Veterinary Medicine - April 2009 - (Page 198)

Special Section PEER-REVIEWED LAPAROSCOPIC OVARIECTOMY Figure 4 drop test9 to check: put the Veress needle valve in the open position, place a drop or two of sterile saline solution in the needle’s hub, and watch for the saline solution to go into the needle as a result of the negative abdominal pressure. If the drop does not disappear into the hub, carefully advance the needle a millimeter at a time while watching the drop in the hub. Once the saline solution disappears into the needle, attach the insuf ation line to the Veress needle, turn the carbon dioxide gas on, and start insuf ation. The Veress needle is guarded, so the safety obturator will cover the needle point once in the abdomen.10 Once pneumoperitoneum to 15 mm Hg is achieved, turn off the stopcock on the Veress needle, and remove the needle from the abdomen. If the pressure is greater than 15 mm Hg, disconnect the insuf ation tubing and use the stopcock on the side of the Veress needle to de ate the abdomen to 15 mm Hg. If the abdominal pressure exceeds 15 mm Hg, patient respiration will be impeded. and, with your cranial hand, carefully grasp the abdominal wall on the midline at the umbilical area and elevate it without incorporating any intestine or the spleen. Place the tip of the Veress needle perpendicular to the elevated abdominal wall, about one-fourth of the distance caudally from the umbilicus to the pelvic brim. I place the Veress needle in this caudal portal location to decrease the risk of inadvertent damage or insuf ation to the stomach, spleen, or liver. Place the index nger and thumb of your caudal hand on the needle hub, and place your ring nger on the shaft of the needle far enough up to just allow abdominal penetration. This nger-brace depthstop helps prevent excessive abdominal penetration. Next, direct the needle in a cranial dorsal direction through the elevated abdominal wall (Figure 5). When you think the abdomen has been penetrated, use the hanging Figure 5 Step 6: Place the laparoscope at the primary camera/caudal portal site After removing the Veress needle, use a No. 11 blade to make a careful stab incision in the center of the caudal portal site. After penetrating the abdomen, place the threaded EndoTIP cannula tip in the incision, and rotate it clockwise with its valve open until you hear gas releasing through the valve. Then turn its valve off, and rotate the cannula tip one to three full rotations more to fully place it intra-abdominally. Attach the insuf ation hose to this cannula, and reestablish a pneumoperitoneum pressure of 12 to 15 mm Hg. If you do not have an EndoTIP cannula, use a Versaport 5mm cannula-trocar assembly or equivalent with an insuf ation stopcock. Remove the trocar, and at the intended camera/caudal portal, make a midline impression with the cannula in the skin caudally one-fourth the distance between the umbilicus and the brim of the pelvis. With a No. 15 blade, make a small full-thickness skin incision across the cannula impression on the midline, plus 2 mm (total incision length should be about 7 mm—just long enough for the cannula-trocar unit to pass). Then use the same technique as for the caudal portal incision to make a skin incision for the operative/cranial portal (to make the correct incision length, add 2 mm to the cannula diameter) on the midline, at a point exactly between the umbilicus and xiphoid process. At the caudal portal site with the trocar in place, angle the instrument toward the bladder, and gently penetrate the abdomen with the cannula-trocar combination. When using Versaport-type cannula-trocar assemblies with cutting blades, grip them properly so that they are armed. To do so, squeeze both the upper (trocar) and lower (cannula hand-grip) portions together so that the blade will protrude with pressure on the tip. Again, use your free hand to grasp the cannula and provide a safety depth stop so that you do not penetrate too deeply. Keep 198 April 2009 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - April 2009

Veterinary Medicine - April 2009 Contents Idea Exchange Practical Matters An Update on Gallbladder Mucoceles in Dogs Digital Radiography Equipment Benefits and Considerations How to Perform a Two-portal Laparoscopic Ovariectomy Author Guidelines CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - April 2009

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