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Laparoscopic vs conventional midline approach for dog spays and post-op activity

Clinical Scenario

At the second vaccination appointment for a young puppy, “Sasha”, you have a discussion with her owner, Mrs Brown, about the advantages and disadvantages of spaying when Sasha is old enough. Mrs Brown wants you to describe the procedure to her and seems disappointed when you explain your standard practice protocol of a midline incision with ovariohysterectomy. On further discussion you learn that her neighbour’s dog was spayed at a nearby practice offering laparoscopic spays. Mrs Brown was under the impression that all practices were doing this now and she believes that because the procedure is “key hole” the dogs are up and about and more active afterwards. You reassure her of the approach you normally take and of the practice protocols for post-operative monitoring. She seems happy with your response, but you begin to wonder if a laparascopic technique would make a difference to your patients post-operatively…

3-Part Question (PICO)

In [bitches undergoing neutering] does [laparascopic ovariectomy compared to conventional ovariectomy] increase [post-operative activity levels]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

dog.mp. OR dogs.mp. OR exp dogs/ OR canine.mp. OR canines.mp. OR canis.mp. OR bitch.mp. OR bitches.mp.

AND

spay.mp. OR spayed.mp. OR spays.mp. OR spey.mp. OR speyed.mp. OR speys.mp. OR neuter.mp. OR neutered.mp. OR ovariohysterectomy.mp. OR OVH.mp. OR ovario-hysterectomy.mp. OR ovariectomy.mp. OR exp Ovariectomy/ OR bitch spay.mp. OR bitch spays.mp.

AND

laparoscopic ovariectomy.mp. OR laparoscopic.mp. OR laparoscopy.mp. OR exp Laparoscopy/ OR keyhole.mp. OR key hole.mp.

CAB Abstracts 1910 to Present using the OVID interface

dog.mp. OR dogs.mp. OR exp dogs/ OR canine.mp. OR canines.mp. OR canis.mp. OR bitch.mp. OR bitches.mp. OR exp Bitches/

AND

spay.mp. OR spays.mp. OR spayed.mp. OR spey.mp. OR speys.mp. OR speyed.mp. OR neuter.mp. OR neutered.mp. OR ovariohysterectomy.mp. OR ovario-hysterectomy.mp. OR OVH.mp. OR ovariectomy.mp. OR exp Ovariectomy/ OR bitch spay.mp. OR bitch spays.mp.

AND

laparoscopic ovariectomy.mp. OR laparoscopic.mp. OR laparoscopy.mp. OR exp laparoscopy/ OR keyhole.mp. OR key hole.mp.

Search Outcome

MEDLINE

  • 79 papers found in MEDLINE search
  • 77 papers excluded as they don't meet the PICO question
  • 1 papers excluded as they are in a foreign language
  • 0 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 173 papers found in CAB search
  • 170 papers excluded as they don't meet the PICO question
  • 1 papers excluded as they are in a foreign language
  • 1 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Culp et al. (2009) USA

Title:

The Effect of Laparoscopic Versus Open Ovariectomy on Postsurgical Activity in Small Dogs

Patient group:

20 intact female dogs weighing less than 10 kg, acquired through an animal welfare society, split into two groups: Laparoscopic ovariectomy (LapOVE) and open ovariectomy (OOVE)

Study Type:

Randomised Controlled Trial

Outcomes:
  • Duration of surgical time
  • Degree of haemorrhage
  • Incision length
  • Activity monitoring using an acceleromitor for a) pre surgical 24 hours and b) post surgical 24 and 48 hours.
Key Results:
  • Median incision lengths in the LapOVE group were shorter than in the OOVE group - 4.2mm (range 3.8-5.6mm) and 9mm (range 7.2-11.3mm) for LapOVE compared to 52mm (range 45-58mm) for OOVE
  • Median surgical time significantly shorter in OOVE group compared to LapOVE group (P=0.005)
  • Median activity count changes from pre-surgical to post-surgical showed no significant change in the LapOVE group (no P value given)
  • Median activity count changes from pre-surgical to post-surgical for the OOVE group showed a significant post-surgery activity decrease at Day 1 (P=0.002) and Day 2 (P=0.002)
  • Total activity counts decreased by 25% after surgery in the LapOVE group (95% Confidence Interval 11-38%) and by 62% in the OOVE group (95% Confidence Interval 48-76%)
Study Weaknesses:
  • P values not quoted for all results
  • Only small breed < 10 kg dogs involved
  • Activity levels post-surgery were compared for each dog to their own pre-surgery activity levels. While this allows each dog to be their own "control", the dogs were housed in a new environment and may not have had "normal" activity levels during the pre-surgery time.
  • Although a greater total decrease in activity is seen in the OOVE group, no direct comparison in total activity counts with the LapOVE group is made.
  • It is not definitively established whether more or less activity post-operatively indicates better analgesia, and this may vary between individuals. Therefore the clinical implications of this result should be interpreted with caution.
Attachment:
Evidence appraisalEvidence appraisal

Comments

Post-surgery analgesia protocol of two injections of buprenorphine may not accurately reflect analgesia protocols in standard veterinary practice.

Bottom line

In small dogs (<10kg), use of a laparoscopic ovariectomy technique may lead to greater activity levels in the 48 hour post-operative period than if ovariectomy is performed using a conventional midline open technique.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Culp WT, Mayhew PD, Brown DC, (2009). The Effect of Laparoscopic Versus Open Ovariectomy on Postsurgical Activity in Small Dogs. Veterinary Surgery 38: 811-17.

 

About this BET

First author:
Hannah Doit
Second author:
Zoe Belshaw
Institution:

CEVM, University of Nottingham

Search last performed:
2017-01-30 15:22:30
Original publication date:
2017-01-31 15:22:30
Last updated:
2017-01-30 15:22:30
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