Читать книгу Small Animal Laparoscopy and Thoracoscopy - Группа авторов - Страница 149

A 2‐ to 3‐cm mini‐laparotomy incision is created in advance for insertion of the port. The inner ring of a 360° atraumatic wound retraction device (Alexis Wound Retractor; Applied Medical, or SurgiSleeve Wound Protector, Covidien) is first inserted through the mini‐laparotomy incision (Figure 6.7). The outer ring of the wound retractor is then rolled until it reaches the level of the skin, causing the retractor sheath to be pulled taut. The tips of the fingers of a sterile latex glove are cut to just allow a 5‐ to 10‐mm trocar–cannula assembly to be inserted. Suture or rubber bands created from strips cut from the surgical glove finger are tied securely around the trocar–cannula assembly at the junction of the latex fingertip and the port. The wrist portion of the glove is then stretched over the external ring of the wound retractor. The insufflator tubing is then attached to any of the finger port Luer‐lock fittings, and then insufflation of carbon dioxide to an intraabdominal pressure of 8–10 mmHg is delivered using a pressure‐regulating mechanical insufflator. All five fingers can be used as ports of entry if necessary [36]. This technique was recently published for the use in dogs undergoing ovariohysterectomy [64]. The wound retractor can also be used with a laparoscopic cap designed for specimen extraction (Figure 6.8; Alexis Laparoscopic System with Kii Fios First Entry, Applied Medical). Additional portals can be added through the laparoscopic cap with the aid of a 6‐mm punch biopsy for 6.5‐mm portals. Leakage of CO₂ may result from too large or too small defects in the cap, the latter due to cracking of the cap when inserting the cannula through an insufficiently sized defect.

Figure 6.6 A wound retractor with latex glove and finger ports can be used as an inexpensive single‐port device.

Figure 6.7 This wound retractor (Alexis; Applied Medical, Rancho Santa Margarita, CA) provides a protected retracted access incision through which organs can be exteriorized.