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Naveen Kumar, Swapan Kumar Maiti
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This book covers most of the topics with updated information of modern diagnostic laparoscopy, laparoscopic surgery, laparoscopic guided organ biopsy and laparoscopic ancillary diagnostic techniques employed in small animal in a very concise from. The book is divided into twelve chapters covering all modern diagnostic and laparoscopic surgical techniques used in small animal practices. The main objective of the book is to provide the latest information to meet the requirements of not only undergraduate and postgraduate students but also to the teachers and veterinarians involved in laparoscopic diagnosis and surgery. The book contains more than 100 good quality colour photographs of laparoscopic diagnosis, laparoscopic surgery and laparoscopic ancillary techniques.

0 Start Pages

Acknowledgement We are thankful to the Indian Council of Agricultural Research, New Delhi for approving and funding one research project on laparoscopic studies in animals, which is the base for this publication. We are grateful to the Director, Indian Veterinary Research Institute, Izatnagar (UP) and Head, Surgery Division, IVRI, Izatnagar for their generous help and support towards this publication. Thanks are also due to all the scientific, technical and supporting staff of the Surgery Division, IVRI without their help it would not have been possible to complete this task. We wish to acknowledge the authors and publishers of different reference books/papers consulted for the preparation of this task. Help and wholehearted support extended by the learned faculty members in general and some PG students of Surgery Division, IVRI especially Drs Avijit Dutta, Ajith P, Anbu Raja, Ninu A R, Mathew D, Dileep Kumar, Tamil Mahan, Sangeetha P and Divya Mohan in particular to bring out the publication are duly acknowledged. Inspiration, suggestion and personal helps by Prof. (Dr) David C. Twedt, Internationally reputed laparoscopic surgeon and Diplomate ACVIM, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, USA is highly acknowledged. Last, but not the least our special heartiest thanks and sincere appreciation to our family for their patience, devotion, deep understanding and cooperation to accomplish this arduous task.  

1 Introduction

Laparoscope The term laparoscope derived from Greek word “Laparo” meaning “flank,” which is the side of the body between the ribs and hips (abdomen) and “scope” means to look at or examine. Laparoscope can be defined as an instrument through which structures within the abdomen and pelvis can be seen or a fiber optic device that consists of a flexible tube. Fiber optic scope is used to directly visualize the internal anatomy of a hollow organ. Laparoscope is used in laparoscopy and laparoscopic surgery. It has lenses like a telescope to magnify body structures, a powerful light to illuminate them and a miniature video camera. The camera sends images of the inside of the body to a TV monitor in the operating room. Specialized surgical instruments can be inserted through the laparoscope.

1 - 10 (10 Pages)
2 History

The early history of laparoscopy is unknown to many surgeons, but Hippocrates (460-375 BC) in Greece was first to describe endoscopy). He made reference to a rectal speculum. Hippocrates also advised injecting a large quantity of air into the intestines through the anus in the case of intestinal obstruction. He also advocated the insertion of suppository that was 10 digits long. These descriptions suggest that Hippocrates was well aware of ileus with intestinal obstruction and thought of several possible etiologies, including faecal impaction, intussusception, and sigmoid volvulus. Moreover, Hippocrates treated these life-threatening conditions with minimally invasive approaches.

11 - 16 (6 Pages)
3 Instrumentation

The basic equipment for performing laparoscopy includes the laparoscope and corresponding trocar and cannula, light source, gas insufflator and the Veress needle. Laparoscope applicable for use in the small animals (dog, goat, sheep and lab animals) ranges in diameter from 2.7 to 10 mm in diameter, however, a 5mm diameter telescope is suitable for most cases and 2.7mm may be required for toy breeds of dogs and lab animals. A 0 or 30 degree direction of vision provides the operator with a “normal’ field of view and has proven most useful. Authors are using a 5-mm diameter 30-degree field of view telescope for routine diagnostic laparoscopy. The 5-mm diameter is adequate for most all small animal procedures in animals of variable size. The 0-degree designation means that the telescope views the visual field directly in front of the telescope.

17 - 34 (18 Pages)
4 Anesthesia

Anaesthesia is an important criterion for doing laparoscopic procedure, which is being achieved by induction of general anaesthesia. However, in certain species, e.g. bovine, caprine etc., it can be done by preanaesthetic agent and infiltration of the local anesthetic agent at the site of the trocar placement. Selection of an anesthetic agent depends on the patient conditions, nature of procedure; time to be taken for the laparoscopic procedure and available facility. For the induction of the general anaesthesia follow the same procedure as in the conventional surgery viz. fasting, water withheld, preanaesthetic, fluid administration etc. Further, due to difference in the physiology of cardiopulmonary system of different animals, all these considerations varied from species to species and breed-to-breed. For instance cattle and buffalo are more prone to regurgitation and subsequent aspiratory pneumonia in general anaesthesia than those of dog and cat. While going for induction of general anaesthesia, an anesthetist should know about the different drug being used, their mechanism of action, effect on the different body system, their adverse effect and pure antagonist, if possible. Besides this an anesthetist should also know about the patient physiology and equipment for the administration of the anesthetic agents, because veterinary anesthetist is faced with numerous disturbances of cardiopulmonary and skeletal muscle function associated with general anaesthesia. For anaesthesia no anaesthetic agent is safe until and unless it is used by an experienced anesthetist.

