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Группа авторов. Small Animal Laparoscopy and Thoracoscopy
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Small Animal Laparoscopy and Thoracoscopy
Contributors
Foreword
Foreword
Preface
Acknowledgment
About the Companion Website
History of Small Animal Laparoscopy and Thoracoscopy
Endoscopy in the Nineteenth Century
1930s: The Glory Days
Out in the Cold: 1940s to mid‐1960s
Controversy Galore: 1970s to 1990s
Small Animal MIS
Early Work: 1970s
MIS Takes Off in Small Animal Surgery: The 2000s and Beyond
Acknowledgments
References
1 Surgeons' Skills Training
Adding Minimally Invasive Surgery to a Surgeon's Repertoire
Basic Laparoscopic Skills
Simulation Training Models
Physical Simulation Models: Box Trainers
Virtual Reality Simulation
Hybrid Training Models: Augmented Reality
Robotic Surgery Simulation Training
How to Train MIS Surgeons Safely; The Optimal Training Program
Basic Skills
Life‐like‐High Fidelity‐ Training
Starting a Simulation Skills Training Curriculum
Tasks and Goals
Motivation
Feedback
Opportunity to Practice
Self‐Directed Training
Miscellaneous Training; Video and Serious Games
References
2 Minimally Invasive Suturing Techniques
Key Points
Introduction to Laparoscopic Suturing
Needle Holders for Laparoscopic Suturing
Suture Materials for Minimally Invasive Suturing. Conventional Sutures
Suture Needles
Barbed Suture
Intracorporeal Hand Suturing Technique
Cannula Placement
Needle Introduction
Needle Positioning
Needle Dance
Techniques for Knot Tying: Simple Interrupted Sutures
Knot Tying Using a Vertical Plane: The “Rosser Technique” (Figure 2.18, Video 2.3)
Knot Tying with Horizontal C‐Loops as Described by Szabo et al. [15, 16](Figure 2.20, Video 2.4)
Continuous Suture Patterns
Extracorporeal Suturing. Indications
Technique
Slip Knots
Tying the Weston Knot (Figure 2.24, Video 2.5)
Tying the Modified Roeder Knot (Figure 2.25, Video 2.6)
Automated Suturing Devices
Using the Endo Stitch
References
3 Imaging Equipment and Operating Room Set‐Up
Key Points
Imaging Equipment
Imaging Chain
Telescopes. h3. General Concepts
Light Sources
Light Cables
Endoscopic Video Cameras
Display Monitors, Auxiliary Screens, and “All‐in‐One” Video Systems
Insufflators
Capture and Storage of Images and Video
Video Carts and Ceiling Booms
Integrated and Intelligent Operating Rooms
Operating Room Setup
Preparation for Open Surgery
Considerations for a Minimally Invasive Theater or Suite
Ergonomic Considerations
Planning Coordination and Efficiency
Fully Equipped Minimally Invasive Surgery Suite: Hybrid Rooms
References
4 Surgical Instrumentation
4.1 Surgical Instrumentation
Key Points
Instrument Design
Forceps
Scissors
Tissue Retractors
Needle Holders and Suturing Devices
Laparoscopy Packs
4.2 Trocars and Cannulas
Key Points
The Trocar, Cannula, and Sheath
Cannula
Seal
Obturator
Trocar–Cannula Placement
Veress Needle Technique
Direct Insertion Technique
Hasson Technique
Types of Trocar Assemblies
Disposable Trocar Assemblies
Nondisposable Trocar Assemblies
Trocar Assembly‐Related Complications
Vascular Injury
Visceral Injury
Port Closure Devices
References
4.3 Miscellaneous Surgical Instrumentation
Key Points
Specimen Retrieval Bags
Suction and Irrigation Devices
Wound Protector and Retractor Devices
Morcellators
References
5 Energy Devices and Stapling Equipment
Key Points
Electrosurgical Theory
Waveforms
Monopolar Electrosurgery
