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A 2‐ to 3‐cm mini‐laparotomy is created in advance for insertion of the port. To insert this single‐port device, a small amount of sterile lubricant is applied to its soft base (Video 6.2). The port is inserted into its 2‐ to 3‐cm abdominal incision by clamping two curved Rochester‐carmalt forceps at the base in a staggered fashion. Varying techniques have been described for insertion into the incision: it can be performed without abdominal wall countertraction or with a form of countertraction such as grasping the facial edges with two large rat‐toothed tissue forceps, Army‐Navy retractors, or stay sutures. Regardless of traction, the tips of the Rochester‐carmalts are directed into the incision in a cranial direction toward the diaphragm or away from any underlying viscera. When the base is seeded within the incision, the clamps are then released to allow the bottom portion of the port to expand and fit snugly within the incision. Three 5‐mm cannulae (supplied with the port) are then partially inserted into the three inner cylinders with the aid of a 5‐mm blunt obturator. The SILS port is also supplied with a 12‐ to 15‐mm trocar–cannula assembly to allow larger instruments to be inserted with two other 5‐mm cannulae. The heights of the cannulae are staggered to minimize cannula contact (Figure 6.5). Insufflator tubing is then attached, and the abdomen is insufflated to 8–10 mmHg with carbon dioxide using a pressure‐regulating mechanical insufflator. Once insufflation is complete, the three canulae can then be inserted deeper into the port. The multitrocar port can be positioned to have the three 5‐mm cannulae at the 12, 4, and 8 o’clock positions relative to the surgical site, although any arrangement is possible. Advantages of this port include the relative ease of insertion and reinsertion during a procedure and its ability to fit snugly within the incision, preventing loss of pneumoperitoneum.

Despite being sold as single‐use instruments, it is not uncommon to reuse various minimally invasive surgery devices in veterinary medicine for economic reasons. Multiple studies have been conducted to test the reusability of the SILS devices [61–63]. Results indicate that the ports can be decontaminated and sterilized by ethylene oxide and hydrogen peroxide vapor for repeated use. In one study [62], the foam component was found to have positive light growth after eight uses. The reuse of the SILS ports appears to carry a low risk of infection to the patient; however, the mechanical stability of the ports after reuse has yet to be widely tested.

Figure 6.4 With the SILS (single‐incision laparoscopic surgery) device (Karl Storz Endoscopy, Goleta, CA), it is recommended to stagger the cannulae to minimize interference.

Figure 6.5 With some port devices, some triangulation can still be maintained, but this varies by device.