What is laparoscopic surgery or keyhole surgery?

Laparoscopic surgery is a technique using specialized equipment to make tiny keyhole incisions to gain access to the abdomen using equipment that gives you a high-resolution, close-up picture of what's happening in the abdomen. And then, you use the equipment through extremely tiny incisions that you make to get into the abdomen to perform the procedure. Typically, if we needed access to the abdomen, we might have to make a long incision to see into the abdomen, but using keyhole surgery or laparoscopic equipment allows us to make tiny incisions to get instruments into the abdomen. And we then use magnification and video screens to see in much more detail what's happening in there. And so, it's a minimally invasive surgery technique. It's pretty standard in human medicine. They do a lot of surgical procedures on the human side using these techniques because they're less painful, there are fewer complications, and quicker healing times. It requires additional equipment and training, which is part of the reason why it's less prevalent in veterinary medicine. Fortunately, that is changing.

Dr. Shawn McCorkle
Summer Creek Animal Clinic

What are the differences between a laparoscopic spay and a traditional spay?

There are many differences, and one of the reasons we have been so interested in investing in this technology and the benefits of laparoscopic spays versus traditional spays is that we can access the abdomen and particularly the ovaries that we want to remove with tiny incisions. And so we can get to where we need to go without making a big incision in your dog's abdomen. Instead of healing in 10 to 14 days, they can heal up in as little as 24 to 72 hours in the sense that they're able to return more to their regular activity within one to three days. That's a huge benefit, especially when you're dealing with a younger animal, as it’s challenging to keep them quiet for that amount of time (the two weeks it would normally take for recovering from a spay).

And then the other thing is we have fewer risks of complications postoperatively because the incisions are very small, and you're less likely to have devastating consequences if the incision opens up like you would if it were a longer incision. And then, studies have shown that laparoscopic spays are 65% less painful and that the animals are 65% less painful postoperatively. And it's actually not as much to do with the incision size, but more to do with what we're doing with the ovaries. So in a standard spay procedure, we have to remove the ovaries from the abdomen to do that, and there is a ligament attached to the ovary that goes from the ovary to the diaphragm that keeps that ovary in place. And we have to manually break down that ligament to get the ovary out of the abdomen and do what we need to do safely. It is very painful to break down that ligament, as there are many nerve endings associated with it. So that's actually the most painful part of the procedure is breaking down that ligament. And so, you essentially have to tear it off of the diaphragm. And when you do that, those dogs wake up more painful because that area on their diaphragm is sore. Now, with a laparoscopic procedure, we don't have to bring the ovary out of the abdomen because we're putting the instruments that give us real high-resolution imaging into the abdomen. We get to remove the ovaries without tearing that ligament, which is a significant benefit in pain control during the procedure and postoperatively.

The other massive benefit of laparoscopic surgery is there will be less risk of bleeding during the procedure because, again, as we're tearing those tissues to try to get the ovary where we can handle it appropriately during a traditional spay, there are many vessels and that gives us more risk for that type of bleeding. However, with a laparoscopic or minimally invasive spay, we’re able to ligate with electrocautery those vessels without having to tear anything. And so the chances for bleeding are significantly less, and that, in turn, reduces the risk for your dog.

The only negative side is that laparoscopic space requires significantly more costly equipment. And the equipment requires a lot more handling before and after the procedure and much more training to handle that equipment appropriately. And so, the cost of doing these procedures is higher.

Besides dog spays, what other procedures might laparoscopic surgery be used for?

One example would be a liver biopsy. So liver disease in dogs is quite common, and it's often difficult to understand the underlying cause without doing a BI of the liver. That typically means that we can do a workup to try to understand what's going on. And then we kind of get stuck with, well, if we're going to figure this out, we end up having to do the liver biopsy, and traditionally that has to be done with open surgery. You have to open up the abdomen to access the liver and get the biopsies. That’s highly invasive and often a little too much for pet owners to wrap their heads around. It's just very invasive. And so, with laparoscopic techniques, again, we can make small keyhole incisions where we need them to access the liver and obtain biopsies and be able to visualize all of the surrounding organs in a really detailed way with the high-resolution magnifying imaging on the screen. And so it allows us to do those types of procedures where it's not going to be major surgery with weeks of recovery, but we can do the procedure quickly with tiny incisions. So again, the dog heals in a matter of days, and we get the diagnostic details that we need, particularly with the liver, to understand what's going on. So then we can treat the root problem, and that's often difficult for us to do with certain diseases without biopsying the tissue.

