Laparoscopy in small-animal practice (Proceedings) - Veterinary Healthcare
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Laparoscopy in small-animal practice (Proceedings)


CVC IN BALTIMORE PROCEEDINGS


Ovariohysterectomy /ovariectomy

Ovariohysterectomy or ovariectomy can be performed using laparoscopy in most all medium and large size dogs. The space in the abdominal cavity of small dogs and cats make the procedure technically difficult. The advantage of this technique is the perceived rapid patient recovery following the procedure and the improve visualization of the ureters and the pedicle for hemostasis.

The procedure is performed on dorsal recumbency and tilting the dog on the right and the left side to expose the ovaries.

Two cannulas are enough to perform an ovariectomy or an ovariohysterectomy. The ovariohysterectomy is laparoscopically assisted then. The cannula for the endoscope is placed caudal to the umbilicus.

For an ovariohysterectomy the second cannulas is placed caudal in the abdomen. The ovaries are suspended with a transcutaneous suture on the abdominal wall. Each ovarian pedicle is ligated with either suture, or hemostasis control with electrocautery. After ligation of both ovarian pedicles, the uterus is exteriorized in the caudal abdomen through the caudal cannula. The cervix is ligated outside the abdominal cavity like during a regular ovariohysterectomy. The cervix is then returned to the abdomen.

For an ovariectomy the second cannula is placed cranial to the umbilicus. The ovarian pedicles are ligated as described above. Another ligature will be placed on each uterine horn before transecting the ovaries from the uterus. Electrocautery can be used to transect the uterus at the level of the proper ligament. Both ovaries will be removed through one cannula site.

The enlarged cannula sites are sutured with a simple continuous suture pattern with 2-0 monofilament absorbable suture material. Subcutaneous tissue and skin are closed in a routine fashion. The other cannula site requires only subcutaneous and skin sutures.

Cryptorchid surgery

A testicle that is located in the abdominal cavity can be removed easily with laparoscopy. Laparoscopic vasectomy can also be performed through this technique. The dog is placed in dorsal recumbency. The monitor is placed at the end of the table as described for ovariohysterectomy surgery. The procedure is performed with two cannulas. One is placed cranial to the umbilicus while the other is caudal to the umbilicus.

The ectopic testicle is usually readily visible upon entering the abdominal cavity. The ectopic testicle of one side rarely ever crosses the midline but stays lateral to the bladder on the effected side. The testicle is grabbed with a fine tooth grasper and a transcutaneous suture is placed through the abdominal wall to stabilize the ectopic testicle. The vascular pedicle and the vas deference are ligated with a pre-tied suture, clips, or electrocautery. The ectopic testicle is removed through one the cannula holes that generally must be enlarged. The enlarged cannula site is sutured with a simple continuous suture pattern with 2-0 monofilament absorbable suture material. Subcutaneous tissue and skin are closed in a routine fashion. The other cannula sites require only subcutaneous and skin sutures.

Laparoscopic cystoscopy

Laparoscopic cystoscopy is an alternate method that allows placement of a laparoscopic telescope into the urinary bladder that has been exteriorized through the abdominal wall for examination, biopsy and calculi removal. The technique involves a standard laparoscopic entry with the telescope placement on the abdominal midline cranial to the umbilicus. Once the urinary bladder is visualized a second trocar cannula is placed directly over the urinary bladder at the location of exteriorization. Using atraumatic forceps with multiple teeth the bladder is grasp and pulled into the trocar cannula as described in intestinal biopsy section. Once the apex of the bladder is exteriorized stay sutures are placed from the bladder wall. The bladder is temporally pexied to the abdominal wall. A small incision is made in the bladder wall, the bladder is then flushed with sterile saline and the telescope is introduced into the bladder. Forceps can be placed in the lumen along the telescope to obtain a biopsy or remove calculi. At the conclusion of the procedure the bladder is closed in a standard manner and placed back into the abdomen. The cannula ports are then closed. The pexy is released and the abdominal wall closed in a routine fashion.

Laparoscopy is a minimally invasive technique for diagnostic and surgical procedures. Once the basic technique of laparoscopy is mastered and the appropriate indications are applied to the procedures it becomes a simple and rewarding addition to small animal veterinary medicine and surgery. As our ability advances newer diagnostic and therapeutic procedures will no doubt be developed.


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Source: CVC IN BALTIMORE PROCEEDINGS,
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