title: Computed Tomography Determined Changes in Position of the Hepatobiliary and Gastrointestinal Systems after CO2 Insufflation to Determine Optimal Positioning for Abdominal Laparoscopy.
abstract: OBJECTIVE
  To evaluate changes in body position and effect of CO2 insufflation on the hepatobiliary and gastrointestinal systems using computed tomography (CT) to determine optimal laparoscopic approach.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  Healthy intact female Beagles (n = 6) of similar age, weight, and body condition score.
  
  
  METHODS
  Urinalysis, peripheral blood smear, and abdominal ultrasonography were performed to determine dog health. A series of pre insufflation (PrI) CT scans in ventrodorsal routine (VDR), ventrodorsal Trendelenburg (VDT), left lateral (LL), and right lateral (RL) recumbency were performed before and after abdominal insufflation (PoI) with CO2 (10-14 mm Hg). Pre-determined measurements were made on PrI and PoI scans and differences compared.
  
  
  RESULTS
  Liver position was affected by body position and under gravitational influence moved to the dependent part of the abdominal cavity. The gallbladder was best exposed in LL. Stomach position was not significantly changed after insufflation. Different areas of small intestine were dependent on gravitational effects. The pancreas maintained a similar position after insufflation.
  
  
  CONCLUSIONS
  VDR was the ideal position for all laparoscopic procedures of the liver. The LL position could be used for surgery of the gallbladder but likely provides poor exposure to the rest of the liver. In approaching the stomach and intestines, the area of interest should be used to determine the best position.
authors.affiliation: Departments of Small Animal Surgery and Diagnostic Imaging, University of Pretoria, Onderstepoort, South Africa.
authors.forename: Ross Christopher
authors.initials: RC
authors.lastname: Elliott
authors.affiliation: Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa.
authors.forename: Robert Murco
authors.initials: RM
authors.lastname: Kirberger
authors.affiliation: Department of Paraclinical Sciences, Section of Pharmacology, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa.
authors.forename: Kenneth Edward
authors.initials: KE
authors.lastname: Joubert
mesh_terms: D000818:Animals; D002245:Carbon Dioxide / Q000008:administration & dosage; D004285:Dogs; D005260:Female; D005704:Gallbladder / Q000473:pathology; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging; D007327:Insufflation / Q000662:veterinary; D010535:Laparoscopy / Q000662:veterinary*; D008099:Liver / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000601:surgery / Q000662:veterinary*; D011187:Posture; D011859:Radiography; D014054:Tomography / Q000662:veterinary
chemical_list: D002245:Carbon Dioxide