So liver biopsy would probably be the biggest thing, but you can get biopsies of other organs that again would otherwise require open surgery—pancreatic biopsies, kidney biopsies, intestinal biopsies. And then there’s what's called laparoscopic-assisted procedures. For example, a cystotomy where you make an incision into the bladder to deal with bladder stones is the most common reason we’d do a bladder surgery. We can use the laparoscopic equipment to access the bladder, to bring it to a position on the abdomen where we can then make a smaller incision to access the bladder. So we don't have to make as long of an incision on the abdomen to access the bladder. So it's not entirely done laparoscopically, but the laparoscope assists the procedure in making it as minimally invasive as possible. There are also more specialized procedures like removing the gallbladder, which can sometimes be done with a laparoscopic technique. Many people still like to do that with open surgery. You can also do what's called rhino on the dog’s nasal cavity, so you're looking at the airways.

Will a specialist be needed to perform laparoscopic surgery?

Yeah, that's a good question because, in most contexts, that is the case. We can do a laparoscopic liver biopsy here in Fort Worth, Texas. For example, I personally have taken one of my dogs to a specialist to have a laparoscopic liver biopsy done. However, the reality is it doesn't require a specialist to use this equipment. It just requires somebody willing to invest in it and take the time to do the training. And so, at Summer Creek Animal Clinic, that's what we want to do. And starting in early 2022, we're going to be offering these types of procedures so that they don’t require referrals and are a more cost-efficient way because we're not a specialty facility. We hope to provide these really helpful surgeries and diagnostic procedures in a context where a client and patient are more comfortable with their primary care physician. It doesn’t require a referral to a separate facility. Now, of course, with certain conditions and more complicated situations, we refer to our partners with the tools and equipment available, but in a lot of these cases, it's not necessary that that be done. We just end up referring because we don't have access to that type of thing. So, the shorthand answer is no; laparoscopic surgery does not require a specialist, just somebody that has extensive training with the equipment and a desire to provide this level of care.

How does the cost of laparoscopic surgery compare to traditional surgery?

Laparoscopic surgery will be more expensive in most cases because, again, the equipment is so much more expensive and so much more tedious to care for than the standard surgical equipment. However, you also have to factor in how this kind of surgery makes things more efficient. And so that can help bring the cost down some, and there are certain situations with more flexible laparoscopic equipment where that can be the case more readily. Overall, it’s likely to be more expensive, but how much so depends on the procedure and the equipment and time involved.

Why would my veterinarian recommend laparoscopic surgery for my dog?

We can highlight the benefits, as this makes us really passionate and excited about this type of procedure. There is less pain for your pet in a quicker recovery time from these procedures, and the value of that cannot be overestimated. This equipment allows you to do things that you just couldn't imagine before having a dog recovered from a procedure in one to three days, and that is unheard of with traditional surgical techniques. For example, if you have a dog that is, say, six months or a year old that is going to get spayed. The clients are often very concerned about keeping that pet in an E collar for that long—keeping them quiet for nearly two weeks, which is virtually impossible. And unfortunately, devastating things can happen if they're too active and that incision opens up.

So being able to provide a technique that makes your dog so much less painful postoperatively and allows quicker recovery time is huge. So in my mind, that's the biggest thing. And I think that's the thing that clients want more and more. They’re more attuned to what's happening with their pets, and they want their pets to be comfortable and recover quickly from these procedures. That's why we would recommend it primarily for less painful and less invasive procedures with quicker recovery time.

Clients who are really connected with their pets have hesitations with referring outside of the facility that they're most comfortable with. So we may have a client willing to have the additional diagnostic procedures done. For example, a liver biopsy or an intestinal biopsy could be super helpful for understanding what's going on, allowing us to treat more specifically the disease process. But they stop short of spending an extra 2000 to $2,500 on referral. So having this available in a primary care facility like Summer Creek Animal Clinic provides all of those benefits and more, and we're excited about it. So if you have more questions about this type of procedure, understanding laparoscopic or minimally invasive surgery, we would love to chat with you more about it. We're also going to have more and more information available on our website, as our goal is to help educate you more.

If you still have other questions and you'd like to reach out to us, you can call us directly at (817) 523-1139, you can email us, or you can reach out on Facebook. But please do reach out, and we'll get back to you as fast as we can.

Dog Laparoscopic Surgery - FAQs

Dr. Shawn McCorkle
Summer Creek Animal Clinic

What is exploratory laparoscopy in dogs?

It's a surgical technique using specialized minimally invasive surgical equipment to access the abdomen of a dog or cat. It allows us to access the abdomen through very small incisions to insert equipment that has high-resolution magnified cameras. This way, we can see what's happening on a large screen outside of the abdomen without making large incisions. It is beneficial because you can get a closer look at the abdomen's organs because you're using magnifying equipment. So it's better than looking with the naked eye. With laparoscopic techniques, you can get to areas of the abdomen that are much more difficult to look at from the outside. Depending on the technique, you make very small incisions, insert various equipment through your ports, and look around the abdomen.

