Page 140 - Clinical Manual of Small Animal Endosurgery

128 Clinical Manual of Small Animal Endosurgery

sample that includes a minimum number of intact glomeruli, renal arte-
rioles and cortical interstitium (Freeman, 2009).
Once properly seated into the kidney parenchyma, the needle is acti-
vated to cut the biopsy, and the sample is recovered. Two to three
samples are usually collected. Following biopsy, pressure is applied for
a few minutes to the renal surface with the palpation probe to control
haemorrhage. Haemostatic foam application can be used if necessary.
Postoperative haematuria, usually self-limiting, is a common sequel to
any method of kidney biopsy.

The small intestine
For examination of the intestine two instrument portals are required.
The procedure is usually performed with the patient in dorsal recum-
bency, with a standard ventral midline approach. The two instrument
portals are located a few centimetres lateral to the scope on each side.
Two pairs of Babcock forceps are used to grasp the intestine and ‘run’
as much of it as possible. The intestinal surface, blood supply and lymph
nodes are evaluated. Small intestinal biopsies are usually obtained using
a laparoscopy-assisted technique. This entails exteriorising the selected
portion of intestine through a small incision in the abdominal wall.
Pneumoperitoneum is lost during the procedure, and therefore intestinal
biopsies are performed after other procedures. When the location for
the biopsy is selected, the antimesenteric border of the intestine is firmly
grasped with Babcock forceps and gently pulled up slightly inside the
cannula. The intestine and forceps are then removed from the abdomen
together with the portal. In order to easily exteriorise the intestine, it is
often needed to enlarge the incision by 2–4 cm. This is carefully accom-
plished by cutting away from the cannula with a blade, under direct
visualisation. For this procedure the use of a 10 mm port should be
considered, as this is less likely to require enlargement and makes the
procedure easier. Gelpi retractors can also be positioned in the incision,
to keep it open and decrease compression of the mesenteric root.
Once a 3–4 cm section of the intestine has been exteriorised, stay
sutures are placed on its antimesenteric border, and the biopsy is carried
out in a standard fashion. After the biopsy is completed local lavage can
be performed away from the abdominal incision site, and the intestine
is gently replaced into the abdominal cavity. Care should be taken not
to exteriorise too large a loop of intestine, as it can then be difficult to
return it to the abdomen. In this case, the Babcock forceps inserted in
the other instrument port can be used to gently pull the loop back into
the abdominal cavity.
If multiple intestinal biopsies are required, the cannula needs to be
reintroduced into the abdomen, and the pneumoperitoneum re-
established. In order to create a sufficient seal to maintain insufflation
of the abdomen, a purse-string suture can be placed around the operative