Will Laparoscopic Spay Replace Open Celiotomy?

August 16, 2018
Natalie Stilwell, DVM, MS, PhD

Dr. Natalie Stilwell provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting. In addition to her DVM obtained from Auburn University, she holds a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida.

A recent survey assessed the views of veterinary professionals regarding minimally invasive spay techniques.

Although increasingly popular, minimally invasive spay techniques, including single-port (SP) and 2-port (TP) laparoscopy, are more expensive than traditional open celiotomy. Experimental ovariectomy methods that are not yet established in veterinary medicine include natural orifice transluminal endoscopic surgery (NOTES), which is performed by passing a camera orally into the stomach and then using an incision to enter the abdomen.

Researchers recently assessed the perceptions of various ovariectomy methods among employees and students at 5 North American veterinary teaching hospitals. The investigators hoped the study would establish a baseline with which to compare future general-population data on this topic.

Study Design

An electronic survey was distributed in 2015 to dog-owning veterinarians, veterinary technicians, and veterinary students at the University of Pennsylvania, University of California-Davis, University of Florida, Ontario Veterinary College, and Colorado State University.

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The survey included written and visual descriptions of 3 canine spay techniques performed at all participating institutions (open celiotomy, SP laparoscopy, and TP laparoscopy), as well as the experimental technique known as NOTES. Descriptions included average duration and perceived benefits of each technique. The average cost of open celiotomy was listed as $260.

Questions assessed owner and pet demographics, including surgical histories. Respondents were then asked to consider a hypothetical scenario for their own pets in order to (1) rank order of preference of the 4 surgical procedures, if cost was not a factor, (2) choose among the 3 minimally invasive approaches (SP laparoscopy, TP laparoscopy, or NOTES) with the option to refuse surgery, and (3) state how much more money they would pay for minimally invasive sterilization compared with open celiotomy.

Results

One thousand eligible participants completed the survey, including 165 veterinarians, 271 technicians, and 564 students. Response rates from each institution ranged from 11.2% to 58.5%, and 80.6% of respondents were female. Participants owned 1435 dogs at the time of the study; 94% were already sterilized and 34.6% had also undergone other surgeries.

Responses to the 3 main questions were as follows:

  • If money was not a factor, most owners preferred TP (54.5%) or SP (33.8%) laparoscopic spay to other techniques.
  • If open celiotomy was not available, 60.4%, 37.6%, and 1.7% preferred TP laparoscopy, SP laparoscopy, and NOTES, respectively; the remaining 0.3% would refuse surgery rather than choose a minimally invasive procedure.
  • All respondents indicated they would pay more for minimally invasive spay techniques compared with open celiotomy, with responses ranging from an additional cost of less than $100 to $1000 to $2000 extra.

Veterinarians and respondents over age 35 were most likely to prefer open celiotomy to minimally invasive techniques, while owners of dogs with previous laparoscopic surgeries were more likely than other respondents to choose first-choice laparoscopy.

Major Conclusions

Most respondents in the veterinary community perceived minimally invasive spay procedures, particularly SP and TP laparoscopy, as popular alternatives to open spay. The authors believed their description of the NOTES procedure as “experimental” likely deterred respondents from choosing it over other methods.

Dr. Stilwell received her DVM from Auburn University, followed by a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida. She provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting.