Wormser Chloe, Singhal Sunil, Holt David E, Runge Jeffrey J
Section of Surgery, Matthew J. Ryan Veterinary Hospital, Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.
J Am Vet Med Assoc. 2014 Nov 1;245(9):1036-41. doi: 10.2460/javma.245.9.1036.
To describe the use of thoracoscopic-assisted pulmonary surgery (TAPS) for partial and complete lung lobectomy in small animal patients and to evaluate short-term outcome.
Retrospective case series.
11 client-owned dogs and cats. Procedures-Medical records of dogs and cats that underwent a partial or complete TAPS lung lobectomy were reviewed. All patients underwent general anesthesia and were positioned in lateral recumbency with the affected hemithorax uppermost. One-lung ventilation was not implemented in any patient. For initial exploration, a 5- to 10-mm incision was made for insertion of a 30° telescope approximately 5 to 7 rib spaces away from the site of the pulmonary lesion in the dorsal third of the thorax. All subsequent incision placements were case dependent and determined by the location of the lesion to be resected. Following lesion localization, a 2- to 7-cm minithoracotomy incision was made with direct thoracoscopic visualization without the use of rigid rib retractors. In 10 of 11 patients, a 360° wound retraction device was placed at the minithoracotomy site prior to exteriorization and resection of the affected lung. Lymph nodes were inspected intraoperatively, but biopsies were not performed; incisions were closed routinely, and a thoracostomy tube was placed in all patients.
3 cats and 8 dogs underwent successful partial (5) or complete (6) TAPS lung lobectomy over a 5-year period (2008 through 2013). Median surgery time was 92.7 minutes (range, 77 to 150 minutes). Thoracostomy tubes were removed a median of 22.3 hours after surgery (range, 18 to 36 hours). The median time to discharge was 3.1 days (range, 1 to 6 days). No intraoperative complications were encountered. All patients were discharged from the hospital, with 9 of 11 patients alive 6 months after surgery.
Results of this study suggested that lung lobectomy by means of TAPS can be successfully performed in dogs and cats. When compared with total thoracoscopic surgery, TAPS may offer a more technically feasible approach from both a surgical and anesthetic standpoint, because it provides the benefits of minimally invasive thoracic surgery without the necessity of 1-lung ventilation.
描述胸腔镜辅助肺手术（TAPS）在小动物患者中用于部分和全肺叶切除的应用，并评估短期结果。
回顾性病例系列。
11只客户拥有的犬猫。
回顾接受部分或完全TAPS肺叶切除的犬猫的病历。所有患者均接受全身麻醉，患侧胸部朝上侧卧。所有患者均未实施单肺通气。初始探查时，在胸部背侧距肺部病变部位约5至7个肋间隙处做一个5至10毫米的切口，插入30°胸腔镜。所有后续切口位置视具体病例而定，由待切除病变的位置决定。确定病变位置后，在胸腔镜直视下做一个2至7厘米的小开胸切口，不使用刚性肋骨牵开器。11例患者中有10例，在将患肺牵出并切除之前，在小开胸切口处放置了360°伤口牵开装置。术中检查了淋巴结，但未进行活检；切口常规缝合，所有患者均放置了胸管。
在五年期间（2008年至2013年），3只猫和8只犬成功接受了部分（5例）或完全（6例）TAPS肺叶切除。中位手术时间为92.7分钟（范围为77至150分钟）。胸管在术后中位22.3小时（范围为18至36小时）拔除。中位出院时间为3.1天（范围为1至6天）。术中未出现并发症。所有患者均出院，11例患者中有9例术后6个月存活。
本研究结果表明，TAPS肺叶切除在犬猫中可成功实施。与全胸腔镜手术相比，从手术和麻醉角度来看，TAPS可能提供一种技术上更可行的方法，因为它提供了微创胸外科手术的益处，而无需单肺通气。
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