Hybrid single‐port laparoscopic cisterna chyli ablation for the adjunct treatment of chylothorax disease in dogs

Abstract

Objective: To describe a hybrid, single-port, minimally invasive cisterna chyli ablation (CCA) technique in clinical cases of canine idiopathic chylothorax and evaluate this technique as a method for mesenteric lymphangiography (ML) in canine cadavers and clinical cases of idiopathic chylothorax. Study design: Cadaveric and retrospective study. Animals: Six canine cadavers and 14 client-owned dogs with naturally occurring idiopathic chylothorax. Methods: Both cadaveric and clinically affected dogs were placed in sternal recumbency. A wound retractor device (WRD) and a single-port device were placed in the abdominal flank 2-3 cm caudal to the 13th rib. Mesenteric lymphangiography was evaluated by using indocyanine green (ICG) in 6 canine cadavers. Single-port laparoscopic CCA was performed in all clinical cases with idiopathic chylothorax. Results: Successful ML was completed by using ICG in all 6 canine cadavers. A right-or left-sided single-port laparoscopic CCA was successfully performed in 14 dogs with naturally occurring idiopathic chylothorax. Mesenteric lymphangiography was successfully performed through the WRD in 11 of these cases. No intraoperative complications were reported. Three dogs developed severe chyloabdomen postoperatively, with 1 dog requiring multiple abdominocenteses. Conclusion: Direct ML and single-port laparoscopic CCA was performed through a WRD in dogs positioned in sternal recumbency. Although minimal operative complications were noted, postoperative chyloabdomen was reported. Clinical significance: This hybrid single-port laparoscopic technique performed in sternal recumbency allows both a CCA and an intraoperative ML through the same incision. This procedure may be combined with thoracoscopic thoracic duct ligation and pericardectomy for the treatment of idiopathic chylothorax in dogs.

Morphology of the cisterna chyli in nine dogs with idiopathic chylothorax and in six healthy dogs assessed by computed tomographic lymphangiography

“…Slices were reviewed at the level of the insertion of the left renal artery into the aorta as well as at the level of the intervertebral disc space and midbody of the vertebra cranial to the insertion of the left renal artery into the aorta (three slices total). This area was chosen because it has been suggested as the target area for cisterna chyli ablation 4,6,10‐12 . The perimeter and cross‐sectional areas of the cisterna branches and aorta were determined by using free‐hand selection and the “Measure” tool in ImageJ.…”

“…This area was chosen because it has been suggested as the target area for cisterna chyli ablation. 4,6,[10][11][12] The perimeter and cross-sectional areas of the cisterna branches and aorta were determined by using free-hand selection and the "Measure" tool in ImageJ. The ImageJ application was used to zoom in on the area of interest for increased accuracy, although no standard zoom factor was used.…”

“…This theoretically reduces pressure in the lymphatic system caudal to the site of thoracic duct ligation and may promote formation of new lymphaticovenous connections outside the pleural space 5 . Currently recommended techniques for cisterna chyli ablation are celiotomy or minimally invasive surgery for transabdominal retroperitoneal approach to the cisterna chyli dorsal to the left kidney and sharp dissection or traction of the cisternal membranes from the aorta 4,5,9‐11 . Currently the extent of ablation required for optimal decompression is not known.…”

“…5 Currently recommended techniques for cisterna chyli ablation are celiotomy or minimally invasive surgery for transabdominal retroperitoneal approach to the cisterna chyli dorsal to the left kidney and sharp dissection or traction of the cisternal membranes from the aorta. 4,5,[9][10][11] Currently the extent of ablation required for optimal decompression is not known. However, the configuration of the cisterna chyli may have an impact on the extent and outcome of ablation.…”

Anatomic and volumetric characterization of the cisterna chyli using CT lymphangiography and computer‐assisted design software in dogs with idiopathic chylothorax

“…The pathophysiology is poorly understood and may vary between dogs, which has contributed to the variety of surgical interventions and outcomes currently reported 1,2 . Recently, clinical investigation of the cisterna chyli (CC) has increased as it has become a diagnostic and therapeutic target for interventional procedures in both human and veterinary medicine 3–9 . Consequently, a thorough understanding of the variability in anatomic location of the CC and thoracic duct (TD) is essential to improve diagnostic interpretation and to plan potential interventions 10–12 .…”