A laparoscopic approach for removal of ovarian remnant tissue in 32 dogs

Abstract

BackgroundSurgical treatment of ovarian remnant syndrome (ORS) in dogs usually necessitates large celiotomies and considerable manipulation of organs because of the relatively deep position of ovarian remnant tissue, large patient size, and often encountered adhesions. In women, laparoscopic treatment of ORS is successful and has significant advantages over laparotomy. Since laparoscopic ovariectomy has significant advantages over open ovariectomy in dogs, including reduced surgical stress and postoperative pain and shorter convalescence period, the rationale for a laparoscopic approach of canine ORS is evident. Feasibility and efficacy of a laparoscopic approach for treatment of ORS in dogs was prospectively evaluated using a standardized protocol for diagnosis, treatment, and follow-up. Treatment success was evaluated by histology of removed tissues, postoperative hormone testing, and long-term clinical follow-up.ResultsThirty-two client-owned predominantly medium and large breed dogs diagnosed with ORS underwent abdominal ultrasound for ovarian remnant localization prior to laparoscopic surgery for removal of ovarian remnants. Tissue dissection and excision was performed using a vessel sealing forceps. Laparoscopy subjectively enabled detailed visibility and facilitated detection and removal of suspected ovarian tissue in all cases. Histology confirmed ovarian origin of removed tissue in all dogs. Additionally, a GnRH stimulation test was performed in fourteen dogs after a median follow-up of 10.5 months, which verified absence of residual functional ovarian remnant tissue in all dogs. Median surgery duration was 97.5 min and mean total convalescence duration, subjectively scored by owners, was 1.5 ± 0.7 days. No major complications occurred. Adhesions were observed in 79% of the dogs, complicated the surgical approach, and significantly affected surgery duration (85 versus 109 min; p = 0.03). Minor hemorrhage occurred in 12% and significantly increased surgery duration (95.5 versus 128 min; p = 0.02). Trendelenburg position and lateral tilting of the patient were essential for proper access to ovarian remnants. GnRH stimulation test results and/or absence of clinical signs indicative of ORS after a median follow-up period of 22.5 months confirmed treatment efficacy in all dogs.ConclusionLaparoscopic surgery for ORS in dogs is effective with minimal complications and short convalescence and can successfully replace the conventional, more invasive open surgical procedure.Electronic supplementary materialThe online version of this article (10.1186/s12917-018-1658-y) contains supplementary material, which is available to authorized users.

Neurobiology of anesthetic-surgical stress and induced behavioral changes in dogs and cats: A review

“…Sex steroids are known mainly for their role in fertility and reproduction, but during stressful events, they are also mediated by the HPA when it recognizes a nociceptive stimulus [32,33]. The effects of gonadocorticoids vary, but, in general, testosterone, LH, and FSH concentrations decrease during the first 5 post-operative days [32,34,35].…”

A systematic review of complications related to laparoscopic and laparoscopic‐assisted procedures in dogs

“…Classification of studies by organ system is presented in Tables S1 and S2. Numbers of studies and participants were reported within each organ/system group including female genital tract (22 studies [n = 1407 dogs]), 1,7,11,20,30‐47 urinary tract (7 studies [n = 114]), 3,48‐53 stomach (9 studies [n = 250]), 10,18,54‐59 intestinal tract (5 studies [n = 48]), 60‐64 liver (5 studies [n = 288]), 12,17,65‐67 adrenal gland (5 studies [n = 62]), 13,28,68‐70 spleen (7 studies [n = 111]), 19,71‐76 and other (4 studies that included gastropexy and ovariectomy procedures [n = 148]) 9,77‐79 . One experimental study, in which colopexy in seven male dogs was described, was classified as intestinal tract even though these dogs were also sterilized during the surgical procedure because this study reported only complications and outcomes related to colopexy 63 .…”

“…The benefits of minimally invasive laparoscopic surgery compared with conventional open surgery are numerous and include increased diagnostic accuracy, improved visibility, 1 decreased patient stress and postoperative pain, faster patient recovery, reduced infection rate, and decreased morbidity and hospitalization stay 2‐8 . The use of laparoscopic and laparoscopic‐assisted techniques is becoming increasingly commonplace in small animal surgery, most notably for elective procedures including ovariectomy and elective gastropexy 9‐11 .…”

Ovarian sex-cord stromal tumor in Yorkshire Terrier dog

“…However, Sontas explained that the causes of ORS may include the presence of ovarian residue resulting from a surgical technical error or the presence of accessory ovarian tissues at the adjacent tissue (Sontas et al, 2007). These remnant tissues will continue to secrete sex hormones and the bitches will then present clinical signs of proestrus, estrus, ovarian or mammary tumors, or stump pyometra (Ball et al, 2010;van Nimwegen et al, 2018). The symptoms mentioned above may occur within a week to several years following the neutering of the animal (van Nimwegen et al, 2018;Vissiennon et al, 2010).…”

“…These remnant tissues will continue to secrete sex hormones and the bitches will then present clinical signs of proestrus, estrus, ovarian or mammary tumors, or stump pyometra (Ball et al, 2010;van Nimwegen et al, 2018). The symptoms mentioned above may occur within a week to several years following the neutering of the animal (van Nimwegen et al, 2018;Vissiennon et al, 2010). Furthermore, these remnant tissues will continue to function as normal ovary and may be risk of developing ovarian tumor (Oliveira et al, 2012).…”