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Endosurgery

( Stephen J. Divers BVetMed, DZooMed, Dipl ACZM, Dip ECZM (herpetology), FRCVS

In order to evolve from observation and biopsy into endosurgery, accurate hemostasis becomes increasingly critical. Radiosurgical and laser devices have become available to veterinarians and have facilitated the ability to incise and debride internally without significant hemorrhage. A variety of radiosurgery devices are available for use with foot-pedal activated 3.8 and 4.0 MHz radiosurgery units (Ellman International Inc, Hewlett, NY 11557, USA). The most useful instruments compatible with the 14.5 Fr operating sheath are the needle electrode and polypectomy snare.

The standard 2.7mm sheathed telescope is still used to provide visualization, additional operating cannulae provide access ports for the insertion of additional instruments. Each additional access port is created using a 2.5 or 3.5 mm cannula and trocar, and once inserted the trocar is removed allowing the insertion of a 2 or 3 mm instrument respectively. Currently, 2 mm instruments are limited to Babcock forceps, dissecting forceps and scissors. However, a greater variety of 3 mm instruments is available including dissection forceps, grasping forceps, scissors, biopsy forceps, bipolar forceps, palpation probes, needle holders and extracorporeal knot-tiers. These instruments have a standard attachment that enables them to be used interchangeably with a variety of different handles. Most handles are of plastic or metal construction and possess a radiosurgical connection that can turn scissors or forceps into monopolar devices. Some handles have a hemostat or Mahnes style racket mechanism to maintain a firm hold of tissue even if the endoscopist releases grip of the instrument.


Basic rigid endoscopy system.
(A) 2.7 mm telescope housed within a 14.5 Fr operating sheath with light guide cable and endovideo camera attached;
(B) close-up of the end of the operating sheath illustrating biopsy forceps protruding from the instrument channel;
(C) 5 Fr endoscopic instruments for use with the 14.5 Fr operating sheath - grasping forceps (1), biopsy forceps (2), aspiration/injection needle (3), and single-action scissors (4).




Radiosurgical polypectomy snare.
(A) Handle of the snare illustrating the thumb control (arrow);
(B) snare retracted into outer sheath;
(C) snare extended and open.




Cannulae and trocars.
(A) Plastic and graphite cannulae and trocars with valves but no insufflation stop-cocks, 2 mm (top) and 3 mm (bottom);
(B) plastic and graphite cannulae and trocars with valves and insufflation stop-cocks, 2 mm (top) and 3 mm (bottom);
(C) surgical steel cannulae and trocars with valves and stop-cocks, 2 mm (top) and 3 mm (bottom);
(D) 6 mm endotip cannula with valve and stop-cock.
(Please note that any cannula stop-cock must be closed when used within avian airsacs).




Endoscopic instruments, 20 cm x 3 mm.
(A) Forceps - Babcock forceps (1), atraumatic dissecting and grasping forceps with single-action jaws (2), Reddick-Olsen dissecting forceps (3), fenestrated grasping forceps (4), long curved Kelly dissecting and grasping forceps (5), short curved Kelly dissecting and grasping forceps (6);
(B) scissors and biopsy instruments - micro hook scissors with single action jaws (1), Blakesley dissecting and biopsy forceps (2), scissors with long sharp curved double action jaws (3), scissors with serrated curved double action jaws (4);
(C) probes - distendable palpation probe (1), palpation probe with cm markings (2), irrigation and suction cannula (3).




Human pediatric 3 mm laparoscopy system.
(A) Endoscopic instrument (I) inserted through cannula (C) and coupled to a plastic handle (H) with a radiosurgical monopolar lead (R) connected;
(B) close-up demonstrating radiosurgical connection (R), and instrument (I) insertion into the handle by pressing the button (arrow).




Endoscopic instrument handles.
(A) Plastic handle with radiosurgery connector (arrow);
(B) surgical steel handle;
(C) Plastic handle with hemostat style racket (arrow);
(D) Plastic handle with Mahnes style racket.




Rigid 5 mm endoscopy equipment suitable for reptiles over 10 kg.
(A) 5 mm 30o telescope (1), 5 mm biopsy forceps (2), 10.5 cm 6 mm endotip cannula (3), and 6.5 cm 6 mm endotip cannula (4);
(B) 10.5 cm 6 mm endotip cannula with external thread for screw insertion (1), multifunctional telescope and instrument valve (2), and insufflation stop-cock (3).


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