Page 304 - Clinical Manual of Small Animal Endosurgery

292 Clinical Manual of Small Animal Endosurgery

expose the lung when it is held maximally inflated: the lung is grasped,
a small incision made for entry of the endoscope and the lung edges
sutured to the skin incision. The lung edges can otherwise be held with
stay sutures or atraumatic elasticated hook stays used on a flat retractor
ring (Lonestar retractor). In iguanas and similar lizards, the lung can be
grasped when maximally inflated via a small, mid-lateral intercostal
approach. In monitor lizards the lung is adherent to the dorsal body wall,
and may be similarly accessed from a dorsal approach. The lung is closed
at the end of the procedure with an absorbable suture. Incisions in the
lung made during coelioscopy for internal examination are not recom-
mended as these may not heal due to pressure effects and lung wall
movements.
A similar technique has also been described in chelonians, where the
lung is entered after an access hole is burred or drilled into the carapace
at a point selected on radiography. Care should be taken not to introduce
debris or contamination from the carapace into the lung, and use of a
second sterilised burr to make the final entry into the pleural cavity is
advisable. The lung is again grasped, and punctured or incised when
maximally inflated.
Divers (2011) has most recently reported using access from within the
avascular caudal region of the lung to perform liver biopsies in snakes.
The liver is localised and the overlying air sac and liver capsule incised,
before a biopsy is taken. This appears preferable to a coelioscopic
approach, which in snakes yields poor visualisation.
In larger lizards, such as the green iguana, multiple entry techniques
such as orchidectomy and oophorectomy (ovariectomy) (Fig. 10.14) are
possible using a paralumbar fossa approach when the ovary is inactive.
Radiosurgery is recommended and low settings are necessary to avoid
damaging the closely associated adrenal glands and vena cava.
In tortoises and terrapins, a coelioscopy-assisted oophorectomy can
be performed. Via a left prefemoral fossa approach the ovary is localised
and the fibrous non-follicular tissue is grasped with 3 mm atraumatic
grasping forceps. The ovary is then exteriorised before standard removal
using radiosurgery or haemostatic vascular clip application. Innis et al.
(2007) report that in the majority of pet species both ovaries can be
removed through the same left prefemoral incision. Care should be taken
not to damage or rupture a follicle during coelomic retrieval, as this will
lead to postoperative yolk-induced coelomitis.
Reptile skin has a tendency to invert, and this can impede healing.
Normal skin healing is prolonged in reptiles, and sutures should be left
in place for a minimum of 4–6 weeks (Mader et al., 2006). An evert-
ing suture pattern should be used for closure of port sites, such as
simple interrupted horizontal mattress sutures, and monofilament non-
absorbable suture material is recommended. The raw everted wound
edges can further be sealed with tissue adhesive to reduce the risks of
both contamination and subsequent wound infection, as well as wound-
edge irritation or pain.