Читать книгу Small Animal Laparoscopy and Thoracoscopy - Группа авторов - Страница 4

1 f10Figure 1 Bozzini’s Lichtleiter, a vase‐shaped, leather‐covered tin lantern u...Figure 2 Laparoscopy performed in 1974, before the introduction of video lap...Figure 3 From left to right, Drs. Todd Tams, Steve Hill, and David Twedt are...Figure 4 A proctoscope is used as a low‐cost laparoscope for visualization o...Figure 5 A Corkmaster, a carbon dioxide dispenser intended for opening wine ...Figure 6 Drs. Lynnetta J. Freeman and Ronald J. Kolata are performing laparo...Figure 7 Dr. Clarence Rawlings.Figure 8 The Veterinary Endoscopy Society was founded by Dr. Eric Monnet in ...

2 Chapter 1Figure 1.1 A number of laparoscopic skills training boxes are commercially a...Figure 1.2 Commonly used dimensions in laparoscopic training boxes.Figure 1.3 An example of a homemade training box.Figure 1.4 High‐quality web cameras enable real‐time imaging to a relatively...Figure 1.5 Logotype for the Veterinary Assessment of Laparoscopic Skills (VA...Figure 1.6 Peg transfer task. Six objects are lifted from the left‐sided peg...Figure 1.7 Pattern cut task. A 4‐cm circle is cut, with a penalty applied if...Figure 1.8 Ligature loop application task.Figure 1.9 Extracorporeal suture task. (A). A suture is placed in a Penrose ...Figure 1.10 Intracorporeal suture task.Figure 1.11 The LapSimHaptic system virtual reality trainer is combining hig...Figure 1.12 The ProMis augmented reality trainer is a combination of a physi...Figure 1.13 Graphic representation of an ideal training program, balanced wi...

3 Chapter 2Figure 2.1 Pistol grip laparoscopic needle driver.Figure 2.2 Needle driver with handle designed for thumb–ring finger grip. Th...Figure 2.3 For novice laparoscopic surgeons, we recommend needle drivers tha...Figure 2.4 Different configurations of needle driver jaws. From top to botto...Figure 2.5 Double‐ligated cystic duct (A) and right ovarian pedicle (B) usin...Figure 2.6 Numerous needle configurations can be used for intracorporeal sut...Figure 2.7 Barbed suture has greatly facilitated intracorporeal continuous s...Figure 2.8 A number of clinical applications have been facilitated by barbed...Figure 2.9 V‐Loc 90 (A) and Quill Monoderm (B) barbed suture materials. V‐Lo...Figure 2.10 Classical cannula triangulation to optimize instrument angles an...Figure 2.11 Transabdominal needle introduction. The needle is ideally introd...Figure 2.12 Needle introduction through cannula site. (A) The cannula is rem...Figure 2.13 Needle introduction through a cannula. (A). The suture is graspe...Figure 2.14 Needle position correction. (A). The needle is not perpendicular...Figure 2.15 Needle introduction through a left‐sided cannula according to Br...Figure 2.16 Needle introduction through a right‐sided cannula according to B...Figure 2.17 The “needle dance” for needle positioning. (A). The needle is to...Figure 2.18 Knot tying in a vertical plane: the Rosser technique. (A). A sut...Figure 2.19 Clockwise and counter‐clockwise wrapping of suture. (A). Clockwi...Figure 2.20 Knot tying with horizontal C‐loops, as described by Szabo [14]. ...Figure 2.21 (A). Extracorporeal suturing requires suture material to enter a...Figure 2.22 Extracorporeal knot tying requires the use of a knot pusher. (A)...Figure 2.23 Modified Roeder knot. This is similar to a previously described ...Figure 2.24 Weston knot tying. (A). A right‐to‐left bite has been simulated....Figure 2.25 Modified Roeder knot tying. The coloring is not fixed on the rop...Figure 2.26 Automated suturing devices. Small and standard endo stitch devic...Figure 2.27 V‐Loc 180 automated suture loading unit, 7 in. length with a ter...Figure 2.28 SILS (single incision laparoscopic surgery) Stitch automated sut...Figure 2.29 Loading the EndoStitch device with suture. (A). A variety of sut...

4 Chapter 3Figure 3.1 The basic endoscopic imaging chain.Figure 3.2 Rigid endoscopes used in laparoscopy and thoracoscopy. From botto...Figure 3.3 Operating laparoscopes. (A). Right angled. (B). Oblique.Figure 3.4 Telescope viewing angles. (A). 0°. (B). 30°.Figure 3.5 ENDOCAMELEON^® telescope with variable viewing angle, adjuste...Figure 3.6 New‐generation electronic LED cold light source CO2mbi LED.Figure 3.7 A unique state‐of‐the‐art light source combining LED white light ...Figure 3.8 (A) FULL HD CMOS single chip lightweight camera, 1920 × 1080 pixe...Figure 3.9 (A). 4K modular imaging system combining white light and NIR/ICG ...Figure 3.10 Insufflators. (A). Veterinary dedicated insufflator with max flo...Figure 3.11 Digital capture and archiving system with integrated touch scree...Figure 3.12 Mobile cart equipped with NIR/ICG imaging system for laparoscopi...Figure 3.13 (A). State‐of‐the‐art integrated operating room with simultaneou...

