Veterinary Endoscopy for the Small Animal Practitioner

7 Chapter 7Figure 7.1 Schematic of the reproductive tract of the bitch.Figure 7.2 Anatomy of the cervical tubercle and vaginal fornix in the bitch ...Figure 7.3 Canine rigid endoscope (TCI scope)‐Karl Storz SE & Co. KG.Figure 7.4 TELE PACK™‐Karl Storz SE & Co. KG.Figure 7.5 Catheters (Rusch‐Teleflex) for endoscopic transcervical procedure...Figure 7.6 Introduction of the TCI scope in an angled direction.Figure 7.7 Endoscopic view of the urethral papilla (A) and vaginal opening (...Figure 7.8 Endoscopic view of vaginal folds.Figure 7.9 Endoscopic view of the dorsal median fold (DMF) and paracervical ...Figure 7.10 Endoscopic view of the dorsal median fold (DMF), paracervical ar...Figure 7.11 Endoscopic view of the cervical tubercle and os (arrow) in the b...Figure 7.12 Catheterization of the cervix under endoscopic view to perform e...Figure 7.13 Endoscopic view of fluid in the cervical area in the bitch.Figure 7.14 Endoscopic view of cervix catheterization (a) and semen back flo...Figure 7.15 Endoscopic view of the vagina during proestrus in the bitch.Figure 7.16 Endoscopic view of the vagina during estrus in the bitch.Figure 7.17 Endoscopic view of the vagina during diestrus in the bitch.Figure 7.18 Endoscopic view of the vagina during anestrus in the bitch.Figure 7.19 Endoscopic view of a vaginal septum (dorso‐ventral septum) that ...Figure 7.20 Endoscopic view of a vaginal band that is easily ruptured by dig...Figure 7.21 Endoscopic view of the resection of a vaginal septum in the bitc...Figure 7.22 Endoscopic view of vaginitis in the bitch.Figure 7.23 Endoscopic view of lymphoid follicles in the bitch.Figure 7.24 Endoscopic view of vaginal mass in the bitch.Figure 7.25 Endoscopic view of vaginal polypus in the bitch.Figure 7.26 Endoscopic view of uterine bifurcation in the bitch.Figure 7.27 Endoscopic view of cervical tubercle during normal postpartum (f...Figure 7.28 Endoscopic view of a single paw in a dystocia case in the bitch....Figure 7.29 Endoscopic view of the urethra in the bitch.Figure 7.30 Endoscopic view of paracervical region during estrus in the bitc...

8 Chapter 8Figure 8.1 Using a 10 mm diameter operating laparoscope in a single‐port for...Figure 8.2 An S‐PORTAL for single laparoscopic surgery (SILS). The S‐Portal ...Figure 8.3 Performing a laparoscopic ovariectomy in a dog using a two‐port t...Figure 8.4 Performing a laparoscopic ovariectomy and laparoscopic‐assisted g...Figure 8.5 An intact female Golden Retriever positioned on a tilt table in p...Figure 8.6 A right‐side ovarian pedicle site seen with laparoscopy following...Figure 8.7 A large blood clot in the right lumbar gutter of the patient seen...Figure 8.8 A right‐side ovarian pedicle site seen with laparoscopy in an 11‐...Figure 8.9 An insufflator used for laparoscopy in small animals. This unit, ...Figure 8.10 A Veress needle used for initial insufflation of the abdomen wit...Figure 8.11 Disposable low‐pressure insufflation tubing with a filter for co...Figure 8.12 Five millimeter diameter CLICKline instruments with 36 cm length...Figure 8.13 Three types of 5 mm biopsy forceps for small animal laparoscopy ...Figure 8.14 Close‐up images of the tips of the working inserts of 5 mm opera...Figure 8.15 Ten millimeter diameter operative instruments with 36 cm length ...Figure 8.16 Two options for stabilizing the ovary against abdominal wall whe...Figure 8.17 A three‐blade gall bladder extractor used for removal of large o...Figure 8.18 Examples of needle holders and assistants used for intracorporea...Figure 8.19 Curved CLICKline instruments for use with SILS ports. This desig...Figure 8.20 Lateral drawing of an undistended abdomen with a Veress needle i...Figure 8.21 Lateral drawing of distended abdomen with a Veress needle in pla...Figure 8.22 The Veress needle is inserted until the tip of the needle is in ...Figure 8.23 The “hanging drop” test for proper Veress needle position in the...Figure 8.24 When the Veress needle is properly placed in the peritoneal spac...Figure 8.25 If the Veress needle is NOT properly placed, either in the abdom...Figure 8.26 A transverse view of the abdominal wall at the linea alba with a...Figure 8.27 The appearance of flow and pressure readings of an insufflator a...Figure 8.28 The appearance of flow and pressure readings of an insufflator a...Figure 8.29 The ideal arrangement for laparoscopy with the telescope pointed...Figure 8.30 Initial right paramedian operating portal site determination usi...Figure 8.31 Abdominal wall displacement produced by external digital palpati...Figure 8.32 A number 10 scalpel blade penetrating the abdominal wall with a ...Figure 8.33 Proper hand position for holding a laparoscopy trocar‐cannula fo...Figure 8.34 The tip of the trocar of a laparoscopy trocar‐cannula properly p...Figure 8.35 Proper insertion of a smooth laparoscopy trocar‐cannula with the...Figure 8.36 When the cannula is properly inserted, the trocar is removed and...Figure 8.37 The leading edge of the screw tip of an EndoTIP laparoscopy cann...Figure 8.38 A 6 mm EndoTIP cannula threaded adequately into the abdomen.Figure 8.39 The normal‐appearing lateral abdominal wall looking transversely...Figure 8.40 As the telescope is angled from the transverse position craniall...Figure 8.41 Continued rotation of the telescope from the cranial direction a...Figure 8.42 Progression to a transverse position of the telescope to the rig...Figure 8.43 With the telescope pointed caudally into the right side of the p...Figure 8.44 A thick well‐defined internal rectus abdominis muscle sheath lay...Figure 8.45 A thin but easily seen and well‐defined internal sheath of the r...Figure 8.46 A subtle poorly defined internal rectus abdominus sheath at the ...Figure 8.47 There is no visible