Safety of Monopolar Electrosurgery
Bipolar Electrosurgery
Tissue Fusion Device
Ultrasonic Dissector
Microwave Ablation
Clip and Staple Applicators
References
6 Single Incision Laparoscopic Surgical Platforms
Key Points
Development of a New Platform
Adoption into Veterinary Laparoscopy
Access Methods for Single‐Port Surgery. Operative Laparoscopy and Advanced Operative Laparoscopy
Single‐Port Access
Commercially Available Single‐Port Devices
Principles of Single‐Port Surgery
Access in Single‐Port Surgery
Insertion Techniques for Specifically Manufactured Single‐Port Devices
SILS Port (Covidien; Figures 6.3 and 6.4)
TriPort System (Olympus)
Insertion Technique of Standard Trocars for Single‐Port Entry
Innovative Adaptations of Existing Equipment. Wound Retractor with Latex Glove and Finger Ports (Figure 6.6)
Instrumentation
Optics
Conclusion
References
7 Anesthesia Management of Dogs and Cats for Laparoscopy
Key Points
Introduction
Anesthesia Considerations Related to Disease
Anesthesia Considerations Related to Surgery
Pathophysiology of Pneumoperitoneum. Hemodynamic Effects
Respiratory Effects
Complications Associated with Pneumoperitoneum
Anesthesia Management
Summary
References
8 Laparoscopic Access and the Working Space
Key Points
Necessary Considerations Before Laparoscopic Access. Physics of Entry
Peritoneal Tenting and Curtain Effect
Relevant Anatomic Knowledge
Trocar and Cannula Design
Closed‐Entry Techniques (Blind)
Blind Abdominal Access Using a Veress Needle Followed by Blind Trocar Insertion. Use of a Veress Needle to Establish Pneumoperitoneum
Holding and Manipulating the Veress Needle
Veress Needle Entrance Location
Verification of Appropriate Intra‐Abdominal Veress Needle Placement
Double‐Click Test
Aspiration Test
Injection Test
Hanging‐Drop Test
Intra‐Abdominal Gas Pressure Test
Misplacement of the Veress Needle
Blind Trocar Insertion After Establishment of Pneumoperitoneum
Access Through Direct Trocar Insertion
Open‐Entry Techniques. Open Laparoscopic Entry (Hasson Technique)
Visual Entry Techniques. Optical‐Access Trocars
Ternamian Visual Entry
Evidence for Entry Technique Safety and of Efficacy
Single‐Access Surgery
Access to the Retroperitoneal Space
The Laparoscopic Working Space
The Pneumoperitoneum. Insufflation Gases for Hyperbaric Pneumoperitoneum
Warmed, Humidified Gases
Port Site Metastasis (Figure 8.10)
Desufflation
Obesity
Low Pressure vs High Pressure
Pressure Effects of Pneumoperitoneum
Gasless Laparoscopy
Patient Positioning
Conclusion
References
9 Laparoscopic Contraindications, Complications, and Conversion
Contraindications
Instrument‐Related
Box 9.1 Contraindications for Laparoscopic Surgery
Operator‐Related
Patient‐Related
Hemodynamically Unstable Patient
Respiratory Comorbidities
Previous Abdominal Surgery and Adhesion Formation
Disease‐Related. Diaphragmatic Hernia
Large Abdominal Mass
Septic Peritonitis
Intra‐Abdominal Malignancy
Increased Intracranial Pressure
Pregnancy
Portal Hypertension and Coagulopathies
Complications. Organizational Problems
Entry Complications
Instrument‐Related
Box 9.2 Entry Complications
Operator‐Related
Patient‐Related
Disease‐Related
Capnoperitoneum Failure
Box 9.3 Checklist Capnoperitoneum Failure
Instrument‐Related
Operator‐Related
Disease‐Related
Obscured Visualization
Instrument‐Related
Box 9.4 Checklist for Obscured Visualization
Operator‐Related
Patient‐Related
Disease‐Related
Hemostasis Failure