5 Chapter 4-1Figure 4.1 Endoscopic surgical instrument components. (A). Working end (jaws...Figure 4.2 Minimally invasive surgical instrument handle types (from left to...Figure 4.3 Examples of a single‐action jaw mechanism (left) and a double‐act...Figure 4.4 Duvall and Babcock forceps (from left to right): 10‐mm, double‐ac...Figure 4.5 (A). Grasping forceps (from top to bottom): straight dissecting a...Figure 4.6 Biopsy forceps (from top to bottom): biopsy forceps without teeth...Figure 4.7 Endoscopic scissors (from top to bottom): straight scissors; curv...Figure 4.8 (A). Palpation probe with centimeter markings. Inset shows detail...Figure 4.9 Retractors used in human minimally invasive surgery (from top to ...Figure 4.10 An ovariectomy hook with a T‐shaped handle.Figure 4.11 KOH macro‐endoscopic needle driver with straight handle. Used wi...Figure 4.12 Endoscopic needle holders (from top to bottom): straight jaws, j...Figure 4.13 Endo stitch device with suture loaded into jaws.Figure 4.14 Suture assist devices (from top left to bottom right): Koeckerli...Figure 4.15 An example of a laparoscopic instrument pack in its tray for ste...

6 Chapter 4-2Figure 4.16 Veress needle.Figure 4.17 Close up photograph of the specialized tip to a Veress needle....Figure 4.18 Disposable bladeless cannula with a safety shield.Figure 4.19 Disposable optical view cannula–trocar with an internal flange a...Figure 4.20 Different sizes of smooth stainless steel reusable cannulas.Figure 4.21 A Ternamian (i.e., threaded) EndoTIP stainless steel reusable ca...Figure 4.22 Multiple types of plastic reusable thoracic ports.Figure 4.23 Reusable Thoracoport.Figure 4.24 Principal function of many port closure devices (PCD) include a ...Figure 4.25 Many port closure systems utilize a suture guide to facilitate p...

7 Chapter 4-3Figure 4.25 (A). Homemade retrieval bags are cost effective. (B). Commercial...Figure 4.26 (A). A homemade retrieval bag for small lesions can be made out ...Figure 4.27 (A). A suction irrigation device with a 2‐way stopcock and later...Figure 4.28 (A). A suction irrigation device has many fenestrations in the t...Figure 4.29 Use of a wound retractor in abdominal minimally invasive surgery...Figure 4.30 A wound retractor applies centrifugal force on the incision, gre...Figure 4.31 Wound retractor in the chest.Figure 4.32 The wound retractor facilitates exteriorizing of organs while pr...Figure 4.33 (A). Application of a wound retractor. With the flexible ring po...Figure 4.34 A laparoscopic cap makes a wound retractor to a laparoscopic sys...Figure 4.35 A morcellator.

8 Chapter 5Figure 5.1 Most electrosurgery units operate within the medium radiofrequenc...Figure 5.2 Pure cut is a continuous low‐voltage waveform. Coagulation wavefo...Figure 5.3 Alternating current flows from the generator to the handpiece. El...Figure 5.4 Electrode extensions are available in various tip configurations....Figure 5.5 Both J‐ and L‐shaped extensions are available for use with monopo...Figure 5.6 Direct coupling occurs when the active electrode is in close prox...Figure 5.7 Indirect coupling or insulation failure occurs when there is dama...Figure 5.8 Valley Lab Force Triad generator, which combines monopolar, bipol...Figure 5.9 Valley Lab LigaSure generator with numerous bipolar handpieces fo...Figure 5.10 A variety of bipolar handpieces are available for open and MIS. ...Figure 5.11 Sonicision is a cordless ultrasonic dissector that is approved f...Figure 5.12 Endoclips come in different shaft diameters and clip sizes. They...Figure 5.13 Endoscopic gastrointestinal anastomosis staplers have a 10‐mm‐di...

9 Chapter 6Figure 6.1 This operating laparoscope (Karl Storz Endoscopy, Goleta, CA) inc...Figure 6.2 Single‐port access laparoscopy is performed by the passage of thr...Figure 6.3 The SILS (single‐incision laparoscopic surgery) port (Covidien, M...Figure 6.4 With the SILS (single‐incision laparoscopic surgery) device (Karl...Figure 6.5 With some port devices, some triangulation can still be maintaine...Figure 6.6 A wound retractor with latex glove and finger ports can be used a...Figure 6.7 This wound retractor (Alexis; Applied Medical, Rancho Santa Marga...Figure 6.8 The wound retractor in figure 11 can be used with a laparoscopic ...Figure 6.9 Coaxial instruments used through single‐port devices can obviate ...Figure 6.10 A right‐angle adaptor placed onto the connection between the lig...

10 Chapter 7Figure 7.1 Inadvertent splenic puncture.Figure 7.2 Radiographic image showing inadvertent placement of insufflation ...Figure 7.3 Dog prepared for laparoscopic intervention in Fowler position (re...

11 Chapter 8Figure 8.1 When the Veress needle (VN) is used to achieve abdominal access, ...Figure 8.2 Veress needles (VNs) come in a variety of forms. (A), Reusable VN...Figure 8.3 Intercostal placement of a Veress needle.Figure 8.4 In some commercially available ports, the distance between the ex...Figure 8.5 Cannula design compatible with use in small patients. A very shor...Figure 8.6 Open placement with the Hasson technique. (A), Dissection of the ...Figure 8.7 The Visiport Plus Optical Trocar Covidien/Medtronic, Salem, CT. T...Figure 8.8 Ternaminan visual (TV) laparoscopic entry (Video 8.2) utilizes a ...Figure 8.9 Single‐port‐single Instrument surgery. In this technique (here a ...Figure 8.10 Port site metastasis demarcated with asterisks identified at the...Figure 8.11 Intra‐abdominal view of a cat undergoing transperitoneal insuffl...Figure 8.12 Gasless isobaric pneumoperitoneum by use of an abdominal wall li...Figure 8.13 Reverse Trendelenburg is pictured in (A), while Trendelenburg is...Figure 8.14 The patient is in lateral recumbency while utilizing the lateral...