internal rectus abdominis muscle sheath in t...Figure 8.48 The left caudal portion of the lateral abdominal wall is visible...Figure 8.49 The translucent central tendon of the diaphragm. A portion of br...Figure 8.50 The muscular portion of the diaphragm in this image demonstrates...Figure 8.51 A single island of muscle tissue in the central tendon of the di...Figure 8.52 Multiple islands of muscle tissue in the central tendon of the d...Figure 8.53 Irregular contour of the central tendon with more dense tissue a...Figure 8.54 Irregular contour of the central tendon seen with a large transl...Figure 8.55 The central tendon of the diaphragm in a very small dog that is ...Figure 8.56 The internal end of the inguinal canal or vaginal ring in a norm...Figure 8.57 The same structures as in Figure 8.56 in an intact male dog with...Figure 8.58 In a 12‐year‐old male dog that was neutered as a young dog, the ...Figure 8.59 A 13‐year‐old neutered male cat showing atrophied deferent duct ...Figure 8.60 The vaginal process in a female dog passing through the vaginal ...Figure 8.61 Continuation of the falciform ligament to meet with the median l...Figure 8.62 A thin falciform ligament with minimal fat and multiple transluc...Figure 8.63 A thickened fat‐filled falciform ligament in an older dog seen f...Figure 8.64 The left side of the fat‐filled falciform ligament seen in Figur...Figure 8.65 The falciform ligament of the liver, a variable remnant of the v...Figure 8.66 A normal fat‐filled falciform ligament extending cranially to co...Figure 8.67 Atypical‐appearing fat on the abdominal wall in the caudal abdom...Figure 8.68 Normal appearance of the liver with rounded smooth surfaces and ...Figure 8.69 A normal‐appearing liver demonstrating sharp margins of the lobe...Figure 8.70 A normal‐appearing liver with a dappled bright red coloration pr...Figure 8.71 Dark muddy purple coloration of a normal‐appearing liver. A norm...Figure 8.72 Brown coloration of a normal‐appearing liver. A normal‐appearing...Figure 8.73 A normal‐appearing liver with dappled coloration and prominent s...Figure 8.74 A normal‐appearing common bile duct in a cat seen as the dark pu...Figure 8.75 The left kidney is seen with the patient in a right oblique posi...Figure 8.76 The right kidney is visible with the patient in a left oblique p...Figure 8.77 A blunt probe is positioned under the hepatorenal ligament to de...Figure 8.78 The cranial extent of the pancreas is visible as an off‐white sm...Figure 8.79 The caudal portion of the right lobe of the pancreas seen from t...Figure 8.80 A normal‐appearing spleen with the typical dark purple coloratio...Figure 8.81 A normal spleen in an 11‐year‐old dog with accentuated roughenin...Figure 8.82 A normal spleen with a linear area of pink on the caudal margin....Figure 8.83 A normal spleen with a circular area of pink on the ventral surf...Figure 8.84 Siderosis on the surface of the spleen in a 7‐year‐old spayed fe...Figure 8.85 A normal distended bladder with prominent blood vessels. This bl...Figure 8.86 A normal partially distended bladder with small subtle blood ves...Figure 8.87 A grossly overdistended bladder filling the caudal abdomen and i...Figure 8.88 A segment of the left ureter seen on the surface of the lumbar f...Figure 8.89 The same ureter in Figure 8.88 seen further caudally where it di...Figure 8.90 The normal left ureter seen crossing ventral to the colon and en...Figure 8.91 The ventral surface of the gastric body seen on the left side of...Figure 8.92 The ventral surface of a moderately distended gastric body seen ...Figure 8.93 The ventral surface of the gastric body is visible on the right ...Figure 8.94 A moderately distended stomach showing the greater curvature on ...Figure 8.95 The ventral surface of the pyloric antrum, pylorus, and proximal...Figure 8.96 Angulation of the pylorus for better visualization using graspin...Figure 8.97 Exposing the pylorus for better visualization by pushing the pyl...Figure 8.98 Loops of jejunum seen against the left abdominal wall without ov...Figure 8.99 The mesenteric border of the jejunum seen without omental coveri...Figure 8.100 The ileum is identified by visualizing the antimesenteric ileal...Figure 8.101 A gas‐distended cecum covered with omentum is visible ventral t...Figure 8.102 The descending colon visible in the left lumbar gutter free of ...Figure 8.103 The descending colon seen in the caudal abdomen dorsal to the b...Figure 8.104 The descending colon seen in the right caudal abdomen dorsal to...Figure 8.105 The left ovary in a juvenile dog is seen caudal to the left kid...Figure 8.106 The right ovary in a juvenile dog seen in the right lumbar gutt...Figure 8.107 The area of the left ovary in a young dog in estrus demonstrati...Figure 8.108 The left ovary in an older female dog surrounded by fat. The ov...Figure 8.109 The opening of the right ovarian bursa in a dog during anestrus...Figure 8.110 The appearance of the proliferated fimbria of the infundibulum ...Figure 8.111 The uterine tube is seen in this image as a pink raised ridge o...Figure 8.112 The uterus of a young dog undergoing estrus with numerous promi...Figure 8.113 An older intact female dog that had been through multiple heat ...Figure 8.114 The left uterine horn in a 12‐year‐old multiparous large breed ...Figure 8.115 The uterine body, bifurcation, and caudal portion of the uterin...Figure 8.116 The uterine body, bifurcation, and caudal portion of the uterin...Figure 8.117 The left adrenal gland in a 10‐year‐old spayed female Saint Ber...Figure 8.118 A mildly hypertrophied right adrenal gland in an 11‐year‐old ne...Figure 8.119 A left adrenal gland in a one‐year‐old overweight female Rottwe...Figure 8.120 Vascular supply to the left ovary in an overweight juvenile dog...Figure 8.121 The caudal