35 - 40 (6 Pages)
5 Laparoscopic Procedures

Positioning of the patient/anesthesia The patient is transported to the operating room and after general anesthesia the patient is placed in a desirable position. Some operating tables can be repositioned intraoperatively, allowing the surgeon to change the angle of the patient during the procedure. Special care should be taken to avoid nerve injury by malpositioning the patient, particularly along the popliteal fossa and brachial plexus. If any part of the patient is in contact with a metal object, patient may be at risk of electro surgical burns. General anesthesia is preferred for laparoscopy as it provides adequate muscle relaxation and assisted respiration particularly as the patient is in Trendelenburg position.

41 - 46 (6 Pages)
6 Techniques for Laparoscopic Examination

Laparoscopy is an operative procedure designed for the visual inspection of peritoneal cavity and biopsy of organs. Laparoscopy is a valuable diagnostic and therapeutic tool in clinical medicine. In the field of cholecystectomy, appendicectomy, vagotomy, hernia repair and adhesion release laparoscopy surgery offers significant advantages over open surgery in humans. For gynecological problems like ovarian cyst or in the case of oophorectomies and hysterectomies, laparoscopic surgery (‘scarless surgery’) is now considered a better alternative in addition to laparoscopic sterilization. Only in the last 15 years laparoscopy is widely used in different animal species for research and clinical diagnostic and therapeutic purposes. The first canine laparoscopy procedures were performed in the early 1900’s (Kelling, 1902). Anderson (1937) used dogs to perfect his skills prior to human clinical trials. The first clinical application of laparoscopy in dog’s involved ovarian function studies in the early 1960’s and Lettow reported the first laparoscopic liver biopsy procedure in a dog in 1972.

47 - 62 (16 Pages)
7 Laparoscopic Guided Organ Biopsy and Minor Surgery

Laparoscopy is not only used in the examination of the abdominal cavity organs, surgical treatment but also in the diagnosis of the different disease conditioned by biopsy examination (removal of a sample of tissue from the living body for histopathological examination). Biopsy is indicated to ascertain a correct diagnosis, specific therapy and accurate prognosis. Laparoscopy is becoming an alternative method of monitoring biopsies of internal organs. It permits precise localization and accurate site on the various abdominal organs surface such as kidney, liver, spleen etc. Since, it is relatively noninvasive so it ranks highest amongst biopsy techniques. The technique allows visual control over the biopsy procedure, which considerably limits post biopsy complications and increases the likelihood of obtaining diagnostically useful biopsy specimens.

63 - 78 (16 Pages)
8 Laparoscopic Ancillary Diagnostic Procedures

The most common indication for laparoscopy is to examine and biopsy the abdominal organs or masses. Additional diagnostic procedures that can be performed using laparoscopic guidance include gall bladder puncture to collect bile, contrast radiographic techniques for the diagnosis of bile duct obstructions, overdistension of gall bladder, portography and splenic pulp pressure measurement.

79 - 86 (8 Pages)
9 Laparoscopic Sterilization in Bitches

Among the various modern surgical methods, laparoscopy is now held as one of the most potent and promising aids for both diagnostic (laparoscopy) and therapeutic (laparoscopic surgery) use. Laparoscopy is an endoscopic procedure that bridges the gap between clinical evaluation and surgical exploration. The laparoscopic surgical techniques in both and human and veterinary medicine have grown tremendously. Laparoscopy requires a minor surgical intervention and it provides the only available practical means of making repeated direct observation of abdominal viscera. The advantage of surgical laparoscopy over the conventional open surgical laparotomy include faster patient recovery because of smaller surgical sites, decreased hospitalization, improved cosmetic, improved visualization of abdominal organs, lower postoperative morbidity with lower infection rates, and less postoperative pain and stress. Surgeons are commonly looking for more progressive and stressful surgical methods of sterilization in dogs, particularly in canine birth control programs in urban industrial areas. Demographically dense urban and industrial areas require effective animal birth control programs that can overcome the problems of hospitalization, postoperative complications and reduction in the overall cost of operation. In a large scale animal birth control program, the conventional methods of sterilization require a long period between capture of dogs and their release, due to the time taken for the surgical wounds to heal. In this aspect, keyhole surgery (laparoscopic surgery) can revolutionize the entire program, as it needs only a very small surgical wound, which usually needs no postoperative care or regular dressings.

