Endoscopy has experienced significant growth among both specialty and general veterinary practitioners in recent years, and perhaps the greatest area of growth is in laparoscopic-assisted spays. As with many relatively new surgical procedures, the technique and its equipment have evolved rapidly to meet the needs of veterinarians. Jim Houchens, DVM, of Arvada Veterinary Hospital in Northern Denver, says that adding laparoscopic-assisted spays to his practice’s arsenal of offerings has helped him to attract new clients. “For established veterinarians like me, the procedure is a terrific cure for burnout,” he says. “For younger veterinarians, it’s a way of whetting their appetite for the skills and technology that will be coming down the pipeline.” The clinical advantages of the laparoscopic-assisted ovariohysterectomy technique were established in a study published in the Journal of the American Veterinary Medical Assn. in 2005. For the study, Chad Devitt, DVM, MS, Dipl. ACVS, of the Veterinary Referral Center of Colorado, worked with Ray Cox, DVM, of the Deer Creek Animal Hospital, and Jim Hailey, DVM, of the Redstone Animal Hospital in Littleton, Colo., to compare traditional OHE with a laparoscopic-assisted OHE using two portals. The study found that dogs spayed using the laparoscopic-assisted OHE technique experienced less pain and surgical stress than those spayed in a traditional open procedure. Since the study, the veterinarians, working in partnership with BioVision Technologies in Golden, Colo., have refined the procedure to use only one portal. Evolving Procedure Jeff Mayo, DVM, owner of Mayo Veterinary Services in Mountlake Terrace, Wash., operates a mobile practice that provides relief work, in-house surgical training and surgical practice. He first starting performing laparoscopic-assisted spays in 2004. “At that time, about 25 percent of my clients were accepting of the procedure as a better and less-painful method of sterilization for their female pets,” he says. “In the beginning, I was performing one-, two- and three-port approaches using various electrocautery devices or extracorporeal knot tying,” Dr. Mayo adds. “As I advanced in my skill, I began using various devices I can attach to my radiowave radiosurgery Ellman unit. My currently preferred method is a one- or two-port procedure.” Randy Hutchison, DVM, of Animal Clinic Northview in North Ridgeville, Ohio, has been performing laparoscopic-assisted spays for nearly three years, the bulk of which are ovariectomies. He uses a two-port technique. “I think a lot of the instrumentation is still geared toward multiport techniques,” he says. “But as a lot of the instrumentation evolves, I do think the single port will be the way to go in the future. Each time you can reduce the number and length of incisions, the better for the patient.” Jeff Latimer, DVM, owner of Princess Animal Hospital in Kingston, Ontario, Canada, says that veterinarians owe it to themselves and their patients to perform laparoscopic-assisted spays in the fastest and easiest way possible. He uses a one-port technique on the midline of the patient. “When performing biopsies and exploring organs, you will need to use a multiport technique,” he says. “If you buy a single-port system, it will come with the necessary items that you will need to place one or two more ports as needed. “If you buy a system that is only able to be used with multiple ports, you will likely choose not to perform spays, as the benefits are lost if you have three small incisions instead of one,” he adds. Veterinarians who choose the single-port approach must ensure that the instruments they purchase are long enough to go through the scope, Dr. Latimer notes. Benefits for General Practitioners Mayo, who has taught the laparoscopic-assisted spay technique to veterinarians across the United States and Canada, says that certain large metropolitan areas of the country seem to embrace the procedure more than others. “It has been slow to catch on, and I think practitioners are finally starting to see the value in the procedure itself, as well as the other procedures and income that rigid endoscopy can bring to their practices,” he says. Latimer says that his practice now performs 75 percent of its canine spays using laparoscopy. The technique is performed using BioVision’s one-port system, through a 10-millimeter operating scope. However, the laparoscopic-assisted spay technique wasn’t what prompted his practice’s purchase of the system. “Using one port, we can get diagnostic-sized biopsies of liver, spleen, kidneys, pancreas and intestines while being much less invasive than when performing a traditional exploratory,” Latimer says. “It was being able to provide a new option for the pet owners in Kingston that drove the decision