We hypothesized that the technique will be fast and the complication rates would be low in the study population. The first hypothesis was supported in that procedure durations was briefer than those reported for traditional prescrotal castration as mentioned by Miller et al (2018) [18] (1,9 minutes ± 0.5 minutes in cases with complications and 2,1 minutes ± 0.4 minutes in cases without complications in this study compared with 3.5 ± 0.4 minutes reported by Miller et al.). Based on this, we concluded that the technique in this study provides a rapid technique for castration. Shorter duration of castration in male dogs using Ligasure were reported also by Faluvégi et al. 2018 [19], but they used a prescrotal approach.
Another hypothesis for the present study was that the complication rate would be low. This hypothesis was supported in that presented technique resulted in no haemorrhagic complications for any of the 200 surgeries performed, and minor complications observed were self- limiting and only few. Based on these results, we concluded that the Ligasure scrotal technique provides a rapid and safe approach for canine orchiectomy.
Major hemorrhage associated with orchiectomy is uncommon in dogs [20], and most complications involving hemostasis result in scrotal hematomas, likely due to oozing from the vaginal tunic with open orchiectomy [1, 20]. According to Miller’s et al. experience [18], large dogs with large gonads will generally have a larger gonadal blood supply than small dogs with small gonads. Interestingly, dogs that were less than 10 kg were 3 times (CI: 0.9–11.3, P = 0.040) more likely to develop complications compared to the dogs that weighted more than 10 kg in our study. Anyway, the complications were not due to hemorrhage. No hemostatic complications were seen after Ligasure application in our study. The weight of the dog was the only variable that was significantly associated with complications (including both AMIC and AMICSC) following orchiectomy by scrotal approach using a vessel-sealing device in this study. We consider the behaviour and temperament of the small dogs to be mostly responsible for incisional complications.
All complications were identified at 24 hours post-surgery assessment and resolved without additional surgery. All incisional complications were managed by telephone communication with the owners. None of the owners with incisional complications felt that their dog required additional analgesia. The cases that developed incisional and scrotal complications (dog 46 and 118) were admitted for examination and additional analgesia with NSAIDs and antibiotics were administered. None of the cases required hospitalization or additional surgery. Both complications were encountered in client owned animals. In case 118, the owners were unable to apply the buster collar as soon as automutilation was noticed due to aggression of the dog. In case 46 that both incisional and scrotal complications were also observed, the application of the collar was delayed because the dog was left unattended for several hours. Based on this, we can assume that automutilation is an important factor in the appearance and progression of complications. In the authors’ experience, shelter animals had less complications, assuming that the distractions in the environment prevented automutilation or complications passed unnoticed.
In the uncomplicated cases contraction of the scrotum and elimination of the incisional gap was observed by day 3. In all cases that the complications were observed, sufficient regression of the scrotum with no incisional gap was observed by day 10. In the cases that both incisional and scrotal complications were observed (46, 118), some skin discoloration remained in the scrotal region by day 10. Nevertheless, the majority of the animals in the study did not require buster collar, and strict exercise restriction was limited to 24 hours post discharge. Interestingly, the limited postoperative restrictions and the avoidance of the buster collar were factors that were strongly appreciated by the owners when they were questioned regarding owners satisfaction. Assessment at 10 days after surgery is routinely performed by several practices but the value of assessment at this time point is questionable due to the fact that the majority of the complications arise the first days after the procedure [5]. Due to the uncomplicated healing and the rapid elimination of the incisional gap, most owners felt that further assessment was not necessary.
Activation of the vessel sealing system uses electrosurgical radiofrequency energy that causes the collagen and elastin in the blood vessel walls to reorganize within the tissue thereby forming a permanent seal [21]. Monopolar electrosurgery was used to incise the scrotal skin, and to control minor bleeding from septal vessels. Even though skin incisions made with monopolar electrosurgery were associated with decreased healing compared to scalpel made incisions [21], sufficient regression of the scrotum and no incisional gap was evident by day 10 in all cases. Clearly benefits in hemostasis improvements, and overall anaesthesia and surgery time reduction were demonstrated in many studies [22–27]. Even though there are reasonable concerns regarding the high cost of using VSD in routine procedures, appropriate re-sterilisation of the hand piece allows a significant reduction in the costs by increasing the number of procedures without decreasing safety characteristics [13, 28].
Several limitations of the study should be considered when interpreting the results. Some incisional complications could have developed beyond the 24-hour postoperative. Anyway, the owners were instructed to report any complication with the surgery. Similar to our study, in a previous report [5], most complications following canine orchiectomy were discovered at the 24-hour recheck examination and no complications were found at the next recheck examination, performed 10 days after surgery. The authors of the study also advocated for rechecking of patients in the immediate postoperative period and questioned the value of rechecking the patients 10 days after surgery.
We found only one study of postoperative complications after Ligasure orchiectomy in the peer-reviewed veterinary literature, thus, direct comparisons with the findings of the present study is limited [19]. Moreover, the authors of the study used prescrotal approach, thereby precluding any meaningful comparison with our data.
Another limitation of the study include the use of semiobjective methods for documenting each complication and the fact that the assessment of the majority of the cases was based on owners perception. For these reasons, long-term results should be evaluated in a larger randomized prospective studies.