Authors : Emil Ofner, DVM
Ivica Ukić, DVM
Davor Crnogaća, DVM
Silvijo Tarasić, Eng; OLYMPUS d.o.o. Zagreb
Small Animal Veterinary Clinic More, Šibenik, Croatia
Key words : Gyrus PKS plasma SORD, Laparoscopic ovariectomy
Since the beginning of 2012 two hundred laparoscopic ovariectomyes with two – portal method was done in veterinary clinic More. The average body weight of female dogs was 25 kg. While no surgical problems were encountered in small and medium size dogs, overweight and obese patients demonstrated to be more challenging both for the surgeon and anesthesiologist. Because of problems encountered in large and obese female dogs, especially the difficulties of removing easily ovaries with large ovarian bursa, it was necessary to find new easier and faster way for removing such ovaries through laparoscopic portals without elongation of incision. That was reason for implementation of high frequency bipolar morcellator Gyrus PKS plasma SORD for fast removal of ovaries and its adherent burse in large and obese patients.
Materials and methods
All dogs were sedated using alpha-adrenergic agonists or acepromazine. Induction of anaesthesia was done with propofol. After intubation patients were maintained on isofluran. Analgesia during surgery was provided by constant–rate infusion (CRI) of fentanyl. Most patients were breathing spontaneously and ventilatory assistance was used if needed.
To facilitate ovary visualization laparoscopic positioner was used. Ovarian fixation for resection was done with a percutaneous needle technique. Resection of ovaries was done with bipolar forceps (Grus PKS) or ultrasonic knife (Ethicon). For large and obese female dogs removal of resected ovaries was done by bipolar high frequency Gyrus PKS plasma SORD morcellator.
A total of 200 laparoscopic two portal ovariectomies were done from the beginning of 2012. A body weight span of dogs was from 4.0 kg to 65 kg. The average body weight of female dogs was 25 kg. Of all dogs 29 % (58 dogs) were characterized large (above 30 kg) , overweight or obese (body condition score > 4) .
Time for ovary resection and removal in small and medium size dogs was similar like in large and obese dogs when using PKS plasma SORD morcellator. For both groups surgical time in most of the cases was under 40 minutes. For dogs under 30 kg average time was 23.45 minutes, and for large and obese dogs average surgical time was 34 minutes.
Only one dog had a postoperative wound infection which was managed with antibiotics and in one dog (8 years old Alaskan Malamute) we couldn’t establish pneumoperitoneum because of huge deposits of intra-abdominal fat tissue so we proceeded to open laparotomy.
Veterinary laparoscopic ovaryectomy is traditionally done by three – portal method and we can call it a universal method for every type and size of the patient. But, it’s not as minimally invasive as two and single portal method.
Single portal laparoscopic ovariectomy is only method which is the not universal or ideal for every patient because of technical, intraoperative difficulties (especially in obese and large female dogs) mostly related to difficulty in viewing anatomical structures for precise surgical resection. Single portal ovariectomy in our opinion can be only ideal for small and medium size female dogs from 7 to 20 kg especially before the first heat (5-7 months old female dogs).
Two portal method has some disadvantages, but we can also call it universal method for every type and size of dog. The main deficiency of two portal method was difficult removal of large ovaries with its adherent burse thrue laparoscopic portals in obese and large breeds of dogs. Also, using a percutaneous needle technique in two portal method for fixation of ovaries in the abdomen makes them very often hidden behind its adherent bursa and difficult for viewing in order to do a precise disection to get a smaller tissue piece for easy extraction (Picture 1).
Ovaries with adherent bursa in large and obese female dogs by our own measurements can be over 6 cm in diameter. The traditional method for removal of large ovaries was an elongation of laparoscopic portals by scalpel No. 11. Unfortunately, if you are using threaded trocars (we use endotip trocar type) this can be little challenging. Also making portal larger by incision is abandoning basic principles of minimally invasive surgery and causes more intraoperative trauma. Size of elongated incisions of laparoscopic portals is getting close to standard open laparotomy incision size and then we can’t absolutely say that we did minimally invasive surgery.
Problem of removal of large ovaries in three portal method is not so important because the surgeon can easily use scissors and forceps to divide such ovaries intra-abdominal in two or more segments and take them out separately but that also lengthens operation time.
Removing ovaries with large ovarian bursa is very often time-consuming and elevates stress on the surgeon and its assistants, also lengthens anaesthesia time and increases risk for the patient.
Also, there are mortality risks in obese patients during and after laparoscopic surgery that are proportional to operative time which is often increased in these patients. Because of that operative time becomes very important factor (Table 1).
Taking into consideration things mentioned above, we tried to make two portal method easy and fast even in large and obese patients (> 30 kg) with large ovarian bursa making surgical time for resection and removal of both ovaries under 30 minutes.
To achieve this we started to use human gynaecological bipolar morcellator Gyrus PKS plasma SORD (SORD – solid organ removal device) and HF generator Gyrus G400 (Picture 2, 3 , and 4).
Main advantages when using Gyrus PKS plasma SORD are :
- easy to use (Plug and play)
- small diameter (12 mm / 15 mm)
- light (250 grams)
Main disadvantages are :
- single use instrument (can be reprocessed)
- smoke production (use of insufflators with the automatic smoke evacuation system resolves this problem)
Two portal laparoscopic ovariectomy using Gyrus PKS plasma SORD morcellator makes this method suitable for technically demanding ovariectmies especially in large and obese dogs. Difficult ovariectmies in these patients are done with minimal intraoperative trauma without elongation of laparoscopic portals and short period of time (up to 30 minutes). After 3 years using Gyrus PKS plasma SORD morcellator we can conclude that to us it’s become a crucial instrument in every two portal laparosopic ovariectomy of obese dogs. Using this instrument makes two portal laparoscopic ovariectomy universal, fast and safe especially in large and obese dogs. Only downside of using Gyrus PKS plasma SORD morcellator is its price.