Keyhole Surgery
What is keyhole neutering
Keyhole neutering involves the introduction of a camera and instruments into the abdominal cavity via three small incisions. The ovaries are visualised and ligated without the need for “tugging” the uterus. And unlike the standard spay, the keyhole incision allows the abdominal cavity to not be exposed to room air.
Why do we think it’s better
Less Pain
It is intuitive that if you make a smaller incision there will be less pain. In reality most experienced surgeons make quite small incisions for routine ovariohysterectomy already. Whilst the aesthetic result of keyhole neutering tends to be superior to basic spaying most of the advantages derive from what you can’t see. All vets will tell you the most painful part of a basic spay is when the surgeon has to pull the ovary through the abdominal incision. This often results in hyperventilation of the patient and requires an increase in anaesthetic dose. In keyhole procedures this is not necessary. Dogs undergoing keyhole neutering have lower pain scores and increased post op actvity. (Culp WT, 2009; Hancock RB, 2005; Gower S, 2008.)
Fewer Complications
Small incisions and accurate haemostasis means patients undergoing keyhole surgery typically lose less blood than those undergoing basic ovariohyserectomy. They also have a lower risk of post operative adhesions (Shariati E, 2014.) In our experience they have lower rates of infection or seroma formation.
Quicker Recovery
Dogs recover quicker from keyhole surgery because it’s less painful. This means they need fewer drugs and feel more like themselves sooner. The incisions are smaller and this means they can return to exercise sooner, this stops them being bored and bothering their incision. (Gower S, 2008; Culp WT, 2009.)
What to expect
Before the surgery
We think it is important that you understand the procedure that your beloved pet is undergoing, why we’re doing it and what to expect afterwards. Hopefully this website has answered most of your questions but if in doubt you should always ask a vet.
It is advisable for dogs undergoing any kind of surgery to have been treated recently for lungworm (Angiostrongylus Vasorum) as this infection can cause clotting problems. There are a variety of prescription medicines licensed for this use and it should be listed on the datasheet.
The night before the operation dogs should be starved from 10pm, there is no need to withhold water.
During the surgery
It’s our job to worry about this bit! Dogs will be admitted to the hospital in the morning of the procedure. They are given drugs that make them drowsy before being induced with an injectable anaesthetic. Animals are monitored closely during anaesthesia, we measure things like blood pressure, expired carbon dioxide, oxygen saturation, heart and respiratory rate.
Dogs will have a large shaved area approximately following their rib cage. The whole area is prepped for surgery before pets are moved to a dedicated sterile operating theatre.
Surgery begins by introducing a veress needle and gently pumping medical carbon dioxide into the abdominal cavity. Once inflated two ports are pushed through the skin these facilitate the introduction of a camera (laparoscope) and instruments. The ovaries are identified, the blood vessels supplying them sealed by electrocautery and the attachments subsequently disected. The ovaries are removed through the same holes that carry the ports. The skin and abdominal wall are closed with a single stitch or tissue glue. The patient is returned to the ward to recover and will have their endotracheal tube removed once sufficiently awake.
After the surgery
Dogs will go home later that same day. They will probably be a bit tired so don’t be surprised if they sleep it off. Many dogs leave in much the same mood as they arrived! You will have 3 days’ worth a pain medication and they will be sent home with a cone just in case it is needed. But we can appreciate every dog is different and you may find the cone is never used! Your dog must stay on the lead for three days after the surgery. At this point we would like to see them again, either at the practice or via an email appointment. If all is well, they are then free to resume their normal lives!
