Introduction

Recent studies revealed that conventional ovariohysterectomy (OVH) causes more post-surgical pain and morbidity in comparison to recently developed minimally invasive approaches. However, such endosurgical techniques must be systematically assessed for safe use in the routine.

Objectives

The aim of the current study was to compare pain and stress following recently developed natural orifice transluminal endoscopic surgery (NOTES group), single-port laparoscopic-assisted (SPLA group) and traditional celiotomy (OPEN group) approaches for OVH in bitches.

Methods

Ten mongrel bitches were assessed per group. NOTES-OVH was performed following the insertion of a single trocar into the abdominal cavity through a cul-de-sac vaginal incision. An operative laparoscope was used and a bipolar forceps were inserted through its working channel for both coagulation and resection of the ovarian pedicles, as performed in the SPLA group. Pain and stress were assessed using the visual analogue scale (VAS) and serum cortisol, respectively, in different moments: baseline (M0) and 1, 2, 4, 8, 16, and 24 hours following extubation (M1-24).

Results

Pain scores remained above the baseline until M4 in NOTES, until M8 in SPLA and in all moments in the OPEN group (p < 0.0001). Natural orifice transluminal endoscopic surgery and SPLA presented lower VAS scores than OPEN in all moments (p < 0.001). Serum cortisol was above the baseline until M4 in the OPEN group (p < 0.0001). The requirement for rescue analgesia using the VAS criteria was higher in the OPEN group (p < 0.05).

Conclusions

The NOTES and SPLA approaches were less painful and stressful than conventional OVH in bitches and provided better convalescence.