Abstract
ObjectiveVarious techniques to reduce air space after pulmonary lobectomy especially for lung cancer have been an important concern in thoracic surgical practice. The aim of this study was to assess the effectiveness of Botulinum toxin A (BTX-A) injection into the diaphragm to reduce air space after right lower pulmonary lobectomy in an animal model.MethodsTwelve male New Zealand rabbits were randomly allocated into two groups. All animals underwent right lower lobectomy. Then, normal saline of 0,1 ml and 10 units of 0,1 ml Botulinum toxin type A were injected into the muscular part of the right hemidiaphragm in control (n = 6) and BTX-A groups (n = 6) respectively. Residual air space and diaphragmatic elevation were evaluated with chest X-ray pre- and postoperatively. Diaphragmatic elevation was measured as a distance in millimetre from the line connecting the 10th ribs to the midpoint of the right hemidiaphragm.ResultsThe mean diaphragmatic elevation in BTX-A and control groups were 7.0 ± 2.5 and 1.3 ± 1.2 millimetres respectively. Diaphragmatic elevations were significantly higher in BTX-A group (p = 0.0035).ConclusionIntraoperative Botulinum toxin type A injection may reduce postlobectomy spaces effectively via hemidiaphragmatic paralysis in rabbits. Further studies are needed to validate the safe use of Botulinum toxin type A in human beings.
Highlights
Lung resection alone is the most effective therapy for the patients with non-small cell lung carcinoma limited to the lung without distant metastasis
The aim of our present study was to evaluate whether Botulinum toxin type A (BTX-A) can be effective for hemidiaphragmatic paralysis to prevent postlobectomy space in an animal model
Two animals in BTX-A group had about less than 10% increase in respiratory rate at the 3rd day and normalised at the 4th day (From about 70 to 80 breaths per minutes)
Summary
Lung resection alone is the most effective therapy for the patients with non-small cell lung carcinoma limited to the lung without distant metastasis. Complete resection is the goal of all operations for lung cancer. Every patient with locoregional lung cancer should be approached as a potential candidate for resection. For patients with adequate lung function, the current standard cancer resections include lobectomy, bronchoplastic lobectomy, bilobectomy and pneumonectomy, based on the extent of (page number not for citation purposes). BTX-A is currently used for cosmetic and therapeutic goals for years, but to our knowledge, has not been reported for the treatment of postlobectomy spaces in literature so far. The aim of our present study was to evaluate whether BTX-A can be effective for hemidiaphragmatic paralysis to prevent postlobectomy space in an animal model
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