12 Chapter 9Figure 9.1 Intra‐abdominal adhesions after previous surgery, as in this case...Figure 9.2 Illustration of an improper stance, consisting of neck rotation a...Figure 9.3 Endoscopic view of the visual entry technique with a 30‐degree an...Figure 9.4 Extreme abdominal wall tenting occurs when the skin incision is t...Figure 9.5 Blunt insertion techniques can lead to the trocar ricocheting off...Figure 9.6 Stay sutures, used to lift the abdominal wall during direct troca...Figure 9.7 Splenic laceration or perforation, due to improper trocar entry t...Figure 9.8 Starting a laparoscopic procedure with a near‐empty CO₂‐cannister...Figure 9.9 Preoperative check of the integrity of the cannula valve to avoid...Figure 9.10 The two most common causes for obscured visualization are lens f...Figure 9.11 Obscured visualization (A) caused by placing the caudal midline ...Figure 9.12 Intraoperative view of a hemostatic sponge sticking to the grasp...Figure 9.13 Intraoperative view of the sliding knot of a ligating loop engag...Figure 9.14 Intraoperative view of profuse arterial bleeding occurring durin...Figure 9.15 Intraoperative view demonstrating collateral thermal damage from...Figure 9.16 Persistent hemorrhage from a liver biopsy site in a dog with sev...Figure 9.17 Placing an activated light cable on the patient drapes will quic...Figure 9.18 Alternate pathway burns, in this case resulting from return pad ...Figure 9.19 Liver laceration occurred in this dog when, during a sudden loss...Figure 9.20 Emergent conversion was performed after the Endotip cannula perf...

13 Chapter 10Figure 10.1 Illustration of the major vascular anatomy of the gastrointestin...Figure 10.2 Intracorporeal view of the right cranial abdomen of a dog in lef...Figure 10.3 Preoperative sagittal abdominal computed tomography (CT) image o...Figure 10.4 A motorized tilt table used to facilitate both lateral and rever...Figure 10.5 Preoperative images (A and B) of a dog with a small intestinal f...Figure 10.6 Illustration of the operating room set up for laparoscopic‐assis...Figure 10.7 Illustration for correct port location for a multiport laparosco...Figure 10.8 Illustration of correct location for a single‐incision port for ...Figure 10.9 Intracorporeal view of the visceral gastric surface during retra...Figure 10.10 Intracorporeal view of the gastric antrum during elevation of t...Figure 10.11 Intraoperative view of extracorporealized bowel using a Gelpi r...Figure 10.12 Intraoperative view of a hyperemic region of small bowel after ...

14 Chapter 11Figure 11.1 Postoperative image of a patient with a nasoesophageal feeding t...Figure 11.2 Image of a patient with an esophageal feeding tube in place. The...Figure 11.3 Intraoperative image of a patient undergoing open abdominal surg...Figure 11.4 Recommended port locations for laparoscopic‐assisted enterostomy...Figure 11.5 Recommended port locations for laparoscopic‐assisted enterostomy...Figure 11.6 Illustration of a dog undergoing laparoscopic‐assisted enterosto...Figure 11.7 Intraoperative image of an intestinal dehiscence in a dog with s...Figure 11.8 Sagittal and frontal plane computed tomography CT) images from a...Figure 11.9 Intracorporeal view of a dog with small intestinal obstruction a...Figure 11.10 Intraoperative image of the same dog from Figure 11.9. Notice t...Figure 11.11 Intraoperative images of a dog undergoing laparoscopic‐assisted...Figure 11.12 Intraoperative view of a dog undergoing extracorporeal small in...Figure 11.13 Appositional closure of an enterotomy in a dog undergoing singl...Figure 11.14 Appositional, simple interrupted, small intestinal anastomosis ...Figure 11.15 Illustration of a simple continuous, small intestinal anastomos...Figure 11.16 Intracorporeal omentalization of the enterectomy and anastomosi...

15 Chapter 12Figure 12.1 For laparoscopic‐assisted gastropexy, a wide margin should be cl...Figure 12.2 The operating room layout for a multiport or single‐port laparos...Figure 12.3 Port placement for two‐port laparoscopic‐assisted gastropexy.Figure 12.4 A 10‐mm instrument port is placed for laparoscopic‐assisted gast...Figure 12.5 10‐mm DuVall forceps can be used for grasping the stomach from t...Figure 12.6 The forceps and antrum are exteriorized by removing the cannula ...Figure 12.7 Laparoscopic view of completed intracorporeally‐sutured gastrope...Figure 12.8 Operating room layout for an intracorporeally sutured gastropexy...Figure 12.9 Instrument and port placement for the intracorporeally sutured l...Figure 12.10 A stay suture placed percutaneously is passed full thickness th...Figure 12.11 Partial‐thickness incisions made on the seromuscular layer of t...Figure 12.12 Knotless suture relies on the barbs cut into the suture to main...Figure 12.13 Monopolar electrosurgery is used to score a 3–4 cm line into bo...Figure 12.14 For a single‐port laparoscopic‐assisted gastropexy, placement o...Figure 12.15 Stay sutures are placed in the cauterized or cut edges of the t...Figure 12.16 Single‐port device in place at the designated gastropexy site....

16 Chapter 13Figure 13.1 This survey radiograph shows a large space occupying lesion in t...Figure 13.2 The operating room layout for repair of a sliding hiatal hernia ...Figure 13.3 Port position for repair of sliding hiatal hernia is shown. The ...Figure 13.4 The operating room setup and port positioned are shown in this i...Figure 13.5 The left lateral lobe of the liver is being retracted by a blunt...Figure 13.6 Hiatal plication is being performed using intra‐corporeal suturi...Figure 13.7 The first two sutures of the hiatal plication are pictured showi...Figure 13.8 Initiation of the esophagopexy is shown using barbed suture. The...Figure 13.9 A left‐sided gastropexy is the final part of the surgical repair...Figure 13.10 The completed left‐sided intracorporeally‐sutured gastropexy is...Figure 13.11 Liver lacerations can be seen secondary to iatrogenic instrumen...

