Laparoscopy and Key Hole Surgery

Laparoscopy and Key Hole Surgery

What is Laparoscopy?

Laparoscopy, or 'keyhole surgery', is a minimally invasive procedure that allows the visualisation of the abdominal cavity and organs through small 3-5mm incisions.

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Benefits of keyhole surgery

There are four major benefits to keyhole surgery:

  1. Large reduction in post-operative pain due to smaller incisions and less bruising.
  2. Faster healing and recovery time.
  3. Reduced chance of infection.
  4. Shorter procedure time – in many cases the time taken to perform a procedure is reduced with keyhole due to a big improvement in accessibility and visibility.

Diagnostic laparoscopy can be used in both cats and dogs for a number of diagnostic minimally invasive procedures including:

  • liver biopsy
  • intestinal biopsy
  • kidney biopsy
  • tumour biopsy
  • gallbladder bile aspirates (cholecystocentesis) for cytology + bacteriology.

This procedure still requires a general anaesthetic but has the advantage of allowing biopsies to be taken in often debilitated patients, quickly and accurately. This not only increases the diagnostic accuracy but most importantly, reduces morbidity (complications) for the patient.

Surgical laparoscopy can also be performed in animals to allow visualisation of the abdominal organs and exteriorsation of these organs to allow surgical procedures to be performed outside the body wall. This is called 'laparoscopic-assisted; surgery. This still offers all the benefits of laparoscopic or keyhole surgery, whilst increasing the repertoire of potential surgical procedures performed through very small incisions compared to traditional surgery.

Such procedures include:

  • prophylactic gastropexy (for the prevention of GDV in at-risk breeds)
  • cystoscopy
  • intestinal biopsies
  • gastric and intestinal feeding-tube placements
  • cryptorchid surgery

The limited degree of invasiveness, diagnostic accuracy, and rapid patient recovery make laparoscopy an ideal alternative to traditional surgery for diagnostic investigations and surgical procedures. 

What is the difference between a traditional spay and a laparoscopic spay?

A traditional bitch spay often involves a 4-5cm incision through the abdominal wall. This incision is considered a source of postoperative pain in animals. The surgeon will then locate the uterus and pull it to the surgical wound.  The uterine horns are then used to identify the ovaries and ovarian attachments.  The ovarian ligaments are then pulled away from their attachments along the body wall causing some trauma and bruising. This tissue manipulation is also a source of post operative discomfort. The ovarian vessels are tied off and freed from its blood supply.  The body of the uterus is then exposed and tied off allowng the entire uterus and both ovaries to be removed.

A laparoscopic spay on the other hand, involves making two small 3-5mm skin incisions on the midline of the abdomen. The use of a rigid endoscope (or 'laparoscope') allows the structures to be visualised with light illumination and magnification. There is minimal to no bleeding, as the blood vessels are sealed with a 'vessel sealing device' resulting in minimal handling of other tissues and thus less resultant trauma. The ovaries are removed via the very small portal incisions and are are then closed, without the need for skin sutures. Laparoscopy therefore enables the surgeon to remove the ovaries without tearing the tissue from their attachments through very small portal incisions resulting in much less trauma, bruising, and post-operative pain.

Do you remove the ovaries and uterus?

Current veterinary literature, both in USA and Europe, have shown that removing both the ovaries and uterus (ovariohysterectomy) is usually unnecessary and can increase post operative discomfort. Removal of both ovaries (ovariectomy) is the preferred technique offering the advantage of reduced surgical time and trauma for the patient. The uterus is examined in every patient and would be removed only if considered abnormal on this visual inspection.

What are the risks?

Rarely, the surgeon may experience technical difficulties during the procedure requiring conversion to conventional surgery. There is a very small risk of damaging internal organs during placement of the cannula; however, this risk is considered extremely low provided proper technique is applied.

Keyhole Procedures
Laporoscopy - Feline VetPlanning port placement for cryptorchid surgery (retained testicle) in dog
Laporoscopy - Feline VetBitch spay through Single Incision Laparoscopic Surgery Port system
Laporoscopy - Feline Vet Laparoscopic cholecystocentesis (bile aspirate)
Laporoscopy - Feline Vet Laparoscopic liver biopsies
Laporoscopy - Feline Vet SILS port
Laporoscopy - Feline Vet Laparoscopic bitch spay
Laporoscopy - Feline Vet Laparoscopic kidney biopsy
Laporoscopy - Feline Vet Laparoscopic preparation
Laporoscopy - Feline Vet Laparoscopic surgery
Laporoscopy - Feline Vet Diagnostic laparoscopy can be an extremely useful minimally invasive tool for abdominal exploration and biopsy collection.

Article Links
VetStream Article: Tracheoscopy
VetStream Article: Transurethral Cystoscopy
VetStream Article: Bronchoscopy
VetStream Article: Laryngoscopy