Читать книгу Small Animal Surgical Emergencies - Группа авторов - Страница 43

For a liver lobectomy procedure in which there is potential for significant hemorrhage, a bipolar vessel sealing device (LigaSure) can be beneficial in providing hemostasis in areas where ligations by hand would be difficult. The LigaSure handpieces come in a variety of shapes, such as the Precise, Impact, and Atlas. The Atlas comes in an assortment of lengths, diameters and with blunt and tapered tips. In addition, Hemoclips, Ligaclips^®, and Surgiclips are valuable additions to your operating room instrumentation when there is high risk for hemorrhage because they can be applied quickly and securely to vessels. Removal of the affected liver lobe can be achieved using a stapling device, such as the TA™ or GIA™ vascular stapler, which applies two to four rows of interlaced staples. For reference, the TA Auto Suture vascular stapler by Covidien comes in cartridge lengths of 30 mm, 55 mm, or 90 mm, with staple widths ranging from 3–4 mm and staple height ranging from 2.5–4.8 mm. For larger tissue resections, the GIA stapler comes in cartridge lengths of 50 mm, 60 mm, 80 mm, and 90 mm, with staple widths from 3–4 mm and staple heights ranging from 2.5–4.8 mm. Other hemostatic agents include Vetspon^® absorbable hemostatic gelatin sponge (gel foam) and oxidized regenerated cellulose (Surgicel^®). Both are applied to a site of hemorrhage to aid in clot formation and can be left in place indefinitely until eventually absorbed or removed during surgery once hemostasis is achieved. The instruments needed are listed in Box 2.4.

Figure 2.1 Balfour retractor (bottom left), Poole suction tip (top left), sterile suction tubing (bottom right), and suction canister (top right) for abdominal lavage.

Figure 2.2 Portable suction machine.