Comparison of Different Synthesis Methods After Partial Pulmonary Lobectomy in Dogs

Abstract

Background: Pulmonary loborraphy can be performed using manual sutures and staples, although other methods such as tissue adhesives are also cited in the veterinary literature. However, despite the wide availability, no efficient suture material has yet been recognized that is completely safe in preventing any air leakage, a complication that is heavily investigated in medicine and not uncommon in veterinary medicine, despite the few studies and reports in dogs. Although the surgery is well tolerated in the canine species, failure in pulmonary aerostasis is still a reality, since all the methods described so far eventually lead to air leakage after the use of the partial lobectomy technique in the lungs. Within this context, the aim of this research was to compare the effectiveness of different hermetic sealing methods after partial lobectomy of the right caudal lung lobe (RCLL) in dogs. Using 30 cadaver models of canine lungs obtained immediately after death. The 30 cadavers models were divided in 6 groups: G1 - cobbler suture associated with simple continuous; G2 - overlapping continuous suture associated with simple continuous suture; G3 - Ford interlocking suture; G4 - Stapling device; G5 - Tissue glue (cyanoacrylate). After performing the sealing techniques, the lungs were submerged in water, inflated with oxygen at positive ventilatory pressures at physiological (20 cmH2O) and supraphysiological levels (above 20 cmH2O) to evaluate the performance of the sealing methods and to asses the level of ventilatory pressures at which air leakage occur. Results: At physiological ventilatory pressure levels there was no difference between groups. However, when evaluating such methods at ventilation pressure levels above 20 cmH2O, it was found a superiority of G5 over G3 and G4. Conclusion: Manual sutures, as well as staples and synthetic tissue glue were able to promote aerostasis after partial lobectomy of the RCLL at physiological ventilatory pressures. Sealing with surgical glue was superior to Ford interlocking suture and stapling device at supraphysiological levels of ventilatory pressure. This study supports the efficay of all manual, mechanical sutures and synthetic glue sealant when used after partial lobectomy in dogs.

Effects of cyanoacrylate on leakage pressures of cooled canine cadaveric jejunal enterotomies

“…The authors hypothesize that this difference in ILL is due to the cyanoacrylate “plugging” the suture holes when in the viscous state at the time of application, essentially waterproofing that area, and reducing the leakage seen from the needle holes. Although the waterproofing properties of synthetic sealants have previously been reported, their ability to also create an airtight seal has only recently been demonstrated in canine cadavers, following partial lung lobectomies 23,24 . As the suture continues to be the keystone in holding the incision together, this suggestion may explain the difference in the leakage location for the HS + CE group.…”