Minimally Invasive Laparoscopic Ovariohysterectomy (MiLOVH), also known as spaying, is a less intrusive veterinary surgical technique for removing a female dog’s ovaries and uterus. Growing in popularity, it offers advantages such as minimal post-operative discomfort, accelerated recovery, improved visibility, reduced surgical complications and enhanced aesthetic outcomes, contributing to the overall health and well-being of the canine companion. Ovariohysterectomy is a commonly prevailing surgical procedure in veterinary practice that mitigates the risk of mammary cancer (Schneider et al., 1969), pyometra and the inconveniences of vaginal discharge and male attraction during estrus. Laparoscopic ovariohysterectomy (LOVH) is a minimally invasive sterilization technique available for companion animals. Compared with conventional ovariohysterectomy (OVH), LOVH has been associated with several advantages, including reduced postoperative pain, a decreased risk of hemorrhage and wound dehiscence and fewer postoperative wound-related complications (Patil et al., 2025).
       
Single port was introduced in human surgery to minimize incisions while ensuring adequate cannulas for the procedure and the drawbacks include loss of triangulation leading to instrument interference (Romanelli and Earle, 2009). A primary drawback of laparoscopic surgery is the requirement for acquiring new surgical skills and mastery of these techniques involves a gradual and steep learning curve, often utilizing simulators (Malm et al., 2004; Mayhew, 2011). However, the latter is time-consuming and poses a significant financial constraint. In veterinary medicine, soft tissue surgery is also transitioning to minimally invasive procedures, mirroring the trends observed in human medicine. This drawback can elevate technical challenges, potentially necessitating the use of articulated instruments.
       
The single port technique has been used for various complicated surgical procedures like intestinal surgery, laparoscopic-assisted splenectomy, cholecystectomy, cryptorchidectomy, foreign body removal, nephrectomy, adrenalectomy, pyometra, abdominal tumour removal etc. There are no reports regarding comparing surgical duration, pain score and difficulty of surgeon for single port over three port for ovariohysterectomy under Indian field conditions. Therefore, by standardizing this technique, we can expand its application to various surgical procedures that currently rely solely on conventional open approaches. The present study was conducted with objective to determine the relative efficiency of minimally invasive single port laparo-endoscopic technique over three port technique for elective ovario-hysterectomy in bitches.

The research was carried out on twelve female dogs presented to Madras Veterinary College Teaching Hospital for elective ovariohysterectomy to evaluate the relative efficiency of laparo-endoscopic single site technique (LESS-OHE) over three port technique (Lap-OHE). Twelve female dogs were selected randomly and divided into two groups - Group I (Lap-OHE; n=6) and Group II (LESS-OHE; n=6). Routine haemato biochemical and radiological examinations were performed. The mean overall surgical time was recorded and intraoperative period was divided into 5 stages: (1) time of creation of pneumoperitoneum; (2) insertion of ports (3) resection of first ovary (Fig 1) (4) resection of second ovary (Fig 2) (5) resection of uterus. Surgeon’s scoring was done to evaluate the difficulty of surgical procedure. A Likert scale ranging from one to five was employed, where one denoted the least difficulty and five, the highest level of complexity. Glassgow’s pain scale was measured to evaluate the pain of the animal. The length of surgical wound was measured using Vernier Caliper. Surgeons were asked to complete a questionnaire for assessing the difficulty levels of surgical approaches.




       
Blood count and serum biochemical profile were conducted. Food was withheld for twelve hours preceding the procedure. The bladder was evacuated by either manual compression or urinary catheterization. Catheterization of the cephalic vein was performed to facilitate the administration of anesthetic agents and fluids throughout the surgery. The bitches were premedicated with Inj.Diazepam at 0.25 mg/kg and Inj.Tramadol @ 4 mg/kg intravenously. General anesthesia was induced with Inj.Propofol at 4-6 mg/kg intravenously and maintained with 2% Isoflurane gas in 100% oxygen. Intravenous fluid was administered at the rate of 10 ml/kg/hr.
 
Three port laparoscopic ovariohysterectomy (Lap-OHE)
 
Using the Veress needle, the abdominal region was accessed, employing a sharp outer cannula and a spring-loaded inner stylet. Carbon dioxide insufflation inflated the abdominal cavity, reaching 10-12 mmHg pressure. Three ports, mostly 5 mm except for a 6 mm Ternamian endotip trocar in middle port, were established along the ventral midline. The surgical procedure involved repositioning the patient first into right lateral oblique recumbency for left ovary removal and subsequently into left lateral oblique recumbency for right ovary removal. The left ovarian proper ligament was grasped using grasping forceps and gentle caudal traction and elevation were applied. After identifying blood vessels, monopolar electrocautery was introduced through the caudal port and the broad ligament and associated mesenteric tissue were transected using monopolar electrocautery, initially on the coagulation setting followed by cutting. The patient was then tilted into left lateral recumbency and same procedure used for right ovary cauterization. The extracted ovaries and uterus passed through the caudal 5-mm cannula after cauterization with Merryland monopolar electrocautery. Surgical times, including pneumoperitoneum creation and ovary/uterus resection, were recorded and compared among techniques.
 
Laparoendoscopic single site ovariohysterectomy (LESS-OHE)
 
The modified glove-port technique (Fig 3) was prepared by using a pair of size 6 1/2 surgical gloves, two 5-mm laparoscopic cannulas, one 6-mm cannula and a silicone single port were employed in this procedure. Surgical glove fingers were repurposed as makeshift rubber bands. After making small longitudinal incisions in another surgical glove’s fingertips, 5-mm cannulas were inserted and secured. A 6-mm cannula was inserted to the middle finger for the telescope passage.


