Modified rib pivot lateral thoracotomy: a case series

Abstract

Objective To describe a modified rib pivot thoracotomy and its clinical application in client-owned dogs and cats.Study design Case series of 24 dogs and 1 cat requiring a thoracotomy.Methods A lateral thoracic incision over the required thoracic segment was made. The latissimus dorsi muscle was reflected dorsally. The predetermined rib was identified and the periosteum overlying the rib was elevated circumferentially, avoiding the intercostal neurovascular structures. Holes were pre-placed above and below the proposed osteotomy site. The rib was osteotomised and pivoted cranially. The pleura was incised and the required intrathoracic procedure was then performed. The thoracic cavity was closed by pre-placement of a suture through the pre-placed holes within the osteotomised rib. The pleura and intercostal musculature were closed, avoiding the intercostal neurovascular structures. The rib was re-apposed and the lateral approach was closed. The cases included were reviewed for both the rib pivoted as per the procedure required and postoperative complications. ResultsThe study group comprised 8 Staffordshire Bull Terriers, 2 Poodles, 2 German Shepherd Dogs, 1 each of Basset Hound, Rhodesian Ridgeback, Golden Retriever, Australian Shepherd, Vizsla, Bull Mastiff, Schnauzer, Jack Russell Terrier, Bulldog, Deerhound, Labrador Retriever and Australian Terrier, and 1 cat. A modified rib pivot thoracotomy was performed for lung lobectomy (n = 11), oesophagectomy (7), subtotal pericardectomy (5), patent ductus arteriosus ligation (1) and thoracic duct ligation (1). Follow-up ranged from 2 to 40 weeks postoperatively. Postoperative complications included seroma formation in two dogs.Conclusion A modified rib pivot thoracotomy should be considered as an alternative lateral thoracic approach with good exposure, minimal complications and low morbidity. T he rib pivot lateral thoracotomy was first described in 1988, 1 but has since been neglected as a lateral thoracic surgical approach. Descriptions in textbooks make mention of the rib pivot but imply that the procedure is associated with increased morbidity over a lateral intercostal thoracotomy.2,3 The procedure is usually discussed in connection with rib resection thoracotomy, implying similar morbidity. 4 Although the rib pivot thoracotomy and rib resection thoracotomy afford increased exposure over an intercostal thoracotomy, pivoting the rib affords preservation of the rib and chest wall conformation, and is thus quite different to rib resection. The original proposed benefit to the rib pivot thoracotomy over a rib resection was preservation of the rib and the associated soft tissue structures, thereby minimising the tension placed on the tissues to maintain the integrity of the closure. 1 We describe a modified rib pivot thoracotomy, combined with latissimus dorsi muscle elevation, and its application in a series of cases. Materials and methodsMedical records of dogs that underwent a rib pivot thoracotomy between July 2009 and July 2016 at Murdoch University Veterinary ...

In this issue – January/February 2018

“…A case series from Murdoch University demonstrates the use of a modified rib pivot thoracotomy in dogs and a cat. 5 The authors used a medical record review to assess the signalment, indications, surgical approach and complications of the technique, and demonstrate the approach using cadaver material. The authors conclude that planning is crucial and discuss the advantages and disadvantages of this approach compared with rib resection thoracotomy.…”

“…A case series from Murdoch University demonstrates the use of a modified rib pivot thoracotomy in dogs and a cat . The authors used a medical record review to assess the signalment, indications, surgical approach and complications of the technique, and demonstrate the approach using cadaver material.…”