Lap bitch spays - a few questions if I may?

RE: Lap bitch spays - a few questions if I may?

Darren Barnes — Wed, 06 Sep 2023 19:18:08 GMT

No I agree, although not needing to expand ports for ovary removal, and having a single 'mini-laparotomy' results in a more precise and neat incisional closure, at least in my hands - but you do have to live with instrument clash when operating.

RE: Lap bitch spays - a few questions if I may?

Alasdair Hotston Moore — Wed, 06 Sep 2023 01:12:23 GMT

I’ve seen the SILS ports and I think VI offer one intended for re use. But do you really think reducing port numbers has an advantage in our patients?

RE: Lap bitch spays - a few questions if I may?

Michael Woodhouse — Mon, 04 Sep 2023 20:15:43 GMT

[quote userid="29502" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may/242300#242300"]using the SILS port (from Medtronic).[/quote]

They look cool, but I imagine expensive. Good news about - provides atraumatic transanal access, and protects their anorectal sphincter function - I've been worrying about anal leakage since we ordered the stack

RE: Lap bitch spays - a few questions if I may?

Darren Barnes — Mon, 04 Sep 2023 16:49:20 GMT

Sorry im late to this discussion - but can I throw an alternative opinion into the mix - I only perform the occasional lapOVE in referral work, but im a proponent of the ONE port technique, with a single 2cm incision at the umbilicus using the SILS port (from Medtronic). I prefer this one slightly larger port as I think its a neat opening, which closes to reconstruct the umbilicus, managing hernias there too if present. In dogs with fattier ovarian bursas whereas I sometime needed to enlarge ports when using two 5mm ports, the ovaries will always fit through this aperture. The ports themselves are expensive but we have put these through the EO to resterilise (I don't know how many times, but definitely double digits) until the foam shows first signs of degradation.

RE: Lap bitch spays - a few questions if I may?

Dinu Catilina — Tue, 29 Aug 2023 08:20:30 GMT

[quote userid="3169" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may/242231#242231"]

Intrigued by this type of reusable device

https://www.ebay.co.uk/itm/275144086423?hash=item400fdd9397:g:xYwAAOSwLfJh9NRF&amdata=enc%3AAQAIAAAA0CQjmfiLfq4M%2FUZ%2BcaUC6Zr5ieKyCt0SVMdbKkjguhW%2Bqt9hEUONAgjWXJp8LDgBEm1krJhi6Q1FOG%2BBJdaGmZ3Vl1xbSK7n6Lep9ni4Ls4AH1ZZCwJDaeDztd04%2FRqNjMX1EJJB1qg%2B5TvCFJa2cNmtQstqdJT0VctYG9Rb554YPvqwtHiFOEb26yd4Suic6IFPk4e4VEhdRdvBX%2BcGMGe167GkTNjFiw8CZk0zC48%2F6obsySH3cmjwxRymgFGoQ4D1OIc0a%2Bx%2B%2FfpNptiukWI%3D%7Ctkp%3ABk9SR87gxsfEYg

[/quote]

This one looks very similar to the Photon surgical one and it's a bipolar basically that will also cut. You will need to buy an adaptor to use it on your Gima but you will need this adaptor for any bipolar handpiece.

They are not true vessel sealers, they can't measure the tissue impedance and let you know when the tissue is sealed. But they do work and I had no issues with haemostasis for bitch spays. Just best not to use them on anything with large vessels.

I bought a few spare things from India. I can't afford loads of Storz ports but I was quite clumsy at the beginning and dropped quite a few during surgery hence my need to have spares sterile. The indian ones work well but when they don't there is no warranty even if you're promised one. Sending anything back to India is extremely difficult with customs.

They also may or may not be autoclavable even if they say they are.

RE: Lap bitch spays - a few questions if I may?

Alasdair Hotston Moore — Mon, 28 Aug 2023 18:19:40 GMT

[quote userid="3169" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may/242236#242236"] advanced bipolar electrosurgical[/quote]

No, the GIMA is not. The Vetseal is. But the handpiece you’ve seen might be a autoclaveable alternative t the Hotblade

RE: Lap bitch spays - a few questions if I may?

Michael Woodhouse — Mon, 28 Aug 2023 15:55:31 GMT

[quote userid="8663" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may/242232#242232"]It is interesting but will not be a vessel sealer in the same way as the Ligasure or Vetseal without an advanced bipolar electrosurgical unit[/quote]

This is the unit Freelance Surgical supplied (Gima 122)

https://www.freelance-veterinary.co.uk/gima-diathermy-unit-mb122-120-watt-kit

and these are the handpieces

https://www.freelance-veterinary.co.uk/powerblade/hotblade-vesselsealinghandpiece

Is that what you mean by an advanced bipolar electrosurgical unit?

RE: Lap bitch spays - a few questions if I may?

