Page 154 - Clinical Manual of Small Animal Endosurgery

142 Clinical Manual of Small Animal Endosurgery

Fig. 5.6 Ethicon specimen-retrieval bag. The wire band assists in holding
the specimen-retrieval bag open for insertion of tissue.

Tissue retrieval
Most of the time, tissue retrieval is simply facilitated by removing the
trocar with the tissue, releasing the pneumoperitoneum and enlarging
the incision. For retrieval of friable tissue or to ensure that contamination
does not occur, a tissue specimen bag (ENDOPOUCH® Retriever™,
Ethicon Endo-Surgery) may be used. The tissue is placed inside the
bag and the top is closed. The tissue is then removed while in the bag
(Fig. 5.6).

Inspection and closure
Final inspection of the operative site and abdominal viscera should be
performed prior to closure to ensure that there is no active bleeding and
no evidence of iatrogenic tissue injury. If necessary, the abdomen can be
lavaged with sterile saline and the fluid aspirated. It can be quite difficult
to remove all of the lavage fluid without loss of pneumoperitoneum, and
therefore there is almost always some residual fluid left in the abdomen.
I prefer to remove the secondary ports while the abdomen is still insuf-
flated. The tissue layers are grasped as the trocar is removed because in
this way they are best aligned and most easily visualised. Each tissue
layer is closed in succession with one or two absorbable sutures. The
Hasson trocar is removed last. The sutures are used to elevate the body
wall and ensure that all of the excess carbon dioxide is allowed to escape.
The linea alba, subcutaneous tissue and skin are then closed routinely.
A 5% lidocaine patch (Endo Pharmaceuticals) may be cut and applied
around each of the port sites to provide regional analgesia without sys-
temic effects (Fig. 5.7).