Evaluation of a pre‐tied ligature loop for canine total lung lobectomy

Abstract

Objective: To determine the ability of a pre-tied ligature loop (PLL) to create a seal against physiological airway pressures after total lung lobectomy and report outcomes in dogs requiring lung lobectomy. Study design: Ex vivo experimental randomized study and clinical case study.Sample population: Thirty cadaveric canine lung lobes and 5 client-owned dogs.Methods: Thirty canine lung lobes from dogs weighing 22.5-35 kg were randomized to lobectomy with stapler, PLL, or suture ligation. After lobectomy, each bronchial stump was submerged in water, and the mainstem airway pressure was increased to 80 mm Hg. Leakage was compared between techniques. The PLL was subsequently used in 5 dogs (17-25 kg) with neoplastic disease requiring total lung lobectomy. Results: Two stapled and 4 sutured bronchial stumps leaked at supraphysiological pressures >15 mm Hg. One stapled bronchial stump failed at a physiological airway pressure (5 mm Hg). None of the PLL lobectomies leaked. The incidence of bronchial stump failures did not differ among techniques (P = .15). Lung lobectomy was performed successfully with the PLL in 5 clinical cases with no intraoperative or postoperative complications; median follow-up time was 6 months. Conclusion: Bronchial ligation with the PLL reliably resisted physiological airway pressures and performed comparably to current standard techniques in cadavers. The PLL provided an adequate air and vascular seal in 5 clinical cases undergoing total lung lobectomy. Clinical relevance: Pre-tied ligature loops provide an alternative method for total lung lobectomy in dogs.

Lung perforation caused by suture ends as a complication of lung lobectomy in a dog

“…Several techniques have been described for vascular and bronchial closure after total lung lobectomy 14,15 . There seems to be no consensus regarding the best technique (manual vs. mechanical, vessels and bronchus en bloc vs. separately) or suture material (absorbable vs. nonabsorbable).…”

“…Even within stapler‐using lobectomies, different techniques have been described. Bronchi, pulmonary arteries and veins can either be stapled en bloc or separately 3,7,14,16 . In this case, dissection was performed to separate vessels and bronchi, and then a combination of manual sutures and staples was used to ensure that the lobes were removed as close as possible to the hilum for optimal tumour excision.…”

“…A potential risk of en bloc occlusion could be the postoperative development of an arteriovenous shunt, but this complication appears to be rare 14 . Most reported cases of arteriovenous shunts are congenital or associated with trauma or neoplasia rather than being secondary to a ligature, for which only one case has been reported, secondary to castration in a dog 17–20 .…”

“…Most reported cases of arteriovenous shunts are congenital or associated with trauma or neoplasia rather than being secondary to a ligature, for which only one case has been reported, secondary to castration in a dog 17–20 . In addition, during lung lobectomy, the artery and vein are separated by the cartilaginous bronchus, and when the hilum is ligated en bloc, the risk of arteriovenous communication is likely to be further reduced by the interposition of this bronchial tissue 14 . In our case, an en bloc stapling technique would have permitted us to avoid this dramatic complication.…”

Resorbable self‐locking device for canine lung lobectomy: A clinical and experimental study

“…Bronchial ligation with a pre-tied ligature loop resisted physiological airway pressures in cadavers, and in five clinical cases of total lung lobectomy, one or two pre-tied ligation loops provided air and vascular seal. 23 In a comparison between techniques, intercostal thoracotomy may be more desirable than median sternotomy in terms of postoperative pain, oxygenation, and complications. 24 The optimal intercostal incision site to use when performing thoracoscopic-assisted lung lobectomy has been studied in normal, cadaveric dogs.…”