87 - 96 (10 Pages)
10 Laparoscopic Sterilization in Male Dogs

Many surgeons have made attempts to develop minimally invasive surgical techniques with minimum blood loss and fewer traumas, to treat the disease process and minimize patient morbidity. Laparoscopic surgery may provide a wide field of its extensive application particularly in surgical sterilization of different animal species. Furthermore, high demographic urban and industrial area requires an effective animal birth control programme, which can overcome the problem of hospitalization, postoperative complications, and the overall cost reduction of operation. The sterilization of (both male and female) is effective measure in controlling the stray dog’s problem. Because the sterilization of either male or female alone is not effective and also sterilization of female consume more time when compared to male sterilization. To combat stray dogs in Animal Birth Control (ABC) programme, it is effective to sterilize the male also. Castration of male dogs by conventional open method has many disadvantages and postoperative complications such as hemorrhage, wound dehiscence, infections, maggot infestations and scrotal swellings etc. In a large scale Animal Birth Control programme, the conventional methods of sterilization requires a long period between capture of dogs and their release due to the time taken for the surgical wounds to heal. In this aspect, Keyhole surgery (Laparoscopic surgery) can revolutionize the entire programme, as it needs only very small surgical wound, which usually needs no postoperative care or regular dressings. It also avoids postoperative complications such as wound dehiscence, herniation, etc. and reduces the surgical stress to animal as well as recurring cost of each surgery.

97 - 102 (6 Pages)
11 Laparoscopy in Zoo Animals Practice

Introduction The most common indication for laparoscopy in zoo animal clinical medicine includes evaluation of liver disorders (e.g. cirrhosis, hepatitis, hepatomegaly), staging for cancer treatment (liver and peritoneal metastases), diagnosis of various peritoneal diseases (e.g. ascites), diagnosis of pelvic soft tissue diseases (e.g. ovarian problem, endometritis, pyometra,) and diseases of spleen and pancreas. The utility of laparoscopy in zoo animal practice is wide and it has been used in almost all the species with encouraging results. Laparoscopy is now most commonly used in zoo animal medicine to examine and biopsy of liver, gall bladder, kidney, spleen, pancreas, ovaries and prostrate. It provides an excellent means for visualizing the surfaces and colour. Even subtle color and texture changes can be readily detected. The liver is generally evaluated through a right lateral mid abdominal approach in canine and feline species of zoo animals. Abnormal gross liver changes that can be readily appreciated include hepatic lipidosis, glycogen leaden liver, metastasis or multifocal neoplasm, nodular hyperplasia, cirrhosis, cholangihepatitis, extra hepatic biliary tract obstruction etc. Using grasping forceps advanced through the second puncture cannula, the biopsy can be obtained quickly and safely in zoo animals. The pancreas can usually be visualized thorough a right abdominal approach and biopsy samples can be safely obtained.

103 - 108 (6 Pages)
12 Laparoscopy in Animal Physiology

Introduction Laparoscopy is an operative procedure, performed through a keyhole opening with a rigid telescope that allows visual inspections and biopsy of the peritoneal cavity and its organs. Laparoscopy was first introduced in 1901 in human medicine. It has only been in the last 15 years that laparoscopy has been widely used in various animal species for research, clinical diagnosis and therapeutic purposes. Veterinary laparoscopy was widely used initially in the reproductive physiology in equine, nonhuman primate and various zoo and exotic species. The first clinical application of laparoscopy in dog involved ovarian physiology in the early 1960s, and Lettow reported the first laparoscopic liver biopsy procedure in a dog in 1972. The utility of laparoscopy in animal physiology particularly in reproductive physiology is wide and it has been used in almost all the species with encouraging results.

109 - 116 (8 Pages)
13 End Pages

References Ajith, P., Maiti, S.K., Kumar, N. and Sharma, A.K. (2010) Comparative evaluation of laparoscopic vs. ultrasound guided liver biopsy techniques in canines, Indian Journal of Animal Sciences, 80:405-409. Altobelli LC et al., (1980) LaprocatorTM Preventive Care and Maintenance. JHPIEGO Corporation: Baltimore, MD. Anburaja, M., Kumar, N., Maiti, S.K., Sharma, A.K., Dimri, U. and Kataria, M. (2009) Laparoscopic sterilization Vs open method sterilization in dogs: A comparison of two techniques, Turkish Journal of Veterinary and Animal Sciences, 33:427-436. Anderson (1937) Cited by Magne, M.L. (1990) Laparoscopy: Instrumentation and Technique. In: Small Animal Endoscopy (Tams, T.R. editor) C.V. Mosby Company. St. Louis, pp. 367-375. Bozzini, Philip (1804) Cited by Magne, M.L. (1990) Laparoscopy: Instrumentation and Technique. In: Small Animal Endoscopy (Tams, T.R. editor) C.V. Mosby Company. St. Louis, pp. 367-375. Bunch, S.E., Polak, D.M. and Hornbuckle, W.E. (1985) A modified laparoscopic approach for liver biopsy in dogs. J. Am. Vet. Med. Asso. 187: 1032-1035.


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