Electrocautery device does not provide adequate pulmonary vessel sealing in transumbilical anatomic pulmonary lobectomy.

INTRODUCTION: Safe pulmonary vessel sealing device plays a crucial role in anatomic lung resection. In 2014, we reported high rates of massive bleeding complications during transumbilical lobectomy in a canine model due to difficulty in managing the pulmonary vessel with an endostapler. In this animal survival series, we aimed to evaluate the outcome of pulmonary vessel sealing with an electrocautery device to simplify the transumbilical thoracic surgery. METHODS: Under general anesthesia, a 3-cm longitudinal incision was made over the umbilicus. Under video guidance, a bronchoscope was inserted through the incision for exploration. The diaphragmatic wound was created with an electrocautery knife and used as the entrance into the thoracic cavity. Using the transumbilical technique, anatomic lobectomy was performed with electrosurgical devices and endoscopic vascular staplers in 15 canines. RESULTS: Transumbilical endoscopic anatomic lobectomy was successfully completed in 12 of the 15 animals. Intraoperative bleeding developed in three animals during pulmonary hilum dissection, where one animal was killed due to hemodynamic instability and the other two animals required thoracotomy to complete the operation. There were five delayed bleeding and surgical mortality cases caused by inadequate vessel sealing by electrosurgical devices. Postmortem examination confirmed correct transumbilical lobectomy in the twelve animals that survived the operations. CONCLUSION: Transumbilical anatomic lobectomy is technically feasible in a canine model; however, the electrosurgical devices were not effective in sealing the pulmonary vessel in the current canine model.

Video. Natural orifice transtracheal evaluation of the thoracic cavity and mediastinum.

BACKGROUND: This study aimed to determine the feasibility of a novel transtracheal endoscopic technique for thoracic and mediastinum evaluation in a canine model. METHODS: In two dogs under general anesthesia, a transverse incision was made in the right lateral wall of the lower trachea and used as an entrance for thoracic and mediastinum evaluation. RESULTS: Transtracheal thoracoscopic evaluation was possible in both animals. One animal experienced massive subcutaneous emphysema immediately after evaluation of the thoracic cavity and required chest tube drainage. The follow-up endoscopies 2 weeks after surgery showed good healing of the tracheal openings in both animals. CONCLUSIONS: The transtracheal approach to the thoracic cavity and mediastinum appears to be feasible. This technique may provide an intriguing platform for the development of natural orifice transluminal surgery (NOTES) in the thoracic cavity.

Feasibility of transtracheal surgical lung biopsy in a canine animal model.

Successful natural orifice transluminal endoscopic surgery (NOTES) procedures have been reported in animal studies. However, very little is known about the optimal approach for the application of these surgeries in the thoracic cavity. This study presents the feasibility of transtracheal evaluation of pleural cavity in a canine model using the NOTES technique.

Use of the Arndt wire-guided endobronchial blocker via nasal for one-lung ventilation in patient with anticipated restricted mouth opening for esophagectomy.

Functional separation of the lungs may be accomplished by several methods. Patient with restricted mouth opening has limited options for one-lung ventilation. We report the use of wire-guided endobronchial blockade, a new tool for achieving one-lung ventilation in a patient with restricted mouth opening requiring nasotracheal, fiberoptic intubation for esophagectomy and reconstruction with gastric tube substitution.