Intracorporeal Knot Tying for Thoracoscopic Ligation of the Thoracic Duct in a Case of Canine Idiopathic Chylothorax
B.S. Medeiros1; A. Quadros2; M.A.M. Silva3; M.V. Brun4; R.M.M. Linn5; C.E. Bortolini6; I. Bisognin7
Both clinical and surgical management may be considered in cases of chylothorax. Conservative management consists of specific diet and repeated thoracocentesis. Thoracic duct ligation (TDL) is indicated in refractory cases.
A case of successful thoracoscopic TDL using intracorporeal knot tying in a mongrel bitch, age 9 years old, bearing idiopathic chylothorax is reported.
Following a 10-day period of non-successful clinical management, the patient was submitted to thoracoscopic TDL. The patient was positioned in oblique dorsal/left-lateral recumbency. Methylene blue injection into the popliteal lymph node for dyeing the thoracic duct (TD) was attempted. A 5-mm trocar was placed at the 9th intercostal space (ICS) for prior endoscopic inspection. Moderate amount of lymph was viewed. Two 5-mm instrument ports were established at the 8th and 10th ICS. The parietal pleura was dissected ventrally to the azygos vein and dorsally to the esophagus and thoracic aorta. The TD wasn't stained but was completely dissected from the dorsal aorta surface. The TD was triple ligated using surgeon's intracorporeal knot (3-0 nylon thread). A chest drain was positioned on the 7th ICS and residual lymph and air were drained. The trocars were withdrawn and synthesis was carried out routinely in two layers.
Overall surgical time for thoracoscopic TDL was 96 minutes. The patient convalesced uneventfully and was discharged on the 2nd day postoperatively.
Thoracoscopic TDL using intracorporeal knot tying was feasible and should be considered for minimal trauma, better visualization, and reduced postoperative pain in canine patients.