Comparison and Description of Transdiaphragmatic and Abdominal Minimally Invasive Cisterna Chyli Ablation in Dogs

Abstract

Both TD and AB minimally invasive approaches can be used to achieve successful CC ablation.

Current Concepts in Minimally Invasive Surgery of the Abdomen

“…This technique can be performed with 2 portals placed 2-to 3-cm caudal to the 13th rib on the left side in the dorsal third of the abdomen, or with a transdiaphragmatic portals placed in the dorsal third of the left 10th or 11th intercostal space (use of nonvalved port is critical to prevent tension pneumothorax). 27 Initial dissection is through the craniolateral aspect of the peritoneum between the lateral margin of the left kidney and the dorsolateral body wall. The renal artery is identified and followed to the aorta.…”

Visualisation of the thoracic duct after popliteal lymph node injection in the pig: comparison of radiographic and thoracoscopic techniques

“…Leasure et al (2011) cannulated an efferent mesenteric lymphatic vessel in the region of the ileocecocolic LNs in dogs; after MB injection, the TD colouration was successful in all dogs (5/5). Sakals et al (2011) achieved a cisterna chyli colouration after intrapopliteal MB injection in 12/14 adult dogs. In one dog, in which colouration was not observed, MB was observed in the abdominal lymphatics, but the cisterna chili was not found.…”

“…Because the observed resolution rates with conservative management are low, surgery is usually preferred. Current surgical management of chylothorax consists of the following: TD ligation (Fossum et al 1986;Fossum et al 1991); partial pericardiectomy with or without TD ligation (Fossum et al 2004;Carobbi et al 2008); clipping of the TD during thoracoscopy (Radlinsky et al 2002); clipping or sealing of the TD and pericardiectomy during thoracoscopy (Allman et al 2010;Haimel et al 2012); cisterna chyli ablation with or without TD ligation (Hayashi et al 2005;Sakals et al 2011); omentalisation with or without TD ligation (Williams and Niles 1999;Talavera et al 2009;Stewart and Padgett 2010); or pleurodesis (Radlinsky 2012).…”

Recent advances in soft tissue minimally invasive surgery

“…With experience gained from performance of some of the simpler laparoscopic procedures, veterinary surgeons have been able to conquer some of the challenges associated with laparoscopic instrumentation, the development of hand-eye coordination and depth perception which has allowed a number of more advanced laparoscopic procedures to be developed. These include recently results of VATS lung lobectomy (Lansdowne et al 2005, Mayhew et al 2013c) and minimally invasive approaches to chylothorax (Radlinsky et al 2002, Allman et al 2010, Sakals et al 2011, Mayhew et al 2012a) have been documented from more than one centre. Other interventions in small numbers of cases using VATS techniques include patent ductus arteriosus ligation (Borenstein et al 2004), cranial mediastinal mass resection (Mayhew & Friedberg 2008), auricular mass resection (Ployart et al 2013), ligation of persistent right aortic arch (Isakow et al 2000, MacPhail et al 2001, tracheobronchial lymph node resection (Steffey et al 2012) and treatment of bullous emphysema (Brissot et al 2003).…”

“…The minimally invasive approach to cisterna chlyi ablation has been described in healthy research dogs (Sakals et al . ) but results of the procedure have not yet been published in a population of clinical cases.…”