vena cava in an icteric cat seen at the level of the...Figure 8.122 The caudal vena cava in a young dog seen in the central abdomen...Figure 8.123 Blood vessels and nerves visible laparoscopically with the pati...Figure 8.124 Bruising of the abdominal wall secondary to a traumatic inciden...Figure 8.125 Scarring of the abdominal wall seen as an incidental finding du...Figure 8.126 Defects in the abdominal wall muscles from an old injury. The p...Figure 8.127 Adhesions to the abdominal wall due to an old injury unrelated ...Figure 8.128 Abdominal wall bruising following ultrasound‐guided fine needle...Figure 8.129 Omental adhesions to the ventral abdominal wall secondary to an...Figure 8.130 Abdominal wall scar tissue at the site of previous laparoscopy ...Figure 8.131 Acute adhesions of the liver to the abdominal wall in a patient...Figure 8.132 The abdominal wall lesion after blunt division of the adhesions...Figure 8.133 Adhesions of omentum to the abdominal wall in another area of t...Figure 8.134 Using sharp dissection to divide adhesions of omentum to the ab...Figure 8.135 A vessel sealing device used for dividing omental adhesions to ...Figure 8.136 An inguinal hernia ring in a male dog seen as an incidental fin...Figure 8.137 The left internal inguinal ring in a dog with a left side retai...Figure 8.138 Omentum herniated through an umbilical hernia ring viewed from ...Figure 8.139 Nodules of neoplastic tissue on the abdominal wall of a 14‐year...Figure 8.140 A thin sheet of cancer cells on the abdominal wall of the patie...Figure 8.141 A thick hard mass of neoplastic tissue in a different area of t...Figure 8.142 Nodules of adenocarcinoma on the surface of the spleen in the p...Figure 8.143 A single nodule of neoplastic tissue on the surface of the blad...Figure 8.144 A small mass of neoplastic tissue in the omentum in the above p...Figure 8.145 Inflammatory nodules on the abdominal wall of a six‐year‐old sp...Figure 8.146 Hyperemia of the abdominal wall in a 7‐year‐old 30 kg mixed bre...Figure 8.147 Petechia on another area of small intestine in the patients see...Figure 8.148 Hyperemia and petechia on the diaphragm in same patient with pe...Figure 8.149 A large neoplastic mass originating from the central diaphragm ...Figure 8.150 Steatitis associated with active pancreatitis in a cat.Figure 8.151 Changed fat shape visible on the mesenteric border of the small...Figure 8.152 A small nodule of tissue attached by a narrow stalk to the omen...Figure 8.153 Marked yellow discoloration of fat in a cat with bile duct obst...Figure 8.154 Caudal abdominal fat discolored with blood in a patient with he...Figure 8.155 Altered fat appearance on the mesenteric side of the jejunum in...Figure 8.156 A linear metallic foreign body visible in the omentum of the ce...Figure 8.157 The foreign body grasped with 5 mm dissector/grasping forceps....Figure 8.158 The foreign body partially freed of tissue and held with the gr...Figure 8.159 The foreign body after removal from the omental tissue.Figure 8.160 The foreign body was transferred to a second grasping forceps w...Figure 8.161 The foreign body site after removal of the foreign body examine...Figure 8.162 Increased reticulation of the liver surface with no other chang...Figure 8.163 The distant liver lobe has an increased reticulation pattern, a...Figure 8.164 Loss of liver reticulation in a case with grade 3–4 (on a scale...Figure 8.165 A close‐up view of the liver in Figure 8.164 showing almost com...Figure 8.166 A liver surface with partial loss of reticulation in an 11‐year...Figure 8.167 Widened swollen pale interlobar tissue obscuring the reticulate...Figure 8.168 Surface irregularity of the liver in an 11‐year‐old spayed fema...Figure 8.169 Surface irregularity of the liver with moderate accumulations o...Figure 8.170 Blunting of liver margins and loss of reticulation in the left ...Figure 8.171 Blunting of the liver margins with uniform surface irregularity...Figure 8.172 Distortion of the liver in a seven‐year‐old spayed female Golde...Figure 8.173 Fibrosis on the surface of the liver in a two‐year‐old spayed f...Figure 8.174 Focal areas of fibrosis in the liver of a 13‐year‐old American ...Figure 8.175 Focal areas of fibrosis in the liver of an 11‐year‐old spayed f...Figure 8.176 Extensive fibrosis of the liver without significant distortion ...Figure 8.177 Extensive fibrosis of the liver with mild distortion, moderate ...Figure 8.178 Severe distortion of the liver shape and contour with extensive...Figure 8.179 The left liver lobes in a 13‐year‐old neutered male Golden Retr...Figure 8.180 The right liver lobes in the same dog as in Figure 8.179 showin...Figure 8.181 A tumor‐like mass in the liver of a dog with severe cirrhosis s...Figure 8.182 A tumor like mass in the liver of a dog with severe cirrhosis r...Figure 8.183 Lipidosis of the liver in a seven‐year‐old Domestic Shorthair c...Figure 8.184 A small but otherwise normal‐appearing liver in a six‐month‐old...Figure 8.185 An eight‐month‐old female Vizsla with a small liver based on ul...Figure 8.186 The appearance of a liver with marked diffuse lobular dissectin...Figure 8.187 An area of the liver in an 11‐year‐old neutered male Shetland S...Figure 8.188 Another area of the liver in Figure 8.187 with two defined area...Figure 8.189 An unusual‐appearing liver with marked fibrosis appearing on th...Figure 8.190 Another area of the liver from Figure 8.189 with less visible f...Figure 8.191 A hepatocellular adenoma in an eight‐year‐old neutered male Cho...Figure 8.192 Another area of the hepatocellular adenoma that does not have t...Figure 8.193 A well‐differentiated hepatocellular carcinoma that appears lik...Figure 8.194 A hepatocellular carcinoma that has variable appearance with ar...Figure 8.195 A hepatocellular carcinoma