Page 136 - Clinical Manual of Small Animal Endosurgery

124 Clinical Manual of Small Animal Endosurgery

Fig. 4.18 Adhesion to the liver following previous open surgery and liver
biopsy.

performed together a right lateral approach is used. This approach allows
good visualisation of the right limb of the pancreas, but limited access to
the left limb. To examine the whole pancreas, or when pancreatic exam/
biopsy is performed at the same time as biopsy of other organs, a ventral
midline approach is used, and the pancreas is accessed from the ports
positioned for the other biopsy procedures. The animal is rotated to the
left and the blunt probe or grasping/Babcock forceps are used to lift the
duodenum and expose the right lobe of the pancreas. The right limb of
the pancreas is followed beginning from the distal end as far to the left
as possible. The left lobe, situated in the omental bursa, is visualised by
elevating the greater gastric curvature and applying cranial traction to
the omentum. Blunt dissection of the greater omentum caudally to gastro-
epiploic vessels allows surgical access to it. The normal pancreas is pale
cream in colour, with a lobulated appearance (Fig. 4.19). In cases of
pancreatitis irregular firm tissue, fat necrosis and adhesions are often
evident close to the pancreas, and may prevent its visualisation.
Punch biopsy forceps or, less commonly, cup biopsy forceps are used
for pancreatic biopsy; with these instruments only one accessory port is
needed. However, a second instrument port permits insertion of an
instrument (such as a blunt probe or Babcock forceps) to hold the pan-
creas in place, and is necessary when manipulation of the surrounding
organs is needed to obtain an unobstructed view of the pancreas. A
second instrument port also allows use of a vessel-sealing device or a
ligature biopsy technique.
Biopsies are collected from the lobe periphery, avoiding the body,
where pancreatic ducts cross the gland to enter the duodenum together
with the common bile duct. The area at the tip of the right pancreatic
limb is also best avoided, as here the caudal pancreaticoduodenal vessels
enter the gland.