Читать книгу Small Animal Laparoscopy and Thoracoscopy онлайн

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Today, a very wide range of precision‐engineered laparoscopic trocars exist, which has revolutionized patient care as we know it. Surgical trocars in human medicine are most commonly a single‐patient use instrument and have graduated from the “three‐point” design that gave them their name to either a flat bladed “dilating tip” product or something that is entirely blade free. In veterinary medicine, the most commonly used trocar assemblies are reusable, reautoclavable configurations made of stainless steel or plastic or silicone materials.

Laparoscopic entry is covered in detail in ssss1. However, a brief description as it relates to instrumentation follows here.

Initial trocar placement can be done after insufflation of the peritoneum or preceding it depending on the method chosen. Creating a pneumoperitoneum, or insufflation of the abdomen, allows for separation between the body wall and internal organs and allows for increased internal working space for manipulation of organs by surgical instruments. Cannula placement can be done by one of three methods: Veress needle, direct trocar insertion, or the open Hasson method. Insufflation can be performed using a Veress needle before placement of the primary trocar or via the trocar itself through a gas intake port, typically located on the side of the outer cannula. After the laparoscope has been introduced, secondary trocars can be placed under direct laparoscopic observation to minimize the risk of injury.