to purchase the equipment. Using the equipment for spays is just an added bonus.” Similarly, Dr. Houchens says that his client base has been overwhelmingly receptive to the laparoscopic-assisted spay technique, which he has been performing for nearly two years. Interest in the procedure skyrocketed after his practice and its use of the technique were featured in a local newspaper. This past August, his practice ceased to offer the traditional open spay as an option. Craig Stoenner, DVM, of All Pet Complex Veterinary Hospital in Boise, Idaho, says his practice has also moved to exclusively offering the laparoscopic-assisted spay technique. “As a group, our veterinarians decided that since this is the best way to do the procedure, it’s the only way we should do it,” he says. “As a profession, veterinary medicine continues to evolve,” he adds. “Twenty years ago, we didn’t supplement patients with fluids, and we didn’t perform preliminary blood work. Now practitioners do these things because we’ve realized they represent better medicine. And that’s the way we feel about the laparoscopic-assisted spay.” Training Requirements Mayo says it is important to learn other procedures before tackling the laparoscopic-assisted spay. This enables practitioners to become comfortable with the equipment, he says. “Once the practitioner is comfortable with performing simple procedures—such as biopsies in a two-dimensional live image—then I would move on to the laparoscopic-assisted spay techniques,” Mayo says. “That being said, I have met a fair number of doctors who can pick up the procedure fairly easily in a staged teaching environment in a single day.” Dr. Devitt, developer of the laparoscopic-assisted OHE technique, says that a single training course is enough to get a general practitioner started with the laparoscopic-assisted spay technique. “However, it’s worthwhile to consider taking two or more courses,” he says. “It greatly increases a practitioner’s comfort level in performing the procedure. Latimer concurs. He says he purchased his equipment last fall and spent a day of formal training on the single-port laparoscopic-assisted spay technique. “I returned from this and spayed eight to 10 dogs for the humane society,” he says. “After this, I began spaying our own clients’ dogs, without charging more for the service. I then did a three-day advanced lab at Colorado State University,” Latimer says. “After this lab, I felt comfortable charging for this service and giving the clients the choice.” Paul Young, DVM, of the Sunset Boulevard Animal Clinic in Houston, Texas, began working with the single-port laparoscopic-assisted spay technique toward the end of 2007. He did about 10 procedures in the first month after training. “The training was at a good pace, and not too advanced for the first-time user of the equipment,” he says. “To anyone who is interested, I would highly recommend taking another veterinarian from the practice—or their primary surgical technician—to the training sessions. Having an extra set of ears and eyes for this kind of work is invaluable.” Healthy ROI Regardless of the clinical benefits of laparoscopic-assisted spays, many general practices have been slow to adopt the technique, with major reasons for hesitation being the initial start-up costs and training requirements. Latimer says the main drawback to the technique is that practitioners must relearn how to spay a patient. “I have been doing this for six weeks, at an average of a surgery a week, and I am down to 50 minutes,” he says. “The good news is that the big fat Labrador is just as fast as the small dog. “There is also a learning curve for your staff to learn how to prepare the instruments,” he adds. Mayo says that seasoned laparoscopists can comfortably spay a dog in 20 minutes. Moreover, he says, the return on investment is healthy. “It is difficult to charge enough for spays to support the costs of the equipment,” he notes. “If a practitioner is considering obtaining rigid endoscopic equipment, I recommend learning not only the spay, but also the cryptorchid neuter, organ biopsies, gastropexies, rhinoscopy and cystoscopy.” Dr. Stoenner says that a practice does not need to be large to benefit from adding the laparoscopic-assisted spay to its offerings. “The single-port system in particular is really designed for the general practitioner,” he says. “The equipment very easily pays for itself. If veterinarians are looking for services to help build their practices, this does that very well. Not only does it elevate the perception that the client has of your clinic, but it is also something that your staff will take great pride in.” Click here to watch a five-minute training video of a lapraoscopic spay, courtesy of Karl Storz Endoscopy-America Inc. <HOME>