composed entirely of tissue that doe...Figure 8.196 A hepatocellular tumor in a 12‐year‐old neutered male Golden Re...Figure 8.197 A tumor mass in another area of the liver in the case of hepato...Figure 8.198 A bile duct carcinoma with the classic doughnut shape.Figure 8.199 The bile duct carcinoma in the same patient as Figure 8.198 wit...Figure 8.200 An anaplastic sarcoma of the liver in a 10‐year‐old spayed fema...Figure 8.201 A small purple hemangiosarcoma lesion that appears cystic or bl...Figure 8.202 Small flat solid‐appearing hemangiosarcoma lesions in the same ...Figure 8.203 Multiple solid‐appearing masses of various sizes and shapes in ...Figure 8.204 A large blood‐filled cystic‐appearing hemangiosarcoma lesion ad...Figure 8.205 A large cystic‐appearing blood‐filled mass adjacent to a smalle...Figure 8.206 A small solitary metastatic islet cell tumor lesion in a dog wi...Figure 8.207 Multiple liver metastatic islet cell tumor masses.Figure 8.208 A small solitary metastatic islet cell lesion on the underside ...Figure 8.209 The liver of a 12‐year‐old neutered male Domestic Shorthair cat...Figure 8.210 A large metastatic adenocarcinoma of undetermined origin in the...Figure 8.211 A small pink lesion representing a metastatic adenocarcinoma le...Figure 8.212 Another metastatic adenocarcinoma lesion appearing as a small w...Figure 8.213 A mass of non‐neoplastic hyperplastic liver tissue in the liver...Figure 8.214 A small pale nodule of nodular hyperplasia in the liver of an 1...Figure 8.215 A normal‐appearing gall bladder and liver. The gall bladder was...Figure 8.216 The gall bladder in a 10‐year‐old neutered male Shih Tzu with g...Figure 8.217 Variation in gall bladder color in an uncompromised dog without...Figure 8.218 An incidental finding of a focal area of gall bladder wall thic...Figure 8.219 Apparent gall bladder wall thickening due to an empty gall blad...Figure 8.220 Apparent gall bladder wall thickening due to the gall bladder b...Figure 8.221 Gall bladder distension in a 14‐year‐old spayed female Domestic...Figure 8.222 A large distended gall bladder with no indication of bile duct ...Figure 8.223 Mild dilation of the common bile duct in a cat with no cause of...Figure 8.224 Marked dilation of the common bile duct in a dog without convol...Figure 8.225 Marked dilation of the extra‐hepatic bile ducts with severe con...Figure 8.226 A mass is visible in the case in Figure 8.225 with bile duct di...Figure 8.227 A normal‐appearing kidney in a six‐month‐old Goldendoodle with ...Figure 8.228 An indentation on the surface of an otherwise normal‐appearing ...Figure 8.229 Hydronephrosis of the left kidney in a three‐year‐old spayed fe...Figure 8.230 Hemangiosarcoma in the left kidney of a 12‐year‐old neutered ma...Figure 8.231 A kidney in a 14‐year‐old spayed female Domestic Shorthair cat ...Figure 8.232 The left kidney in a 16‐year‐old spayed female Domestic Shortha...Figure 8.233 The right kidney in a 12‐year‐old neutered male Domestic Shorth...Figure 8.234 Severe pancreatitis in a 17‐year‐old spayed female Domestic Sho...Figure 8.235 Inflamed fat surrounding a poorly defined abscess cavity in the...Figure 8.236 Pancreatic swelling without changes in the appearance of pancre...Figure 8.237 Pancreatic swelling with early changes in the appearance of the...Figure 8.238 An insulinoma in the distal right lobe of the pancreas visible ...Figure 8.239 A malignant islet cell tumor hidden in peripancreatic fat and o...Figure 8.240 A pancreatic pseudocyst in an eight‐year‐old neutered male Dome...Figure 8.241 Needle aspiration of the pancreatic pseudocyst has removed its ...Figure 8.242 A small nodule on the spleen determined by histopathology to be...Figure 8.243 A splenic hematoma appearing as a discrete round mass on the sp...Figure 8.244 An elongated mass on the spleen that was a hematoma.Figure 8.245 A large irregular hematoma in the spleen of a 10‐year‐old spaye...Figure 8.246 A high‐grade anaplastic sarcoma in the spleen with metastasis t...Figure 8.247 Metastatic melanoma in the spleen of a 12‐year‐old neutered mal...Figure 8.248 A spleen with color variation from purple to red with no other ...Figure 8.249 A red rather than purple spleen. Is this color a normal spleen ...Figure 8.250 An abnormally shaped spleen with a projection or normal‐appeari...Figure 8.251 A spleen that appears folded sharply at mid‐body.Figure 8.252 A variation in surface texture of a spleen in a 12‐year‐old spa...Figure 8.253 Marked roughening of the surface of a spleen in a 12‐year‐old s...Figure 8.254 Normal‐appearing splenic tissue projecting from the margin of t...Figure 8.255 A pale raised area of splenic tissue. Without biopsy there is n...Figure 8.256 A raised area of tissue with mottled coloration. Without biopsy...Figure 8.257 Surface fibrosis of a spleen suspected to be secondary to previ...Figure 8.258 Extensive alteration of splenic shape with surface fibrosis tho...Figure 8.259 Adhesions of omentum to the spleen and abdominal wall with scar...Figure 8.260 A small nodule (<1.0 cm diameter) of ectopic splenic tissue in ...Figure 8.261 A larger mass of ectopic splenic tissue in the cranial abdomen ...Figure 8.262 Nodular hyperplasia of the left adrenal gland in an 8‐year‐old ...Figure 8.263 A hyperplastic right adrenal gland in a Domestic Shorthair cat....Figure 8.264 A pheochromocytoma in the right adrenal gland of an 11‐year‐old...Figure 8.265 A pheochromocytoma in the left adrenal gland of an 11‐year‐old ...Figure 8.266 A larger noninvasive adrenal mass in a 14‐year‐old neutered mal...Figure 8.267 An increased number of prominent blood vessels visible on the e...Figure 8.268 Dramatically increased dilated tortuous blood vessels on the ex...Figure 8.269 A bladder with a normal‐appearing external surface and with sig...Figure 8.270 