Frequently asked questions

Laparoscopic Spays

What is a keyhole spay?

The key hole spay or laparoscopic spay is a minimal invasive method of neutering female dogs. Typically, only 2 small holes are made in the abdomen (tummy) and only the ovaries are removed through one of those holes with the use of specialized equipment and instruments.

What is the difference between keyhole spay/lap spay and the traditional spay?

The size of the incisions (holes/wounds) are much smaller than on the traditional spay resulting in a faster recovery and reduced rest time after the procedure. There is less handling of the tissues inside and no use of sutures apart from closing the small incisions which results in less pain, less risk of infection and other complications. We use a vessel sealing device which reduces the risk of bleeding. With the use of the endoscope and magnification we can inspect all the abdomen whereas the traditional spay only allows a limited inspection.

 What are the advantages of a lap spay?

• Faster recovery
• Less complications (less bleeding, less risks of infection and wound breakdown)
• Higher magnification allows more precise surgery and inspection of other organs during procedure.
• Smaller incisions and reduced trauma to tissues
• Reduced pain after the initial recovery

Why does the lap spay costs more than traditional spay?

The laparoscopic spay requires advanced training of the surgeon and a greater amount of equipment and specialized vessel sealing devices. All the set up takes a little longer than a traditional spay but the advantages greatly outcome the difference in price.

Are there increased risks on doing keyhole surgery?

In general, there are less risks compared with the traditional spay due to the smaller incision, the higher magnification used to inspect the ovaries and the vessel sealing device. The other risk that include accidental perforation of organs, bleeding from pedicles during the vessel sealing/ligatures, are similar to the traditional spay. If any complications occur, we will convert in an open surgery (with a larger incision like the traditional spay) to finish the procedure safely.

Why is the uterus not routinely removed and what risks does that bring on the future?

The most recent studies and guidelines of neutering indicate that if there is no changes on the uterus on inspection (like cyst, lumps or fluid inside) there is no need to remove the uterus. By removing the ovaries completely the production of sexual hormones cease and there is no risk of infection on the uterus (pyometra) or formation of cysts in the future. The risk of lumps is similar, although very rare, to the traditional spay with uterus removal.

Why does it need gas insufflation and which gas is used? How is it removed after?

During the lap spay we need to insufflate the abdomen (tummy) with carbon dioxide (CO2) so we can create a “tent” effect. That allows to visualize the organs and specially the ovaries better and manipulate the instruments inside safer without traumatizing any organ. After the operation most of the gas is release through the incisions (holes) before closure and the remaining will be absorbed by the muscles and released through the breathing.

What happens after my animal is admitted in the veterinary practice?

After completing the medical check by your vet or nurse and signing the consent forms, you pet will be taken to a dedicated ward while waiting for the procedure. If indicated, a blood sample may be taken and tested. She will have a catheter placed in one arm and she will be give a pre-medication with pain killer and sedative. Then she will be fully anaesthetized, prepared for the procedure and taken to a dedicated surgical theater. After the procedure she will recover in the ward until fully awake, stable and comfortable to be discharged home.

Why is it necessary a wider clipping on my dog?

In smaller and medium dogs, in order to suspend the ovaries for the vessel sealing and ovary removal, it is necessary to pass temporarily a suture in each side of her tummy. You won’t see a hole there but a couple of little dots where the needle passed. In order to avoid infection inside we needs to clip those sides and clean it properly before the procedure.

What is the minimal weight for the procedure?

Due to the size of the instruments used regularly, the fact that smaller animals have smaller tummy space and the thermal effect of the vessel sealing device, the risk of trauma to the other organs is bigger compared with medium size and larger dogs.
Plus, the traditional spay is these smaller pets is much faster with a shorter anaesthetic time and the size of the incision is typically very small as well.
For this reason the Endosurgical Vet doesn’t offer laparoscopic spay in dogs less than 5kgs and cats.
If you have any further questions feel free to discuss with your veterinarian or nurse during the admission.

Soft tissue surgery

What is included on BOAS?

The brachycephalic obstructive airway syndrome (BOAS) surgery is a combination of procedures to improve the airflow of the patient in a view to improve their quality of life. It usually involves rhinoplasty and palatoplasty but some cases will also need laryngeal sacs trimming, tonsillectomy and even laryngeal cuneiform trimming for laryngeal collapse cases.
It is also advised to have neck and thorax radiographs prior to surgery to evaluate the diameter of trachea and collapse, check for pneumonia and non-dynamic hiatal hernias.

Do the patients need hospitalizations after the procedure?

It has been shown that most cases of BOAS surgery benefit from recovery at home post-procedure as it is less stressful and allow for a smoother recovery, as long as they are stable to be discharged. If not stable, they may require hospitalization for monitoring and potentially be transferred to a OOH centre.
Other procedures may need hospitalization for continuation of pain relief, for monitoring breathing difficulties, or more critical recoveries that can’t be done at home.

Do I bring all equipment for any given procedure?

Yes, all the kits and equipment needed (including diathermy, suction, endoscopy units, etc) and consumables (such as gowns, gloves, suture material, swabs, etc) will be brought.
The only things needed are usually the medications and anaesthetic drugs, fluids and IV pups, GA monitoring equipment.

What does the practice need to require the services?

The most fundamental thing is a dedicated surgical theatre and a nursing staff member/team for the anaesthetic monitoring and support. Only in rare occasions a surgical assistant is required and that can be discussed prior to booking. However, any staff member or student is welcome to assist or scrub in.

Who admits and discharges animal?

For routine lap spay and castrations, the practice staff can admit and discharge the patient (guidance and support will be provided). In other more complex cases I will discuss the procedure with the owner and admit the patient myself. I will call the owner after the procedure and then discharge can be done by a practice member.

Is there going to be discharge notes?

Yes, a discharge form containing information about the procedure, recovery and after care plus medication will be sent to the practice to be ready before discharge time.

Endoscopy

After the endoscopy do you take biopsies if needed?

Most of the endoscopic exams require biopsies for a more comprehensive investigation of the clinical signs presented. The biopsies are included on the price of the exam (except BAL). The processing and pricing of the histology is done by the practice.

What about foreign body removal?

If identified, the foreign body will be attempted to be removed depending on location and size.

How is the recovery?

The recovery from the endoscopy procedures is generally good and fast as they are minimally invasive so the patient is able to be discharge few hours after the procedure. Some endoscopies as bronchoscopy with BAL may require closer monitoring due to risks of bronchospasm and pulmonary oedema but all will be discussed previously. The rhinoscopies with biopsies will have increased discomfort and may have some nasal bleeding which should be controlled before discharge.