How does Minimally Invasive Surgery Work?
After the patient is under general anesthesia and prepped for
surgery, standard surgical drapes are placed. In abdominal
procedures, a specialized (Veress) needle is placed through the
abdominal wall to insufflate, or fill the abdomen with air (carbon
dioxide). This allows for safer placement of instruments and allows
for easier manipulation of abdominal organs. In thoracic
procedures, insufflation is not necessary. In arthroscopy, sterile
saline is used instead of air. After insufflation, 1-3 portals are
created. Portals are small incisions that allow for placement of
cannulae so that instruments and the camera can be passed into the
cavity being worked on. Depending on the instrument size, portals
are usually 5-10 milimeters. The camera and special surgical
instruments are then introduced through the cannulae and the
procedure is performed. Specialized instruments used include
graspers, retractors, hemostats, scissors, biopsy forceps and even
a bipolar vessel sealing device (LigasureTM). At the end of
surgery, the patient's tissues are closed with suture and the
patient is recovered.
Can my pet have Minimally Invasive Surgery?
As with any surgery, you should discuss your pet's surgical
needs with your surgeon. In some cases, the surgery can be done in
a completely minimally invasive manner. In other cases, a small
incision may be needed to assist with the surgery (i.e.
laparoscopic/thoracoscopic-assisted surgery). A final use of MIS is
evaluation of organs prior to a more invasive surgery; the surgery
can be started in a minimally invasive manner (for example, to
visualize a liver tumor and determine whether it can be removed or
not) and then converted to an 'open' procedure.
Some of the more common minimally invasive surgeries that are
performed include spays and gastropexies. If you have a large or
giant breed dog (Doberman, Rottweiler, German Shepherd, Great Dane,
Boxer, etc.), especially if they have a deep chest conformation or
relatives with a history of GDV (Gastric Dilatation and Volvulus),
you should talk to your veterinarian about prophylactic gastropexy
to prevent GDV.
Why should my pet have Minimally Invasive Surgery?
Just like in humans, MIS is becoming more popular in veterinary
medicine because it allows the pet to be more comfortable with a
smaller incision(s). In addition, a great advantage is the superior
visualization achieved by the magnified camera view. Finally, some
procedures can be performed more quickly because opening and
closure time is greatly reduced.
How big does my pet have to be to have MIS?
Ideally, pets undergoing MIS are larger than 20 pounds to allow
for easier placement of portals and scopes. However, it is possible
to perform MIS in small dogs and cats. Talk with your veterinary
surgeon to decide what is right for your pet.
How long does my pet have to stay after surgery?
It depends on the surgery; most can go home the following day.
Ovariectomies (removal of the ovaries) and gastropexies can often
go home the same day but sometimes we like to monitor our patients
overnight especially if their surgery is in the afternoon.
What is my pet's recovery and care after surgery?
Again, it depends on the surgery but the goal of MIS is to allow
the pet to recover faster and in less pain than an open procedure.
However, they will still have a small incision that needs to be
kept clean and dry until it heals (in approximately 7-10 days).
They should wear an E-collar to prevent licking at the incision and
be kept quiet (no running and playing) while they recover, just as
with any surgery.
What is the difference between an ovariectomy (OVE) and an
OVE is the removal of both ovaries while OVH includes removal of
the ovaries and uterus. While "spay" simply means to sterilize a
female animal by removal of the ovaries, a 'traditional' open spay
performed in the United States usually entails removal of both the
ovaries and uterus (OVH). With MIS, removal of the ovaries alone is
faster and less invasive as it allows for a much smaller incision
as compared to removal of the entire uterus. In addition, there is
no increased risk of problems (such as pyometra or endometritis)
when leaving the uterus as long as the ovaries are removed.† Of
course, both techniques result in sterilization of the female.
What are the risks and disadvantages of MIS?
During placement of the needle or instruments, the biggest risk
is inadvertent puncture of an abdominal organ. Because of its
location, this most commonly happens to the spleen and bleeding can
result. Usually this can be controlled by simply applying pressure
but conversion to an open procedure is possible in severe cases.
The patient is always prepped for an open surgical procedure in the
event that the MIS has to be converted to an open procedure.
Because the abdomen must be filled with air for visualization in
laparoscopy, or the lungs must collapse when performing
thoracoscopy, anesthetic and cardiac complications are possible.
The patient is monitored closely and given positive pressure
ventilation to prevent these complications. Rarely, the CO2 from
insufflation can accumulate underneath the skin after the
procedure; this will resolve on its own in a few days.
Some minimally invasive surgeries can be more expensive because
of the additional equipment needed and expertise needed; however,
this can sometimes be offset by shorter hospital stays. In
addition, some surgeries take longer to perform in a minimally
invasive manner. For example, in an obese dog, it may be more
difficult to visualize the ovaries so that surgery time may be
For pricing or other information concerning Minimally Invasive
Surgery, please contact Texas A&M University, College of
Veterinary Medicine at (979) 845-2351.
†Okkens, AC et al. Comparison of long-term effects of
ovariectomy versus ovariohysterectomy in bitches. J Repro Fert
Janssens LAA et al. Bilateral flank ovariectomy in the dog -
surgical technique and sequelae in 72 animals. J Sm Anim Pract
Van Goethem B et al. Making a rational choice between
ovariectomy and ovariohystectomy in the dog: a discussion of the
benefits of either technique. Vet Surg 2006;35:136-143.
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