17 Chapter 14Figure 14.1 The operating room is set up for laparoscopic splenectomy with t...Figure 14.2 For multiport total laparoscopic splenectomy (TLS), the procedur...Figure 14.3 A single incision laparoscopic device has been placed 3–5 cm cau...Figure 14.4 A wound retractor device (WRD) has been placed for performing LA...Figure 14.5 During total laparoscopic multiport splenectomy, the spleen is r...Figure 14.6 A vessel‐sealing device can be seen sealing and dividing the fin...Figure 14.7 The WRD is in place and the spleen with the splenic mass has bee...Figure 14.8 During laparoscopic‐assisted splenectomy the spleen is manually ...

18 Chapter 15Figure 15.1 Laparoscopic view of the gallbladder adjacent to the quadrate li...Figure 15.2 Operating room setup, including equipment, surgeon(s), and patie...Figure 15.3 Location for placement of two 6mm ports for performing multi‐por...Figure 15.4 Placement of the single‐port device for performing single‐port l...Figure 15.5 Single‐port technique for a laparoscopic resection of a biliary ...Figure 15.6 Extraction of a biliary cyst adenoma of the quadrate lobe follow...Figure 15.7 Microwave ablation unit with 2.45 Ghz generator.Figure 15.8 Laparoscopic view of left medial lobe elevation using a blunt pr...Figure 15.9 The gallbladder is elevated using a blunt probe in this laparosc...Figure 15.10 For harvesting a laparoscopic liver biopsy, the laparoscopic cu...Figure 15.11 A blunt probe is placed at the site of laparoscopic liver biops...Figure 15.12 Intraoperative image demonstrating articulation and positioning...Figure 15.13 Intraoperative image of a dog undergoing stapled laparoscopic r...Figure 15.14 Laparoscopic image of an HCC in a dog and the associated planni...Figure 15.15 Laparoscopic image of a laparoscopic MWA procedure of a 2.5 cm ...Figure 15.16 Preoperative planning and follow‐up imaging of an HCC before (A...Figure 15.17 (A and B), A SILS port has been placed for laparoscopic liver b...Figure 15.18 (A and B), Laparoscopic image of spinal needle entry into gallb...

19 Chapter 16Figure 16.1 Operating room setup for laparoscopic cholecystectomy. The endos...Figure 16.2 For LC the dog is positioned quite close to the end of the surgi...Figure 16.3 Port positioning for the multiport cystic‐duct first (CDF) techn...Figure 16.4 Portal positioning for the fundic dissection first (FDF) method....Figure 16.5 Port placement for single‐port cholecystectomy is shown. The sin...Figure 16.6 The fan retractor can be seen at the top of the image retracting...Figure 16.7 Forceps can be seen passing cranial to the cystic duct after dis...Figure 16.8 Hemostatic clips can be seen in position on the cystic duct prio...Figure 16.9 The Hem‐o‐lok applicator can be seen with the clip in position p...Figure 16.10 The gall bladder can be seen within the specimen retrieval devi...Figure 16.11 The specimen retrieval bag has been partially exteriorized with...Figure 16.12 Anatomy of membrane structure of the gallbladder. Dissecting wi...Figure 16.13 A small sharp incision is made in the gallbladder serosa using ...Figure 16.14 After a small incision is made in the serosa of the gallbladder...Figure 16.15 The assistant’s forceps are holding the dissected gallbladder s...Figure 16.16 After dissecting within the subserosal layers of the gallbladde...Figure 16.17 After making a small hole at dorsal side of the bile duct using...Figure 16.18 A contrast agent is flushed through a catheter, and the bile du...Figure 16.19 Intraoperative cholangiography showed obstruction indicated at ...

20 Chapter 17Figure 17.1 A right‐sided adrenal mass can be seen with the phrenicoabdomina...Figure 17.2 In this contrast‐enhanced computed tomography image, a small thr...Figure 17.3 In this coronal reconstruction of a contrast‐enhanced computed t...Figure 17.4 In this case, a large right adrenal mass is present that is prim...Figure 17.5 Both surgeons stand on the side of the patient's ventral abdomen...Figure 17.6 For sternal positioning, padding is placed in between the front ...Figure 17.7 Positioning for retroperitoneal laparoscopic adrenalectomy is sh...Figure 17.8 For laparoscopic adrenalectomy in lateral recumbency, three port...Figure 17.9 Port placement for laparoscopic adrenalectomy in sternal recumbe...Figure 17.10 Port placement for retroperitoneal laparoscopic adrenalectomy. ...Figure 17.11 A laparoscopic j‐hook monopolar electrosurgical probe is being ...Figure 17.12 This left‐sided adrenocortical mass was found upon entry into t...Figure 17.13 The course of the renal vein on the left side can be clearly se...Figure 17.14 This right‐sided caudal pole adrenal mass is intimately attache...Figure 17.15 In this series of images, the progression of the dissection of ...Figure 17.16 A small defect can be seen in the diaphragm at the end of the d...Figure 17.17 The inverted thumb of a large‐sized surgical glove has been use...Figure 17.18 The adrenal mass has been placed into a commercially available ...Figure 17.19 SILS‐port placement. Instrument trajectory is caudal to cranial...Figure 17.20 Typical view of the retroperitoneal perirenal space during righ...Figure 17.21 This aldosterone‐secreting tumor in a cat can be seen lying dor...Figure 17.22 In this right‐sided lesion, the capsule of the mass has been pe...

