Читать книгу Small Animal Laparoscopy and Thoracoscopy - Группа авторов - Страница 111

Reusable trocar assemblies are the most common type used in veterinary medicine. These include smooth and threaded, a.k.a. Ternamian, stainless steel trocars (Figures 4.20 and 4.21). These have the advantages of being easy to clean and sterilize with a long shelf life. The plastic valves that attach to these trocars are also autoclavable, but they eventually wear or crack over time. The threaded cannulas can be used without an obturator as the distal end is shaped to penetrate the body wall and screw into place, avoiding the need for retention sutures. These may be difficult to place through very thick tissue planes without appropriate insufflation pressures or without an appropriately sized skin incision.

Figure 4.18 Disposable bladeless cannula with a safety shield.

Figure 4.19 Disposable optical view cannula–trocar with an internal flange and balloon for improved retention.

Figure 4.20 Different sizes of smooth stainless steel reusable cannulas.

Source: © 2014 Photo courtesy of KARL STORZ SE & CO, KG.

Figure 4.21 A Ternamian (i.e., threaded) EndoTIP stainless steel reusable cannula.

Source: © 2014 Photo courtesy of KARL STORZ SE & CO, KG.

Figure 4.22 Multiple types of plastic reusable thoracic ports.

Source: © 2014 Photo courtesy of KARL STORZ SE & CO, KG.

Flexible ports or plastic cannulas have been used to gain access to the abdomen or chest (Figure 4.22). Specialized Thoracoports (Covidien, Mansfield, MA) are plastic cannulas with plastic blunt trocars used for atraumatic entrance into the thoracic cavity to decrease the chance of iatrogenic damage to intercostal vessels or underlying structures (e.g., heart, esophagus, trachea) (Figure 4.23). There are also many multiport systems available to veterinary surgeons today, which allow for a telescope and up to three instruments to be passed into a body cavity simultaneously through one incision. These ports are discussed elsewhere in detail. They have different advantages and disadvantages, including cost, resterilization ability, flexibility of instrument handling after the cannulas are engaged, and so on.

Figure 4.23 Reusable Thoracoport.

Source: Photo courtesy of Dr. Philipp Mayhew.