Читать книгу Small Animal Laparoscopy and Thoracoscopy онлайн

97 страница из 232

An intercannula distance of at least 5 cm is desirable for the needle driver and accessory instrument. The working tips of these instruments should meet at oblique angles with each other at a relatively wide angle of 60° or more. If possible, the cannula for the right needle driver should be parallel to the suture line. The distance between cannula entrance and operative field should be approximately half of the length of the instrument (e.g., for 30‐cm instruments, the cannula should be placed 15 cm [∼6 in.] from the target field) [2]. The instruments and camera need to be directed in the same axis as the surgeon's view toward the screen to avoid mirrored vision.

The needle introduction method used depends on the type and size of needle, the size of the cannulas used, and the animal's size in relation to needle size. If the body wall thickness and needle size allow, the needle can simply be passed transcutaneously into the abdominal cavity anywhere in the surgically prepared area and be grasped intracorporeally with the needle driver (ssss1). If so, the needle is ideally passed perpendicular to the dominant hand instrument axis so the needle can simply be grasped at the midpoint, and suturing ensues. Unidirectional barbed suture with a welded loop on the end is also easily introduced transabdominally. However, bidirectional barbed suture, or with a fixation tab, cannot be introduced transabdominally.