Page 217 - Clinical Manual of Small Animal Endosurgery

Thoracoscopy 205

tive computed tomography scans had revealed a maximum size of 4.5 cm,
with no evidence of vascular invasion. Thoracoscopy was performed
using one-lung ventilation via a bronchoscopically placed double-lumen
endobronchial tube. A harmonic scalpel was used for dissection with the
capsule intact, and the thymomas were placed in endoscopic retrieval
bags for removal. One dog was free of recurrence 18 months later, while
the other was euthanased 5 days postoperatively due to aspiration pneu-
monia. This dog had myasthenia gravis, megaoesophagus and aspiration
pneumonia diagnosed preoperatively. While thoracoscopic resection of
modest-sized thymomas is feasible, the postoperative outcome is depend-
ent on preoperative assessment and careful patient selection.

Port-site closure and postoperative care

Before closure the surgeon should check for adequate reventilation of
atelectatic lung lobes that were retracted or collapsed during single-lung
ventilation. If a lung lobe was retracted or pulled back, as for vascular
ring anomaly surgery, it should be checked that there is no lobe torsion.
Instrument port sites can be visualised after the cannulae are removed
for any haemorrhage, although this is uncommon. A two-layer suture
closure is generally sufficient for port sites, with a rapidly absorbable
monofilament (Monocryl, Ethicon; Caprosyn, Covidien) for muscular
and intradermal layers.
A narrow-gauge chest drain is inserted percutaneously at the end of a
thoracoscopic procedure, under visualisation with the endoscope. It
should not be inserted through a port site, but through its own site. It is left
in place while all the ports are closed, and then the pneumothorax is
drained (Fig. 6.26). The drain is then removed. Indwelling postoperative
chest drains are not needed in most procedures, but port-site seromas can
occasionally occur in the 12–24 h postoperatively in cases of pleural effu-
sion, chylothorax and pericardiectomy. These may be best prevented by
suctioning of effusions from the chest cavity at the end of the procedure
and application of a light chest bandage for the first 12 h postoperatively.
Postoperative morbidity is low in most cases that do not require a
mini-thoracotomy, and the majority of cases can be given a small amount
of food and taken for a brief walk for a few minutes outside within 2 h
of recovery from anaesthesia. However, cases are normally best hospi-
talised overnight for observation. Analgesic requirements are usually
similar to those for minor abdominal surgical procedures. Cases requir-
ing a mini-thoracotomy will need additional analgesia, as for open tho-
racic surgery cases.

Further resources

www.vetlapsurg.com or www.veterinarylaparoscopy.com The internet
portal for all aspects of minimally invasive surgery in all veterinary