Dogs serve mankind all over the world as therapy dogs, security dogs, show dogs, breeding dogs, scavengers for rodent and reptile control, and even as food in some regions of Africa and Asia. However, attacks between dogs and other animals and humans during the breeding season can transfer deadly zoonotic diseases like Rabies and other diseases like Echinococcosis/Hydatidosis, Visceral Leishmaniasis, Diphyllobothriasis, and others (WHO –WSPA, 1990). Dog overpopulation and related concerns are a hot topic in today’s society all around the world. As a result, dog population control is both a societal and species-wide necessity. Dog population management has a long history in India, dating back to the nineteenth century. Until the 2000s, inhumane means of killing such as strangling and burying alive, as well as mass euthanasia were widely used. The World Health Organization and the World Society for the Protection of Animals published “Guidelines for Dog Population Management” in 1990, urging comprehensive sterilisation rather than euthanasia. The Animal Welfare Board of India upheld this when it enacted the Animal Birth Control Rules, 2001, under the Prevention of Cruelty to Animals Act, 1960. Various methods for sterilising the female dog have been proposed, including surgical sterilisation and non-surgical procedures. Surgical sterilisation is a permanent contraception option that veterinarians favor all over the world, although the method is still the surgeon’s choice. The common methods of surgical sterilisation are ovariectomy, and the traditional ovaro-hysterectomy, both of which are accepted (Monnet, 2008).
What is Ovariohysterectomy?
Ovariohysterectomy (OVH), the most common surgical procedure performed in veterinary practice, prevents or lessens the risk of development of mammary cancer and pyometra, and the inconvenience of vaginal discharge and male attraction during estrus. OVH is the method of choice for sterilization of the dog (Bloomberg, 1996). Traditional OVH involves surgical removal of the ovaries and uterus through a median celiotomy. The 3 points of attachment of the uterus and ovaries are double ligated and transected, and the abdomen is typically closed in 3 layers. Although generally considered a safe and effective method of OVH in a young, healthy dog, complications can occur. Immediate or short-term surgical complications include hemorrhage from uterine and ovarian vessels, anesthesia accidents, tissue reaction to suture material that may lead to the formation of draining tracts or granulomas, wound infection, dehiscence or delayed healing, seroma formation, tracheobronchitis, coughing, and self-trauma (Berzon, 1979). Long-term complications include recurrent estrus, stump pyometra, delayed hemorrhage, weight gain, urinary incontinence, behavior change, and fistulous tracts or stump granuloma formation. Clients may decline sterilization because of concerns about potential complications, anesthesia, cost, required recovery time, or perceived painful recovery. Laparoscopic hysterectomy (LH) is an alternative to traditional abdominal hysterectomy (AH) in women. In humans, LH is associated with minimal intraoperative complications, less blood loss, equivalent recovery time, and less pain than AH (Leminen, 2000). Likewise, laparoscopic ovariohysterectomy (LOVH) offers a minimally invasive surgical option for clients that resist traditional OVH for their pets. Compared with OVH, LOVH has potential advantages, including decreased pain, less risk of dehiscence and hemorrhage, and less risk of postoperative wound complications. Other advantages may include decreased postoperative pain, and shortened hospitalization and convalescence. There is little information on complication rates and long-term outcomes after LOVH in dogs (Seager, 1990). Thus, our objective was to compare prospectively LOVH and OVH in dogs for perioperative complications, postoperative pain, and long-term outcome.
Procedure of Ovariohysterectomy
LOVH is a practical sterilization technique. In this technique, laparoscope is inserted in the cranial abdomen to view the contralateral ovary and pedicle at a perpendicular angle. This allows excellent observation during ligation and transection. It is simple to grasp the uterine horns with forceps and ‘‘walk’’ them to the ligature sites of the ovaries and uterine body. The uterine tissue is securely held during ligation, with no slippage or misplacement. It is not necessary to break down the broad ligament during LOVH. Rather, it is found easy to tear the ligament digitally, as is done during traditional OVH, when the uterus and ovaries are exteriorized. One modification of the procedure that could be considered is the insertion of the camera through a single portal in the mid-cranial abdomen, as reported for equine laparoscopy. This avoids having to change the camera during the procedure. However, in most dogs, particularly smaller dogs, this does not allow enough room to manipulate instruments and maintain triangulation during LOVH. Further, inadvertent puncture or laceration of the spleen is a risk during initial blind trocarization. Theoretically, locating this portal in the right cranial quadrant is comparatively safer. Ligation of the uterine structures is accomplished with a ligation device (Touche´ Suturing System) that allows crushing and grasping of the pedicle, and feeding, encircling, and cutting of a wire. The use of this instrument requires experience, which contributes to longer surgical times initially. With experience, the surgical time is markedly reduced. The 4-0 stainless steel wire is slightly undersized in some dogs; which may cause oozing after transection with seemingly secure ligatures. As the skill in wire tightening improves, adequate homeostasis is achieved, and additional cauterization is not required. Regardless, in larger dogs, a slightly larger gauge wire could be more appropriate and may reduce the likelihood of this complication. Laparoscopic-assisted removal of the uterine tissue is easily performed by moving the uterus to a portal with grasping forceps, enlarging the portal incision, and removing the uterus and associated tissues. It is important that the incision is enlarged sufficiently to remove the uterus without undue traction. Reinsufflation poses no problem and allows a final thorough check of the abdomen for ligature security, hemorrhage, replacement of the broad ligament remnant, and examination of viscera. Other ligation and transection techniques, such as laparoscopic hemoclips, harmonic scalpel, extracorporeal sutures, laser, and electrocoagulation, may be appropriate for LOVH. Successful laparoscopic ovariectomy using electrocoagulation and transection has been reported in horses (Hand et al., 2002). Regardless of hemostasis method, a surgeon skilled with laparoscopy should be able to routinely perform LOVH in less than 1 hour. This would be comparable to surgical time in women for LH where in 2 reports mean surgery times are 81, 30 and 70 minutes compared with 47, 16 and 74 minutes for AH, respectively (Leminen, 2000).
Portal incisions in LOVH dogs lead to minimal erythema, swelling, or irritation compared with OVH dogs. Some dogs may occasionally lick at the skin sutures; however, this could easily be avoided by the use of an Elizabethan collar. It is important that the deep sutures incorporate the abdominal musculature and secure bites are preferred to prevent oozing from the muscle layer. Eversion of the muscle and subcutaneous tissues into the skin layer could lead to delayed fibrin seal and loss of primary healing. The significantly lower incision scores for LOVH dogs are expected because there is less surgical tissue trauma and less suture material used in these wounds compared with OVH. Appropriate guidelines for humane analgesia after elective OVH and other surgeries have been mentioned in the recent veterinary literature. These reports have attempted to assess postoperative pain in dogs (Hellyer, 1999). No pain scoring system has proven comprehensive and free from weaknesses. Pain is a consequence of surgery in dogs is inevitable but may be minimized theoretically by laparoscopy. A subjective pain scoring system is adapted, using a partial list of behaviors that suggest pain or anxiety in dogs and cats after surgery.
The disadvantages of LOVH include the requirement of more than 1 surgeon, patient size limitations, and equipment cost. Regardless, LOVH may offer the veterinary surgeon an alternative to traditional OVH in healthy, non-parous, medium- to large-sized dogs.