Thoracic Duct Ligation: Right Video-assisted Thoracoscopic Surgery Approach

Devulapalli, Chris; Anderson, Jacqueline; Llore, Nathaly; Hechenbleikner, Elizabeth M.; Marshall, M. Blair

doi:10.1053/j.optechstcvs.2017.04.001

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…Despite all, pleural thickening made difficult the isolation of TD at level of Poirier’s triangle. Other authors [1, 6] in similar cases proposed the mass ligation of all tissues between the aorta, spine, oesophagus, and pericardium above the diaphragm hiatus, via the right pleural space, but also this strategy resulted to be unfeasible due to left access in our cases. Thus, by the incision of the posterior parietal pleural, the TD was isolated behind the thoracic aorta, in an anatomical space delimited by the 4th and the 5th posterior intercostal arteries and the vertebral column.…”

Section: Resultsmentioning

confidence: 71%

“…Surgical TD ligation may be performed via abdominal, thoracic and cervical approach. Actually, many surgeons prefer to ligate TD using thoracoscopy at the diaphragmatic level as this strategy have the advantage of stopping flow from any accessory tributaries [6]. When TD is difficult to identify, talc pleurodesis alone or associated with surgical decortication may be tried.…”

Section: Resultsmentioning

confidence: 99%

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Retroaortic closure of thoracic duct in the management of persistent chylothorax: a case report

Caronia¹,

Miceli²,

Macaluso³

et al. 2019

J Cardiothorac Surg

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Background Chylothorax is a life-threatening pathological condition associated with significant morbidity and mortality. If chyle leakage does not close spontaneously with medical therapy, surgical treatment is inevitable. Herein, we reported a case of spontaneous persistent chylothorax from mediastinal seminoma that was successfully closed between the descending thoracic aorta, and the vertebral column through a left mini-thoracotomy. Case presentation A 24-year old man with mediastinal seminoma was referred to our attention for management of high output persistent chylothorax (> 800 ml/24 h for 30 days) that did not close with conservative treatment. As the leak was isolated within left upper chest cavity, we planned to close the thoracic duct via Poirier’s triangle by uniportal thoracoscopy. However, the long conservative treatment favoured the formation of multiple, tenacious, and bleeding adhesions that made unfeasible thoracoscopy. A conversion to mini-thoracotomy was performed; by the incision of the posterior parietal pleura, the thoracic duct was isolated and ligated behind the thoracic aorta, in an anatomical space delimited by the 4th and the 5th posterior intercostal arteries and the vertebral column. Conclusions Complete resolution of chylothorax was obtained the day after. Patient was discharged on post-operative day 5, and no recurrence was observed during the follow-up. Electronic supplementary material The online version of this article (10.1186/s13019-019-0917-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Retroaortic closure of thoracic duct in the management of persistent chylothorax: a case report

Caronia¹,

Miceli²,

Macaluso³

et al. 2019

J Cardiothorac Surg

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“…The use of VATS ligation of the thoracic duct is well described (27). A left lateral decubitus position is utilised with flexion and some anterior rotation to allow access to the right posterior mediastinum.…”

Section: Traumatic Chylothoraxmentioning

confidence: 99%

“…If it is not identified all fatty and lymphatic tissue between the azygous vein, posteriorly, the oesophagus, anteriorly and the aorta/right pleura distally can be divided. The VATS approach is especially useful in this setting as it provides a 10-fold increase in magnification and the 30-degree scope allows for visualisation between the spine and the aorta where the thoracic duct can reside (27).…”

Section: Traumatic Chylothoraxmentioning

confidence: 99%

Video-assisted thoracoscopic surgery in trauma: pros and cons

2019

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Thoracic injuries account for 60% of all trauma presentations. These patients often have extrathoracic injuries adding to the complexity of their management. Morbidity and the associated mortality are significantly increased in the elderly. The majority of cases will comprise of simple rib fractures, requiring adequate analgesia. In those that require surgical intervention, the use of video-assisted thoracoscopic surgery (VATS) is becoming increasingly more popular. VATS can often provide greater visualisation of the intrathoracic structures, whilst limiting the burden of injury to smaller non-rib spreading incisions. It is therefore becoming increasingly used as a diagnostic tool to identify the extend of the injuries whilst also allowing for therapeutic intervention. These benefits translate into decreased rate of post-operative complications and a shorter length of inpatient stay. We also discuss the relative contra-indications and cautions to the use of VATS in the setting of trauma.

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“…The reason is that the descending aorta and esophagus are considered obstacles during the procedure. Excision of the inferior pulmonary ligament and reflection of the right lung provide visualization of the TD between the aorta and the esophagus, along the lateral border of the vertebra [4]. In patients with an isolated leak in the left upper chest cavity, as in our case, TD can be closed through Poirier's triangle by means of left thoracotomy or standard multiport VATS [5,6].…”

Section: Commentmentioning

confidence: 99%