Page 197 - Clinical Manual of Small Animal Endosurgery

Thoracoscopy 185

the pleura can be performed using cup biopsy forceps, or with incision
and dissection with curved Metzenbaum scissors. The intercostal vessels
and nerves must be avoided. When biopsing lymph nodes, simply grasp-
ing and pulling with cup biopsy forceps may result in tearing of the
mediastinum and associated vessels, with resultant haemorrhage. The
lymph node should be stabilised or grasped with atraumatic forceps for
biopsy. The overlying mediastinum and capsule can be incised with
Metzenbaum scissors; this will lead to a better sample, with reduced
histological crush artefacts.
During exploratory thoracoscopy the surgeon should not forget to
examine the thoracic surface of the diaphragm for any unusual confor-
mation. A primary undiagnosed liver tumour can sometimes be recog-
nised by its abnormally shaped impression on the diaphragm (Fig. 6.9).

(a)

Fig. 6.9 (a) An abnormal nodular
surface to the diaphragm visualised
during thoracoscopy. (b) A brief
exploratory laparoscopy after lung
biopsy revealed the presence of
an undetected primary hepatic (b)
adenocarcinoma.