A urachal diverticulum visible on the external surface of the b...Figure 8.271 A urachal diverticulum seen as a deformity at the apex of the b...Figure 8.272 A urachal diverticulum at the apex of the bladder in a six‐mont...Figure 8.273 A non‐patent urachal remnant visible as a solid band of tissue ...Figure 8.274 A patent persistent urachus extending as an open tube to the um...Figure 8.275 The bladder in a 10‐year‐old spayed female Domestic Shorthair c...Figure 8.276 Change in the external appearance of the bladder wall in a 13‐y...Figure 8.277 Distortion of the apex of the bladder due to a large apical tra...Figure 8.278 A pseudomass or pseudocalculus seen as a small mass in the cent...Figure 8.279 Adhesions to the ventral bladder wall seen at the time of lapar...Figure 8.280 Abnormal blood vessels seen with laparoscopy in a 12‐year‐old s...Figure 8.281 A traumatized bladder visible in a nine‐year‐old intact male Be...Figure 8.282 A large dilated distal ureter at its insertion into the bladder...Figure 8.283 A mildly dilated distal left ureter at its insertion into the b...Figure 8.284 A pedunculated leiomyoma on the external surface of the stomach...Figure 8.285 Abnormal‐appearing blood vessels and lymphatic vessels seen on ...Figure 8.286 A small intestinal small cell lymphoma in a 13‐year‐old spayed ...Figure 8.287 An adenocarcinoma in the small intestine of an 11‐year‐old spay...Figure 8.288 Another segment of the small intestine in the same patient as i...Figure 8.289 A cecal tumor seen in a 13‐year‐old large spayed female mixed b...Figure 8.290 An adenocarcinoma in the colon of a 16‐year‐old spayed female D...Figure 8.291 Prominent lymphatic vessels containing white lymph as an incide...Figure 8.292 Tortuous blood vessels and dilated indistinct lymphatic vessels...Figure 8.293 A focal accumulation of ectopic mineralized tissue of undetermi...Figure 8.294 A very small right ovarian remnant in a 5‐year‐old 27 kg spayed...Figure 8.295 A normal well‐healed right‐side ovarian pedicle site without an...Figure 8.296 A normal well‐healed left‐side ovarian pedicle site without any...Figure 8.297 A small discreet remnant of ovarian tissue on the right side in...Figure 8.298 A large right‐side ovarian remnant in an 18‐month‐old 25 kg spa...Figure 8.299 A left‐side ovarian remnant in a 6‐month‐old 22 kg spayed femal...Figure 8.300 An unusual right‐side ovarian remnant with part of the right ut...Figure 8.301 A dilated fluid‐filled uterine horn in an intact female dog wit...Figure 8.302 A fluid‐filled uterine horn in an intact female dog with pyomet...Figure 8.303 A normal‐appearing cryptorchid testicle seen in the caudal abdo...Figure 8.304 An extrahepatic portosystemic shunt in a neutered male Domestic...Figure 8.305 Enlarged blood vessels at the site of right ovarian pedicle adh...Figure 8.306 An enlarged blood vessel seen in lumbar fat and extending throu...Figure 8.307 Dilated lymphatic vessels on the portal veins of a six‐year‐old...Figure 8.308 Dilated lymphatic vessels on the caudal pole of the left kidney...Figure 8.309 Dilated lymphatic vessels on the gastric wall in the same patie...Figure 8.310 Dilated lymphatic vessels on the colon wall of a three‐year‐old...Figure 8.311 Fat‐filled small intestinal lymphatic vessels in the same patie...Figure 8.312 Fat‐filled lymphatic vessels in the small bowel wall of a six‐y...Figure 8.313 Clear abdominal fluid that is a pure transudate due to a protei...Figure 8.314 Yellow‐colored fluid that is otherwise a clear pure transudate ...Figure 8.315 A modified transudate seen as cloudy abdominal fluid in a patie...Figure 8.316 Serosanguineous fluid in the abdomen of a cat with metastatic n...Figure 8.317 Serosanguineous peritoneal fluid in the patient in Figure 8.314...Figure 8.318 Purulent fluid in the abdomen of a cat with a pancreatic absces...Figure 8.319 Free unclotted blood in the abdomen of a one‐year‐old female Be...Figure 8.320 Blood clots in the lumbar gutter of the patient in Figure 8.319...Figure 8.321 Bleeding from a splenic biopsy site in a 9‐year‐old 37 kg neute...Figure 8.322 Blood clots and free unclotted blood in the abdomen of a dog un...Figure 8.323 Spontaneous hemostasis with clotted blood covering an injury to...Figure 8.324 Gelfoam applied to the site of an injury to the spleen at the t...Figure 8.325 A hepatocellular tumor biopsy site with moderate active bleedin...Figure 8.326 The biopsy site in Figure 8.325 with no active bleeding after l...Figure 8.327 A laparoscopic liver biopsy site performed with a 5 mm diameter...Figure 8.328 Two adjacent liver biopsy sites taken from a 10‐year‐old spayed...Figure 8.329 A moderate but still insignificant amount of bleeding from a li...Figure 8.330 The liver biopsy site from Figure 8.329 a short time after the ...Figure 8.331 Operating room setup and portals for laparoscopic liver biopsy ...Figure 8.332 Two styles of 5 mm apposing cup or clam shell biopsy forceps us...Figure 8.333 Obtaining a liver biopsy from the margin of a liver lobe with t...Figure 8.334 Biopsy forceps positioned for taking a biopsy from the center o...Figure 8.335 Biopsy of a liver mass using the 5 mm apposing cup forceps with...Figure 8.336 The biopsy forceps are closed with moderate pressure and the fo...Figure 8.337 The appearance of the liver biopsy site after removal of the fo...Figure 8.338 Performing cholecystocentesis using a 3.5″ long 20 gauge spinal...Figure 8.339 Cholecystocentesis where the gall bladder was emptied for decom...Figure 8.340 Operating room setup and patient positioning for pancreatic bio...Figure 8.341 Operating room setup and patient positioning for pancreatic bio...Figure 8.342 Pancreatic biopsy in a cat using apposing cup biopsy forceps ap...Figure 8.343 An Endoclip applied to a blood vessel at the biopsy site of Fig...Figure 