PMC8397567_01
Laparoscopic diagnosis and treatment of gossypiboma in a female dog. (a) Placement of the first port (11 mm) in the ventral midline. (b) After lateralisation of the patient, two other trocars (6 mm and 11 mm) were positioned laterally to the first one in triangulation. (c) Laparoscopic aspect of the gossypiboma is envolved by the omentum; blue arrows indicate fibrous adhesions with the abdominal wall. (d) Gossypiboma (black arrows) after adhesiolysis; K: kidney. (e) Introducing gossypiboma into the tissue removal bag. (f) Cannula passage through the fistula after its hydrodynamic debridement. (g) Aspect of the chronic wound associated to the fistula after surgical debridement and laparoscopic positioning of the omentum through the muscular wall. (h) Aspect of the sutured wound. (i, j) Macroscopic aspect of gossypiboma before and after opening the fibrous tissue surrounding the surgical gauze.
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After skin antisepsis, an 11 mm port was placed on the preumbilical midline using the open technique (Hasson-modified) (Figure 1(a)). Finally, a third 6 mm port was placed caudolaterally in triangulation (Figure 1(b)). The first intra-abdominal inspection revealed a mass at the right kidney pole, at the right ovary site, as well as intraperitoneal adhesions (Figure 1(c)). Tuttlingen, Germany), preserving the right ureter, which coursed near the mass. Short gauze threads were identified, while thick fibrous attachments to the right inner flank wall were transected. The specimen was withdrawn using a retrieval bag (LapSac, Cook, Bloomington, USA) following an 11 mm working port small enlargement (approximately 1 cm) (Figures 1(d) and 1(e)). The tip of a 5 mm cannula attached to a vacuum cleaner was inserted through the fistula, which was thoroughly rinsed with 0.1% povidone-iodine solution (Figure 1(f)). Keeping the pneumoperitoneum, an omentum segment was apprehended and positioned through the sinus tract, covering the debrided tissue (Figure 1(g)). Omentopexy was performed using 2-0 USP polyglactin 910, and skin suture over the omentum was performed with interrupted horizontal mattress sutures using 3-0 USP nylon (Figure 1(h)). Postsurgical immediate macroscopic observation of the specimen revealed a surgical gauze involving a thick fibrous capsule (Figures 1(i) and 1(j)).