Page 149 - Clinical Manual of Small Animal Endosurgery

Operative Laparoscopy 137

Fig. 5.2 Line drawing of hand-assisted laparoscopic surgery. From Rudd
and Hendrickson (1999), Fig. 12.9. Reproduced with permission from Elsevier.

laparoscopy (HALS) is performed using a totally laparoscopic approach
with a single large port (Fig. 5.2) that enables the surgeon to insert a
hand into the abdominal cavity and maintain insufflation by providing
a seal around the arm. These techniques are popular in human surgery
for removing an intact kidney in donor nephrectomy procedures and
whenever manipulation or removal of large organs such as the spleen or
colon is anticipated.
Lap-assisted procedures are commonly performed in veterinary medi-
cine for prophylactic gastropexy, intestinal biopsy, feeding-tube place-
ment and cystotomy procedures. The lap-assisted procedure begins as a
laparoscopic approach with placement of multiple trocars and, at the
appropriate time, one of the trocars is removed and a mini-laparotomy
is performed to expose tissue that needs inspection or suturing. In
animals, the lap-assisted procedure is commonly performed because the
body wall is thinner than human patients, making the mini-laparotomy
less invasive, with less risk of dehiscence and wound infection than if the
procedures were performed in people. The optical cavity in small animals
is much smaller than in human patients, making endoscopic suturing and
tissue manipulation more difficult. In addition, in veterinary medicine it
is far more economical to suture, rather than use stapling devices, which
are widely used in human surgery. The veterinary surgeon should always
be prepared for conversion to an open procedure. Each laparoscopy case
is prepared as if conversion will take place and the owners are informed