When we're talking about an exploratory laparoscopic procedure, we're using this minimally invasive technique to look at all the different organs in the abdomen. For example, we may get a liver biopsy in the front part of the abdomen. We get to look closely at the liver and all its different lobes with this equipment. We can look at the gallbladder, kidneys, which are close to the stomach, and the intestines in a lot more detail than we could with a large incision. A less invasive technique allows us to investigate better. That's what an exploratory laparoscopic procedure is.

How can laparoscopic surgery help my dog?

We're passionate about bringing this technique to general practice because it allows dogs and cats to have frequently performed procedures with significantly less pain, up to 65% less pain, and a much quicker recovery time. They normally recover in 10 to 14 days, wear the cone of shame, and be kept quiet on a short leash or in a kennel. This type of procedure allows them to heal well enough within one to three days to return to normal activity. So it is very beneficial for your dog. That's why clients are interested in this type of procedure, which is commonly done with humans.

Another big thing that I think is a barrier for clients is the fact that these types of procedures can only be done when they are referred to a specialist. They would be more willing if it could be done where they're most comfortable, like with their primary care veterinarian. If it requires a referral, they are less inclined to do it. We're able to help more dogs with these types of procedures because we can do it in a more comfortable environment at Summer Creek Animal Clinic, where clients are used to being.

How effective is laparoscopic surgery in dogs?

Extremely effective. Especially because the technology with this type of equipment is quite advanced. The imaging and detailed evaluations we can get with this precise equipment allow us to do very effective procedures. A spay, for example, can be done with this minimally invasive technique. It's probably the most common procedure done, and it allows us to remove the ovary and the uterus as well. But many studies show that it's only necessary to remove the ovaries unless the uterus is already diseased. By removing the ovaries, the risk of disease in the uterus is extremely low to the point where it's not necessary to go through the additional trauma of removing the uterus. That's actually the standard procedure being done all over Europe and is becoming more common in the states. The laparoscopic equipment allows us to hone in on the ovary a lot more effectively because we can see all the surrounding structures and ligate where we need to with specialized electrocautery equipment. We can remove the ovary with minimal to no bleeding.

Is dog laparoscopic surgery curative?

It depends on what we're trying to accomplish. If we're talking about a spay, laproscopic surgery is curative compared to traditional surgery. It's completely effective at removing all ovarian tissue and getting the job done. Another thing that we would use this equipment for is a liver biopsy, for example, where it won't be curative because it's a diagnostic tool. We use the equipment to access the liver with a minimally invasive technique rather than opening the abdomen up, but it's not curative in the sense that we're curing the disease. We're getting tissue samples from the liver so that we can try to get an answer as to what's going on inside. That would require us to do major surgery if we didn't have this laparoscopic equipment.

So it changes the way that we approach a lot of these common issues we come across. Whether it is something as routine as spaying a dog, removing the ovaries, or something more complicated, like a pet with significant liver problems. It's maybe not even significant liver issues at the moment, but there may be evidence in the blood suggestive of something problematic. We were often left guessing before we had liver biopsies. Performing biopsies using this technique that doesn't require major surgery provides an opportunity to get a definitive diagnosis. That's the hope with the biopsies. We can treat that disease directly. It's not a cure, but we can manage it more successfully with a definitive diagnosis, which you don't always get without a biopsy. This equipment and minimally invasive technique allow us to operate more efficiently and perform appropriate therapy directed at the underlying problem with less trauma for the pet.

Is keyhole surgery a better option than open surgery?

In my opinion, yes. It is a better option as it's significantly less painful, less invasive, and there's a quicker healing time. The pet can return to normal activity, like chasing a ball and running around the backyard in significantly less time than with traditional open surgery. We can more readily perform diagnostic procedures that might otherwise be too cost-prohibitive because open surgery for obtaining biopsies is more expensive or just too invasive for clients to agree to. This minimally invasive keyhole laparoscopic procedure to obtain biopsies or other diagnostic procedures often presents a much lower barrier for clients. They more easily say, "Yes, I want to understand what's going on better so that we can treat my pet more appropriately." In many different ways, it is a better option than open surgery.

With that said, there are limitations. We still need to go into the abdomen with certain surgeries because the laparoscopic minimally invasive technique is not enough. For example, if we have a splenic tumor and we need to remove the spleen, it can't be done effectively through a small port incision. It will require a full open surgery to get the best outcome. So there are certain situations where it's not better, but in most common procedures, it provides a great alternative because of all these discussed reasons.

If you still have other questions and you'd like to reach out to us, you can call us directly at (817) 523-1139, you can email us, or you can reach out on Facebook. But please do reach out, and we'll get back to you as fast as we can.