Laparoscopic instrumentation and fundamentals of laparoscopic surgery

Philipp Mayhew

doi:10.22233/9781910443248.3

British Small Animal Veterinary Association , 32 (2015); https://doi.org/10.22233/9781910443248.3

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Laparoscopic instrumentation and fundamentals of laparoscopic surgery

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Author: Philipp Mayhew
From: BSAVA Manual of Canine and Feline Abdominal Surgery
Item: Chapter 3, pp 32 - 44
DOI: 10.22233/9781910443248.3
Copyright: © 2015 British Small Animal Veterinary Association
Publication Date: November 2015

Abstract

Minimally invasive surgery (MIS) is a rapidly developing area of small animal surgery that can offer many advantages over traditional open surgery. This chapter looks at the equipment, techniques and procedures for laparoscopic surgery. Practical tips are highlighted throughout.

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Figures

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3.1

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3.1 All the essential components for laparoscopic surgery are usually housed on an endoscopic tower. (Courtesy of Karl Storz Veterinary Endoscopy)

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3.2

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3.2 High-definition endoscopic camera. (Courtesy of Karl Storz Veterinary Endoscopy)

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3.3

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3.3 Mechanical insufflator. (Courtesy of Karl Storz Veterinary Endoscopy)

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3.4

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3.4 The distal tips of (a) 30-degree and (b) 0-degree 5 mm telescopes. (Courtesy of Karl Storz Veterinary Endoscopy)

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3.5

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3.5 Field of vision of 0- and 30-degree telescopes. (Reproduced from the BSAVA Manual of Canine and Feline Advanced Veterinary Nursing)

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3.6

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3.6 Non-disposable 6 mm trocar–cannula assembly. (Courtesy of Karl Storz Veterinary Endoscopy)

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3.7

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3.7 Disposable trocar–cannula assemblies come in a plethora of different sizes and designs.

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3.8

Minilaparoscopic threaded cannulae are made of graphite. They are very lightweight and ideal for small patients. (Courtesy of Karl Storz Veterinary Endoscopy) © 2015 British Small Animal Veterinary Association

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3.8 Minilaparoscopic threaded cannulae are made of graphite. They are very lightweight and ideal for small patients. (Courtesy of Karl Storz Veterinary Endoscopy)

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3.9

EndoTIP® cannulae are trocarless threaded cannulae that are designed to ‘corkscrew’ through the tissue, causing tissue separation. (Courtesy of Karl Storz Veterinary Endoscopy) © 2015 British Small Animal Veterinary Association

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3.9 EndoTIP® cannulae are trocarless threaded cannulae that are designed to ‘corkscrew’ through the tissue, causing tissue separation. (Courtesy of Karl Storz Veterinary Endoscopy)

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3.10

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3.10 Single incision laparoscopic surgery device (SILS™, Covidien Inc.).

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3.11

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3.11 A selection of 5 mm laparoscopic instrumentation. (Courtesy of Karl Storz Veterinary Endoscopy)

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3.12

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3.12 Laparoscopic trumpet valve suction device. The shaft and tip of the suction wand are not shown. (Courtesy of Karl Storz Veterinary Endoscopy)

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3.13

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3.13 Specimen retrieval bag.

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3.14

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3.14 A variety of designs of disposable Veress needles (shown here) are available, as well as non-disposable types.

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3.15

The tip of the Veress needle is shown, demonstrating the sharp-tipped outer needle that penetrates tissue as well as the spring-loaded inner blunt obturator. © 2015 British Small Animal Veterinary Association

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3.15 The tip of the Veress needle is shown, demonstrating the sharp-tipped outer needle that penetrates tissue as well as the spring-loaded inner blunt obturator.

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3.16

Veress needle mechanism. As the needle tip is pushed against the tissue, the inner blunt obturator retracts into the shaft, allowing the sharp needle tip to penetrate tissue planes. Upon entry into the peritoneal cavity and with the loss of resistance, the blunt obturator jumps forward, limiting potential iatrogenic damage to tissue. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association

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3.16 Veress needle mechanism. As the needle tip is pushed against the tissue, the inner blunt obturator retracts into the shaft, allowing the sharp needle tip to penetrate tissue planes. Upon entry into the peritoneal cavity and with the loss of resistance, the blunt obturator jumps forward, limiting potential iatrogenic damage to tissue. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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3.17

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3.17 Falciform fat can be temporarily exteriorized to confirm peritoneal cavity entry when using the Hasson method of laparoscopic access.