21 Chapter 18Figure 18.1 Anatomy of the pancreas and surrounding structures.Figure 18.2 Operating room (OR) layout for laparoscopic pancreatic surgery. ...Figure 18.3 Patient positioning for laparoscopic flank approach. The thorax ...Figure 18.4 Portal placement for ventral approach to the pancreas. The initi...Figure 18.5 Port placement for laparoscopic flank approach. The initial port...Figure 18.6 Surgical anatomy in dorsal recumbency with a ventral approach. (...Figure 18.7 Laparoscopic images of ventral midline approach in dorsal recumb...Figure 18.8 Normal surgical anatomy of left‐sided flank approach in sternal ...Figure 18.9 Laparoscopic left lateral approach in sternal recumbency in a Ge...Figure 18.10 Normal anatomy of the right flank approach in sternal‐oblique r...Figure 18.11 Right lateral flank laparoscopic approach in sternal recumbency...

22 Chapter 19Figure 19.1 Operating room set‐up for laparoscopic kidney biopsy in dorsal r...Figure 19.2 Operating room setup for laparoscopic left renal biopsy procedur...Figure 19.3 Port positions for laparoscopic kidney biopsy performed in dorsa...Figure 19.4 Port placement for renal biopsy in lateral recumbency.Figure 19.5 Graphic representation of acceptable needle path angles. The nee...Figure 19.6 Laparoscopic visualization of a needle biopsy.Figure 19.7 After removal of the biopsy needle, pressure is applied by a blu...Figure 19.8 A hemostatic cellulose product has been applied to the biopsy si...

23 Chapter 20Figure 20.1 A large multi‐lobulated mass can be seen obliterating the left k...Figure 20.2 Operating room layout for laparoscopic ureteronephrectomy. Durin...Figure 20.3 Port positioning for laparoscopic multiport transperitoneal uret...Figure 20.4 Port position for the single port or “single‐port plus 1” techni...Figure 20.5 The vessel‐sealing device can be seen dissecting and sealing the...Figure 20.6 A pair of 10‐mm right‐angled laparoscopic forceps are positioned...Figure 20.7 Feline laparoscopic ureteronephrectomy. A vessel‐sealing device ...Figure 20.8 Laparoscopic hemoclips have been placed on the renal artery befo...Figure 20.9 In this feline laparoscopic ureteronephrectomy, the ureter has b...Figure 20.10 Laparoscopic hemoclips are being applied to the terminal portio...Figure 20.11 A completely dissected kidney is being placed into a specimen r...

24 Chapter 21Figure 21.1 (A) Open cystotomy on a male dog with a large cystic calculus. (...Figure 21.2 Radiograph of male dog with numerous large cystic and urethral c...Figure 21.3 Radiograph of a female dog with multiple small cystic calculi.Figure 21.4 Male dog in dorsal recumbency clipped for laparoscopic‐assisted ...Figure 21.5 Male cat in dorsal recumbency clipped for laparoscopic‐assisted ...Figure 21.6 Multipurpose rigid endoscope.Figure 21.7 Pediatric operating cystoscope.Figure 21.8 Flexible ureteroscope Flex XC.Figure 21.9 Flexible ureteroscope Flex X2.Figure 21.10 Five‐mm port with Luer lock (attached to suction tubing).Figure 21.11 Five‐mm Ternamian cannula.Figure 21.12 Stone basket (resterilizable).Figure 21.13 360° wound retractor device.Figure 21.14 Location of port position for the two‐port laparoscopic‐assiste...Figure 21.15 Location of port position for the percutaneous cystolithotomy o...Figure 21.16 Operating room set‐up for laparoscopic‐assisted cystotomy or pe...Figure 21.17 The bladder apex is grasped using laparoscopic Babcock forceps....Figure 21.18 The port incision is enlarged to create a mini‐laparotomy, and ...Figure 21.19 Complete cystopexy at the second cannula site.Figure 21.20 Larger uroliths can be grasped with forceps introduced next to ...Figure 21.21 A wound retraction device properly positioned in the abdomen.Figure 21.22 Threaded cannula inserted into the ventral apex region of the u...Figure 21.23 Calculi visible in the trigonal region of the urinary bladder i...Figure 21.24 Flexible ureteroscope entering the threaded trocar on the ventr...Figure 21.25 Cystoscopic image of a single large 7‐mm urethral calculus in a...Figure 21.26 Same patient in Figure 21.25. The urethral calculus has been di...Figure 21.27 Transurethral cystoscopic illumination of an apical bladder mas...

25 Chapter 22Figure 22.1 Intraoperative view from a 0°, 5‐mm telescope view of the left o...Figure 22.2 Intraoperative view from a 0°, 5‐mm telescope of the left uterin...Figure 22.3 Photo of the required hair clip and initial positioning in the o...Figure 22.4 Photograph of a hair clip if an ovariectomy hook or needle suspe...Figure 22.5 A resterilizable ovariectomy hook (Karl Storz Endoscopy, Goleta,...Figure 22.6 Photograph of patient positioned on a tilt table that is used to...Figure 22.7 The operating room layout for a laparoscopic ovariectomy (LapOVE...Figure 22.8 Line drawing of three‐port ventral midline placement for ovariec...Figure 22.9 Line drawing of two port median placement for ovariectomy used w...Figure 22.10 Line drawing showing a single‐port device placed at the umbilic...Figure 22.11 Intraoperative view of a blunt probe being used to hold the rig...Figure 22.12 The suspension suture is passed under transabdominal illuminati...Figure 22.13 Intraoperative view of the percutaneous suspension needle pierc...Figure 22.14 Intraoperative view of the vessel‐sealing device starting to di...Figure 22.15 The uterine horns and ovaries removed from the abdomen through ...Figure 22.16 An intraoperative view of a pyometra that has been exteriorized...Figure 22.17 The left ovarian bursa is lifted with a needlescopic suture gra...Figure 22.18 The cervix and uterine body have been incised on dorsal midline...

