Page 186 - Clinical Manual of Small Animal Endosurgery

174 Clinical Manual of Small Animal Endosurgery

Haemostatic clip applicators

Reusable and disposable minimally invasive surgery haemostatic clip
applicators are available, most commonly in 10 mm diameter, but also
more recently in 5 mm diameter. Right-angled applicators are also avail-
able in 10 mm diameter. Whereas single-use disposable applicators are
easier to use (being double action), are less likely to drop clips and allow
application of multiple clips without needing to reload, they are not good
candidates for reuse as they tend to accumulate blood internally, and
even with prolonged cold-water soaking in an upright position there is
no method of ensuring this has been completely removed. Single- and
double-action reusable applicators are available depending on prefer-
ence. Reusable applicators need to be removed and reloaded for each
clip. One needs to check whether these are for Weck, Ethicon, Covidien
or Helka clips, as well as the specified clip size (10 mm are most com-
monly medium or medium-large), as applicator makes and clip sizes are
not interchangeable. The 5 mm reusable clip applicators are most suit-
able for thoracoscopic procedures.

Extraction bags
A multitude of different extraction bags are commercially available. The
most commonly encountered types are single-use clear plastic bags. The
best, however, are those made of impervious leakage- and rip-proof
‘parachute’ material such as the E-sac (Espiner Medical), which cannot
break or leak even if some considerable force is applied during extraction
(see Fig. 6.4). The only real risk of leakage with this type of extraction
bag comes from inadvertent damage from a scalpel or scissors if trying
to enlarge the extraction site while the bag is in it, or if using these

Fig. 6.4 An impervious leakage- and rip-proof endoscopic extraction sac
made from ‘parachute’ material (E-sac), well suited to removal of lung
tissue through a mini-thoracotomy site, and prevention of port-site
metastasis when removing tumours.