Page 156 - Clinical Manual of Small Animal Endosurgery

144 Clinical Manual of Small Animal Endosurgery

to reduce the number of operative ports and improve operative time.
Other workers studied a laparoscopy-assisted technique that involved
enlarging a caudal midline incision for ligation of the uterine body using
extracorporeal ligatures (Devitt et al., 2005). Simply performing an
ovariectomy was advocated by veterinary surgeons in Europe, citing their
experience with no increased rate of complications following ovariec-
tomy in open procedures (van Goethem et al., 2006). When techniques
for percutaneous suspension of the ovarian pedicle were reported and
utilised effectively, the number of operative reports and operating time
were reduced further. More recently there have been randomised studies
demonstrating that dogs undergoing laparoscopic ovariohysterectomy
required less postoperative analgesia than those undergoing an open
procedure (Davidson et al., 2004; Devitt et al., 2005; Hancock et al.,
2005). Another study demonstrated less decrease in postoperative activ-
ity levels with laparoscopic approaches in small dogs compared to open
surgery (Culp et al., 2009). Currently, bilateral ovariectomy is commonly
performed with an energy modality and one or two operating ports using
the technique that will be described below.

Surgical procedure
Following general anaesthesia and positioning in dorsal recumbency the
animal is aseptically prepared and widely draped. As a general guideline,
in cats and very small dogs a 2.7 mm rigid scope is used, for dogs of less
than 25 kg a 5.0 mm rigid laparoscope is used and a 10 mm rigid laparo-
scope is used for dogs of more than 25 kg. The size of the animal dictates
the size of the Hasson trocar, which is placed on the midline just caudal
to the umbilicus. After initial port placement, insufflation and examina-
tion of the abdominal cavity, a second 5 mm port is placed on the midline
for insertion of a second instrument. The location of the second port
depends on the animal’s size, but approximately 5 cm caudal to the
camera port in an average-sized dog seems to work well. Next, 5 mm
grasping forceps are inserted to identify and retract the left uterine
horn. To aid in visualisation the animal is tilted 30° or more to the right,
towards the surgeon. The grasping forceps are used to trace the uterine
horn proximally, to grasp the proper ovarian ligament, and to elevate
the ovary to a convenient location on the abdominal wall for percutane-
ous suspension. The location must be inside the sterile field. By palpating
the abdominal wall while elevating the ovary the appropriate site is
selected. A laparoscopic spay hook (Fig. 5.8) or a large curved needle is
inserted percutaneously through the body wall until the tip is visualised.
The grasping forceps are then used to drape the ovary over the needle
or hook to ensure that the ovary remains elevated away from underlying
viscera. The needle or hook is then rotated to secure the tissue. If a needle
and suture are used, the needle is removed from the body and forceps
are applied to the suture outside the body. The laparoscopic spay hook
has a weighted handle that, once rotated, maintains the hook in a fixed