STANDARDIZATION OF PORT PLACEMENT FOR LAPAROSCOPIC UNILATERAL NEPHRECTOMY IN PIGS
Loading...
Date
2009
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
AAU, Anand
Abstract
Inspite of considerable technologic innovations in laparoscopy little has changed in our understanding of port dynamics, and improper trocar insertion still causes most of the operative complications of laparoscopic surgery. The increasing number of laparoscopic procedures performed and growing laparoscopic applications in different surgical fields necessitates serious study of accident causation, urgent redesign of our access methods and port placement. The present study on standardization of port placement for laparoscopic unilateral nephrectomy was done in 26 pigs, of which nineteen were male and rest female. The body weight of pigs ranged from 12 to 34 kg (Mean: 21.65 kg). The pigs were allotted to three groups viz., group 1 (<20 kg), group II (between 20 to 25 kg), and group 111 (> 25 kg). Further, each group was subdivided into two on the basis of swording or clashing and non clashing of instruments with telescope, and termed as "non clash' and "clash" groups. In overnight fasted animals, after premedication (Glycopyrrolate @ O.Olmg/kg, Ketamine @ 20mg/kg, and Xylazine @ 2mg/kg i.m) general anaesthesia was induced with Thiopentone sodium @ !Onig/kg i.v. and orotracheal intubation was done. After securing the animal in lateral recumbancy with head and kidney bridge elevated, pneumoperitoneum was created by insufflating C02 inside the abdomen. The camera port was first made on ventral abdomen and other two ports i.e. working and backhand ports were made in triangulation with camera port. The working and backhand ports were invariably made on the lateral abdomen with backhand port at subcostal area. All the three ports were placed at variable lengths from angle of last costovertebral joint, last rib. umbilicus, xiphoid, stifle joint and bony prominence of external angle of ilium. All twenty six pigs underwent laparoscopic nephrectomies as per the standard procedures performed by urology residents and few by the author. At the end of surgical procedure, the measurements (cm) between the ports and selected bony prominences were taken with pigs still under insufflated state. Pigs weighing between 12-19 kg (Group I) were routinely used for laparoscopic uroiogic procedures, hence based on our findings an overall guideline involving placement of camera, working and backhand ports for this group was suggested below. The camera port can be placed at a distance of 5 cm each from umbilicus and stifle joint, and the working port can be placed at a distance of > 5 cm from last rib; further with the increase in body weight, I cm length should be increased for both the ports. Overall a distance of 12-16 cm between stifle joint and working port should be maintained and backhand port should be placed at a distance of < 18 cm from xiphoid.
Description
Keywords
VETERINARY SURGERY AND RADIOLOGY, STANDARDIZATION