8.344 Operating room setup and patient positioning for kidney biopsy ...Figure 8.345 When the kidney to be biopsied is known prior to the procedure ...Figure 8.346 Biopsy of the right kidney with the patient in lateral recumben...Figure 8.347 Biopsy of the right kidney with the patient obliqued from dorsa...Figure 8.348 A pledget of Gelfoam placed on a kidney biopsy site with contin...Figure 8.349 The appearance of the kidney biopsy site and Gelfoam several mi...Figure 8.350 Active bleeding from a kidney biopsy site after sample collecti...Figure 8.351 Application of HemaBlock powder to the actively bleeding biopsy...Figure 8.352 Immediately following application of the HemaBlock powder to th...Figure 8.353 Operating room setup and patient position for laparoscopic‐assi...Figure 8.354 Operating room setup and patient position for laparoscopic‐assi...Figure 8.355 Grasping the antimesenteric border of the jejunum adjacent to a...Figure 8.356 Running the bowel using two 5 mm atraumatic forceps to select a...Figure 8.357 A loop of jejunum selected for biopsy that has been elevated to...Figure 8.358 To enlarge an operative portal for exteriorization of a loop of...Figure 8.359 An intestinal biopsy site that has been returned to the abdomen...Figure 8.360 Biopsy of the margin of the spleen using opposing cup biopsy fo...Figure 8.361 Minimal bleeding from the splenic biopsy site of the case in Fi...Figure 8.362 More significant bleeding from a splenic biopsy site in the cen...Figure 8.363 Spontaneous hemostasis of the biopsy site shown in Figure 8.362...Figure 8.364 A Gelfoam pledget placed in a splenic biopsy site to aid hemost...Figure 8.365 Operating room setup for laparoscopic ovariectomy and ovariohys...Figure 8.366 An alternative operating room setup for laparoscopic ovariectom...Figure 8.367 Telescope portal placement for single‐port ovariectomy using an...Figure 8.368 The left ovary visible between the spleen at the lower left of ...Figure 8.369 The left ovary grasped with 5 mm diameter Babcock forceps passe...Figure 8.370 The ovary is elevated away from the surrounding tissue to provi...Figure 8.371 A TT ovariectomy hook is passed through the abdominal wall at t...Figure 8.372 The telescope portal site on the ventral midline at or caudal t...Figure 8.373 The telescope portal site on the ventral midline at or caudal t...Figure 8.374 The ovary positioned against the abdominal wall with the Mouret...Figure 8.375 Babcock forceps are removed leaving the ovary in place fixed to...Figure 8.376 Initial placement of a 5 mm LigaSure vessel sealing device on t...Figure 8.377 The ovarian pedicle in Figure 8.376 after sealing and cutting t...Figure 8.378 Placement of the vessel sealing device on the uterine horn to c...Figure 8.379 The vessel sealing device placed in the center of the pedicle o...Figure 8.380 The ovarian pedicle site after completion of the transection us...Figure 8.381 The ovary and periovarian tissue after transection of the ovari...Figure 8.382 The ovarian package held in place with the Mouret needle after ...Figure 8.383 Grasping the utero‐ovarian ligament with reinserted Babcock for...Figure 8.384 The ovarian package is pulled up to or into the telescope cannu...Figure 8.385 Portal and needle placement for the two‐port ovariectomy techni...Figure 8.386 The left ovary seen from an umbilical telescope portal with the...Figure 8.387 The left suspensory ligament is grasped with Babcock forceps ad...Figure 8.388 The ovary is elevated away from the surrounding tissue with the...Figure 8.389 The right ovary placed against the abdominal wall in preparatio...Figure 8.390 The right ovary held against the abdominal wall with Babcock fo...Figure 8.391 After placement of the Mouret needle retractor, the Babcock for...Figure 8.392 The Babcock forceps is replaced with a vessel sealing device pa...Figure 8.393 Nearing completion of transection of the ovarian pedicle with t...Figure 8.394 Completed transection of the ovarian pedicle with the vessel se...Figure 8.395 A small ovary with limited periovarian tissue retracted up to a...Figure 8.396 A small ovarian package in a 1‐year‐old female Irish Setter aft...Figure 8.397 A medium‐sized ovary with surrounding fat in a nine‐month‐old f...Figure 8.398 A large ovarian package in a grossly overweight one‐year‐old fe...Figure 8.399 The large ovarian and periovarian tissue mass pulled tightly ag...Figure 8.400 The portal dilating device (Gall bladder extractor) placed arou...Figure 8.401 The ovarian tissue package partially extracted through the abdo...Figure 8.402 After portal placement for the three‐port technique and patient...Figure 8.403 Babcock forceps are passed through the caudal portal and the su...Figure 8.404 The ovary is elevated away from the surrounding tissue with the...Figure 8.405 If the handle of the Babcock forceps is released, the weight of...Figure 8.406 The ovarian pedicle elevated with the weight of the 5 mm Babcoc...Figure 8.407 The ovary held with Babcock forceps in preparation of ovarian p...Figure 8.408 The same ovary as in Figure 8.407 with the Babcock rotated 90° ...Figure 8.409 Transection of the ovarian pedicle using a 5 mm LigaSure vessel...Figure 8.410 Transecting the mesometrium in a thin juvenile dog using scisso...Figure 8.411 Transecting the mesometrium in an older multiparous female Labr...Figure 8.412 Cranial traction is placed on the uterine horn to elevate it aw...Figure 8.413 Tension and elevation of the caudal portion of the right uterin...Figure 8.414 Transection of the uterine horn at the uterine body bifurcation...Figure 8.415 Transection of the uterine body in a juvenile dog using a bipol...Figure 8.416 Transection of the uterine artery and vein as a separate step i...Figure 8.417 Transection through the cervix of the patient seen in Figure 