How to perform a two-portal laparoscopic ovariectomy - Veterinary Medicine
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How to perform a two-portal laparoscopic ovariectomy
Learn more about this laparoscopic procedure, which produces less pain and tissue trauma than a routine open ovariohysterectomy does. Then consider whether you should take the necessary steps to offer it in your practice.


VETERINARY MEDICINE


THE TWO-PORTAL LAPAROSCOPIC OVARIECTOMY TECHNIQUE

Before performing a laparoscopic ovariectomy, inform the owner about the procedure, and obtain a signed permission-to-treat form (including permission to convert to an open procedure, should it be necessary) and a signed estimate form that specifically states laparoscopic ovariectomy. Also, make sure all equipment is sterilized, and prepare the patient, including evacuating the bladder (see the related sidebar titled "General laparoscopic ovariectomy setup instructions for technicians"). I also instruct my technician to administer 20 mg/kg cefazolin intravenously during induction. If any perceived breaks in sterility occur during the procedure, I continue appropriate antibiotic therapy.

Step 1: Position the patient

Position the widely clipped animal in dorsal recumbency on an endoscopic patient positioner that has been securely attached to the surgery table. Secure the patient with the positioner's straps and buckles, making sure the upper thigh straps are secure since they will help hold the patient's legs open when the patient is rotated into the lateral position. Do not use the surgery table ties to secure the patient's legs. Adjust the front of the positioner so the open area between the front sliding V and the fixed caudal V is wide enough to allow easy access to the portal areas and the ovarian tacking sites lateral to the third and fourth mammary glands. Tape may be needed to secure smaller patients instead of the straps. Make sure enough space is available to move easily around the caudal end of the surgery table to the other side. Temporarily place the instrument stand to the side of the tail end of the surgery table. Aseptically prepare the surgical field in the standard fashion.

Step 2: Drape the area

Have a nonsterile assistant open the sterile box pack cover and place it toward the backsplash of available counter space. After donning a cap, a mask, a gown, and gloves, the surgeon removes the large paper drape from the top of the box and places it to the side on the sterile cover drape. The four towels and six towel clamps are used to drape the wide abdominal area. Place the cranial and caudal towels first, and then clamp in the first side towel to the cranial towel. Next, clamp it again farther dorsally following the rib cage to just short of the prepped edge (near the last rib), and place the final towel clamp, securing it to the caudal towel. Do the same on the opposite side.

Step 3: Arrange the instruments


Figure 3
Arrange the instruments for chronological use on the surgery counter (Figure 3) from left to right: the Veress needle, insufflation hose, No. 11 or No. 15 blade (not pictured), suture pack, 5-mm Storz EndoTIP cannula, and another 5- to 14-mm cannula-trocar assembly (depending on the patient's size). Remove the trocar from the cannula-trocar assembly and place it and the cannula side-by-side. Place the camera head and light cable next and the endoscopic grasper toward the back next to the laparoscope.

Step 4: Further positioning and site preparation

Have an assistant move the instrument tray to the tail end of the surgery table and place the tower at the head of the table. I generally do not tilt the surgery table head down (Trendelenburg position8 ) unless I have difficulty locating the ovaries. Place the large paper drape over the toweled-in area, and cover the area from the patient's head to the instrument tray stand.

Have the assistant open the outer wrap on the general surgery pack and place the pack on the drape-covered instrument stand (the pack's weight helps keep the drape in place when the patient is moved from side to side). Next, cut the drape over the two portal entry areas (see below for the exact location of the portals) and secure the drape with four towel clamps.


Figure 4
Run the insufflation, light cable, and camera head lines through the cranial and caudal towel clamps (use the eyes and lock boxes) to help keep the lines in the sterile field (Figure 4). Hand the assistant the filter end of the insufflation line to be plugged into the insufflation unit.


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Source: VETERINARY MEDICINE,
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