Page 175 - Clinical Manual of Small Animal Endosurgery

Operative Laparoscopy 163

surface of the skin with a Chinese finger-trap friction suture. A light
dressing and stockinette bandage are placed to support the tube to the
abdominal wall. Potential complications of jejunostomy tubes include
blockage of the feeding tube, premature dislodgement, self-mutilation,
dermatitis around the site, fistula, leakage, and transient diarrhea and
vomiting associated with feeding (Freeman, 2009).

Advanced laparoscopic procedures
Laparoscopic cholecystectomy, laparoscopy-assisted cholecystostomy
tube placement and laparoscopic adrenalectomy have been performed
by veterinary surgeons with advanced laparoscopic skills in carefully
selected clinical cases. For additional information, refer to Mayhew’s
recent description of these techniques (Mayhew, 2009). Murphy et al.
(2007) described the technique for cholecystostomy for temporary biliary
diversion in cases of extrahepatic biliary tract obstruction. Laparoscopy
is used to view and stabilise the gall bladder in a location that corre-
sponds to the right cranial ventral body wall, just caudal to the costal
arch. An 8–10 French locking-loop catheter is introduced percutaneously
through the body wall to finally reside in the gall bladder. The locking
loop is then fixed by pulling the string to hold the catheter in place. If
successful, the catheter should remain inserted for 3–4 weeks to prevent
leakage. Laparoscopic cholecystectomy could be selected in cases of
uncomplicated gall bladder mucocele. Mayhew et al. (2008) reports
using a four-port technique to provide adequate exposure and visualisa-
tion to enable dissection and ligation of the cystic duct using endoscopic
ligating clips or extracorporeally tied sutures. The gall bladder is dis-
sected from the hepatic fossa and placed in a specimen retrieval bag for
extraction from the umbilical port. Techniques for both right and left
laparoscopic adrenalectomy have been reported in seven dogs (Jiménez
Peláez et al., 2008). Visualisation is excellent; however, the location of
the adrenal gland adjacent to large vessels makes excellent haemostasis
an absolute requirement for successful laparoscopic technique (Fig.
5.20). In the early part of the learning curve, the wise surgeon should be
comfortable in having a low threshold for converting to an open proce-
dure when necessary to ensure operative safety.
A few cases of laparoscopic splenectomy and laparoscopic nephrec-
tomy have been performed in carefully selected cases in client-owned
animals, enabled by the vessel-sealing devices such as LigaSure, ENSEAL
and the Harmonic Scalpel. The camera port is placed at the umbilicus
and the animal is rotated to lateral recumbency to expose the kidney.
Dissection proceeds with the vessel-sealing device, and final haemostasis
of the major blood supply is achieved with a combination of the vessel-
sealing device and clips or an endoscopic stapler. The organ may be
placed in a specimen-retrieval bag and the umbilical incision is extended
along the midline to provide an adequate length for extraction.