Page 147 - Clinical Manual of Small Animal Endosurgery

Chapter 5

Operative Laparoscopy

Lynetta J. Freeman

Although there are a number of ways to approach operative laparoscopy,
patient factors, skill of the endoscopist, available equipment and owners’
desires guide the selection of approach for each animal. The wise veteri-
narian will select the technique that offers the greatest benefit with the
least risk to the animal. Laparoscopists must have the skill to perform
the procedure using the available equipment. In some cases, although
a procedure is technically feasible, performing a totally laparoscopic
approach requires so much more surgical time that it may not be in the
best interest of the animal. Minimally invasive techniques are infre-
quently used in veterinary medicine, so decision-making regarding the
approach is based more on the surgeon’s opinion and experience than
on outcomes of published studies. The purpose of this chapter will
be to discuss totally laparoscopic, laparoscopy-assisted and hand-assisted
laparoscopic for traditional operative laparoscopy, and to introduce two
newly emerging approaches, called SILS™ and NOTES®, that may be
applicable to veterinary minimally invasive surgery in the future.

Definitions

Totally laparoscopic procedures are performed exclusively through small
incisions to introduce trocars into the abdominal cavity, as was discussed
in the previous chapter. Usually multiple ports are placed, one to intro-
duce the laparoscope for viewing the abdominal contents and one or two
working ports for operative equipment. The multiple ports are arranged
such that the surgeon can triangulate instruments to approach the target

Clinical Manual of Small Animal Endosurgery, First Edition. Edited by Alasdair Hotston Moore and
Rosa Angela Ragni.
© 2012 Blackwell Publishing Ltd. Published 2012 by Blackwell Publishing Ltd.