       
A 1.5 to 2 cm incision was made mid-way between the pubic brim and the umbilicus along the ventral midline. The linea alba was punctured for a mini laparotomy and a flexible silicone single port was inserted. The glove with three cannulas was fitted over the retractor, ensuring a snug fit. Pneumoperitoneum was established at 10-12 mm Hg through the 6-mm cannula. A 5-mm laparoscope was introduced through the middle finger’s cannula for abdominal cavity examination.
       
Grasping forceps and monopolar electrocautery were introduced through the glove’s little finger and thumb, respectively. Surgeons stood on the dog’s right side, rotating the table for optimal visibility. The left ovary’s suspensory ligament was elevated and the broad ligament was sealed and divided. The table was tilted for the right ovary. The patient returned to dorsal recumbency and the ovaries and uterus were extracted through the wound retractor after disconnecting the glove from the retractor. The uterus was ligated and transected using PGA 2-0 suture material. After the ovariohysterectomy was completed, the silicone wound retractor was removed. The abdominal fascia was closed with simple interrupted PGA 2-0 sutures, the subcutaneous tissue was gently approximated without sutures and the skin was sutured with Polyamide 3-0 monofilament non-absorbable suture material using a simple interrupted pattern.
       
To detect postoperative complications, physical examination and wound inspection was daily performed for 5 days followed by analgesics and antibiotics.
       
Normally distributed variables are reported as the mean ± SE. An unpaired t-test was used to compare surgical times and surgical wound length. Mann-Whitney U test was used for pain score and surgeon’s score.

The mean ± SE values for time measured in twelve female dogs are shown in Table 1. The mean ± SE values of surgical wound length (centimetres) in Lap-OHE (Fig 4) and LESS-OHE (Fig 5) are 1.96±0.02 and 1.85±0.04 respectively. There was no significant difference in mean overall surgical time and surgical wound length between the two groups. All surgical procedures were conducted by the same surgeons and they subsequently filled out a subjective survey detailing their encounters with both laparoscopic techniques. The score ranges from 1-5 on the Likert scale. Statistical analysis revealed no significant difference in haemorrhage control and instrument collision between the two groups. Difficulty of approach (P<0.05), the difficulty of surgical maneuver (P<0.01) and physical and mental fatigue(P<0.01) was significantly higher in group II. The mean score of Lap-OHE group is 2.25 points which is less than LESS-OHE but not significant (Table 2). Pain scale was significantly less in Lap-OHE group than LESS-OHE group (Table 3).










       
This study is used to compare efficiency of LESS-OHE in female dogs using modified gloveport technique (Khiangte et al., 2011). Performing LESS surgery introduces distinct challenges such as decreased freedom of movement, inline vision with the loss of triangulation and the closer proximity of instruments, resulting in external and intraabdominal clashes and crossing. The limitations of a single port were noted by the authors, where the hands of both the operator and assistant may hinder each other (Bucher et al., 2010; Pérez-Duarte et al., 2014). Although there is no significant difference between the two groups, the total number of incisions were more in three port than single port laparoscopic surgery hence this study emphasizes the evolution of single incision laparoscopic surgery is a progression from three port laparoscopic surgery reducing the surgical trauma.  The total surgical time for single-port laparoscopic ovariohysterectomy exceeded the previous studies (Gonzalez-Gasch and Monnet, 2015), possibly due to challenges like instrument collision and reduced working angles and monopolar electrocautery for ovary resection takes more time than bipolar vessel sealant or harmonic scalpel underscores the impact of instrument selection on surgical efficiency. The single-port offered the advantage of allowing surgeons to perform multiple procedures through a single incision, eliminating the need for additional port placements or conversion to open laparotomy (Runge and Mayhew, 2013). Time to create pneumoperitoneum was less in LESS-OHE group as it uses modified Hasson’s technique than Lap-OHE group which uses veress needle technique. At times, enlarging the port incision may be necessary to extract the uterus from the abdominal cavity, especially in cases involving enlarged adipose ovarian pedicles and bursa which is needed in Lap-OHE group subsequently increasing length of surgical wound but not in LESS-OHE group (Hancock, 2005). The median highest glassgow pain scale was 3 for Lap-OHE group significantly more than LESS-OHE because LESS-OHE group has less number of incisions. The modified gloveport was developed for cost-efficiency and has been employed in various surgical procedures, as commercially available SILS ports tend to be more expensive and the modified gloveport can effectively externalize masses up to 7 cm (Bydzovsky et al., 2019), eliminating the necessity for combining two ports to facilitate externalization. The procedure also results in small surgical wound less than 2.5 cm moreover due to minimal post operative complications; the dogs had shorter hospitalization time and recover to normal clinical status.

Single port surgical technique is comparatively more difficult for the surgeon to perform but it reduces post operative pain experienced by the dog. Time taken for completion of surgery by both the techniques were not significantly different and so equally efficient. Single port is cosmetically superior as it involves only a single incision. Single port takes a steep learning curve to master the technique Standardizing this technique enables us to employ its uses in various surgical techniques. Due to the high cost of commercially available single ports, the modified glove port technique emerges as a cost-effective method.

The author acknowledges the Dean Madras Veterinary College and TANUVAS for providing all facilitates to conduct the research.

All authors declared that there is no conflict of interest.