Small Animal Surgical Emergencies. Группа авторов
for ureteral surgery are listed in Box 2.5 and shown in Figures 2.6–2.10.
Urethral Surgery
Perineal Urethrostomy in Cats: Patient Positioning
A perineal urethrostomy can be performed in sternal recumbency with the patient's hind legs hanging over the end of the table and the tail retracted cranially, as long as there is padding to prevent obturator nerve compression. A roll of bubble wrap can be used, or towels placed under the patient's pelvis (Figure 2.11). Alternatively, the patient can be placed in dorsal recumbency with the hind limbs retracted gently cranially (Figure 2.12). The necessary instruments are listed in Box 2.6 and illustrated in Figures 2.13 and 2.14.
Box 2.4 Instrumentation for Hepatic Surgery
Routine soft tissue instrument set
Balfour retractor
Monopolar cautery
Sterile suction tubing
Multiple suction canister
Lap sponges
Stapling equipment (Figure 2.3 and Table 2.1)
Vessel sealing device (LigaSure) (Figure 2.4)
Weck Hemoclips®, Ethicon Ligaclips®, or Covidien Surgiclips® (Figure 2.5)
Vetspon absorbable hemostatic gelatin sponge (Figure 2.5)
Oxidized regenerated cellulose (Figure 2.5)
Figure 2.3 Stapling device and cartridge options.
Table 2.1 Stapling cartridge information chart.
| Instrument cartridge | Staplesa | ||
|---|---|---|---|
| Width × height (mm) | Closed height (mm) | Configuration | |
| TA 30. 55. 90 blue | 4.0 × 3.5 | 1.5 | Double staggered row of staples |
| TA 30. 55. 90green | 4.0 × 4.8 | 2.0 | Double staggered row of staples |
| TA 30–V3 whiteb | 3.0 × 2.5 | 1.0 | 3 staggered rows |
| GIA 50 | 4.0 × 4.0 | 1.75 | 4 staggered rows of staples with a cut |
| GIA 60 | 3.0 × 2.5 | 1.0 | |
| GIA 60 or 80 | 3.0 × 3.85 | 1.5 | between 2 |
| GIA 90 | 4.0 × 4.0 | 1.75 |
a Absorbable staples: PDS and glycolic acids; stainless steel 316 l.
b Vascular.
Figure 2.4 The bipolar vessel sealing device (LigaSure, Medtronics, Dublin Ireland), comes in many size and shape options. The device aides in decreasing intraoperative and postoperative hemorrhage.
Figure 2.5 An assortment of Hemoclip® and Ligaclip® sizes, Surgicel®, Vetspon® (Gel‐foam®), and Surgiclip® applicator (bottom). Both Gel‐foam and Surgicel are applied to a site to aid in clot formation and can be left in place indefinitely until eventually absorbed, or they can be removed during surgery once hemostasis is achieved.
Box 2.5 Instrumentation for Ureteral Surgery
Routine soft tissue instrument set
Balfour retractor
Sterile suction tubing
Suction canister
Sterion® Silicone vessel loops
Weck‐Cel® cellulose eye spears
Microsurgical needle holders (cats and small dogs)
Microsurgical scissors (cats and small dogs)
Microsurgical forceps (cats and small dogs)
Bipolar cautery
Mixter forceps
Surgical loupes
Operating microscope (recommended for cats and small dogs)
5‐0 to 8‐0 sutures
Retrograde Hydropulsion in Dogs
Retrograde hydropulsion in dogs can be used to flush urethral calculi back into the urinary bladder to relieve urethral obstruction prior to a cystotomy for stone retrieval. Instruments necessary for this technique are listed in Box 2.7.