Step 7: Create the secondary operative/cranial portal
This portal does not require an insufflation stopcock, but it is recommended in case of inadvertent removal of the camera/caudal
portal with the insufflation stopcock.
Figure 6
|
Establish the operative/cranial portal where the cranial skin incision was made earlier (midway between the xiphoid process
and the umbilicus on the midline) by using the same technique as for the first portal. With the camera directed toward your
second portal site, and, using the armed cannula-trocar combination, gently enter the abdomen in a cranial and caudal rocking
motion, angling the trocar caudally away from the stomach and spleen. When introducing a cannula-trocar unit into the abdomen
using only one hand, extend your middle finger along its shaft to act as a depth-stop to prevent excessive penetration. Use
the camera to observe that the trocar tip avoids the spleen and other organs (Figure 6). Then have an assistant reduce the abdominal pressure to 8 to 10 mm Hg for the rest of the procedure.
Step 8: Adjust the patient position
Figure 7
|
I stand on the patient's left side to remove the more easily located right ovary first. Using the patient positioner, rotate
the patient so the right ovary is uppermost (left side down). I face the wall monitor and maintain a baseball diamond orientation.11 I have the ovary at home plate, I am at second base, the portals are at first and third, and I use the ceiling or wall monitor
opposite me as I perform the procedure.
Step 9: Tack the right ovary to the abdominal wall
Figure 8
|
Pass a 5-mm endoscopic Babcock forceps or equivalent through the operative/cranial portal, and direct it and the laparoscope
just caudal to the right kidney to locate the ovary. It is often necessary to first find the ovary (Figure 7) and grasp the ovarian suspensory ligament or the ovariouterine juncture and apply gentle traction to lift the ovary into
the visual field and toward the lateral abdominal wall on the same side (Figure 8). An assistant may carefully grasp the patient along the dorsal midline and lift and jiggle to assist the surgeon in visualizing
the ovary or suspensory ligament. Avoid grasping the ovary to prevent ovarian rupture and seeding the abdomen with ovarian
tissue. If you cannot locate the ovary but only see what appears to be the ovarian suspensory ligament, your patient may have
already been spayed. Grasp the ligament and lift it to follow it caudally to where the ovary should be. If you still cannot
locate it, direct the laparoscope caudally toward the pelvic canal. If the animal is intact or has had an ovariectomy, you
should see the uterine bifurcation lying on top of, or ventral to, the colon and the uterine body dorsal to the bladder.12
|
Featuring Information from:
