Page 151 - Clinical Manual of Small Animal Endosurgery

Operative Laparoscopy 139

(a) (b)
Fig. 5.3 Photographs of a Hasson trocar showing retention sutures secured to the olive plug.
(a) Side view. Each suture is wrapped around the tying posts of the olive plug. (b) Top view. The
insufflation tubing has been attached to the stopcock and the laparoscope is inserted.

through the skin and subcutaneous tissue down to the linea alba. Once
this landmark is visualised the external sheath of the rectus abdominis
muscle is elevated and an incision is made through the linea alba with a
scalpel blade. After confirming entry into the peritoneal cavity, a suture
is placed through the linea alba on each side of the incision and is tied
to the olive plug of the trocar. The olive plug ensures a good seal between
the trocar and the abdominal incision. The sutures hold the trocar in
place during manipulation (Fig. 5.3). In cats and some dogs a portion of
the falciform ligament must be removed to properly place the primary
port and prevent smudging of the laparoscope when it is inserted. The
carbon dioxide tubing is attached to the stopcock of the trocar and insuf-
flation to 12 mmHg is begun. The obturator is removed and the laparo-
scope is inserted to perform a visual inspection of the abdominal cavity.
To prevent laparoscope fogging during insertion into the warm abdomi-
nal cavity, prior warming or an anti-fog solution may be used.

Tissue manipulation and retraction
Depending on the operation, secondary ports are inserted under direct
visualisation in a location to triangulate on the region of interest. The
fingertip is used to indent the body wall and identify the site for port
placement. Following a small skin incision, a sharp trocar is inserted,
keeping the tip in the centre of the field of view at all times. When the