Читать книгу Small Animal Laparoscopy and Thoracoscopy - Группа авторов - Страница 143

The principles of single‐port surgery are very similar to those of conventional multiport laparoscopy, although differences exist associated with the way triangulation is achieved. Having one point of entry inherently prevents the traditional principles of instrument triangulation. The close proximity of the instruments and optics, both intra‐abdominal and extra‐abdominal, causes the surgeon to perform the procedure with suboptimal working space intra‐abdominally. This ultimately causes increased technical complexity for any procedures because of inadequate triangulation, a compromised field of view, inadequate exposure, and frequent instrument collisions, which all occur as a result of the common entry point for the camera and instruments [29]. Single‐port laparoscopy has been able to somewhat overcome this lack of triangulation by using angled optical telescopes, crossing instruments, or bent and articulating instruments. This novel arrangement of both the optics and instruments creates more internal and external working space, allowing for some triangulation that prevents instrument crowding. Although standard instruments can be used for single‐port surgery, numerous instruments and devices have been developed to simplify and make single‐port surgery more user friendly.

Figure 6.3 The SILS (single‐incision laparoscopic surgery) port (Covidien, Mansfield, MA) allows the placement of three cannulae and has a separate CO₂ insufflation port.