scholarly journals Perirectal injection of imaging materials for computed tomographic lymphography and near infrared fluorescent thoracoscopy in cats

2019 ◽  
Vol 64 (No. 8) ◽  
pp. 342-347
Author(s):  
K Kamijo ◽  
E Kanai ◽  
M Oishi ◽  
N Ichihara ◽  
M Asari ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Thoracic Duct ◽  
Near Infrared ◽  
Common Procedure ◽  
Invasive Approach ◽  
Computed Tomographic ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Ct Lymphography

For the treatment of chylothorax, the most common procedure is a thoracic duct ligation; however, recurrence of the issue is often common, generally due to the incomplete ligation of all thoracic duct tributaries. Therefore, accurate localisation of the thoracic duct tributaries is required to determine the ligation sites in each patient. The concept of the perirectal injection of the imaging materials, which provides a simple and minimally invasive approach, is investigated for computed tomographic (CT) lymphography and near infrared fluorescent thoracoscopy in cats. Three clinically healthy cats were used for the CT lymphography, and two clinically healthy cats were used for the near infrared fluorescent thoracoscopy. Iodine contrast agent for the CT or indocyanine green for the thoracoscopy was injected subcutaneously into the peri-anal tissue. The injection site was massaged for 5 min post-injection. However, in the indirect injection of the imaging materials, in three iohexol-administered cats, the abdominal lymphatics, cisterna chyle, and thoracic duct could be depicted by the CT lymphography; and in both indocyanine green-administered cats, the thoracic duct was depicted running alongside the aorta by the near infrared fluorescent thoracoscopy. The ideal imaging procedure for the thoracic duct ligation involves the pre-operative CT lymphography of the entire pathway of the lymphatic vessels in advance, followed by the direct visualisation using a thoracoscopy. A combined CT lymphography and thoracoscopy could be a reliable method for successful surgeries. Crucially, the subcutaneous peri-anal injection of a contrast/dye provides a simple and minimally invasive method for the pre-operative and intra-operative depiction of the lymphatic pathways.

scholarly journals Video-assisted thoracoscopic thoracic duct ligation with near-infrared fluorescence imaging with indocyanine green

2019 ◽  
Vol 45 (4) ◽  
Author(s):  
Benoit Jacques Bibas ◽  
Rafael Lucas Costa-de-Carvalho ◽  
Flavio Pola-dos-Reis ◽  
Leticia Leone Lauricella ◽  
Paulo Manoel Pêgo-Fernandes ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Thoracic Duct ◽  
Near Infrared ◽  
Near Infrared Fluorescence ◽  
Video Assisted ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Near Infrared Fluorescence Imaging

Thoracic duct injury after decortication of lung, new technique to repair thoracic duct in this challenging situation: A case report

2021 ◽  
pp. 021849232199708
Author(s):  
Nandkishore Kapadia ◽  
Saumya Sekhar Jenasamant ◽  
Ganesh Sohan Singh Rawat ◽  
Shailesh Kamkhedkar ◽  
Pratik Shah ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Left Lung ◽  
Lower Lobe ◽  
Late Complications ◽  
Patch Repair ◽  
Double Lumen Tube ◽  
Complex Case ◽  
Thoracic Duct Injury ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

Background Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Very few patients respond to conservative line of therapy. Thoracic duct ligation is often the treatment of choice in post-surgical patients; however, the optimal treatment of this disease process after traumatic injury remains unclear. Case presentation: We present the case of a 46-year-old woman with thoracic duct injury secondary to decortication for post-pneumonic empyema. Conservative therapy and pleurodesis done twice failed. She developed severe cachexia losing 15 kg in 30 days. She was referred to our center for ligation of thoracic duct. Preoperative lymphangiography located the duct injury in upper part of mediastinum. Computerized tomography scan of chest showed collapse of left lower lobe and thickened left pleura, indicating a significant pericardial effusion. She underwent decortication of left lung, pericardial window, and native pericardial patch repair of thoracic duct. Results and Conclusions: In this unusual and complex case, successful resolution of the chyle leak was achieved with new surgical technique of patch repair. The patient recovered well and was now on a normal diet. She has put on 12 kg in four months. We have avoided late complications of thoracic duct ligation by this technique. This nouvelle technique may be recommended as it is simple and effective. Ligation of thoracic duct carries late complications. Isolating right lung by double lumen tube may cause severe hypoxia as left-sided lung is not expanded as in this case.

