Date Published: July 03, 2020
Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Author(s): Monica Carolina Nery Wittmaack, Felipe Farias Pereira da Câmara Barros, Paloma do Espírito Santo Silva, Andresa Matsui, Guilherme Sembenelli, Renata Sitta Gomes Mariano, Pedro Paulo Maia Teixeira, Paola Castro Moraes.
To assess the feasibility of thoracoscopic transdiaphragmatic approach for biopsy of all lung lobes and to determine the optimal intercostal space (ICS) for biopsy of each lung lobe.
Ten rabbits were positioned in dorsal recumbency. Total thoracoscopy lung biopsy was made combined transdiaphragmatic approach and right ICS approaches. A camera port was made in the transdiaphragmatic approach and the instrument port was made of ICS 7 and ICS 9. A pre tied loop ligature was placed to performed a caudal lung lobe biopsy and to simulate biopsies of the others lung lobes.
Biopsy of the cranial aspect of the right caudal lung lobe was performed at ICS 9. Simulated biopsy of the accessory lung lobe was performed at ICS 9. Simulated lung biopsy of the right cranial and middle lung lobes was performed at ICS 7. The caudal and dorsal aspect of the right caudal lung lobe was not visualized by telescope at transdiaphragmatic approach, and biopsy was not performed.
Thoracoscopic transdiaphragmatic approach for lung lobes biopsies was a feasible technique, except for the caudal aspect of the right caudal lung lobe. An ideal intercostal port for biopsy of each right lung lobe was determined.
Thoracoscopy is less invasive than open procedures. Indeed, many prospective, randomized studies conﬁrmed that thoracoscopy reduces postoperative pain, minimizes pulmonary dysfunction and shortens hospital stay1 , 2 . Recently, there has been an increasing enthusiasm for the thoracoscopic transdiaphragmatic approach. A transdiaphargmatic approach offers multiple benefits, including a reduction in the signs of pain attributable to spreading of the ribs, not producing lesion in the intercostal nerves, and preventing intercostal muscle tearing. Additionally, decrease intercostal approaches will reduce postoperative pain3 – 5 .
The present study was approved by the Animal Use Ethics Committee (CEUA) of the School of Agrarian and Veterinary Sciences (FCAV) – UNESP – Campus Jaboticabal, and was carried out in accordance to the animal experimentation guidelines of CONCEA (protocol no. 12,900/15).
A trandiaphragmatic approach has potential advantages such as preventing injuries to intercostal nerves and vessels due to the bypass of the intercostal space during thoracoscopic surgery4 , 12 . Commonly, a transdiaphragmatic approach was indicated as appropriated approach for a lung biopsy because of diffuse lung disease. This approach allows examination of both sides of the thoracic cavity and biopsy of the lungs on the right and left sides7 , 8 . However, a recent study did not recommend transdiaphragmatic approach for evaluation of the dorsal aspect of the chest11 . In the present study, biopsy of all right lungs lobe at transdiaphragmatic approach was not possible. Caudal and dorsal aspect of the caudal lung lobe was not evaluated under direct visualization by telescope at transdiaphragmatic approach, even moving the telescope caudally and dorsally.
Results for the study reported here may provide surgeons with information on the optimal ICS approach to use when performing lung biopsy via transdiaphragmatic approach in patients less than 5kg. Further evaluation of a thoracoscopic transdiaphragmatic approach for biopsy of right caudal lung lobe is required in small dogs and cats.