I recently adopted a 15-year-old Shiba Inu with a mild heart murmur. My vet has diagnosed her with vaginal hyperplasia and recommended laparoscopic spay.
The clinic just recently started offering this procedure. Should I consider the procedure given my dog’s age?
How many such procedures would be considered adequate for a vet to be considered proficient? Would the clinic give me information on complication rates?
Las Vegas, NV
You have asked some very astute questions.
Abdominal surgery in veterinary medicine is most frequently performed the old-fashioned way: the animal is anesthetized, the vet makes a relatively large incision, the areas of interest are visualized (often by removing them through the incision), and surgical work is performed. After surgery, the incision is closed with sutures.
Thanks to the development of laparoscopy, this type of procedure is rarely performed in humans (at least in developed countries) any more. Laparoscopic procedures are performed through a few very small keyhole incisions. A camera is inserted into the abdomen through one of the keyholes to guide instruments (inserted through other keyholes) during surgical work. The potential for pain is lower, the incisions are smaller, and overall physical trauma is markedly reduced.
Make no mistake about it: Laparoscopic procedures are the future. I expect them to become increasingly common. Laparoscopy is especially useful for surgeries such as prophylactic gastropexy (performed in certain breeds to prevent gastric torsion, known colloquially as bloat, later in life). Prophylactic gastropexy without laparoscopy is a relatively major procedure; laparoscopic gastropexy is a dramatic improvement.
Laparoscopy is rare in veterinary practice. The instruments are somewhat expensive, and vets fret that clients will balk at the higher prices associated with the procedures. More important, it takes a great deal of practice to become competent in laparoscopy (or, for that matter, any surgical procedure).
Your vet clearly is forward-looking, since he or she is moving into laparoscopy. But your question about proficiency is spot-on. Fifteen-year-old dogs with heart murmurs are not prime anesthetic candidates. You want the procedure that will minimize the risk of surgical and anesthetic complications. This will depend entirely upon your vet’s proficiency with the scope and its accompanying instruments.
I recommend that you ask your vet directly how many traditional and laparoscopic spays he or she has performed. Ask about his or her experience with the new procedure in older animals. Ask about length of surgical time for laparoscopic spays versus traditional spays. Ask your vet for his or her complication rates with the new and old procedures (personal complication rates are more useful than general ones). Veterinarians have a responsibility to answer these sorts of questions, and clients have a right to ask them.
It may turn out that laparoscopy is the best bet. But it also is possible that your vet is recommending the procedure because he or she is anxious to gain experience â€” in that case, a traditional procedure would be much superior.
Two final thoughts: I recommend that you investigate your dog’s heart murmur more thoroughly before you anesthetize her. It could be benign, but only a heart ultrasound can determine that. If I had to choose only one piece of high-tech equipment to use in your girl, I would prioritize an ultrasound machine over a laparoscope. Also, ask your vet about his or her confidence that the procedure will address the vaginal hypertrophy, and try to confirm that spaying her is in her best interest. In my opinion, this matter is not a foregone conclusion.