Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.
| THE CUTTING EDGE: INTRODUCING REDUCED PORT LAPAROSCOPIC SURGERY with an introducer device.
UÊ/hiÊÃhi>ÌhÊovÊ ÌhiÊ/Ài«oÀ̳Êh>ÃÊ >ÊÃilv-iÝ«>n`in}Ê ring, which allows the base of the port to remain inside the peritoneum. The sheath is also adjust- able; the port sits flush against the skin regardless of abdominal wall thickness or patient size.
UÊ/hiÊoÕÌiÀÊ«oÀÌionÊovÊÌhiÊ«oÀÌÊh>ÃÊÌhÀiiÊx-mmÊ«oÀÌÃÊ >n`Ê>Ê£ä-mmÊ«oÀÌÊÀi`ÕViLliÊÌoÊxÊmm®]Êin>Llin}Ê>Ê surgeon to perform a 4-port laparoscopic proce- dure. The ports have a duckbill-lip seal, which facilitates introduction and removal of instruments while maintaining a pneumoperitoneum.
Figure 7. Illustration of pre-bent intruments and the EndoEYE articulating optic system passing through the Triport+ access system
UÊ/hiÊ «oÀÌÃÊ >ÀiÊ >lÃoÊ vliÝiLliÊ >n`Ê >VVommo`>ÌiÊ different types and sizes of laparoscopic instru- ments, including those that are curved or bent. /hiÊ/Ài*oÀ̳ÊmÕlÌiÌÀoV>ÀÊ `iÛiViÊ h>ÃÊ Ã«iViviV>llÞÊ designed curved instruments that enable triangu- lation within the abdomen. The curves and bends allow the instruments to pass into the abdomen through any of the flexible ports.
Additional Applications The system can be used in combination with a deflect- able tip EndoEYETM
optical camera (olympusamerica.
com) for visualization (Figures 7 and 8). This optical system allows the camera operator to visualize organs from different angles, bending and flexing the scope tip as needed to create the necessary view of the surgi- cal procedure. The outer portion of the port can be removed without
Figure 8. The EndoEYE articulating optic system
Clinical Evaluation nÊÛiÌiÀin>ÀÞÊmi`iVini]ÊÌhiÊivviV>VÞÊ>n`Êlimi-
Ì>ÌionÃÊovÊÌhiÊ- -ÊmÕlÌiÌÀoV>ÀÊ«oÀÌÊÜiÌhÊÕÃiÊ of articulating and straight instruments is currently under evaluation.
Triport+ Access System for Laparo- Endoscopic Single-Site (LESS) Surgery /hiÊ/Ài«oÀ̳ÊmÕlÌiÌÀoV>ÀÊ`iÛiViÊ iÃÊ>nÊ
-
approved multitrocar access port used for reduced port surgery in humans (Figure 3). ÌÊ>lloÜÃÊÌhiÊVliniVi>nÊÌoÊ«>ÃÃÊmÕlÌi«liÊinÃÌÀÕ-
ments simultaneously through the port's single incision (Figure 7).
Port Placement This port is packaged and supplied as a ster- ile single-use device. UÊ nÊ >nim>lÃ]Ê ÌhiÃÊ«oÀÌÊ ÀiµÕiÀiÃÊ >Ê £°x-Ê ÌoÊ 2-cm fascial incision along the midline at the level of the umbilicus. The sheath of the multitrocar port is inserted through this fascial opening into the peritoneum
18 Today's Veterinary Practice January/February 2012
having to disengage the inner sheath from its snug fit against the abdominal wall. This allows for specimen retrieval without port removal.
Clinical Evaluation /hiÊ VliniV>lÊLiniviÌÃÊ >n`Ê limiÌ>ÌionÃÊovÊ ÌhiÊ/Ài*oÀ̳Ê
Figure 9. An extra small Alexis wound retractor being placed on a canine patient's midline. The outer ring is rolled down to sit flush with the abdomen, allowing 360o radial wound retraction.