26 Chapter 23Figure 23.1 Operating room set‐up. Because a majority of the procedure is pe...Figure 23.2 (A) Portal placement. Initial visual cannula placement is on mid...Figure 23.3 Immediately cranial to the inguinal canal the vas deferens (open...Figure 23.4 The vas deferens and testicular vasculature including all connec...Figure 23.5 Left inguinal canal with testicular vessels (black arrow). Vasec...Figure 23.6 Evaluating the inguinal canal. (A) If the testis has completed i...Figure 23.7 Locating an intraabdominal testicle. The gubernaculum (black arr...Figure 23.8 Extruding the testicle. If performing a laparoscopy‐assisted tec...Figure 23.9 Percutaneous suture placement. If bilateral, the first testicle ...

27 Chapter 24Figure 24.1 Computed tomography lymphography of a perineal tumor demonstrati...Figure 24.2 Operating room setup for left‐sided lymph node dissection in lat...Figure 24.3 Operating room (OR) setup for dissection of the right‐sided node...Figure 24.4 Port placement for dissection of the left‐sided iliosacral lymph...Figure 24.5 Port placement for dissection of the left‐sided iliosacral lymph...Figure 24.6 Intraoperative image showing predissection regional anatomy (A) ...Figure 24.7 Intraoperative image showing predissection regional anatomy with...Figure 24.8 A view of intrapelvic sacral lymph nodes. The patient is in ster...Figure 24.9 View of sacral lymph nodes in lateral (A) and sternal (B) recumb...Figure 24.10 Intraoperative indirect lymphography with methylene blue highli...Figure 24.11 View of medial iliac lymph node in a dog presenting for anal sa...Figure 24.12 Excised hypogastric lymph node from a dog with anal sac gland a...

28 Chapter 25Figure 25.1 Diaphragm, abdominal surface. (a), medial; (b), intermediate; (c...Figure 25.2 Diaphragm, thoracic surface.Figure 25.3 Thoracic radiograph of a 4‐year‐old German shepherd hit by a car...Figure 25.4 Thoracic radiograph in right lateral recumbency of the same dog ...Figure 25.5 Sagittal plane of contrast‐enhanced computed tomography image of...Figure 25.6 CT image of peritoneopericardial hernia.Figure 25.7 In peritoneopericardial hernia liver, gallbladder, and small int...Figure 25.8 Different presentations of traumatic or congenital hernias invol...Figure 25.9 Time operative room and equipment setup for diaphragmatic hernio...Figure 25.10 Portal placement for diaphragmatic herniorraphy.Figure 25.11 (A and B) Applying a tension suture at about the midpoint of th...Figure 25.12 The multidirectional traction platform is composed of three dif...Figure 25.13 Gasless diaphragmatic herniorrhaphy in a cadaver‐model of dog u...Figure 25.14 Traction can be applied using atraumatic instruments.Figure 25.15 Reduction of liver is accomplished by instruments lifting rathe...Figure 25.16 Adhesions dissected with a vessel sealing device.Figure 25.17 (A) Hernia closure starting in the dorsal end of the defect. (B...Figure 25.18 Evacuation of air from the pericardial space is achieved intrao...Figure 25.19 Time operative room and equipment setup for inguinal herniorrha...Figure 25.20 Cannula placement for a unilateral (left‐sided) hernia. For lef...Figure 25.21 Cannula placement for a bilateral hernia or in case of patient ...Figure 25.22 (A) Unilaterally (yellow arrow) laparoscopic inguinal herniorra...Figure 25.23 Incarcerated hernia involving the spleen in a dog. (A) The yell...Figure 25.24 Incarcerated hernia in a dog involving uterine horn (hysterocel...Figure 25.25 Sequence of application of an intracorporeal suture for inguina...

29 Chapter 26Figure 26.1 Schematic showing how pairs of T‐fasteners are deployed from ins...Figure 26.2 Endoscopic view of the gastric mucosa after the gastrotomy has b...Figure 26.3 Position of patient, equipment, and surgical time (A and B). The...Figure 26.4 Sequence for positioning the portal for performing transvaginal ...Figure 26.5 Transvaginal H‐NOTES ovariectomy. (A) After raising the uterine ...Figure 26.6 Exposure of the reproductive tract through the vaginal wound to ...Figure 26.7 Sequence of portal introduction to the transvaginal T‐NOTES. (A)...Figure 26.8 (A) The peritoneal cavity is insufflated by the operating laparo...Figure 26.9 Sequence of OVE by T‐NOTES. (A) The uterine horn (U) is apprehen...Figure 26.10 (A) Removal of ovary and a small segment of uterine horn throug...Figure 26.11 Sequence of OHE by T‐NOTES. (A) Vaginal exposition and access u...

30 Chapter 27Figure 27.1 Fogarty catheter with a catheter‐tipped balloon and a lockable i...Figure 27.2 Arndt endobronchial blocker. The loop in the distal end has been...Figure 27.3 Arndt endobronchial blocker showing the endoscope passed through...Figure 27.4 Diagram of the placement of the endobronchial blocker. The ballo...Figure 27.5 (A) End of the endobronchial blocker placed in the left mainstem...Figure 27.6 (A) Cohen endobronchial blocker showing the wheel at the proxima...Figure 27.7 Univent endotracheal tube with incorporated endobronchial blocke...Figure 27.8 Double‐lumen tubes showing the right (A) and left (B) bronchial ...Figure 27.9 Robertshaw double‐lumen endotracheal tubes from four different m...Figure 27.10 Proximal end of a Robertshaw tube with a connector to allow bot...Figure 27.11 Diagram showing the placement of the proximal and distal balloo...Figure 27.12 Diagram showing correct and incorrect placement of left and rig...

