1887

Exploratory laparotomy

image of Exploratory laparotomy
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Abstract

Urinary tract surgery can be technically demanding in rabbits due to their relatively small size and unique anatomy. Some techniques, however, such as cystotomy, are relatively common and fairly straightforward procedures. This chapters assesses Anatomy of the urinary tract; Patient assessment and decision-making; Hypercalciuria and urolithiasis; Lower urinary tract disease; Medical management of urinary tract disease; Surgical considerations and specialist equipment; Surgical procedures; and Postoperative care. : Nephrectomy; Cystotomy.

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Figures

Image of 13.1
13.1 The normal anatomy of the abdomen: left lateral view; Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. right lateral view. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 13.2
13.2 Mass adherent to bladder wall, causing persistent haematuria.
Image of 13.3
13.3 Exploration of adhesions involving the bladder. Note the use of suction to avoid abdominal contamination with urine.
Image of 13.4
13.4 The caecum has been exteriorized to investigate chronic distension and avoid contamination of the abdomen, but must be kept warm and moist and re-placed carefully.
Image of 13.5
13.5 Adhesion formation between cervical stump and gastrointestinal tract. (Courtesy of Ron Rees Davies)
Image of 13.6
13.6 This rabbit had a mass of adhesions throughout the abdomen, involving the gastrointestinal tract and urogenital tract in particular.
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13.7 The abdominal viscera are covered in warm moist swabs when exposed during surgery.
Image of 13.8
13.8 This abscess followed scrotal castration and postoperative infection. On a thorough examination of the abdominal cavity, further abscesses were found , but not generalized peritonitis.
Image of The linea alba is tented away from the viscera and carefully incised.
The linea alba is tented away from the viscera and carefully incised. The linea alba is tented away from the viscera and carefully incised.
Image of The incision is carefully extended with Metzenbaum scissors.
The incision is carefully extended with Metzenbaum scissors. The incision is carefully extended with Metzenbaum scissors.
Image of Untitled
Image of This incision was made from just below the xiphisternum to midway between the umbilicus and the pubis, and is sufficient for most abdominal surgery. The Lone Star retractor is used to further improve access and visibility. However, smaller incisions are advised, where possible, to minimize surgical time, adhesion risk and postoperative pain, and to minimize the risks and severity of wound breakdown subsequently.
This incision was made from just below the xiphisternum to midway between the umbilicus and the pubis, and is sufficient for most abdominal surgery. The Lone Star retractor is used to further improve access and visibility. However, smaller incisions are advised, where possible, to minimize surgical time, adhesion risk and postoperative pain, and to minimize the risks and severity of wound breakdown subsequently. This incision was made from just below the xiphisternum to midway between the umbilicus and the pubis, and is sufficient for most abdominal surgery. The Lone Star retractor is used to further improve access and visibility. However, smaller incisions are advised, where possible, to minimize surgical time, adhesion risk and postoperative pain, and to minimize the risks and severity of wound breakdown subsequently.
Image of A Lone Star retractor used to improve exposure in a cranial laparotomy incision, giving good access to all but the deeper organs. Extension of the incision caudally would improve exposure further, but in deep-chested breeds, access to the dorsal viscera can be challenging. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
A Lone Star retractor used to improve exposure in a cranial laparotomy incision, giving good access to all but the deeper organs. Extension of the incision caudally would improve exposure further, but in deep-chested breeds, access to the dorsal viscera can be challenging. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. A Lone Star retractor used to improve exposure in a cranial laparotomy incision, giving good access to all but the deeper organs. Extension of the incision caudally would improve exposure further, but in deep-chested breeds, access to the dorsal viscera can be challenging. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of A loop of absorbable suture material is placed around the tip of a liver lobe.
A loop of absorbable suture material is placed around the tip of a liver lobe. A loop of absorbable suture material is placed around the tip of a liver lobe.
Image of The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of The biopsy sample and suture packet can then be handed to a non-sterile assistant to be frozen or put into formalin.
The biopsy sample and suture packet can then be handed to a non-sterile assistant to be frozen or put into formalin. The biopsy sample and suture packet can then be handed to a non-sterile assistant to be frozen or put into formalin.
Image of A diseased liver lobe (in this case an accessory lobe) is identified and exteriorized.
A diseased liver lobe (in this case an accessory lobe) is identified and exteriorized. A diseased liver lobe (in this case an accessory lobe) is identified and exteriorized.
Image of The required section (in this case an entire diseased lobe) is isolated with haemostats. Note the retractors used to improve access in this deep-chested breed.
The required section (in this case an entire diseased lobe) is isolated with haemostats. Note the retractors used to improve access in this deep-chested breed. The required section (in this case an entire diseased lobe) is isolated with haemostats. Note the retractors used to improve access in this deep-chested breed.
Image of A suture is preplaced through the parenchyma and over the haemostats after removal of the tissue.
A suture is preplaced through the parenchyma and over the haemostats after removal of the tissue. A suture is preplaced through the parenchyma and over the haemostats after removal of the tissue.

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