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Introduction: Recommended approaches to accessory lung lobectomy (A.L.L) are not readily available. The objective of this study is to introduce a transdiaphragmatic approach to the A.L.L and to compare accessibility and ease of stapler placement in three approaches: intercostal thoracotomy (ICT), median sternotomy (MS) and a combined transdiaphragmatic approach with caudal median sternotomy (TDCM).
Materials and Methods: Twelve canine cadavers underwent A.L.L using an articulating EndoGIA stapler via a randomly assigned approach: ICT (n = 4), MS (n = 4) or TDCM (n = 4). Percentage of accessory lung tissue removed was measured in surface area and in weight. Exposure was measured as the incision area when maximally retracted. Staple line leak pressures were evaluated to 40cmH2O. Ease of stapler placement was evaluated with time from loading of the stapler to lobectomy completion and degree of stapler articulation. Time from start of skin incision to lobectomy completion was recorded.
Results: The average area of exposure was larger in the TDCM approach (TDCM = 193.5cm2, MS = 106.5cm2, ICT = 73.45cm2; P = 0.01). MS was associated with significantly greater degree of stapler articulation (P = 0.016). Two of 4 ICT staple lines leaked at ≤ 40cmH2O, and 1/4 MS resulted in iatrogenic damage to an adjacent lobe. There was no significant difference between percentage of lobe excised between approaches.
Discussion/Conclusions: TDCM provided greater exposure which led to subjectively greater ease of stapler placement for A.L.L, although percentage of lobe excised was not significantly different. TDCM should be further considered for complete A.L.L.
33rd Annual Scientific Meeting proceedings
Stream:
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Session:
Date/Time: 30-11--0001 (00:00 - 00:00) | Location:
Date/Time: 30-11--0001 (00:00 - 00:00) | Location:
Comparison of Three Approaches for Accessory Lung Lobectomy in the Canine Cadaveric Model: Intercostal Thoracotomy, Median Sternotomy and a Novel Transdiaphragmatic Approach Combined with Caudal Median Sternotomy
Duvieusart C, Barbur L*, Brown T
Friendship Hospital for Animals, Washington D.C, USA.
Introduction: Recommended approaches to accessory lung lobectomy (A.L.L) are not readily available. The objective of this study is to introduce a transdiaphragmatic approach to the A.L.L and to compare accessibility and ease of stapler placement in three approaches: intercostal thoracotomy (ICT), median sternotomy (MS) and a combined transdiaphragmatic approach with caudal median sternotomy (TDCM).
Materials and Methods: Twelve canine cadavers underwent A.L.L using an articulating EndoGIA stapler via a randomly assigned approach: ICT (n = 4), MS (n = 4) or TDCM (n = 4). Percentage of accessory lung tissue removed was measured in surface area and in weight. Exposure was measured as the incision area when maximally retracted. Staple line leak pressures were evaluated to 40cmH2O. Ease of stapler placement was evaluated with time from loading of the stapler to lobectomy completion and degree of stapler articulation. Time from start of skin incision to lobectomy completion was recorded.
Results: The average area of exposure was larger in the TDCM approach (TDCM = 193.5cm2, MS = 106.5cm2, ICT = 73.45cm2; P = 0.01). MS was associated with significantly greater degree of stapler articulation (P = 0.016). Two of 4 ICT staple lines leaked at ≤ 40cmH2O, and 1/4 MS resulted in iatrogenic damage to an adjacent lobe. There was no significant difference between percentage of lobe excised between approaches.
Discussion/Conclusions: TDCM provided greater exposure which led to subjectively greater ease of stapler placement for A.L.L, although percentage of lobe excised was not significantly different. TDCM should be further considered for complete A.L.L.
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