Edition 13 - Is there less pain post-surgery with a laparoscopic spay compared to a celiotomy?
- zeropainphilosophy
- 4 days ago
- 4 min read
Do we see improved outcomes with laparoscopic ovariectomy (lapOVE) compared to open ovariohysterectomy (OVH)? It’s a valid question when considering should your practice move to performing laparoscopic procedures, and how you can potentially market the benefits to your clients.
In 2025 Moxon et al examined the differences between laparoscopic ovariectomy and an open celiotomy. This work can be summarised as follows;
· There was no difference in surgery duration
· There were fewer postoperative complications with lapOVE (0.5% vs 1.0%) – still a low complication rate for each procedure
· There were fewer cases reporting wound redness and swelling in the lapOVE group
· There was a lower incidence of behaviours associated with discomfort such as inappetence, licking and chewing after lapOVE.
· Overall there were differences in cases requiring vet attention (lapOVE 12.9% vs OVH 16.3%)
These authors concluded that laparoscopic OVE results in fewer peri and post operative complications compared with open OVH. Since the advent of lapOVE, the question has always been around differences in pain between procedures so we thought it worth a look at the literature.
What are your thoughts so far? Do you have enough information to use this as a justification to moving to laparoscopy over an open approach?
Back in 2005, two techniques were compared by Hancock et al – the harmonic scalpel assisted laparoscopy (HALO) and median celiotomy and ligation (OVH) in dogs. Outcome measures included pain scores using the University of Melbourne pain scale (UMPS), nociceptive threshold scores and plasma glucose, cortisol and creatine phosphokinase levels. Blood parameters were assessed at the time of the incision, and 2, 6, 12, 24, 48, and 72 hours after surgery.
The UMPS scale incorporates physiological parameters which we know are influenced by factors other than pain. Nociceptive thresholds are a useful outcome measure – in this work the authors assessed abdominal palpation pressure. The use of parameters such as blood glucose and cortisol have since been discounted for pain assessment, given the number of other factors that can influence here. Interestingly, the authors state this in their introduction - ‘inconsistent results have occurred when these measures are used alone to evaluate pain’
Abdominal palpation pressures were lower (less pain) in the HALO group (200-270 mmHg) at all times compared to OVH (122.5-233.7 mmHg).
CPK & glucose values – no significant differences at any time
At 2hrs post surgery, the mean OVH cortisol concentrations were significantly higher (527.4nmol/L; 42.9% increase) than the mean HALO cortisol concentrations (226.5 nmol/L; P=.0001). There were no significant differences at any other time point.
One consideration of note was that the HALO procedure was longer (55.7mins vs 31.7mins) compared to OVH – although this contrasts with Moxon above and will be influenced by surgeon experience.
The authors concluded that HALO dogs experienced less postoperative pain and stress than OVH dogs. This conclusion was based on higher UMPS scores in OVH dogs at all postoperative time intervals, higher plasma cortisol concentrations at 2hrs post surgery, and consistently more reaction to lower nociceptive thresholds at all intervals up to 72hrs.
How do you feel the evidence is stacking up so far? How does this influence your decision and what you say to your clients?
Published in the same year as Moxon et al, in their paper entitled ‘Assessment of Pain, Vital Parameters and Oxidative Stress Markers in Dogs After Celiotomy and Three-Port Laparoscopic Ovariectomy’, Naghavi et al (2025) examined pain and the surgical stress response to the two techniques.
Acknowledging that others have documented a reduction in pain with the laparoscopic approach, this work focuses on the effect of the CO2 insufflation; notably peritoneal acidosis and oxidative stress caused through ischemia–reperfusion mechanisms which risks oxidative stress, plus the visceral pain associated with that acidosis.
The outcome measures used were the University of Melbourne Pain Scale and markers of oxidative stress – malondialdehyde (MDA) and total antioxidant capacity (TAC), neutrophil count and white blood cell count.
Regarding pain, there were no UMPS differences between groups at any time, no dog exceeded the rescue threshold of 6/27 and no dogs required additional analgesia. All dogs received morphine 0.5 mg/kg as premedication with meloxicam 0.2 mg/kg SC. The authors concluded that both approaches results in a similar degree of post-op pain.
Information and detail on the oxidative stress markers is available in the manuscript. Briefly, MDA is a measure of oxidative stress whilst TAC is a measure of antioxidant ability. Between groups there were significant differences of both oxidative stress markers at the 7 days timepoint. The authors state that increased MDA levels in the open procedure demonstrates oxidative damage – debunking their hypothesis that insufflation of CO2 would contribute to a reperfusion injury and thence oxidative damage. The TAC levels were higher in the laparoscopy group one week after surgery. The explanation given for this may be due to the physiological effects of CO2 pneumoperitoneum used during laparoscopy, which can induce ischemia–reperfusion injury and possible organ ischaemia due to oxidative stress.
It is stated that future studies with larger cohorts and more frequent time points are warranted to validate and extend the present results. There were 12 dogs in the study and therefore post-hoc power analyses showed a very low power for pain outcomes.
So it doesn’t look like this paper adds further definitive evidence, however their introduction does state that existing work comparing differences in pain levels does support the lapOVE.
Other work you may wish to read to enhance the discussion on this topic;
Fuertes Recuero 2024
Postoperative pain in dogs undergoing either laparoscopic or open ovariectomy
Del Prete 2025
Comparison of outcomes between laparotomic and laparoscopic elective ovariectomy in anestrus dogs: postoperative recovery, pain and inflammatory biomarkers
These references and further links above will help you formulate your thoughts on laparoscopic OVE. In summary we are of the view that there is less pain with lapOVE. Over to you to decide.
References
Hancock RB, Lanz OI, Waldron DR, Duncan RB, Broadstone RV, Hendrix PK. Comparison of postoperative pain after ovariohysterectomy by harmonic scalpel-assisted laparoscopy compared with median celiotomy and ligation in dogs. Vet Surg. 2005 May-Jun;34(3):273-82. doi: 10.1111/j.1532-950x.2005.00041.x.
Moxon R, Yarwood E, Hawkins H, Came J, England GCW. Laparoscopic ovariectomy provides favourable peri- and postoperative outcomes compared with ovariohysterectomy via celiotomy in bitches. J Small Anim Pract. 2026 Jan;67(1):24-33. doi: 10.1111/jsap.70013.
Naghavi R, Kazemi Mehrjerdi H, Heidarpour M. Assessment of Pain, Vital Parameters and Oxidative Stress Markers in Dogs After Celiotomy and Three-Port Laparoscopic Ovariectomy. Vet Med Sci. 2025 11(6). doi: 10.1002/vms3.70683.