Alasdair Hotston Moore — Sun, 27 Aug 2023 22:17:28 GMT

[quote userid="3169" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may/242230#242230"]Got a quote from Simply Keyhole and it was frighteningly expensive[/quote]

Feel free to mail me at ahm@ahmvet.co.uk for another one

RE: Lap bitch spays - a few questions if I may?

Alasdair Hotston Moore — Sun, 27 Aug 2023 22:16:33 GMT

It is interesting but will not be a vessel sealer in the same way as the Ligasure or Vetseal without an advanced bipolar electrosurgical unit

[quote userid="3169" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may/242231#242231"]reusable device[/quote]

RE: Lap bitch spays - a few questions if I may?

Michael Woodhouse — Sun, 27 Aug 2023 20:45:28 GMT

Intrigued by this type of reusable device

RE: Lap bitch spays - a few questions if I may?

Michael Woodhouse — Sun, 27 Aug 2023 20:43:30 GMT

[quote userid="8663" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may/242221#242221"]

Although you could exchange bipolar forceps and scissors, it riskier and inefficient.

[/quote]

I can take riskier and inefficient as an emergency back up.

We bought our stack from Freelance with a starter kit. Appreciate the other suggestions for suppliers of kit - many thanks.

[quote userid="8663" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may/242221#242221"]if you’re wanting to get started, is to have a consultant to take you though purchasing and then spend a day or two in your clinic. Such services are avaithrough Simply Keyhole (Scotland based) or ahmvet.co.uk (interest declared !)[/quote]

Got a quote from Simply Keyhole and it was frighteningly expensive for a Yorkshireman. I do DA's in cows and sheep AI with the scope so think I can figure it out.......

RE: Lap bitch spays - a few questions if I may?

Alasdair Hotston Moore — Fri, 25 Aug 2023 06:07:24 GMT

[quote userid="3169" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may"]What are people using for haemostasis on pedicles? [/quote]

Although you could exchange bipolar forceps and scissors, it riskier and inefficient. If you can access ethylene oxide sterilisation, your best bets are Ligasure type devices or the Enseal. If you can’t, look at the VetSeal. Freelance have all of these and can discuss.
one option, if you’re wanting to get started, is to have a consultant to take you though purchasing and then spend a day or two in your clinic. Such services are avaithrough Simply Keyhole (Scotland based) or ahmvet.co.uk (interest declared !)

RE: Lap bitch spays - a few questions if I may?

Alasdair Hotston Moore — Fri, 25 Aug 2023 06:02:26 GMT

[quote userid="3169" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may"]Are people tending to use 2 or 3 port techniques[/quote]

I’d say most are doing two ports (sadly not everyone listens to me (haha). But I often do three port without a scrubbed assistant with the grasping forcep hanging or resting against my gown. I think it’s best to learn with 3 ports because it gives you the flexibility of triangulation

RE: Lap bitch spays - a few questions if I may?

Alasdair Hotston Moore — Fri, 25 Aug 2023 05:59:12 GMT

[quote userid="3169" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may"]

Any tips on consumable supply - such as the camera covers? Anything else I'm missing - in terms of consumables?

[/quote]

Try DVH for these, or DMS Plus

RE: Lap bitch spays - a few questions if I may?

Dinu Catilina — Thu, 24 Aug 2023 10:34:48 GMT

I use 2 port and I like it because I don't need a camera stand or another nurse helping. I use the hook but you can also buy intraabdominal hooking devices.

The cheapest coag/cut is the bipolar from Photon surgical, it's about 1000 pounds a handle and it is autoclavable. Stay away from Storz Robi plus, it's super fragile. I have two of everything just in case, second hand light source, second hand insufflator and a second vessel sealer handle. That being said I had no failures except for the diathermy generator dying once.

If you drop an instrument on the floor you can quickly cold sterilise it, it's only 10 min. Including the diathermy cables.

I use sterile camera covers single use and the same for CO2 line. Pennine is making us a lap spay kit with everything in it and it works out super cheap and convenient.

RE: Lap bitch spays - a few questions if I may?

Samantha Lane — Thu, 24 Aug 2023 10:22:29 GMT

I also use a three port technique as I find it less faffy and better for triangulation than a two port technique.

I use an enseal but used to use a Ligasure, they are very expensive but we do get multiple uses. We keep three in stock as we sometimes have two lap spays per day and that allows one to fail and us still be able to proceed with surgery as planned. We would usually get 10-15 uses from an enseal but the one I used yesterday had done 33! I found the Ligasure blade used to get blunt sooner than the Enseal does. We use EO to sterilise.

We use filters for our CO2 line from Storz and camera covers which are single use (I think from DMS but can check).

Sam

RE: Lap bitch spays - a few questions if I may?

Rob Loxley — Thu, 24 Aug 2023 07:19:47 GMT

[quote userid="3169" url="~/f/clinical-questions/30753/lap-bitch-spays---a-few-questions-if-i-may"]My worry with the above is what if the device fails during an operation?[/quote]

Convert to open spay always an option