Computed Tomography Determined Changes in Position of the Urogenital System After CO2 Insufflation to Determine Optimal Positioning for Abdominal Laparoscopy

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Objective:To evaluate changes, using computed tomography (CT), in position of the urogenital system before and after CO2 abdominal insufflation for the most commonly used body positions to determine the optimal laparoscopic approach.Study Design:Experimental study.Animals:Healthy intact female Beagles (n = 6) of similar age, weight, and body condition score.Methods:Dogs had urinalysis, peripheral blood smear, and abdominal ultrasonography. Pre-insufflation (PrI) CT scans were performed in ventrodorsal routine (VDR), ventrodorsal Trendelenburg (VDT), left lateral (LL) and right lateral (RL) recumbency, and repeated post insufflation (PoI). Pre-determined measurements were made on PrI and PoI scans and differences compared.Results:The position of the uterus and ovaries was mainly determined by gravitational effects and the attachment of the suspensory ligament. VDT provided best exposure of the uterine body. The kidneys remained in the non-dependent part of the abdomen when the dog was positioned in the opposite lateral position. The bladder remained in the ventral part of the abdomen in all positions.Conclusions:The best approach to the kidney and associated ovary and uterine horn would be the opposite lateral position to the side being approached. For ovariohysterectomy, this would require the dog to be rotated into each lateral position for the left and right uterine horn and ovary. VDT was best to access the bladder and uterine body.

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