31 Chapter 28Figure 28.1 For thoracoscopic procedures performed in dorsal recumbency with...Figure 28.2 For thoracoscopic procedures with the patient in sternal or late...Figure 28.3 Nondisposable cannulae can readily be used for thoracoscopic acc...Figure 28.4 In this case, the thorascopic port was placed too caudally, and ...Figure 28.5 In this case, the pleural reflection has been entered from a sub...Figure 28.6 This Alexis wound retractor device (Applied Medical Inc.) has be...Figure 28.7 During placement of instrument ports, the telescope is used to v...Figure 28.8 A bleeding intercostal vessel can be seen in this image. Interco...Figure 28.9 A seroma can be seen in this dog associated with one of the thor...Figure 28.10 A specimen retrieval bag is used in a thymoma to decrease the r...

32 Chapter 29Figure 29.1 The left pulmonary ligament is visible extending from the ventra...Figure 29.2 The left pulmonary ligament being digitally transected during a ...Figure 29.3 A large pulmonary bullae is readily identified on the ventral ma...Figure 29.4 CT images of a dog with spontaneous pneumothorax in sternal (A) ...Figure 29.5 (A) Port placement for thoracic exploration. (B) Operating room ...Figure 29.6 Localization of paraxiphoid port placement for diagnostic thorac...Figure 29.7 Localization of intercostal port placement for diagnostic thorac...Figure 29.8 (A) A 10‐mm variable angle scope (©KARL STORZ SE & Co. KG, Germa...Figure 29.9 A 10‐mm endoscopic fan retractor may be used to gently retract l...Figure 29.10 The ventral mediastinum has been fenestrated and is retracted b...Figure 29.11 (A) The accessory lung lobe is seen through the thin caudal med...Figure 29.12 Visualization of the medial aspect of the hilus of right (A) an...Figure 29.13 A bullous lesion identified on the lateral aspect of the left c...

33 Chapter 30Figure 30.1 Intraoperative image of a thermally injured lung lobe during vid...Figure 30.2 Intraoperative video‐assisted thoracic surgery image of the left...Figure 30.3 Cardiac apex in a dog undergoing VATS pericardiectomy for chroni...Figure 30.4 The paraconal interventricular branch of the left coronary arter...Figure 30.5 Intraoperative image of a puppy undergoing video‐assisted thorac...Figure 30.6 The craniodorsal mediastinal defect after VATS thymectomy in a d...Figure 30.7 (A) Thoracoscopic image of the mediastinum during a thoracic duc...Figure 30.8 A linear parenchymal lung laceration can be seen in the caudal l...

34 Chapter 31Figure 31.1 Radiograph of a dog with a solitary lung mass in the left caudal...Figure 31.2 Computed tomography of a single tumor in the right middle lung l...Figure 31.3 Pulmonary bullae visualized during thoracoscopic exploration for...Figure 31.4 Biopsy of hilar lymph nodes are often indicated in dogs with tho...Figure 31.5 Intraoperative view of a mass in the left caudal lung lobe (Figu...Figure 31.6 The endobronchial blocker has been placed in the left main stem ...Figure 31.7 Operating room setup for thoracoscopic lung lobectomy of a cauda...Figure 31.8 Operating room setup for thoracoscopic lung lobectomy of a crani...Figure 31.9 Portal placement for thoracoscopic lung lobectomy of a caudal lu...Figure 31.10 Portal placement for thoracoscopic lung lobectomy of a cranial ...Figure 31.11 Portal placement in the ninth intercostal space for a cranial l...Figure 31.12 Example of a thoracoscopic‐assisted approach from a cadaveric s...Figure 31.13 Linear stapler staple cartridge (EndoGIA roticulated, Medtronic...Figure 31.14 The dorsal pulmonary ligament of a caudal lung lobe.Figure 31.15 The cartridge of the linear stapler (EndoGIA, Medtronic, Minnea...Figure 31.16 The cartridge of the linear stapler (EndoGIA, Medtronic, Minnea...Figure 31.17 The linear stapler (EndoGIA, Medtronic, Minneapolis, MN, USA) a...Figure 31.18 The stapled hilus after lung lobe removal.Figure 31.19 Lung lobe is introduced in a retrieval bag. It is important to ...Figure 31.20 A retrieval bag containing a lung lobe after removal from the t...Figure 31.21 Cadaveric example of a thoracoscopic‐assisted approach performe...Figure 31.22 A combined intra‐ and extracorporeal technique can be used to t...Figure 31.23 (A) A hilar lymph node of the cranial lung lobe is pictured in ...

35 Chapter 32Figure 32.1 Operating room layout for thoracoscopic pericardial window or su...Figure 32.2 Possible placement of the telescope for thoracoscopic pericardec...Figure 32.3 (A) Instrument port placement for thoracoscopic pericardectomy i...Figure 32.4 Alternative port positioning of the telescope and instrument por...Figure 32.5 Possible telescope and instrument portal placement for pericarde...Figure 32.6 Tenting the pericardium. With the patient in dorsal recumbency, ...Figure 32.7 Endoscopic view of heart after the subphrenic pericardectomy has...Figure 32.8 Endoscopic view of heart after pericardectomy has been achieved....Figure 32.9 In this case, grasping the pericardium was proving challenging, ...

