Minimally Invasive Surgery: Evidence Based Ligation and Hemostatic Techniques

Key Points

• Minimally Invasive Surgery (MIS) offers many benefits to the surgeon including being less invasive, and by allowing better visualization of many abdominal structures.
• MIS can be technically challenging to perform, and intracorporeal suturing is difficult.
• Various techniques have been developed to reduce the difficulty of performing intra-abdominal ligation.

Introduction
Various surgical approaches and methods of hemostasis have been reported for intra-abdominal ligation and hemostasis in equine MIS. In recent years laparoscopic approaches have become popular in light of the fact that they are minimally invasive, provide superior visualization, allow tension free hemostasis, and eliminate the need for general anesthesia. Laparoscopic techniques described for ligation and hemostasis include sharp dissection and ligature placement, laser dissection and staple or clip placement, sequential electrocoagulation and sharp transection, use of a vessel sealing device and sharp transection and use of an ultrasonic cutting and coagulating device. While all of these methods have proven efficacious certain advantages and disadvantages relating to surgeon preference, equipment costs, speed, reliability, and technical difficulty exist. The purpose of this presentation is to identify the techniques that have been used and the benefits and challenges that each approach provides.  [...]