8....Figure 8.418 The Babcock forceps are positioned to grasp the caudal cut end ...Figure 8.419 The ovarian remnant shown in Figure 8.298 grasped with Babcock ...Figure 8.420 Transection of the ovarian remnant pedicle using the LigaSure v...Figure 8.421 After completion of transection, the sealed incision line is ch...Figure 8.422 The resected ovarian remnant is maintained in the grasp of the ...Figure 8.423 The ovarian remnant tissue package is retracted to the end of t...Figure 8.424 Increased blood vessels in the area of left ovarian pedicle sca...Figure 8.425 Resection of the left ovarian pedicle scar with the enlarged bl...Figure 8.426 Operating room set up for laparoscopic cryptorchid castration w...Figure 8.427 Portal placement for cryptorchid castration using laparoscopic ...Figure 8.428 An intra‐abdominal cryptorchid testicle seen without any organ ...Figure 8.429 Further head down tilting of the patient in Figure 8.428 allows...Figure 8.430 A close‐up view of the gubernaculum testis indistinctly seen in...Figure 8.431 Babcock forceps grasping the head of the epididymis rather than...Figure 8.432 Babcock forceps grasping the tail of the epididymis rather than...Figure 8.433 Babcock forceps positioned to grasp the ductus deferens as anot...Figure 8.434 Transection of the pampiniform plexus and ductus deferens using...Figure 8.435 The transected patient end of the pampiniform plexus and ductus...Figure 8.436 Placement of a pretied loop ligature on the pampiniform plexus ...Figure 8.437 The ligature loop is closed and tightened around the structures...Figure 8.438 The suture and tissue are cut freeing the testicle for removal....Figure 8.439 The abdominal testicle in a unilateral cryptorchid patient that...Figure 8.440 The ligated and transected structures returned to the abdomen a...Figure 8.441 Operating room setup for laparoscopic assisted gastropexy place...Figure 8.442 Portal positions for laparoscopic‐assisted gastropexy with the ...Figure 8.443 The pyloric antrum and pylorus are identified. The pyloric antr...Figure 8.444 A dilated pyloric antrum obscuring visibility of the pylorus.Figure 8.445 A poorly visible pylorus due to position of the tissues and ang...Figure 8.446 Applying pressure to the dilated pyloric antrum seen in Figure ...Figure 8.447 Grasping the pyloric antrum and retracting it caudally allowing...Figure 8.448 The 10 mm Babcock/Duval forceps placed on the ventral surface o...Figure 8.449 The gastropexy site on the ventral wall of the pyloric antrum a...Figure 8.450 The gastropexy site on the ventral wall of the pyloric antrum a...Figure 8.451 The pyloric antrum is manipulated with the grasping forceps to ...Figure 8.452 The pyloric antrum in Figure 8.451 is manipulated with the gras...Figure 8.453 The grasped ventral wall of the pyloric antrum has been elevate...Figure 8.454 In this image, an 11 mm EndoTIP cannula is being used. This is ...Figure 8.455 Enlarging the gastropexy portal by passing a #10 scalpel blade ...Figure 8.456 The enlarged gastropexy portal from the outside with a small po...Figure 8.457 The gastropexy seromuscular incision in the pyloric antrum with...Figure 8.458 A continuous suture line is started at the center of the crania...Figure 8.459 The completed gastropexy site seen from the inside with the abd...Figure 8.460 A healed laparoscopic‐assisted gastropexy site seen during lapa...Figure 8.461 Identification of a ping pong ball gastric foreign body during ...Figure 8.462 Grasping the ping pong ball with Vulsellum forceps for removal....Figure 8.463 A small residual gastric foreign body seen with re‐examination ...Figure 8.464 A gastric foreign body seen with laparoscopic‐assisted gastroto...Figure 8.465 Re‐examination of the stomach in Figure 8.464 revealing an addi...Figure 8.466 Examination of the gastric lumen was repeated to remove all eig...Figure 8.467 The small bowel grasped in normal tissue adjacent to a focal sm...Figure 8.468 The small bowel mass resected using laparoscopic‐assisted techn...Figure 8.469 The cecum with the mass elevated for evaluation to determine re...Figure 8.470 The cecum is grasped in normal tissue adjacent to the mass usin...Figure 8.471 The exteriorized cecum and mass with a stay suture placed ready...Figure 8.472 Resection of the cecal mass with an open surgical stapling devi...Figure 8.473 Operating room setup for laparoscopic cholecystectomy with the ...Figure 8.474 Four‐portals are used for performing laparoscopic cholecystecto...Figure 8.475 Three operative portals are placed using the telescope in the i...Figure 8.476 Grasping a flaccid gall bladder wall for stabilization to allow...Figure 8.477 Following cystocentesis of the gall bladder in Figure 8.476 wit...Figure 8.478 For the top down dissection technique, the gall bladder is gras...Figure 8.479 A blunt probe gently applied as a retractor to move the adjacen...Figure 8.480 Curved 5 mm diameter Metzenbaum scissors are used to cut the ti...Figure 8.481 A free gall bladder prior to extraction from the abdomen with m...Figure 8.482 Irregular rough liver surface after dissection of the gall blad...Figure 8.483 Applying an Endoclip with a 10 mm clip applier to the isolated ...Figure 8.484 Three Endoclips applied to the isolated cystic bile duct after ...Figure 8.485 Two Endoclips applied to the isolated cystic duct that are too ...Figure 8.486 A pretied loop ligature being placed on the common bile duct in...Figure 8.487 The tightened loop ligature after removal of the knot pusher pr...Figure 8.488 Irrigation being applied to the dissection surface of the liver...Figure 8.489 Operating room setup and patient position for performing a part...Figure 8.490 Portal placement for performing a partial pancreatectomy of the...Figure 8.491 Portal placement for performing a partial pancreatectomy