Learning Curve and Initial Experience with Laparo-endoscopic Single Site (Less) Ovariectomy Using a Multitrocar Port, Angled Telescopes and Articulating Instruments in the Dog

Objective
To define the learning curve, describe the technique and evaluate the outcome for dogs that had a Laparo- Endoscopic Single Site (LESS) Ovariectomy using a commercially available multitrocar port with articulating instruments and an angled telescope.

Design
Retrospective case series.

Animals
25 client-owned dogs.

Procedures
The SILSTM commercially available multitrocar port was inserted into the abdomen through a 15-20 mm incision at the umbilicus. A LESS ovariectomy was performed bilaterally using the SILS TM multitrocar port, articulating grasper, bipolar vessel sealing device and a 30o telescope. The excised ovarian tissue was removed through the multitrocar port incision between ovaries.

Results
25 dogs had a LESS ovariectomy. Median body weight was 20.3 kg (range, 3.5-41 kg ). Median surgical time was 30 minutes (range, 15-90 minutes). Median patient age was 334 days (Range, 184-2913 days). For a single surgeon, a Chomsky learning curve revealed that after the 12th procedure a surgeon reaches 90% of the fastest time expected (p =0.046) with a 95 % confidence interval. Complications included minor haemorrhage due to a splenic laceration for dog #13 and an incisional infection occurred postoperatively in dog #14.

Conclusions and Clinical Relevance
The learning curve for the LESS ovariectomy is short and definable. The LESS ovariectomy is a safe procedure that can be utilized as a minimally invasive laparoscopic sterilization technique. Caution should be taken to avoid splenic injury during multitrocar port insertion.