Median sternotomy versus intercostal thoracotomy for lung lobectomy: A comparison of short‐term outcome in 134 dogs

Abstract

Objective: To compare short-term outcomes between dogs undergoing lung lobectomy via median sternotomy (MS) or intercostal thoracotomy (ICT).Study design: Retrospective case control study.Methods: Medical records of dogs that underwent lung lobectomy via MS or ICT at a single institution were reviewed for demographics, intraoperative findings, and postoperative management and outcomes. Dogs with pleural effusion, pneumonia, migrating foreign body, lung abscess, spontaneous pneumothorax, or lung lobe torsion were excluded. Short-term outcome factors up were compared up to the time of death, euthanasia, or discharge from the hospital.Results: One hundred and thirty-four dogs met the inclusion criteria. Forty-one (31%) dogs underwent MS and 93 dogs (69%) underwent ICT. Fluid production from the chest tube (P 5 .0061), alveolar arterial pressure gradient (P 5 .0001), and complications requiring intervention (P 5 .0245) were more common in the MS group than the ICT group. Pain management and all other short-term outcome factors did not differ between procedures. Five dogs from the MS group and 4 from the ICT group were euthanized in the postoperative period (P 5 .0925). Conclusion:In a surgical procedure that does not preclude either approach, ICT may be more desirable than MS in terms of postoperative pain, oxygenation, and complications. However, since no other short-term measure of outcome differed, we can state that both MS and ICT are well tolerated by dogs.

CT is helpful for the detection and presurgical planning of lung perforation in dogs with spontaneous pneumothorax induced by grass awn migration: 22 cases

“…1,10 Lateral thoracotomy is reported more desirable than median sternotomy in terms of postoperative pain, oxygenation, and complications. 9 However, the lateral thoracotomy or lateral thoracoscopic-assisted thoracotomy are lateralized techniques, which require a correct lateralization of the perforation site and the results of our study suggest that CT may be helpful for achieving this. 2,8 The main limitation of our study results from the inclusion of only spontaneous pneumothorax cases with surgically confirmed grass awn, which introduced a selection bias as cases with pneumothorax and suspected but unfound grass awn and cases with spontaneous pneumothorax that did not undergo thoracic surgery were excluded.…”

“…Accurate pre‐operative localization of the perforated lung lobe or its side has an important impact on surgical planning, as multiple surgical techniques are available for exploration of spontaneous pneumothorax . Lateral thoracotomy is reported more desirable than median sternotomy in terms of postoperative pain, oxygenation, and complications . However, the lateral thoracotomy or lateral thoracoscopic‐assisted thoracotomy are lateralized techniques, which require a correct lateralization of the perforation site and the results of our study suggest that CT may be helpful for achieving this …”

Optimization of surgical approach for thoracoscopic‐assisted pulmonary surgery in dogs

“…A TA VA3 30‐mm stapling device was used for simulated thoracoscopic‐assisted lung lobectomy in this study and is commonly used by surgeons for many open thoracic and abdominal surgical procedures, including lung lobectomy . Although endoscopic stapling devices are readily available, they are not commonly used in veterinary surgery and are associated with considerable cost.…”

Crimped monofilament nylon leader for median sternotomy closure in 10 dogs

“…In this case series, median sternotomies were successfully closed with crimped MNL, which led to few postoperative complications. The primary objective of median sternotomy closure is to achieve a stable fixation to allow uncomplicated sternotomy healing while minimizing postoperative pain 1,5,18 . In human medicine and veterinary surgery, this is most commonly performed with SSW 1,7‐10,19,20 .…”

“…The primary objective of median sternotomy closure is to achieve a stable fixation to allow uncomplicated sternotomy healing while minimizing postoperative pain. 1,5,18 In human medicine and veterinary surgery, this is most commonly performed with SSW. 1,[7][8][9][10]19,20 The use of alternative materials such as monofilament or multifilament suture, ribbon, tape suture, and cable tie has been described.…”