Veterinary Medicine - April 2009 - (Page 202)

Special Section PEER-REVIEWED LAPAROSCOPIC OVARIECTOMY tacking spot to allow transillumination (turn off the room lights) (Figure 9). Use a large needle holder to carefully pass the swaged needle straight into the abdomen at the intended tacking Figure 10 holder with your right hand and use the widely spread ngers of your left hand to help pass the needle point back out through the abdominal wall. Carefully unclick the forceps, and remove them from the ovarian suspensory ligament to prevent incorporating them in the ligature. Then use a double throw in the suture, and draw the ovary up snuggly against the body wall and remove all slack from the suture. Do not tie a knot, Figure 11 bezel helps facilitate instrument placement on the tissue to be coagulated and cut. Remove only a small amount of tissue on either side of the ovary to speed up the procedure and facilitate tissue removal through the portal. Use the LigaSure as close to the abdominal wall as safely possible. Place the laparoscope in your caudal hand and the LigaSure in your cranial hand, and gently grasp the ovarian suspensory ligament one instrument jaw width away from the ovary. Close the LigaSure on the ligament by squeezing the front hand grip toward the handle Figure 12 spot from lateral to medial under direct observation (Figure 10). Alternatively, use a Tankersley ovariectomy hook (Karl Storz) or a large cruciate needle in place of the swaged needle, armed with No. 2 nylon suture. In cats and smaller dogs, use a regular suture needle and material. Retract the laparoscope a short distance to avoid damaging it with the needle and avoid inadvertent organ puncture. Then have an assistant use a sterile towel or paper drape square as a barrier to hold the camera in the selected position, keeping the needle centered in the monitor’s screen. Carefully slide your left hand over to grasp the needle holder from your right hand. Regrasp the endoscopic grabbers with your right hand, carefully penetrate the mesovarium under and next to the ovary with the needle, and tilt the needle up to prevent the ovary from slipping off. Avoid passing the needle directly into the ovarian tissue since this can lead to ovarian tissue seeding and ovarian remnant syndrome.13 Because of the needle’s large size, you may want to withdraw it partially as you keep the point close to the abdominal wall and then force the point through the abdominal wall. Once the mesovarium is on the needle, remove your hand from the endoscopic forceps. Take the needle but grasp the suture material securely with the needle holder next to your double throw to temporarily tack the ovary to the abdominal wall (Figure 11). Remove the endoscopic graspers from the portal. Step 10: Remove the right ovary Before you remove the ovary, keep in mind that to ensure hemostasis, you will use the LigaSure to create coagulation or a seal and will press the blade cutting button only after the LigaSure unit’s energy cycle signal tone has ended. Always try to grasp the same amount (depth) of tissue each time you go through the sequence. To prevent sticking, periodically use salinemoistened gauze to wipe off any eschar from the instrument’s jaws and to clean off the end of the laparoscope. The LigaSure has a six-bar, or power level, graph display; I use three bars for large dogs, two bars for medium dogs, and one bar for cats and small dogs. Pass the LigaSure through the cranial portal, and direct it toward the tacked ovary. The LigaSure shaft can be rotated in either direction, and the until it clicks and locks, and push the power button until the tone stops (Figure 12). Then advance the cutting blade by pulling the lever on the front of the hand piece. The tissue on both sides of the instrument jaws turns white and steam is generated. Release the LigaSure grip by squeezing the handle again and opening the jaws. Carefully move the instrument toward the ovary so that its next position overlaps that of the rst. Activate the power again, and when the tone stops, advance the cutting blade by pressing the button on the front of the instrument handle. Again, gently open the LigaSure jaws and release. Continue this sequential technique until the entire ovarian suspensory ligament and the blood supply to the ovary have been carefully coagulated and cut. Then direct the LigaSure to the ovariouterine juncture and, using the same technique, sever the ovary from the uterus. Again, by applying gentle traction on the LigaSure, you ensure that you will not damage the body wall. 202 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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