A spay refers to a procedure undertaken in veterinary surgery to remove the reproductive organs of a pet in order to prevent breeding, unwanted litters and/or some associated medical conditions. But there are several widely used approaches – so which one is better?

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What are the different spay approaches?

In cats, there are 2 different “traditional” approaches to a spay, the midline or “open” incision or the flank incision. In dogs, flank spays are less common as it is harder to reach all of the organs due to a deeper abdominal cavity and more anchored / stronger ligaments on the ovaries making it harder to access them in this position. Midline approaches in dogs are therefore the most common spay approach. 

Laparoscopic spays can be performed in both cats and dogs and is sometimes used in exotics such as rabbits. 

Midline or “open” spay 

With the midline approach, the underside of the belly is cut to give access to the abdominal contents and reproductive organs. This approach cuts through the linea alba; a fibrous portion of connective tissue between the tummy muscles that heals more quickly than the muscle itself, giving it an advantage over some other approaches. Also, should a complication arise, this approach allows the surgeon to quickly extend the incision and visualise the whole abdomen and correct any complications / stop any bleeding. 

Flank spay

A flank approach involves an incision into the side of the belly to visualise the reproductive organs and remove them. The advantage of this approach is that should a complication arise with the healing of the incision postoperatively or the patient interferes with the surgical site, it is less likely that organs would prolapse out of the site leading to catastrophic complications. It tends to be a slightly quicker procedure than midline also, reducing anaesthetic risk due to that fact. 

Laparoscopic spay

Laparoscopic spays are minimally invasive and involve 2 small incisions in the underside of the belly. A small amount of gas is then introduced into the abdomen, creating a tent effect. This lifts the body wall away from the internal organs; facilitating the surgeon to have great visibility of the abdominal contents and reproductive organs. A small camera is inserted to visualise the ovaries which are then surgically removed through the other incision. A laparoscopic spay almost always involves an ovariectomy only, where the ovaries and not the uterus, are removed. 

What is an Ovariectomy and Ovariohysterectomy and is one better than the other? 

Ovariectomies involve removal of the ovaries alone and not the uterus; also in contrast to an ovariohysterectomy where both the ovaries and the uterus are removed. In dogs, uterine cancers and diseases are typically caused by the female hormones oestrogen and progesterone, produced by the ovaries. And so with removal of the source, the risk of these diseases are very small. 

Removal of the ovaries alone is less traumatic than ovary and uterus removal. And so it has become more common to perform ovariectomies in dogs with either midline “open” approaches or laparoscopic approaches. This is because the benefits frequently outweigh the risks. 

What are the benefits of laparoscopic spay? 

  • A less invasive procedure 
  • Quicker recovery times postoperatively 
  • Reduced pain for the patient postoperatively due to techniques being very gentle on internal structures
  • Surgical wounds tend to be smaller laparoscopically
  • Postoperative rest period can be reduced to 5 days on average compared to the usual 10-14 day recovery of traditional spay approaches
  • There are significantly reduced risks of complications

Are there any additional risks or disadvantages of laparoscopic spays?

  • If complications occur, most can be dealt with using specialist laparoscopic instruments but sometimes it is necessary to convert the procedure to a full “open” or midline approach for better visualisation and to treat any problems. This generally results in no long-term or lasting effects. 
  • In smaller patients, surgical instruments may be too large (although smaller kits are now available) and so it may be too cumbersome to attempt the procedure in these patients. 
  • Longer anaesthetic time may be necessary for laparoscopy due to the time it takes to set up the specialist equipment and the skills involved in using that equipment. 
  • A lot more fur will need to be clipped than in traditional methods as the surgeon needs access to the whole of your pet’s tummy for laparoscopy. Fortunately it doesn’t take long to grow back, though it’s always nice to know what to expect. 
  • Cost: laparoscopic surgery involves specialist equipment and a specially trained veterinary surgeon and so it is charged at a higher cost than a traditional spay. 

When might laparoscopic spays be better than the more commonly used approach?

  • Larger dog breeds definitely benefit from laparoscopic spays as in open techniques the surgeon is required to pull the ovaries up into the incision to visualise and remove them, this causes pain and discomfort to the patient and slows recovery. Laparoscopic techniques are much less invasive in these patients, reducing the risk of intraoperative bleeding, and post-operative pain and complications. 
  • Anxious pets that don’t respond well to pain or have a low pain threshold could benefit from a less invasive surgery with smaller incisions and quicker recovery times. 
  • Very active pets that don’t like to sit still may benefit from smaller incisions and reduced recovery times of laparoscopic surgery as well as the reduced post-operative risks associated with this technique of surgery. 

When might traditional spay techniques be better for some pets?

  • Very small patients may benefit from traditional midline or open techniques due to the size of the equipment making the procedure more difficult and risking damage to organs due to this
  • Older pets or pets with suspected or known disease of the uterus would be better having the traditional surgical approach due to better visualisation and easier removal of abnormal tissue and organs. This also allows the surgeon to explore the abdomen and ensure there is no other concerning disease in these patients. 
  • Pets with other known illnesses may benefit from traditional techniques due to slightly shorter anaesthetic times, reducing the risk of anaesthetics due to their illnesses i.e., those with heart disease or lung diseases. 
  • Overweight pets, due to laparoscopic surgery requiring patients to be positioned on their backs, and their abdominal cavities filled with gas for the procedure, overweight patients can have complications with gas pushing on their diaphragms impeding breathing. Risks of bleeding also increases with overweight patients. Weight loss would always be recommended if laparoscopic surgery was preferred.  

Can any vet perform a laparoscopic spay or do I need a specialist?

Laparoscopic surgery is an advanced technique requiring additional training for your vet to be able to undertake it skillfully. Until recently, this technique was limited to specialists and specialist centers. But now, with advancements in technology and equipment, more and more first-opinion vets are trained in, and have access to, the equipment needed for laparoscopic spay. Ask your veterinarian if you are interested in finding out more about laparoscopic spays and procedures in your clinic. 

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So, are laparoscopic spays better?

It depends on YOUR pet, their breed, size, age, and any concurrent illnesses that your pet may have. For larger pets, anxious pets that would benefit from a minimally invasive, procedure with less pain, or very active pets that would benefit from a reduced surgical incision and reduced risks of post-op complications, yes, laparoscopic surgery certainly could be better for these patients. 

I would recommend you talk to your vet about your pet. They can best advise you on the suitability of your individual pet to undertake a laparoscopic spay. 

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