Occlusion of the Thoracic Duct Using Ultrasonically Activated Shears in Six Dogs

Abstract

To assess the feasibility of sealing the thoracic duct (TD) in dogs using ultrasonically activated shears via thoracoscopy. In vivo experimental study. Mature dogs (n = 6). Dogs were anesthetized without pulmonary exclusion and positioned in left lateral recumbency. Lymphangiography was performed to identify TD anatomy. Methylene blue was injected into the lymphatic catheter to identify the TD and its branches. Under thoracoscopic guidance (right dorsal 8-10th intercostal spaces), the TD was sealed with an ultrasonic device and lymphangiography was repeated. If the flow of contrast continued beyond the occlusion site, additional attempts to seal the duct were made. Dogs were euthanatized, the TD was excised and fixed in formalin for histopathology. Thoracoscopic identification of the TD was possible in 5 dogs. Three dogs required conversion to a thoracoscopic-assisted approach and 3 dogs required resealing of the TD closer to the diaphragm. Thoracic duct occlusion (TDO) was ultimately achieved in all 6 dogs based on follow-up lymphangiography. TDO by tissue coagulation was confirmed by histopathology. Thoracoscopic identification and occlusion of the TD using ultrasonically activated shears with bilateral lung ventilation is technically feasible in normal dogs and provides a less invasive alternative to open thoracotomy procedures.