of the...Figure 8.492 Portal placement for performing a partial pancreatectomy of the...Figure 8.493 An insulinoma in the caudal portion of the right lobe of the pa...Figure 8.494 The right lobe of the pancreas is isolated by incising the meso...Figure 8.495 A pretied loop ligature was used in this patient and is seen be...Figure 8.496 The pretied loop has been positioned and tightened on the pancr...Figure 8.497 After suture placement, the pancreas is cut with Metzenbaum sci...Figure 8.498 The freed pancreas segment prior to preparation for extraction....Figure 8.499 The resected pancreas segment is placed into a tissue retrieval...Figure 8.500 The tissue retrieval bag is removed through the operative cannu...Figure 8.501 A cyst in the center of the left lobe of the pancreas with an e...Figure 8.502 Aspiration of the lesion in Figure 8.501 with a 20 gauge spinal...Figure 8.503 Completion of aspiration leaving a collapsed cyst. Aspiration c...Figure 8.504 The omental grasping forceps are replaced with forceps to grasp...Figure 8.505 The cyst is opened with Metzenbaum scissors initially with an o...Figure 8.506 Resection of the cyst‐free wall is continued with Metzenbaum sc...Figure 8.507 The cyst‐free wall is completely excised leaving only the porti...Figure 8.508 Thorough lavage of the surgery site is done after excision of t...Figure 8.509 Portal placement for nephrectomy with the patient in lateral re...Figure 8.510 Operating room setup for laparoscopic adrenalectomy with the pa...Figure 8.511 Portal placement for laparoscopic adrenalectomy with the patien...Figure 8.512 Portal placement for laparoscopic adrenalectomy with the patien...Figure 8.513 Cutting the translucent avascular hepatorenal ligament with sha...Figure 8.514 Dissection of tissue off of the caudolateral portion of the rig...Figure 8.515 Application of two Endoclips on the isolated phrenicoabdominal ...Figure 8.516 Transection of the phrenicoabdominal vein between the Endoclips...Figure 8.517 The adrenal gland and mass are separated from the vena cava usi...Figure 8.518 The phrenicoabdominal arterial trunk crosses the dorsal aspect ...Figure 8.519 Dissection of the caudal pole of the adrenal gland is done with...Figure 8.520 Completion of dissection of the adrenal gland leaves the origin...Figure 8.521 Multiple Endoclips are applied to the phrenicoabdominal vein fo...Figure 8.522 The vessel is transected peripheral to the Endoclips with Metze...Figure 8.523 All Endoclips are left on the patient side of the cut to ensure...Figure 8.524 Operating room setup and patient positioning for laparoscopic e...Figure 8.525 Portal placement for laparoscopic exploration of patients with ...Figure 8.526 After exploration and definition of the shunt vessel, additiona...Figure 8.527 If indicated, the telescope is moved to the initial operative p...Figure 8.528 Operating room and patient position for laparoscopic splenectom...Figure 8.529 Portal placement for urethral occluder implantation with an umb...Figure 8.530 The apex of the bladder is grasped with Babcock forceps and the...Figure 8.531 The medial ligament of the bladder and its extension caudally v...Figure 8.532 The translucent avascular lateral ligaments of the bladder wher...Figure 8.533 This is a mockup of the first step for the method of laparoscop...Figure 8.534 A Babcock grasping forceps is passed into one of the caudal ope...Figure 8.535 The long monofilament nonabsorbable suture loop is pulled throu...Figure 8.536 Babcock forceps are reinserted into the 6 mm cannula and passed...Figure 8.537 The Babcock forceps and the loop of suture through the occluder...Figure 8.538 The occluder in position in a patient after completion of the s...Figure 8.539 A mockup picture with the suture passed through the second eyel...Figure 8.540 The occluder in a patient after the end of the monofilament non...Figure 8.541 A mockup of placing an extracorporeal knot to secure the occlud...Figure 8.542 In a patient, the suture ends have been tightened to pull the o...Figure 8.543 Occluder position is checked after the suture is tied and the a...Figure 8.544 The actuating tube in the abdomen seen with the telescope in an...Figure 8.545 Short areas of tissue were present surrounding the actuating tu...Figure 8.546 Multiple significant adhesions were present with omentum attach...Figure 8.547 Adhesions of the bladder to the abdominal wall.Figure 8.548 Division of the omental adhesions to the abdominal wall with sh...Figure 8.549 Division of adhesions of the bladder to the abdominal wall with...Figure 8.550 Tissue attachment points of the actuating tube were divided wit...Figure 8.551 The actuating tube was exposed as far caudally as was reasonabl...Figure 8.552 Endoclips were applied to the actuating tube for occlusion to m...Figure 8.553 Portal placement for laparoscopic‐assisted cystoscopy with the ...Figure 8.554 The exact site for operative portal placement is determined by ...Figure 8.555 Once the site is selected for portal placement and an appropria...Figure 8.556 The operative portal cannula is placed using a blunt obturator ...Figure 8.557 The apex of the bladder is grasped with 5 mm Babcock or other a...Figure 8.558 The grasped bladder is elevated to the cannula. In some patient...Figure 8.559 The bladder is pulled through the abdominal wall portal to perf...Figure 8.560 A closed cystotomy incision after return of the bladder to the ...Figure 8.561 Portals for laparoscopic‐assisted cystopexy. An umbilical teles...Figure 8.562 Cranial traction is applied to the apex of the bladder from the...Figure 8.563 The bladder wall site for cystopexy is grasped with Babcock or ...Figure 8.564 The completed cystopexy with a continuous suture pattern attach...Figure 8.565 The healed cystopexy site in the previous patient seen nine mon...