Page 165 - Clinical Manual of Small Animal Endosurgery

Operative Laparoscopy 153

Both techniques begin with the animal positioned in dorsal recum-
bency and prepared for aseptic surgery with wide draping. An initial
5 or 10 mm port is placed on the midline just caudal to the umbilicus
for insertion of the laparoscope and viewing of the abdominal cavity.
Once the location of the testis is identified, a second 5 or 10 mm port
is placed on the opposite side, depending on the size of the retained
testicle and whether the initial port is 5 or 10 mm. If both testicles are
retained they can usually be removed with only two ports, but the
surgeon should not hesitate to place a third port, if necessary. During
insertion of additional ports, careful palpation of the proposed trocar
insertion site should be performed to avoid trauma to the caudal deep
epigastric vessels.
When using two ports it is necessary to use a percutaneous suture
or the laparoscopic spay hook to suspend the testicle to the abdominal
wall to elevate and isolate the ductus deferens and pampiniform plexus
from underlying structures. The technique is similar to that for sus-
pending the ovary in an ovariectomy procedure. The grasping forceps
hold the testicle next to the body wall while the needle or hook is
inserted and rotated to grasp a portion of the testicle and elevate it to
the body wall. The grasping forceps are removed and the vessel-sealing
device is inserted and placed across the gubernaculum, pampiniform
plexus and spermatic cord in succession. The device is activated to
coagulate and then cut the tissue (Fig. 5.12). If desired, a double seal
can be performed on the pampiniform plexus prior to transection. An
alternative to using the vessel-sealing device is to use ligating clips or
sutures. Initially, the technique was described using pre-tied ligatures
(Gallagher et al., 1992). Once ligation and transection are complete, the
testicle is removed from one of the port sites. If a 10 mm port is placed
on the midline, as a less traumatic approach, the laparoscope is trans-
ferred to the second port and the testicle is removed from the midline
location with Babcock grasping forceps, removing the trocar cannula as
the testicle is withdrawn. Otherwise, the laparoscope is left in place and
the testicle is removed through the parapreputial port. If a laparoscopy-
assisted gastropexy is being performed during the same procedure, the
second 10 mm trocar is placed in the right cranial quadrant and the
testicle can be removed through this port. The port sites are closed rou-
tinely in layers.
When using the laparoscopy-assisted technique, the second port is
placed on the same side as the retained testicle. Babcock forceps are
used to grasp and elevate the testicle until it can be exteriorised. The
incision may need to be extended slightly for adequate exposure. Liga-
tion of the gubernaculum, pampiniform plexus and spermatic cord
is performed with suture outside the abdominal cavity, similar to open
surgery. If the testicle is neoplastic, measures to protect the port site from
the potential for neoplastic seeding should be taken. If there is evidence
of testicular torsion, appropriate exposure may be needed to ensure an
easy removal.