34th Annual Scientific Meeting proceedings

Review of latest techniques/developments in procedures that can be performed thoracoscopically in veterinary medicine

VATS definition: Video assisted thoracoscopic surgery

“Thoracoscopy” refers to the visualization of the thoracic cavity

VATS refers to the surgical procedures performed

Benefits of VATS/minimally invasive surgery for thoracic surgery

• Avoiding thoracotomy, pain and complications
• Minimize incision
• Improve visualization with magnification
• Faster recovery
• Literature suggests fewer complications, lower infection, shorter hospitalization
• Utility for diagnostic and therapeutic procedures

Anesthesia considerations

Equipment requirements

Review of common procedures

Mediastinal disease/masses
Top tips/tricks

• Case selection
• Patient and owner preparation
• Patient positioning
• Instrumentation
• Regularly checking vital structures
• Post operative concerns
  • Wound
  • Pain
  • Signs of MG
  • Late port complications

Lung lobectomy- VATS and VATS assisted techniques
Top tips/tricks

• Use of wound retractor devices such as Alexis
  • Allows avoidance of rib retractors
• Use patient positioning to your advantage
  • Tilt table
  • Use of sand bags
• Don’t forget to breakdown/cut diaphragmatic ligament for caudal tumours
• Easier access to lymph nodes compared to complete thoracoscopic approach
• Still can leak test though mini thoracotomy site
• Recommendation that TA lung lobectomy can be performed in smaller patients (>3 kg) and in lesions up to 10 cm Scott et al

VATS pericardiectomy
Top tips/ tricks

• Can be performed with or without OLV
• Don’t panic at hemorrhage at first incision into pericardium
• Use of vessel sealing devices with caution
  • Ventricular fibrillation has been reported with electrosurgical devices (reported as 3% in an online survey of all pericardiectomy surgery)
• Careful identification of phrenic nerves
• Patience- retain all pieces of pericardium to measure size of excised tissue

Cardiac neoplasia
Top tips/tricks

• Case selection
  • SMALL MASSES
  • TIP OF ATRIUM/may not be appropriate for those at base of appendage
  • Use of imaging: echocardiogram/cardiac MRI
  • Preparation for conversion
  • Controversy if presence of metastasis

VATS; new directions

• Improvements in virtual reality thoracoscopic training
• Movement to uniportal and needlescopic techniques
• RATS- robotic assisted thoracoscopic surgery
• Improvement in local regional pain techniques

Conclusions

• Consider minimally invasive approaches for optimizing patient outcome
• Set time limit, prepare patient and owner for conversion
• Consider approaches/single incision ports
• Remember conversion is not a complication
• Case selection