Page 141 - Clinical Manual of Small Animal Endosurgery

Diagnostic Laparoscopy 129

port. Reinsufflation is also needed if inspection of biopsy sites for haem-
orrhage is necessary.
An alternative technique employs a laparoscopic wound-retraction
device (Alexis Wound Retractor , Applied Medical UK), which keeps a
®
small circular orifice open into the abdomen. In this way the intestine
can be exteriorised through a wider incision, avoiding the risk of com-
pression of the mesenteric roots. The wound-retraction device is also
useful in performing biopsy of other structures such as lymph nodes, and
in various laparoscopy-assisted surgical procedures.

Mesenteric lymph nodes
Samples from small lymph nodes are usually obtained with an excisional
biopsy. The lymph nodes are identified laparoscopically and carefully
dissected from the surrounding tissue, preferably using the Harmonic
Scalpel or other power-assisted device. Grossly enlarged lymph nodes
can be biopsied with cup forceps, often following dissection of overlying
mesentery to expose the surface. A right flank approach may be useful
to improve exposure of the mesenteric lymph nodes.

Other abdominal organs
Laparoscopic biopsies can also be obtained from the spleen and the
adrenal glands. Cup biopsy forceps are commonly employed, and the
technique is the same as for liver biopsy. Care should be taken with
splenic or adrenal biopsy, because significant haemorrhage is common.
In addition, laparoscopy is useful for staging and biopsying abdominal
tumours. The excellent visualisation of vascular changes in tissue is very
helpful in identifying metastatic disease: lesions less than 1 mm in diam-
eter can be detected on the liver or peritoneal surface. This is particularly
valuable in cases of unexplained ascites or suspected mesothelioma.

Complications

In addition to complications that may be encountered with any surgery
(such as anaesthesia-related complications, haemorrhage, infection,
wound dehiscence, adhesion formation, etc.), specific complications
associated with laparoscopy generally arise from Veress needle and
trocar insertion and abdominal insufflation. Insufficient or malfunction-
ing equipment, together with operator inexperience, play a major role
in the insurgence of most operative complications, and consequently
careful planning helps in minimising their occurrence.
Complications resulting from Veress needle or trocar insertion include
major vessel injury and damage to underlying organs, which in turn can
lead to mechanical organ damage and/or gas embolism. Abdominal-wall
penetration may in fact injure the superficial or deep epigastric vessels,