Instrument‐Related
Box 9.5 Checklist Hemostasis Failure
Operator‐Related
Patient‐Related
Patient Trauma
Box 9.6 Checklist Patient Trauma
Instrument‐Related
Operator‐Related
Conversion. Prepare for Conversion
Timing of the Decision to Convert
Consequences of Conversion
References
10 Diagnostic Laparoscopy of the Gastrointestinal Tract
Key Points
Preoperative Considerations. Gastroenteric Pathophysiology
Relevant Anatomy
Diagnostic Workup
Patient Selection
Patient Preparation
Patient Position
Port Type and Position
Working Space and Exposure
Instrumentation
Surgical Techniques. Laparoscopic‐Assisted Gastrointestinal Exploration
Challenges
Complications
References
11 Laparoscopic‐Assisted Feeding Tube Placement, Gastrotomy, Enterotomy, and Intestinal Resection and Anastomosis
Key Points
Laparoscopic‐Assisted Feeding Tube Placement. Preoperative Considerations
Patient Selection
Patient Position
Port Type and Position
Working Space and Exposure
Surgical Techniques. Instrumentation
Laparoscopic‐Assisted Gastrostomy
Laparoscopic‐Assisted Enterostomy
Complications
Postoperative Care. Pain Control
Prophylactic Measures
Hospitalization Time
Laparoscopic‐Assisted Gastrotomy, Enterotomy, Intestinal Resection and Anastomosis. Preoperative Considerations. Gastrointestinal Wound Healing
Diagnostic Workup
Patient Selection
Prognostic Factors
Patient Preparation. Patient Positioning, Port Positions, and Working Space
Surgical Techniques. Instrumentation
Laparoscopic and Laparoscopic‐Assisted Gastrotomy
Enterotomy and Intestinal Biopsy
Enterectomy and Anastomosis
Omentalization
Challenges
Complications and Prognosis
Postoperative Care. Pain Control
Prophylactic Measures
Hospitalization Time
References
12 Laparoscopic and Laparoscopic‐Assisted Gastropexy Techniques
Key Points
Preoperative Considerations
Patient Preparation
Surgical Techniques. Laparoscopic‐Assisted Gastropexy (Multiport Technique)
Intracorporeally Sutured Laparoscopic Gastropexy (and Modification with Novel Suture Devices)
Single‐Port Access Gastropexy (Including Combined Procedures)
Complications and Prognosis
Postoperative Care
References
13 Laparoscopic Treatment of Hiatal Hernias and Associated Gastroesophageal Reflux
Clinical Presentation
Diagnostic Imaging
Functional Assessment of the LES and Antireflux Barrier
Medical Management of GER and SHH
Surgical Management
Laparoscopic Technique for Repair of Hiatal Hernia. Patient Position and Port Positions
Post‐Operative Care
Conversion and Complications
Outcomes of Laparoscopic Hiatal Hernia Repair
References
14 Laparoscopic Splenectomy
Key Points
Introduction
Preoperative Considerations. Surgical Anatomy
Preoperative Workup/Diagnostic Imaging
Patient Selection
Prognostic Factors
Patient Preparation. Surgical Preparation
Operating Room Set‐Up and Patient Positioning
Portal Position and Creation of Working Space
Surgical Techniques. Surgical Instrumentation
Multiple‐Port Total Laparoscopic Splenectomy
Single‐Port Total Laparoscopic Splenectomy
Laparoscopic‐Assisted Splenectomy
Complications and Prognosis
Postoperative Care
References
15 Laparoscopic Liver Biopsy, Resection, Ablation and Cholecystocentesis
Key Points
Preoperative Considerations. Surgical Anatomy
Preoperative Diagnostic Evaluation
Patient Selection
Patient Preparation. Preparation for Surgery
Operating Room Setup and Patient Positioning
Portal Position and Creation of Working Space
