and instruments needed to perform laparoscopic spaying are expensive, but they cost no more than many other advanced medical devices commonly seen in small-animal practices (such as ultrasound, digital X-ray systems and lasers) and are far less expensive than others (CT and MRI). Additional training is needed, but this surgery is easier to learn and perform, with fewer problems and complications than many other new surgical techniques that are being incorporated into small-animal medicine. This technique is well within a skill level attainable by most general practitioners.
The bottom line for pet owners: Animals spayed with laparoscopy recover faster and have less pain than those operated on using the traditional technique. It’s time for a change!
Dr. Timothy C. McCarthy is a board-certified surgeon in the Portland, Ore., area who has pioneered the application of many minimally invasive diagnostic and therapeutic techniques that are now becoming the standard of care.