Page 153 - Clinical Manual of Small Animal Endosurgery

Operative Laparoscopy 141

cedure must be vented to prevent obscuring the operative field. For large
pedicles where precise dissection is not needed, I prefer the LigaSure or
ENSEAL® (Ethicon Endo-Surgery) devices as they are capable of bipolar
coagulation of vessels up to 7 mm in diameter. Pre-tied loop ligatures, such
as the ENDOLOOP, can also be used when there are two operating ports
and the tissue can be grasped through the loop (Fig. 5.5). As an alterna-
tive, sutures that are tied outside the body with a Roeder knot can be
advanced into the cavity to perform secure ligation.

(a)

(b)

Fig. 5.5 A pre-tied loop ligature is being positioned and tightened to
prevent bile leakage from the gall bladder after obtaining a bile sample for
culture. Two working ports are required: (a) grasping forceps are inserted
through the centre of the loop to grasp the tissue around the opening in
the gall bladder; (b) final appearance after the loop has been tightened
and the suture cut.