Surgical Technique. Instrumentation for Laparoscopic Liver Biopsy, Resection and Laparoscopic Cholecystocentesis
Surgical Procedures
Laparoscopic Liver Biopsy
Laparoscopic Liver Resection
Laparoscopic‐Assisted Ablative Therapies
Laparoscopic Cholecystocentesis
Complications
Postoperative Care
References
16 Laparoscopic Cholecystectomy
Key Points
Preoperative Considerations. Surgical Anatomy
Preoperative Diagnostic Evaluation
Patient Selection
Patient Preparation. Surgical Preparation
Operating Room Setup and Patient Positioning
Portal Position and Creation of Working Space
Surgical Technique. Instrumentation for Laparoscopic Cholecystectomy
Procedure. Cystic Duct First (CDF) Method
Fundic Dissection First (FDF) Technique (SAMIT) Method with Subserosal Dissection
Bile Duct Flushing and Intraoperative Cholangiography (IOC)
Laparoscopic Common Bile Duct Exploration and Treatment of Obstruction
Complications of Laparoscopic Cholecystectomy and Their Management
Management for Complications and Severe Cases
Postoperative Care
Acknowledgment
References
17 Laparoscopic Adrenalectomy
Key Points
Preoperative Considerations. Surgical Anatomy
Preoperative Diagnostic Evaluation
Diagnostic Imaging
Patient Selection
Patient Preparation. Surgical Preparation
Operating Room Setup and Patient Positioning
Portal Position and Creation of Working Space
Instrumentation for Laparoscopic Adrenalectomy
Surgical Technique. Transperitoneal Surgical Technique
Retroperitoneal Surgical Technique
Feline Laparoscopic Adrenalectomy
Complications and Prognosis
Postoperative Care
References
18 Laparoscopic Surgery of the Pancreas
Key Points
Preoperative Considerations. Relevant Pathophysiology
Surgical Anatomy
Diagnostic Workup and Imaging
Patient Selection
Prognostic Factors
Patient Preparation. Surgical Preparation
Patient Positioning
Portal Type and Position. Ventral Approach
Lateral Approach (Left or Right Sided)
Creation of Working Space. Pneumoperitoneum and Abdominal Access
Ventral Approach in Dorsal Recumbency
Left Lateral Approach
Right Lateral Approach
Surgical Technique. Specific Instrumentation. Required
Alternatives
Facilitating Instruments
Surgical Technique. Pancreatic Biopsy
Excision of Pancreatic Lesions
Challenges to the Technique
Complications and Prognosis
Postoperative Care. Pain Control
Prophylactic Measures
Hospitalization Time
References
19 Laparoscopic Renal Biopsy
Key Points
Indications for Renal Biopsy
Box 19.1 Indications and Contraindication for Renal Biopsy. Indications for Renal Biopsy
Contraindications for Laparoscopic Renal Biopsy
Preoperative Considerations
Patient Preparation
Instrument Placement
Selection of the Biopsy Needle
Box 19.2 Examples of Completely Automated Biopsy Needles
Biopsy Needle Technique
Cup Biopsy Technique
Sample Handling and Submission
Complications Associated with Renal Biopsy
Box 19.3 Complications of Renal Biopsy
Postoperative Care
References
20 Laparoscopic Ureteronephrectomy
Key Points
Preoperative Considerations. Surgical Anatomy
Preoperative Diagnostic Evaluation
Patient Selection
Patient Preparation. Surgical Preparation
Operating Room Setup and Patient Positioning
Portal Position and Creation of Working Space
Surgical Technique. Instrumentation for LA
Surgical Technique
Complications and Prognosis
Postoperative Care
References
21 Transurethral Cystoscopy and Laparoscopic‐Assisted Cystotomy for Urolith Removal and Mass Resection
Key Points
