Page 10 - Journal of Laparoscopic Surgery
P. 10

Anburaja Mahalingam et al
          animals were randomly divided into two equal groups (I and  of blood vessels. Then, the vas deferens and spermatic artery-
          II). In group I, laparoscopic vasectomy by cauterization and  vein plexus were visualized. The vas deferens was identified
          cutting of vas deferens was performed. In group II, along  by its characteristic ivory-colored, cord-like structure (Fig. 1).
          with laparoscopic vasectomy as done in group I,  clipping  Each vas deferens was observed at the site where both of
          of spermatic artery vein plexus was also performed. The  them joined dorsal to the bladder, and they were easily
          animals were premedicated with atropine sulphate at the  traced to the point where they enter the abdominal cavity at
          dose rate of 0.04 mg/kg body weight subcutaneously. Fif-  the inguinal ring. The vas deferens was held by fenestered
          teen minutes later xylazine hydrochloride (at the dose rate  grasping forceps, inserted through the same side port (Fig. 2).

          of 1.0 mg/kg body weight) and ketamine hydrochloride  The monopolar scissors was inserted through the opposite
          (at the dose rate of 10.0 mg/kg body weight) were adminis-  side port to cauterize the vas deferens and attached it with
          tered intramuscularly. Depth of analgesia was monitored  electrocautery unit. A 60 W monopolar current was used for
          during the entire period of surgery. Incremental doses of  cutting and cauterization. A piece of 2 to 3 cm of vas defer-
          ketamine may be given if required. After administration of  ens was resected after coagulation and removed through the
          anesthesia the animals were placed in dorsal recumbency  cannula (Fig. 3). The same procedure was repeated for the
          having a Trendelenburg position.                    opposite vas deferens. In animals of group II, the procedure
             A small 0.5 cm skin incision was made at the level of   for vas deferens was repeated as mentioned in group I. After
          umbilicus. By grasping the skin around the incision by one  resection and removal of vas deferens, the spermatic artery-
          hand, simultaneous insertion of Veress needle was done by  vein plexus were identified. Unlike in the scrotum, the vas
          other hand. Intraperitoneal placement was confirmed by  deferens within the pelvic cavity was not associated with

          injecting 5 ml of saline through the needle. Insufflation of  the spermatic artery-vein plexus that courses laterally along
          abdominal cavity was done by carbon dioxide gas at the rate  the dorsolateral portion of the abdominal wall. Clipping
          of 2 l/min with pressure gradient of 10 mm Hg in both the  was done after holding these vessels by fenestered grasping
          groups. After attaining a sufficient pneumoperitoneum, Veres  forceps. The vessels were clipped by applying two titanium
          needle was removed and a 6 mm safety trocar and cannula unit  clips at a distance of 1 to 2 cm between them by using clip
          was inserted into the abdominal cavity. A rigid type telescope  applicator (Fig. 4). The same procedure was repeated to the
          (30º, 5 mm in diameter, Frontline Co, Germany) connected  opposite one.
          with light source (40 w, Halogen lamp) and digital camera   After completion of the procedure the carbon dioxide
          was then introduced through cannula. Two ports of 6 mm  gas was removed and the port wounds were sutured with
          size were created using 6 mm trocar-cannula unit under the  single interrupted mattress suture pattern using nylon.
          guidance of telescope distal to the laparoscope insertion site  All the wounds were cleaned and dressed regularly at the
          and 4 to 6 cm bilaterally from the ventral midline. Through  portal and incisional site with povidone iodine and antiseptic
          these ports, the operative instruments were inserted for   cream. Dressing was done in the morning after recording the
          surgical procedures. The intraperitoneal organs along with  clinical parameters. Up to 7th postoperative day they were
          vas deferens were thoroughly visualized. The urinary bladder  closely observed away from their sight, for any behavioral
          was visualized first by its characteristics tortuous structures  changes due to surgery.

            Fig. 1: Identification of the vas deferens by its characteristic   Fig. 2: Holding of the vas deferens by fenestrated grasping
                      ivory-colored, cord-like structure                    forceps in animals of group I
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