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An Urban Experience
one or 2 trocards are inserted cranial and caudal to the camera trocard, using the same line (ie, slightly ventral to the camera. For a sternal approach either a 30 degree or 0 degree scope can be used. The 30 degree will need to be placed a bit more dorsal than the 0 degree scope. For a retroperitoneal approach the 30o scope is preferred.
The right adrenal approach is similar but placed a bit more cranial. Visualisation can be improved by cutting the renohepatic ligament. A retroperitoneal approach is preferred for a right-sided large adrenal gland.
Thoracoscopic procedures
The main advantage of thoracoscopy is the avoidance of a large thoracotomy incision. Thoracotomy incisions are associated with a large amount of discomfort, a long recovery period, intensive care and large obvious scars. The main disadvantage of thoracoscopic surgery is the limited visibility and small working space caused by the chest wall and insufflation of the lungs.
Lung lobectomy
Blunt trocars are entered using a small entry hole (made by a mosquito) and pressure. The scope entry port is made first. A thorough exploration of the thorax and lung lobectomy is only possible when the lungs are partially insufflated. One-sided lung ventilation can be achieved using a specialized double-lumen (bronchus-blocking) tracheal tube. This will cause one side lung collapse and excellent visibility in the chest. Thoracoscopy can be used for multiple procedures such as exploration, biopsy, pericardectomy, thoracolumbar disc fenestration and lobectomy.
Lung lobectomy in dogs is a relatively easy procedure using thoracoscopy because of the division of all the lung lobes. The hilus of the lung lobe is relatively narrow compared to a human lung lobe and often allows a single endoscopic stapler to do the job. The stapler
is inserted, after the hilus is sufficiently visualized, and placed carefully around the hilus. Care must be taken not to lacerate the hilar vein and artery. After placement, the staple is closed and fired. The stapler places 4 rows of staples and cuts in between. The lung is removed from the thorax using a sterile glove or specially designed bag. Closure of the entry ports is routine.
Mayhew PD, Kirpensteijn J. Laparoscopic adrenalectomy. In Small Animal Laparoscopy and Thoracoscopy. Mayhew PD and Fransson BA Eds, John Wiley and Sons 2015; pp 156-166.

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