Page 197 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

staggered staple lines of 30 mm (TA30), 55 mm (TA55) and
PRACTICAL TIP
90 mm (TA90). For the TA55 and TA90 there are two sizes
VetBooks.ir When suspicious of lung neoplasia, three views of the (green cartridge). For partial or complete lung lobectomy,
of staple available: 3.5 mm (blue cartridge) and 4.8 mm
thorax left and right lateral, and ventrodorsal
the authors prefer to use the blue 3.5 mm cartridge (com-
should always be taken. Nodules must be at least 5
mm to 1 cm in diameter to be recognized on a plain
three staggered rows of 3 mm staples (compressing to
film (just over 10% of pulmonary neoplasia is missed pressing to 1.5 mm) or the white 30V3, which provides
on survey radiographs). Sternal and hilar lymph nodes about 1 mm) for additional security (‘V’ stands for
should be evaluated whenever possible vas cular). The green 4.8 mm cartridge is for thick tissue
and the staples compress to a size of about 2 mm, which
is inadequate compression in the lung and will result in
significant haemorrhage. Staplers can add to the cost of
Thorough physical examination for other primary sites the procedure but this may be offset by decreased anaes-
of neoplasia should be combined with haematology, serum thetic time and reduced risk for a critical patient.
chemistry profile and urinalysis. Cytological evaluation of Thoracoscopic lung lobectomy may also be performed
pleural fluid obtained via ultrasound- or CT-guided fine- in select cases as described earlier in this chapter.
needle aspiration can be helpful to provide more informa-
tion prior to surgery.
WARNING
Surgical treatment Mechanical staplers are relatively simple to use but
some experience is necessary to select the
Partial or complete lobectomy is indicated if there is a soli-
appropriate size of device and to manipulate this
tary lesion or multiple lesions within a single lobe. A partial equipment within the tight confines of the thorax
lung lobectomy can be performed if the lesion involves the
distal two-thirds of the affected lung lobe; otherwise, a
complete lung lobectomy is necessary. These procedures
Testing for leaks can be performed by filling the thorax
(described in Operative Technique 14.1) require the use of with sterile saline, inflating the lungs to a pressure of
a mechanical ventilator or an assistant dedicated to pro-
3 cmH 2O and looking for bubbles. Small leaks may
viding manual ventilation. Use of pulse oximetry, capno- seal spontaneously, but application of small titanium clips
graphy and blood pressure monitoring equipment to
(Surgiclips, Covidien Inc.) can prove useful to ensure a
monitor the patient is recommended. If using perioperative surgical seal. Excised tissue should be submitted for
antibiotics, these should be given intravenously at the time
histopathological evaluation. It is important to examine the
of anaesthetic induction. hilar lymph nodes, especially in cases of suspected neo-
Use of mechanical stapling devices to perform partial
plasia. Wedge biopsy or lymph node extirpation should be
or complete lung lobectomies provides a rapid and reliable performed where possible. A thoracostomy tube should
alternative to hand suturing (Figure 14.12). Thoraco-
be placed and the pleural space emptied at the end of
abdominal (TA) staplers come in a variety of sizes to create
the surgery.
Prognosis
Survival times for dogs and cats are dependent on the
grade and/or differentiation of the tumour. In one study
(McNeil et al., 1997), dogs with well differentiated tumours
had a median survival time (MST) of 790 days, whereas
dogs with poorly differentiated tumours had an MST of 251
days. A more dramatic difference was found in cats with
primary lung tumours: cats with moderately differentiated
tumours had an MST of 698 days, which was significantly
longer than that for cats with poorly differentiated tumours
(MST = 75 days) (Hahn and McEntee, 1998). Solitary lung
tumours in dogs carry a poor prognosis unless local lymph
nodes are clean and metastatic disease is absent (Polton
et al., 2008). For further details regarding primary lung
neoplasia and adjunctive treatment options, see the
BSAVA Manual of Canine and Feline Oncology.

References and further reading

Bexfield N and ee ( 14) BSAVA Guide to Procedures in Small Animal
Practice, 2nd edn. BSAVA Publications, Gloucester
Brissot HN, Dupre GP, Bouvy BM and Paquet L (2003) Thoracoscopic treatment
of bullous emphysema in 3 dogs. Veterinary Surgery 32, 4 9
Cooper ES, Syring RS and King LG (2003) Pneumothorax in cats with a clinical
diagnosis of feline asthma: cases (199 ). Journal of Veterinary
Emergency and Critical Care 13, 9 1 1
Danielski A, Diaz Otero MA and Quintavall F (2007) The bronchoalveolar lavage
Complete lung lobectomy (right middle lung lobe) using (BAL) in metastatic lung cancer investigation in dogs and cats: a retrospect.
14.12
thoracoabdominal stapling e uipment. Annali della Facolta ta di Medicina Veterinaria 22, 791 8 4

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