Preoperative Considerations. Introduction to Urolith Management
Surgical Management of Urolithiasis: Comparative Aspects
Veterinary Surgical Management of Urolithiasis
Pathophysiology of Uroliths in Dogs and Cats
Epidemiology. Cats
Dogs
Surgical Anatomy
Diagnostic Workup and Imaging
History and Clinical Signs
Physical Examination Findings
Laboratory Testing
Diagnostic Imaging. Survey Radiography
Contrast Radiography
Abdominal Ultrasonography
Computed Tomography
Cystoscopy
Patient and Technique Selection
Patient Preparation. Surgical Preparation
Surgical Technique(s) Equipment
Equipment List. Commonly Used Cystoscopes for Laparoscopic‐Assisted or Transurethral Cystoscopy in Canine and Feline Patients
Commonly Used Ports and Trocar‐Cannula Assemblies for Laparoscopic‐Assisted Cystotomy
Other
Surgical Techniques. Port Position and Creation of Working Space
Transurethral Cystoscopy
Laparoscopic‐Assisted Cystotomy
Modified Laparoscopic‐Assisted Cystotomy
Percutaneous Cystolithotomy
Complications and Prognosis
Postoperative Care
Bladder Tumor Biopsy and Polyp Resection
Preoperative Evaluation
Cystoscopy for Bladder Mass Biopsy and Polyp Resection
Transurethral Cystoscopy for Bladder Mass Biopsy
Laparoscopic‐Assisted Cystoscopy for Resection of Bladder Masses
References
22 Laparoscopic Ovariectomy, Ovariohysterectomy, and Hysterectomy
Key Points
Preoperative Considerations. Relevant Anatomy and Pathophysiology
Patient Selection for LapOVE and LapOHE
Diagnostic Workup
Patient Preparation
Portal Placement
Surgical Technique. Instrumentation
Laparoscopic Ovariectomy. Two‐Port Technique
One‐Port Technique
Laparoscopic Ovariohysterectomy. Three‐Port Technique
Single‐port Technique
Laparoscopic Ovariohysterectomy for Pyometra
Challenges Specific to the Technique
Complications
Postoperative Care
Choosing between a Laparoscopic Ovariectomy and Ovariohysterectomy
Hormone Sparing Spay; Hysterectomy
Patient Selection
Operating Room Set Up and Portal Placement
Relevant Anatomy Considerations
Surgical Procedure Laparoscopy‐assisted Hysterectomy. Instrumentation
Surgical Technique
Postoperative Care
Outcome
References
23 Laparoscopic Castration and Sterilization Techniques of the Male Dog
Key Points
Background to Alternative Castration and Sterilization Techniques
Laparoscopic Castration by Devascularization. Patient Selection
Required Instrumentation
Surgical Technique
Challenges Specific to the Technique
Postoperative Care
Complications and Prognosis
Laparoscopic Canine Vasectomy. Preoperative Client Communication
Surgical Technique
Recovery
Complications
Outcome
Cryptorchidectomy. Preoperative Considerations
Clinical Signs
Diagnosis
Surgical Anatomy
Patient Selection and Preparation
Surgical Technique
Complications and Prognosis
Postoperative Care
References
24 The Role of Laparoscopy in Cancer Staging
Key Points
Diagnostic Laparoscopy and Biopsy
Lymphatic Staging
Preoperative Considerations. Surgical Anatomy
Diagnostic Workup and Imaging
Patient Selection
Patient Preparation. Surgical Preparation
Operating Room Setup and Patient Positioning
Lateral Recumbency
Sternal Recumbency
Portal Position and Creation of Working Space
Surgical Technique
Abdominal Lymph Node Excisional Biopsy
Box 24.1 Instrumentation for Laparoscopic Lymph Node Biopsy or Resection. Instruments Required
Instruments That May Facilitate the Procedure
Medial Iliac Lymph Node Excisional Biopsy
Hypogastric Lymph Node Excisional Biopsy
Sacral Lymph Nodes
