Page 152 - Clinical Manual of Small Animal Endosurgery

140 Clinical Manual of Small Animal Endosurgery

trocar cannula is seen the sharp obturator is removed and the cannula
is secured. Some trocars have threads on the outside of the cannula which
are very helpful in keeping the cannula secure during the procedure. A
blunt probe is useful for tissue manipulation. If tissue needs to be ele-
vated, blunt grasping forceps can be utilised. If it is necessary to expose
an organ, endoscopic Babcock forceps are useful in grasping and elevat-
ing tissue and viscera, such as the stomach or urinary bladder. Retraction
is almost always achieved by positioning the animal and letting gravity
assist in moving organs out of the field of view; however, fan-shaped
retractors are available and are sometimes necessary to enhance expo-
sure. When 5 mm-diameter instruments are inserted through 10 mm
ports, a reducer cap is necessary to prevent loss of pneumoperitoneum.

Haemostasis
To maintain an adequate field of view, excellent haemostasis must be
achieved or the operative field will become too dark for proper visual-
isation. A number of devices are used for haemostasis and each has
advantages and disadvantages. For single, well-isolated pedicles, laparo-
scopic ligating clips may be used and, depending on the source, may
be relatively inexpensive. Haemostasis of the ovarian pedicles and
uterine body is most easily achieved with ultrasonic energy delivered
by the Harmonic® Scalpel (Ethicon Endo-Surgery; Fig. 5.4) or by bipolar
electrocoagulation delivered with the LigaSure™ vessel-sealing device
(Valleylab). The author prefers the Harmonic Scalpel for safety and
precise dissection; however, the water vapour generated during the pro-

Fig. 5.4 The proper ligament of the right ovary is suspended with a
percutaneous suture as the 5 mm Harmonic Scalpel device is positioned on
the suspensory ligament and ovarian pedicle. There is minimal lateral
thermal damage.