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Rigid endoscopy: laparoscopy

image of Rigid endoscopy: laparoscopy
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Abstract

Exploratory laparotomy is a major invasive procedure, often carried out on a sick or debilitated patient. Clinicians may hesitate to put their patient through such a procedure, and may therefore rely on incomplete information from indirect observations such as blood tests and other imaging studies to form their diagnosis. Owners may also be reluctant to subject their pet to major surgery 'just to get a sample'. Laparoscopy is a minimally invasive surgical technique used in veterinary practice for diagnostic procedures and surgical treatment of a variety of conditions. It is a very safe technique if the basic rules are followed. Laparoscopy enables surgeons to carry out a thorough visual inspection of the abdominal cavity and obtain tissue samples quickly, with minimal trauma to the patient. This chapter explains Instrumentation; Anaesthetic considerations; Procedure; Biopsy; Feeding tube placement; Gastropexy; Ovariohysterectomy; Ovariectomy; Ovarian remnant removal; Cryptorchid surgery; Laparoscopic-assisted cystoscopy; Cholecystectomy; Other potential surgical procedures; and Complications.

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Figures

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11.2 Introducing the Veress needle.
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11.3 Inserting the primary trocar and cannula.
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11.4 Following insertion of the telescope, the area immediately underlying the primary port and Veress needle is examined for iatrogenic damage. A secondary port has been inserted for the introduction of the biopsy forceps.
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11.5 Portal positions for liver biopsy (O) and pancreatic biopsy (X) in left lateral recumbency. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.6 Inspecting the liver with a palpation probe.
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11.7 Biopsy of the liver using cup biopsy forceps.
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11.8 Liver biopsy site immediately after a sample has been taken, showing minimal haemorrhage.
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11.9 Biopsy of a normal pancreas using punch-type biopsy forceps.
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11.10 Pancreatic biopsy site immediately after a sample has been taken, showing minimal haemorrhage.
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11.11 Laparoscopic view of the right kidney of a cat with renal lymphosarcoma.
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11.12 Taking a biopsy sample from the right kidney with an automatic core-type biopsy needle.
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11.13 Portal positions for full-thickness intestinal biopsy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.14 Exteriorized loop of small intestine.
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11.15 Portal positions for laparoscopic ovariohysterectomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.16 Caudal abdomen of a bitch at laparoscopy showing the uterine body and horns emerging from beneath the urinary bladder.
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11.17 Ovarian pedicle exposed with caudal retraction of the uterus. Vascular clips have been placed.
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11.18 Transecting the ovarian pedicle with the Hotblade bipolar device.
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11.19 Exteriorizing the uterus through the caudal portal position.
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11.20 Wound closure following laparoscopic ovariohysterectomy in a 2-year-old Retriever.
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11.21 Both uterine horns have been passed through an Endoloop™.
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11.22 Removal of the ovarian remnant with monopolar scissors in a cat.
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11.23 Normal inguinal canal showing the vas deferens and testicular vessels.
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11.24 Removal of an ectopic testicle.
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11.25 Right cryptorchid testicle cranial to the bladder. An Endoloop™ has been placed around the pampiniform plexus.
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11.26 Laparoscopic-assisted cystoscopy. The primary telescope portal is in place and a small skin incision has been made for insertion of the instrument portal.
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11.27 Babcock forceps are placed in the secondary portal to grasp the apex of the bladder.
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11.28 Bladder wall sutured to the abdominal incision.
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11.29 Telescope and laser fibre inserted into the bladder.
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11.30 Small bladder polyp seen at laparoscopic cystoscopy.
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11.31 View of urethra looking caudally towards the pelvic flexure.
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11.32 Postoperative view following wound closure after cystoscopy.

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