Page 167 - Clinical Manual of Small Animal Endosurgery

Operative Laparoscopy 155

oscopic cystoscopy are that bladder trauma is limited to a very small
incision and there is less likelihood of urine contamination of the abdomi-
nal cavity. With a single very large stone, the abdominal incision and
incision in the bladder must be large enough to retrieve the stone. Most
often, the laparoscopy-assisted cystoscopy is performed in male dogs
because females have a larger urethra and are more amenable to retrieval
of larger stones with the traditional cystoscope. The laparoscopy-assisted
cystoscopy approach involves placing a midline trocar for viewing
abdominal contents prior to placing a second port for exteriorising a
portion of the urinary bladder (Rawlings et al., 2003). Recently, the
keyhole transvesicular cystourethroscopy procedure has been advocated
to avoid the need for the laparoscopic approach (Runge et al., 2008). The
bladder is distended and a small laparotomy is made on the midline.
The cranial portion of the bladder is grasped and exteriorised. After this, the
steps of both procedures are the same and will be described in detail.
Both techniques use a rigid cystoscope, which provides excellent visu-
alisation of the internal surface of the bladder and proximal urethra,
ideally ensuring that all stones are removed and that any surface irregu-
larities are seen and biopsy samples taken for further evaluation. The
cystoscope comprises a 30° 2.7 mm rigid scope with a 14.5 French sheath
for most cases (Fig. 5.13). A smaller cystoscope, which uses a 1.9 mm
scope, is available for cats and small dogs. Other equipment needed for
the procedure includes a stone basket which fits through the working
channel of the cystoscope sheath and a variety of forceps, including
alligator forceps, arthroscopy forceps and 5 mm laparoscopic grasping
forceps. Irrigation fluids with a pressure cuff are connected to the cysto-
scope to provide constant irrigation and clearing of the site. When
numerous small stones are present, a 5 mm threaded trocar cannula, such
as the Thoracoport™ (Covidien), can be inserted into the bladder and

Fig. 5.13 Photograph illustrating the 2.7 mm cystoscope being used with
a 5 mm Thoracoport™ cannula.