Intraoperative Lymphography
Complications and Challenges
Postoperative Care
References
25 Diaphragmatic and Inguinal Herniorrhaphy
Key Points
Anatomy and Physiology of the Diaphragm
Acquired Diaphragmatic Hernia
Congenital Peritoneopericardial Diaphragmatic Hernia
Indication and Case Selection for Minimally Invasive Herniorrhaphy
Minimally Invasive Surgical Technique: Acquired Diaphragmatic Herniorrhaphy
Gasless System for Diaphragmatic Herniorrhaphy
Laparoscopic Peritoneopericardial Diaphragmatic Herniorrhaphy (PPDH) Patient Selection and Preparation
Surgical Technique
Postoperative Care
Complications and Prognosis
Surgical Techniques for Inguinal and Abdominal Hernias. Laparoscopic Inguinal Herniorrhaphy
Inguinal Herniorrhaphy by Laparoscopic‐Assisted Technique
References
26 Natural Orifice Translumenal Endoscopic Surgery: NOTES
Key Points
Natural Orifice Translumenal Endoscopic Surgery (NOTES)
History of NOTES
Advantages and Disadvantages of NOTES
Surgical Techniques via Transgastric NOTES. Preoperative Preparation
Surgical Spay Procedures via Transgastric NOTES
Transvaginal NOTES Using Flexible and Rigid Endoscope
Preoperative Considerations
Surgical Techniques via Transvaginal H‐NOTES. Case Selection
Abdominal and Transvaginal Access
H‐NOTES Ovariectomy
H‐NOTES Ovariohysterectomy
Surgical Techniques by Transvaginal T‐NOTES. Abdominal and Transvaginal Access
T‐NOTES Ovariectomy
T‐NOTES Ovariohysterectomy
Complications and Considerations for Future Application
References
27 Anesthesia for Thoracoscopy
Key Points
Pathophysiology of One‐Lung Anesthesia
Hypoxic Pulmonary Vasoconstriction
Reexpansion of the Lung
Ventilation
Volutrauma
Atelectrauma
Anesthesia
Monitoring
Pulse Oximetry
Capnography
Arterial Blood Pressure
Electrocardiography
Blood Gases
Spirometry
Body Temperature
Support
Ventilator
Anesthetic Machine
Thoracic Insufflation in Small Patients
One‐Lung Ventilation
Tracheobronchial Dimensions
Endobronchial Blockers. Fogarty Catheter (Edwards Lifesciences Corp., Irvine, CA) (Figure 27.1)
Arndt Endobronchial Blocker (Cook Medical Inc. Bloomington, IN) (Figure 27.2)
Cohen Blocker (Cook Medical Inc. Bloomington, IN) (Figure 27.6a)
Coopdech Blocker (Daiken Medical Co., Osaka, Japan) (Figure 27.6b)
E‐Z Blocker (Teleflex Medical Inc., Research Triangle Park, NC) (Figure 27.6c)
Univent and Fuji Uniblockers (Fuji Systems Corp., Tokyo, Japan) (Figure 27.7)
VivaSight Endotracheal Tubes
Troubleshooting Positional Problems with Endobronchial Blockers
Double‐Lumen Endotracheal Tubes
Carlens
Dr. White
Robertshaw [105]
Sher‐I‐Bronch (Sheridan)
Broncho‐Cath (Mallinckrodt)
Silbroncho (Fuji)
Methods Used to Confirm a Seal on a Bronchial Blocker or Double‐Lumen Tube
Troubleshooting Positional Problems with DLTs
Single‐Lumen Bronchial Intubation
Changing from Double‐Lung Ventilation to One‐Lung Ventilation
Managing Hypoxemia During One‐Lung Ventilation
Pain Management
References
28 Patient Positioning, Port Placement, and Access Techniques for Thoracoscopic Surgery
Key Points
Operating Room
Patient Positioning
Thoracic Access Techniques
Open Technique
Optical Entry
Veress Needle Technique
Thoracic Port Types, Placement, and Position
Subxiphoid Port Placement
Intercostal Port Placement
Thoracic Inlet Approach
Placement of Instrument Portals
Complications of Thoracic Access
References
29 Thoracoscopic Anatomy, Exploration, and Diagnostic Thoracoscopy
Key Points
