Page 215 - Clinical Manual of Small Animal Endosurgery

Thoracoscopy 203

long articulated (Endo GIA Roticulator) staple cartridge is often the most
suitable in limited operating space, and where one is unable to ade-
quately retract structures such as the lung hilus. A spare cartridge should
always be available in the eventuality of a misfire. Endosurgical staplers
require placement of a 12 mm port for their insertion, which also allows
easy insertion of an endosurgical specimen-retrieval bag.
There has been recent interest in human surgery in the use of bipolar
tissue-sealing devices and ultrasonic scalpels as an alternative to endo-
scopic staplers. This holds both cost advantages as well as only requiring
a 5 mm port for insertion, rather than the 12 mm port needed for staplers.
Bipolar tissue feedback pulmonary wedge resections of solitary small
peripheral pulmonary nodules in humans have been performed using
LigaSure, which was found to be comparable in safety and efficacy of
air-tight sealing to endoscopic stapling in 22 human patients (Kovacs
et al., 2009). Use of a 5 mm ultrasonic scalpel (Ultracision or Autosonix)
was also found to yield results comparable to use of an endoscopic
stapler for taking peripheral lung biopsies in an experimental animal
model study (Molnar et al., 2004).
While current knowledge appears to suggest that the use of the 5 mm
LigaSure bipolar tissue sealing device or ultrasonic scalpel may be suit-
able for peripheral lung biopsies, there is no published work evaluating
its safety, efficacy or predictability when used in abnormal or diseased
small-animal lung tissue. The use of extracorporeal loop ligatures cur-
rently appears to remain the most cost-effective, evidence-based tech-
nique for peripheral lung biopsy in veterinary companion animals.

Partial and complete lung lobectomy and pneumolobectomy

Thoracoscopy-assisted lobectomy techniques have been described in
canines in a number of reports (Lansdown et al., 2005; Levionnois et
al., 2006; Radlinsky, 2008; Laksito et al., 2010). Even if the procedure
is completed entirely thoracoscopically in a suitably sized patient, a
conversion of one of the port sites to a mini-thoracotomy is still needed
for tissue removal. This should ideally be performed via a rip-proof,
leak-proof retrieval bag to prevent pleural and extraction-site contamina-
tion, infection or metastasis. By avoiding rib retraction, postoperative
pain and morbidity are still reduced in comparison to a standard inter-
costal thoracotomy. Thoracoscopy-assisted lung lobectomy is compli-
cated by the wide variation in canine chest anatomy. Ironically, breeds
with laterally compressed chests such as Irish setters and Weimaraners
appear in most cases to be easier to perform lateral thoracoscopy on,
and to access the hilar region, than round-chested breeds such as Lab-
radors, contrary to what one may expect. Conversion to a standard
thoracotomy is more likely to be necessary due to poor visibility or access
when performing a cranial lung lobectomy in a small patient, or when
performing lobectomy of the right middle or accessory lobes.