thumb forceps
Rat‐tooth forceps
20 4 × 4 gauze sponges
Box 2.2 Instruments for Gastrointestinal Surgery
Routine soft tissue instrument set
Balfour retractor (used for ventral midline abdominal approach)
Sterile suction tubing
Suction canister
Monopolar and bipolar cautery (bipolar cautery should be available for esophageal surgery)
Doyens intestinal clamps
Lap sponges
Suture for enterotomy closure
25‐gauge needle and 5–10 cc syringe for performing a leak test after enterotomy closure
See Box 2.12 for additional instruments necessary for a lateral thoracotomy approach and closure.
Biliary Emergencies
In cases of biliary obstruction due to choleliths, cholecystitis, pancreatitis, neoplasia or gallbladder mucocele, either biliary duct stenting for reversible obstruction or cholecystectomy or cholecystoenterostomy for non‐reversible obstruction can be performed. Instruments recommended for biliary emergencies are listed in Box 2.3.
Liver Lobectomy
For a liver lobectomy procedure in which there is potential for significant hemorrhage, a bipolar vessel sealing device (LigaSure) can be beneficial in providing hemostasis in areas where ligations by hand would be difficult. The LigaSure handpieces come in a variety of shapes, such as the Precise, Impact, and Atlas. The Atlas comes in an assortment of lengths, diameters and with blunt and tapered tips. In addition, Hemoclips, Ligaclips®, and Surgiclips are valuable additions to your operating room instrumentation when there is high risk for hemorrhage because they can be applied quickly and securely to vessels. Removal of the affected liver lobe can be achieved using a stapling device, such as the TA™ or GIA™ vascular stapler, which applies two to four rows of interlaced staples. For reference, the TA Auto Suture vascular stapler by Covidien comes in cartridge lengths of 30 mm, 55 mm, or 90 mm, with staple widths ranging from 3–4 mm and staple height ranging from 2.5–4.8 mm. For larger tissue resections, the GIA stapler comes in cartridge lengths of 50 mm, 60 mm, 80 mm, and 90 mm, with staple widths from 3–4 mm and staple heights ranging from 2.5–4.8 mm. Other hemostatic agents include Vetspon® absorbable hemostatic gelatin sponge (gel foam) and oxidized regenerated cellulose (Surgicel®). Both are applied to a site of hemorrhage to aid in clot formation and can be left in place indefinitely until eventually absorbed or removed during surgery once hemostasis is achieved. The instruments needed are listed in Box 2.4.
Figure 2.1 Balfour retractor (bottom left), Poole suction tip (top left), sterile suction tubing (bottom right), and suction canister (top right) for abdominal lavage.
Figure 2.2 Portable suction machine.
Box 2.3 Instruments for Biliary Surgery
Routine soft tissue instrument set
Monopolar and bipolar cautery
Balfour retractor
Sterile suction tubing
Suction canister
Lap sponges
Culturette
Hemoclips® or Surgiclips™
± Covidien™ feeding tube and red rubber urethral catheter (Kendall™) for common bile duct stenting
Urinary System
Ureteral Surgery
Instruments used 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