Preoperative Considerations. Thoracoscopic Anatomy
Indications for Diagnostic Thoracoscopy
Patient Selection
Preoperative Diagnostics
Patient Preparation. Surgical Preparation
Patient Positioning
Port Type and Positioning
Creation of Working Space
Surgical Technique. Instrumentation. Endoscope
Pulmonary Retraction
Other Instrumentation
Surgical Technique
Challenges
Complications and Prognosis
Postoperative Care
References
30 Thoracoscopic Contraindications, Complications, and Conversion
Key Points
Strategies to Avoid Complications. Preoperative Assessment
Patient Preparation and Conversion
Antimicrobial Prophylaxis
Exposure and Working Space
Complications. Port Placement
Pericardial
Vascular
Pulmonary
Postoperative Surveillance
References
31 Thoracoscopic and Thoracoscopic‐Assisted Lung Biopsy and Lung Lobectomy
Key Points
Preoperative Considerations. Patient Selection
Diagnosis and Imaging
Patient Evaluation and Preparation. Patient Preparation
Creation of Working Space: OLV
Creation of Working Space: Carbon‐Dioxide Insufflation
Surgical Techniques. Lung Biopsy
Approach
Surgical Technique
Complete Thoracoscopic Lung Lobectomy. Approach
Thoracoscopic‐Assisted Lung Lobectomy Approach
Surgical Technique: Thoracoscopic Lung Lobectomy
Surgical Technique: Thoracoscopic‐Assisted Lung Lobectomy
Surgical Technique: Lymph Node Biopsy
Postoperative Care
References
32 Thoracoscopic Pericardial Window and Subtotal Pericardectomy in Dogs and Cats
Key Points
Preoperative Considerations. Surgical Anatomy
Diagnostic Workup and Imaging
Patient Selection
Prognostic Factors. Etiology of Pericardial Effusion
Minimally Invasive Versus Open Surgery and Pericardial Window Procedure Versus Subphrenic Pericardectomy
Patient Preparation. Surgical Preparation
Patient Positioning
Port Type and Positioning. Pericardectomy in Dorsal Recumbency [28]
Pericardectomy in Lateral Recumbency
Specific Port Placements for Tumor Removal [21]
Creation of Working Space. Open Pneumothorax
One‐Lung Ventilation
Moderate Pneumothorax
Surgical Technique. Specific Instrumentation
Procedures. Pericardial Window Versus Subphrenic Pericardectomy
Patient in Dorsal Recumbency
Patient in Lateral Recumbency
Pericardectomy and Thoracic Duct Ligation
Pericardectomy and Tumor Removal
Complications and Prognosis. Pericardial Grasping
Lack of Visualization
Lack of Instrument Motion
Complications Encountered During Thoracoscopic Pericardectomy
Postoperative Care. Pain Control
References
33 Thoracoscopic Placement of Epicardial Pacemakers
Key Points
Preoperative Considerations
Pathophysiology and Clinical Presentation
Patient Selection
Surgical Approach
Patient Preparation. Surgical Preparation
Surgical Technique. Operative Requirements
Complications and Prognosis
Postoperative Care
References
34 Right Auricular Mass Resection
Key Points
Relevant Pathophysiology
Diagnostic Workup and Imaging
Patient Selection
Required Instrumentation
Surgical Technique
Challenges Specific to the Technique
Complications and Prognosis
Postoperative Care
References
35 Minimally Invasive Treatment of Chylothorax
Key Points
Preoperative Considerations; Etiology of Disease
Relevant Pathophysiology
Surgical Anatomy
Diagnostic Workup
Preoperative CT Lymphangiography
Treatment of Chylothorax. Medical Management
Surgical Management. Patient Selection for Surgical Treatment
Prognostic Factors and Surgical Technique Selection
Patient Preparation
Surgical Preparation and Positioning
