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Rigid endoscopy: laparoscopy

image of Rigid endoscopy: laparoscopy
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Abstract

Laparoscopy is a minimally invasive surgical technique that is becoming increasingly popular in veterinary practice, and has a number of advantages over exploratory laparotomy. This chapter covers indications, instrumentation, patient preparation, anaesthetic considerations, biopsy, and a number of procedures including feeding tube placement, ovariectomy, splenectomy, hernia repair and cancer staging. The chapter also contains a video clip.

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Figures

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12.3 Introducing the Veress needle.
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12.4 Location of the incision in the linea alba with blunt haemostats before placement of a Ternamian tipped cannula.
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12.5 (a) Following insertion of the telescope, the area immediately underlying the primary port and Veress needle is examined for iatrogenic damage. (b) A secondary port has been inserted for the introduction of biopsy forceps.
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12.6 Port 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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12.7 Inspecting the liver with a palpation probe.
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12.8 Biopsy of the liver using cup biopsy forceps.
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12.9 Liver biopsy site immediately after a sample has been taken, showing minimal haemorrhage.
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12.10 Aspiration of the gall bladder under laparoscopic control.
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12.11 Biopsy of a normal pancreas using punch-type biopsy forceps.
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12.12 Pancreatic biopsy site immediately after a sample has been taken, showing minimal haemorrhage.
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12.13 View of the right kidney from a right lateral approach. The Tru-Cut needle is placed in the cranial pole of the kidney.
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12.14 Laparoscopic view of the right kidney of a cat with renal lymphosarcoma.
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12.15 Applying tamponade with a palpation probe to control haemorrhage following renal biopsy.
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12.16 Port positions for full-thickness intestinal biopsy. Alternatively, all ports maybe placed in the midline. Drawn by S. J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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12.17 Biopsy of an exteriorized loop of small intestine.
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12.18 Laparoscopic-assisted gastropexy. The pyloric antrum has been exposed through a 3 cm incision caudal to the last rib on the right side. Two flaps are being created in the seromuscularis layers of the pyloric antrum.
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12.19 Laparoscopic gastropexy. An incision has been made in the transverse abdominal muscle and two seromuscularis flaps have been created in the pyloric antrum. Unidirectional barbed suture has been used to complete the more lateral continuous pattern between the edge of the transverse abdominal muscle and one of the seromuscularis flaps of the pyloric antrum.
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12.20 The laparoscopic gastropexy has been completed with the second suture between the edge of the transverse abdominal muscle and the more medial seromuscularis flap of the pyloric antrum.
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12.21 Port positions for laparoscopic ovariohysterectomy. Drawn by S. J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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12.22 Laparoscopic view of the caudal abdomen of a bitch, showing the uterine body and horns emerging from beneath the urinary bladder.
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12.23 Transecting the ovarian pedicle with a bipolar cutting device.
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12.24 Exteriorizing the uterus through the caudal port position.
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12.25 Wound closure following laparoscopic ovariohysterectomy in a 2-year-old Retriever.
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12.26 Both uterine horns have been passed through an Endoloop.
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12.28 Ovary suspended against the abdominal wall with an EndoGrab device for dissection with a vessel sealer/divider.
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12.29 Removal of the ovarian remnant using monopolar scissors in a cat.
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12.30 Normal inguinal canal showing the vas deferens and testicular vessels.
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12.31 Removal of an ectopic testicle.
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12.32 Right cryptorchid testicle cranial to the bladder. An Endoloop has been placed around the pampiniform plexus.
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12.33 Laparoscopic-assisted cystoscopy. The primary telescope port is in place and a small skin incision has been made for insertion of the instrument port.
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12.34 (a) Babcock forceps are placed in the instrument port to (b) grasp the apex of the bladder.
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12.35 Bladder wall sutured to the abdominal incision.
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12.36 A small cystotomy incision has been temporarily marsupialized to the skin at the cranial margin of the prepuce in readiness for retrograde bladder flushing. Carmalt forceps are being used to open the incision to allow maximal fluid egress via the cystotomy site.
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12.37 Endoscopic view of the urethra looking caudally towards the pelvic flexure.
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12.38 Small bladder polyp seen at laparoscopic cystoscopy.
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12.39 Telescope and laser fibre inserted into the bladder.
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12.40 Postoperative appearance following wound closure after cystoscopy.
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12.41 Placement of a laparoscopic cannula directly into the bladder. Calculi can be removed either through the side port of the cannula or by anterograde flushing of the calculi into a urethral catheter.
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12.42 Progressive sealing of the splenic hilum with a vessel sealer in a totally laparoscopic splenectomy.
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12.43 In this laparoscopic-assisted splenectomy, the spleen has been partially retracted through an ‘assist’ device and the splenic hilus is being serially sectioned using a vessel-sealing device.
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12.44 Port placement for laparoscopic cholecystectomy.
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12.45 Laparoscopic cholecystectomy. Dissection around the cystic duct has been completed using articulating laparoscopic Kelly forceps. This instrument can greatly facilitate this challenging part of the procedure.
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12.46 An intracorporeally sutured knot is being placed on the cystic duct during laparoscopic cholecystectomy in this patient. Laparoscopic needle holders are being used to tie the knot and a fan retractor is being used to retract the gall bladder.
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12.47 (a) Early isolation of the ureter (arrowed) during laparoscopic ureteronephrectomy can aid in elevation and dissection of the renal hilum. (b) Dissection of the renal hilum is being performed, with skeletonization of the renal artery and vein (arrowed) before ligation of these vessels.
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12.48 Inguinal hernia: organs are reduced back into the abdominal cavity by gentle traction.
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12.49 Non-absorbable sutures of polypropylene have been placed between the crural muscles that surround the ventral aspect of the oesophageal hiatus in this dog during laparoscopic hiatal herniorrhaphy.
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12.50 A completed intracorporeally sutured laparoscopic gastropexy has been performed using barbed suture.
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12.51 Three-dimensional CT reconstruction showing a left-sided adrenal mass with the surrounding vascular structures highlighted. These images can help considerably in planning laparoscopic adrenalectomy, which is a complex procedure.
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12.52 A large adrenal mass located just cranial to the left kidney in a cat. This mass was a phaeochromocytoma. Its close adherence to the left renal vein can be clearly seen.
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12.53 This adrenal tumour has been dissected and placed into a specimen retrieval bag for extraction through one of the port sites.

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Passing instruments around the caudal edge of the falciform fat.

Passing instruments around the caudal edge of the falciform fat.

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