36 Chapter 33Figure 33.1 (A) Cannula positions: paraxiphoid 5‐mm telescope cannula, right...Figure 33.2 The lead applicator is inserted via the left instrument portal; ...Figure 33.3 Lead implantation is performed in an area of the epicardium with...Figure 33.4 Incorrect insertion of the lead: the pigtail is visible; screwin...Figure 33.5 The generator is placed against the intercostal muscle as soon a...Figure 33.6 Radiography showing the correct position of the cable with one l...

37 Chapter 34Figure 34.1 Resection of a small tumor (1 cm) located on the right atrial (a...Figure 34.2 Pericardioscopy view of a tumor that is too large to be resected...Figure 34.3 Operating room layout. The dog is positioned on the rear part of...Figure 34.4 Cannula position. A paraxiphoid 5‐mm telescope cannula, operatin...Figure 34.5 Pericardial window extended cranially to increase visualization ...Figure 34.6 Atraumatic 5‐mm grasping forceps used to grasp the tip of the ri...Figure 34.7 The staples have been applied and the right atrial appendage. 5 ...Figure 34.8 The staples have been applied and the right atrial appendage wit...

38 Chapter 35Figure 35.1 Lymphangiogram depicting cisterna chyli and thoracic ducts with ...Figure 35.2 Lymphangiogram depicting thoracic duct and the classical lymphan...Figure 35.3 Representative appearance of cisterna chyli in a normal dog (A) ...Figure 35.4 The thoracic duct anatomy is highly variable between individuals...Figure 35.5 Anatomy of the dorsal thorax in a less chronically affected dog ...Figure 35.6 A preoperative CT lymphangiogram facilitates surgical planning. ...Figure 35.7 Dog positioned on the CT table and draped for popliteal lymphang...Figure 35.8 Severe fibrosing pleuritis in a dog with an eight‐month history ...Figure 35.9 Port placement for thoracic duct ligation procedure with the dog...Figure 35.10 Operating room setup for thoracic duct ligation procedure. If a...Figure 35.11 When positioning a patient for TDL in sternal recumbency, padde...Figure 35.12 Thoracic duct branches are difficult to visualize without dye i...Figure 35.13 (A‐C1) Dissection based on a preoperative CT lymphangiogram (A‐...Figure 35.14 Position of thoracic cannulas and paracostal access with wound ...Figure 35.15 Fluoroscopic lymphangiography performed intraoperatively on a d...Figure 35.16 Intraoperative image of left‐sided single port approach for cis...Figure 35.17 A subcutaneous pleural catheter‐vascular access port being plac...Figure 35.18 CT lymphangiograms obtained approximately six months postoperat...Figure 35.19 Reoccurrence of lymphatic vessels (black arrow) bypassing a pre...

39 Chapter 36Figure 36.1 Normal anatomy. Left aortic arch (LAA) with the brachiocephalic ...Figure 36.2 Vascular ring anomalies with persistent right aortic arch (PRAA)...Figure 36.3 Vascular ring anomalies without PRAA. (A) Left aortic arch (LAA)...Figure 36.4 Operating room setup for vascular ring anomaly treatment.Figure 36.5 Portal placements for vascular ring anomaly treatment. If one‐lu...Figure 36.6 Esophagram of a dog with a persistent right aortic arch and seve...Figure 36.7 Endoscopy of the esophagus. The aortic arch is on the right side...Figure 36.8 Three 5‐mm thoracoscopic cannulas with low profile. Those cannul...Figure 36.9 (A) View of the cranial part of the thoracic cavity with the dil...Figure 36.10 The ligamentum arteriosum (in the forceps) has been dissected f...Figure 36.11 Vascular clips have been placed on the ligamentum arteriosum. T...Figure 36.12 (A, B) Remaining fibers (black arrows) have been picked up from...Figure 36.13 Esophageal ballooning used to identify remaining fibrous bands ...Figure 36.14 Dorsal compression of the esophagus cranial to the ligamentum a...

40 Chapter 37Figure 37.1 Schematic transverse section of the thorax through the heart and...Figure 37.2 Thoracoscopic image demonstrating the relationship between a t...Figure 37.3 Computed tomography angiogram of a dog with a thymoma. (A) The p...Figure 37.4 Operating room setup for thoracoscopic resection of cranial medi...Figure 37.5 The recommended port positions for thoracoscopic cranial mediast...Figure 37.6 Thoracoscopic image during thymoma resection. The surgeon's fing...

41 Chapter 38Figure 38.1 Computed tomography scan demonstrating the right and left trache...Figure 38.2 Computed tomography scan demonstrating the central tracheobronch...Figure 38.3 Operating room setup for dissection of left‐sided (A) or right‐s...Figure 38.4 Port placement diagram for tracheobronchial lymph node resection...Figure 38.5 Port placement diagram for resection of sternal or cranial media...Figure 38.6 Intraoperative image demonstrating dissection of the left trache...Figure 38.7 Intraoperative image demonstrating predissection, right‐sided re...Figure 38.8 Intraoperative image demonstrating dissection of a sternal lymph...Figure 38.9 Intraoperative images demonstrating sentinel lymph node identifi...Figure 38.10 A pathologically enlarged central tracheobronchial lymph node a...

42 Chapter 39Figure 39.1 Photograph depicting the VITOM™ setup during surgery. The HD scr...Figure 39.2 Exoscope.Figure 39.3 VITOM™ setup showing the pneumatic scope holder, the Wingman (St...Figure 39.4 Exoscopy setup for a folding‐flap palatoplasty in a brachycephal...Figure 39.5 Guillotine liver biopsy in a bearded dragon using the VITOM syst...Figure 39.6 Skull with cross lines.Figure 39.7 Surgery room setup.Figure 39.8 Intraoperative view. Pneumatic scope holder, the Wingman (Stryke...Figure 39.9 Tew (KLS Martin) elongated and bayonetted neurosurgical instrume...