Surgical Techniques
Surgical Techniques. Port Placement
Thoracic Duct Ligation
Intraoperative Lymphangiography. Methylene Blue
Near‐Infrared Fluorescence Imaging
Fluoroscopic Lymphangiography
Laparoscopic Cisterna Chyli Ablation
Pericardectomy
Indwelling Thoracic Drainage Devices
Postoperative Care
Complications
Conclusion
References
36 Thoracoscopic Treatment of Vascular Ring Anomalies
Key Points
Preoperative Considerations. Patient Selection
Diagnosis and Imaging
Patient Evaluation and Preparation. Patient Preparation
Patient Positioning
Surgical Technique. Approach
Surgical Technique
Intraoperative Complications
Conversion
Postoperative Care
References
37 Thoracoscopic Mediastinal Mass Resection
Key Points
Preoperative Considerations. Surgical Anatomy
Preoperative Diagnostics
Patient Selection. Tumor Types
Tumor Characteristics
Age
Species
Comorbidities
Patient Preparation. Surgical Preparation
Patient Positioning
Creation of the Working Space
Surgical Technique. Instrumentation
Challenges Specific to Removal of Cranial Mediastinal Masses
Postoperative Care, Complications, and Prognosis
References
38 Minimally Invasive Cancer Staging in the Thorax
Key Points
Diagnostic Thoracoscopy and Biopsy. Pericardial Effusions
Pleural and Mediastinal Biopsy
Lymphatic Staging
Preoperative Considerations. Surgical Anatomy
Diagnostic Workup and Imaging
Patient Selection
Patient Preparation. Surgical Preparation
Operating Room Setup and Patient Positioning
Portal Position and Creation of Working Space
Surgical Technique. Tracheobronchial Lymph Node Excisional Biopsy
Box 38.1 Instrumentation for Thoracic Lymph Node Dissections. Instruments Required
Instruments That May Facilitate the Procedure
Mediastinal and Sternal Lymph Node Excisional Biopsy
Intraoperative Lymphography
Complications and Challenges
Postoperative Care
References
39 Exoscopy in Small Animal Surgery: General Utilization and Pituitary Surgery
Exoscopy Use in General Small Animal Surgery
What Is Exoscopy?
Advantages and Disadvantages
Equipment Necessary for Exoscopy. VITOM™25
Exoscope
Exoscope Holding System
Laparoscopy/Thoracoscopy Tower
Set‐Up
Special Instrumentation
Uses of Exoscopy. Current Indications in Human Medicine and Surgery
Current Indications in Veterinary Medicine and Surgery
Use of Exoscopy in Small Animal Head and Neck Surgery. Folded‐Flap Palatoplasty and Intraoral Laryngeal Surgery
Total Ear Canal Ablation with Lateral Bulla Osteotomy
Ventral Bulla Osteotomy
Laryngeal Paralysis
Use of Exoscopy in Abdominal and Urogenital Surgery
Use of Exoscopy in Exotic Animal Medicine
Use of Exoscopy in Neurosurgery
Ventral Slot Decompression
Exoscopy Highlight: Pituitary Surgery. Introduction
Preoperative Considerations. Relevant Pathophysiology
Surgical Anatomy
Diagnostic Workup/Imaging (Preoperative Diagnostic Evaluation)
Patient Selection
Prognostic Factors
Patient Preparation. Surgical Preparation
Operating Room Set Up and Patient Positioning
Exoscope Position and Creation of a Working Space
Surgical Technique. Surgical Instrumentation/Instrumentation for TSH
Required Instrumentation
Facilitating Instrumentation
Procedure
Complications and Prognosis. Complications
Prognosis
Postoperative Care
Postoperative Supplementation
References
Index. A
B
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D
E
F
G
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I
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