The feasibility and effectiveness of thoracoscopic transdiaphragmatic approach for lung biopsy in rabbits. A randomized study.

Monica Carolina Nery Wittmaack,Renata Sitta Gomes Mariano,Paloma Do Espírito Santo Silva,Paola Castro Moraes,Guilherme Sembenelli,Pedro Paulo Maia Teixeira,Andresa Matsui,Felipe Farias Pereira Da Câmara Barros

doi:10.1590/s0102-865020200050000001

Abstract

Purpose To assess the feasibility of thoracoscopic transdiaphragmatic approach for biopsy of all lung lobes and to determine the optimal intercostal space (ICS) for biopsy of each lung lobe.Methods Ten rabbits were positioned in dorsal recumbency. Total thoracoscopy lung biopsy was made combined transdiaphragmatic approach and right ICS approaches. A camera port was made in the transdiaphragmatic approach and the instrument port was made of ICS 7 and ICS 9. A pre tied loop ligature was placed to performed a caudal lung lobe biopsy and to simulate biopsies of the others lung lobes.Results Biopsy of the cranial aspect of the right caudal lung lobe was performed at ICS 9. Simulated biopsy of the accessory lung lobe was performed at ICS 9. Simulated lung biopsy of the right cranial and middle lung lobes was performed at ICS 7. The caudal and dorsal aspect of the right caudal lung lobe was not visualized by telescope at transdiaphragmatic approach, and biopsy was not performed.Conclusions Thoracoscopic transdiaphragmatic approach for lung lobes biopsies was a feasible technique, except for the caudal aspect of the right caudal lung lobe. An ideal intercostal port for biopsy of each right lung lobe was determined.

Highlights

IntroductionMany prospective, randomized studies confirmed that thoracoscopy reduces postoperative pain, minimizes pulmonary dysfunction and shortens hospital stay[1,2]
Thoracoscopy is less invasive than open procedures
Simulated biopsy of the accessory lung lobe was performed at intercostal space (ICS) 9

Summary

Introduction

Many prospective, randomized studies confirmed that thoracoscopy reduces postoperative pain, minimizes pulmonary dysfunction and shortens hospital stay[1,2]. There has been an increasing enthusiasm for the thoracoscopic transdiaphragmatic approach. Decrease intercostal approaches will reduce postoperative pain[3,4,5]. A thoracoscopic lung biopsy is considered to be the gold standard and is often suggested to clarify the diagnosis of a wide variety of lung diseases[6]. Previous studies have reported the feasibility of a transdiaphragmatic approach for the lung biopsies for multiple lung involvement[7,8]. A randomized study that confirms the biopsy of all pulmonary lobes via transdiaphragmatic approach in small animals has not yet been performed

Methods

Discussion

Conclusion