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3.18

(a) If the cannula tip is positioned correctly within the peritoneal cavity, initial insufflator readings should indicate a low IAP (left-hand number) and good flow rate (1.2 l/min). (b) If initial readings suggest a high IAP with low flow rate (0.2 l/min), consider a possible occlusion in the line, cannula tip positioning not within the peritoneal cavity or the cannula tip being up against an organ or within the falciform fat. (c) With correct cannula positioning the pressure will rise to the pre-selected IAP and the flow rate will drop back down (0.2 l/min). (Courtesy of Karl Storz Veterinary Endoscopy) © 2015 British Small Animal Veterinary Association

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3.18 (a) If the cannula tip is positioned correctly within the peritoneal cavity, initial insufflator readings should indicate a low IAP (left-hand number) and good flow rate (1.2 l/min). (b) If initial readings suggest a high IAP with low flow rate (0.2 l/min), consider a possible occlusion in the line, cannula tip positioning not within the peritoneal cavity or the cannula tip being up against an organ or within the falciform fat. (c) With correct cannula positioning the pressure will rise to the pre-selected IAP and the flow rate will drop back down (0.2 l/min). (Courtesy of Karl Storz Veterinary Endoscopy)

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3.19

Patients should be tilted laterally on a mechanical tilt table during laparoscopic ovariectomy or ovariohysterectomy to facilitate visualization of the ovaries. © 2015 British Small Animal Veterinary Association

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3.19 Patients should be tilted laterally on a mechanical tilt table during laparoscopic ovariectomy or ovariohysterectomy to facilitate visualization of the ovaries.

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3.20

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3.20 Three-port laparoscopic-assisted approach for ovariectomy or ovariohysterectomy.

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3.21

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3.21 Exteriorization of both right and left uterine horns from the caudal incision during laparoscopic-assisted ovariohysterectomy.

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3.22

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3.22 A transabdominal suspension suture is being passed through the body wall to suspend the ovarian pedicle.

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3.23

The ovarian pedicle is being elevated away from other structures and the vessel-sealing device is in position to seal and divide the distal uterine horn during laparoscopic ovariectomy. © 2015 British Small Animal Veterinary Association

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3.23 The ovarian pedicle is being elevated away from other structures and the vessel-sealing device is in position to seal and divide the distal uterine horn during laparoscopic ovariectomy.

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3.24

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3.24 The vessel-sealing device can be seen in place, sealing and dividing the testicular pedicle.

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3.25

A fan retractor is used to elevate the spleen away from underlying organs and expose the hilus so that a vessel-sealer can be used to seal and divide the hilar vessels. © 2015 British Small Animal Veterinary Association

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3.25 A fan retractor is used to elevate the spleen away from underlying organs and expose the hilus so that a vessel-sealer can be used to seal and divide the hilar vessels.

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3.26

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3.26 This spleen was resected laparoscopically and placed in the specimen retrieval device shown before withdrawal from the body cavity.

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3.27

In this male dog a small parapreputial incision has been made for access to the apex of the bladder, which has been exteriorized by traction on two stay sutures. © 2015 British Small Animal Veterinary Association

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3.27 In this male dog a small parapreputial incision has been made for access to the apex of the bladder, which has been exteriorized by traction on two stay sutures.

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3.28

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3.28 For laparoscopic-assisted gastropexy the gastric antrum is grasped midway between the greater and lesser curvatures of the stomach.

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3.29

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3.29 After exteriorization, stay sutures are used to elevate the gastric wall prior to creation of the gastric seromuscular incision.

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3.30

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3.30 View of the completed laparoscopic-assisted gastropexy from the peritoneal cavity.

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3.31

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3.31 Harvesting of a small intestinal biopsy sample through a small ‘assist’ incision that has been created using a wound retraction device.

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3.32

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3.32 This cat has had a small intestinal mass resected in traditional fashion extraperitoneally through a small ‘assist’ incision.