665 PROPHYLACTIC THORACIC DUCT OBSTRUCTION DURING ESOPHAGECTOMY: THE IMPACT ON PERIOPERATIVE RISKS AND LONG-TERM SURVIVAL. A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Clara Santos ◽  
Laura Santos ◽  
Leticia Datrino ◽  
Guilherme Tavares ◽  
Luca Tristão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Thoracic Duct ◽  
Meta Analysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

Abstract   During esophagectomy for cancer, there is no consensus if prophylactic thoracic duct ligation (TDL), with or without thoracic duct resection (TDR), could influence the perioperative outcomes and long-term survival. This systematic review and meta-analysis compared patients who went through esophagectomy associated or not to ligation or resection of the thoracic duct. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central and Lilacs (BVS). The inclusion criteria were: (1) studies that compare thoracic duct ligation, with or without resection, and non-thoracic duct ligation; (2) involve adult patients with esophageal cancer; (3) articles that analyses the outcomes—perioperative complications, perioperative mortality, chylothorax development and overall survival; (4) only clinical trials and cohort were accepted. A 95% confidence interval (CI) was used, and random-effects model was performed. Results Fifteen articles were selected, comprising 6,249 patients. TDL did not reduce the risk for chylothorax (Risk difference [RD]: -0.01; 95%CI: −0.02, 0.00). Also, TDL did not influence the risk for complications (RD: -0.02; 95%CI: −0.11, 0.07); mortality (RD: 0.00; 95%CI: −0.00, 0.00); and reoperation rate (RD: -0.01; 95%CI: −0.02, 0.00). TDR was associated with higher risk for postoperative complications (RD: 0.1; 95%CI 0.00, 0.19); chylothorax (RD: 0.02; 95%CI 0.00, 0.03). Both TDL and TDR did not influence the overall survival rate (TDL: HR: 1.17; 95%CI: 0.86, 1.48; and TDR: HR: 1.16; 95%CI: 0.8, 1.51). Conclusion Thoracic duct obliteration with or without its resection during esophagectomy does not change long term survival. Nonetheless, TDR increased the risk for postoperative complications and chylothorax.

scholarly journals Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

2020 ◽  
Vol 8 (2) ◽  
pp. 767
Author(s):  
Oluwaseun R. Akanbi ◽  
Swaminathan Vaidyanathan ◽  
Prakash Agarwal ◽  
Janeel Musthafa ◽  
Neville A. G. Solomon
Keyword(s):  
Thoracic Duct ◽  
Medium Chain Triglyceride ◽  
Cystic Lymphangioma ◽  
Satisfactory Outcome ◽  
Thoracic Duct Ligation ◽  
Risk Of Mortality ◽  
Duct Ligation ◽  
Surgical Options ◽  
Polytetrafluoroethylene Patch ◽  
Substantial Morbidity

Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.

Uniportal video-assisted thoracoscopic surgery right thoracic duct ligation

ASVIDE ◽  
2021 ◽  
Vol 8 ◽  
pp. 056-056
Author(s):  
Pei Fern Koh ◽  
Narasimman Sathiamurthy ◽  
Nguk Chai Diong ◽  
Benedict Dharmaraj
Keyword(s):  
Thoracic Duct ◽  
Thoracoscopic Surgery ◽  
Video Assisted ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Video Assisted Thoracoscopic Surgery

Laparoscopic Transhiatal Thoracic Duct Ligation for Chylothorax after Esophagectomy

2019 ◽  
Vol 67 (07) ◽  
pp. 606-609 ◽  
Author(s):  
Yukinori Yamagata ◽  
Kazuyuki Saito ◽  
Kosuke Hirano ◽  
Masatoshi Oya
Keyword(s):  
Esophageal Cancer ◽  
Conservative Treatment ◽  
Thoracic Duct ◽  
Thoracic Cavity ◽  
Transthoracic Approach ◽  
Thoracic Esophageal Cancer ◽  
Transhiatal Approach ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Laparoscopic Transhiatal Approach

AbstractIn esophagectomy for thoracic esophageal cancer, chylothorax may develop at a certain frequency. For chylothorax, conservative treatment is selected first, but if it is not improved, thoracic duct (TD) ligation is considered. In general, transthoracic approach is chosen to reach the TD. However, it is sometimes difficult to identify the TD due to adhesion in the thoracic cavity. Hence, we selected a laparoscopic transhiatal approach to the TD. We introduce the procedure of our laparoscopic transhiatal TD ligation technique.

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