Page 168 - Clinical Manual of Small Animal Endosurgery

156 Clinical Manual of Small Animal Endosurgery

the cystoscope can then be repeatedly passed through the trocar without
traumatising the bladder (Fig. 5.13). Similar to patient management for
traditional cystotomy, azotemia and urinary tract infection should be
resolved and the animal evaluated for other systemic abnormalities prior
to surgery. Radiography documents the number and location of radio-
paque stones and ultrasound examination of the kidneys, ureters and
bladder is useful in detecting small or radiolucent stones and determining
if there are irregularities in the bladder wall or trigone. For animals with
recurrent bladder infection, it is wise to obtain a full-thickness biopsy of
the bladder wall for culture at the time of surgery. Perioperative antibiot-
ics are administered and the abdomen is prepared for aseptic surgery
with wide draping. The prepuce is flushed with antiseptic solution in
male dogs and draped into the surgical field.
When performing laparoscopy-assisted cystoscopy the initial 5 mm
trocar is placed on the midline at or just caudal to the umbilicus. The
laparoscope is inserted and visual inspection of the abdomen is per-
formed. A second 5 or 10 mm trocar is then placed on the midline in
female dogs or lateral to the prepuce in male dogs for insertion of the 5
or 10 mm Babcock forceps. The forceps are used to grasp the apex of
the bladder and lift it to the trocar site as the cannula is removed (Fig.
5.14). Usually, the 10 mm incision is sufficient for exteriorisation of the
bladder, but it can be extended if needed. While holding the bladder apex
with the forceps, a minimum of two cruciate stay sutures are placed in
the bladder wall and used for retraction. Some surgeons use four quad-
rate interrupted sutures on the bladder wall and some suture the bladder
wall to the skin to prevent abdominal contamination with urine during
the procedure (Rawlings et al., 2003). Another option is to insert a
threaded trocar cannula, but care must be taken with the reusable ones
to ensure that the screw tip does not traumatise the bladder wall. The
cystoscope is connected to the camera, light source, irrigation fluids and
egress tubing. After scope insertion into the bladder and appropriate fluid
distension, visual inspection is performed. The bladder is lavaged and
inspected, taking care to ensure that any portion of the bladder that is
cranial to the cystotomy site is thoroughly examined. In male dogs one
can pass a urethral catheter to occlude the urethral lumen and to serve
as an additional means of flushing the urethra.
The wire stone basket is efficient for retrieval of calculi (Fig. 5.15).
This device can be passed through the working channel of the cystoscope
into the bladder past the calculi and opened. The calculi are then cap-
tured with the basket, which is subsequently brought to the end of the
cystoscope. The cystoscope is removed and the basket is opened to
deliver the calculi. Some calculi are too large to capture in the stone
basket. For these, forceps can be inserted alongside the cystoscope and
used to grasp the stone. The forceps and cystoscope are removed and
reinserted to remove each stone (Fig. 5.16). Smaller calculi may be
removed by placing a suction device inside the bladder and flushing
through the urethra. The urethral catheter is passed to ensure a smooth