Laparoscopy in small animal practice (Proceedings)
There are a number of minimally invasive surgical (MIS) procedures that are currently performed using laparoscopy. Many of these procedures require multiple trocar/cannula portals, specific minimally invasive surgical instruments, loop ligatures, clip applicators and monopolar electrosurgery. The techniques described below are the "tip of the iceberg" in as far as the potential for MIS in veterinary medicine. They can be performed in a small animal practice.
Intestinal biopsySmall intestinal biopsies can be obtained using laparoscopy simply by exteriorizing a piece of intestine through the abdominal wall and then collecting the sample externally as would be done with a standard surgical biopsy. A 5-mm atraumatic grasping forceps with multiple teeth is used to grasp the intestine at the site to be biopsied. It may be necessary to "run" the bowel with two grasping forceps to select a location to biopsy. The antimesenteric boarder is firmly grasped with the forceps. The intestine is then pulled to the cannula. A 3-4 cm loop of intestine is exteriorized. A small full thickness biopsy is then obtained in the same manner as one would use when performing an open abdominal surgical technique. The intestine is then returned to the abdominal cavity. If too much intestine is exteriorized it is difficult to return it to the abdominal cavity through a small incision.
Intestinal feeding tube placement
Duodenostomy or jejunostomy feeding tubes can be placed using the laparoscope simply by exteriorizing a respective piece of intestine through the abdominal wall and inserting the tube externally. Once the location of the bowel for tube placement is determined the antimesenteric boarder is firmly grasped with the forceps. The intestine is then pulled close to the cannula in which the intestine will be exteriorized. A 3-4 cm loop of intestine is exteriorized and four stay sutures (4-0 monofilament absorbable) are placed in the intestine to prevent the intestine from falling back into the abdominal cavity. A purse-string suture is placed on the antimesenteric border of the intestine. A number 11 blade is used to puncture the intestine in the middle of the purse-string suture and the jejunostomy feeding tube (5 French for cats and 8 French for dogs) is introduced in the loop of bowel in the aboral direction. The purse string suture is closed and the intestine is returned to the abdominal cavity except for the segment containing the feeding tube. The stay sutures are then used to pexy the intestine to the abdominal wall using 4.0 monofilament absorbable sutures. The abdominal wall is then closed with simple continuous suture pattern. Subcutaneous tissue and skin are closed in a routine fashion. The feeding tube exits through the incision.
Intestinal foreign body
Single, non-linear foreign body in the jejunum or ileum can be removed under laparoscopy. Dogs or cats with signs of peritonitis are not good candidates for this procedure. The surgical technique is the same as for a jejunostomy tube placement. The loop of intestine with the foreign body is exteriorized and an enterotomy or an enterectomy is performed outside of the abdominal cavity. The loop of intestine is then returned into the abdominal cavity at the end of the procedure.
A preventive gastropexy can be performed using the laparoscope simply by exteriorizing the pyloric antrum region of the stomach through the right abdominal wall. The animal is placed in dorsal recumbency and the telescope portal is placed on the midline at the level of the umbilicus. A 5-mm atraumatic grasping forceps with multiple teeth is used to grasp the pyloric antrum mid-distance between the lesser and the greater curvature. The pyloric antrum is exteriorized after extension of the cannula site situated behind the last rib on the right side. An incisional gastropexy is then performed.
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.