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犬类单切口剑突下入路胸腔镜手术的可行性

Feasibility of the single-incision subxiphoid approach for video-assisted thoracoscopic surgery in dogs.

作者信息

Gordo I, Hubers M, Bird F G, Camarasa J J, Richard M, de Vicente F, Vallefuoco R, Brissot H N

机构信息

Surgery Department, Pride Veterinary Centre, Derby, DE24 8HX, UK.

Surgery Department, Medisch Centrum voor Dieren, 45 1014, Amsterdam, Netherlands.

出版信息

J Small Anim Pract. 2020 Aug;61(8):480-486. doi: 10.1111/jsap.13174. Epub 2020 Jul 17.

Abstract

OBJECTIVES

To report early results of uniportal video-assisted thoracoscopic surgery in dogs using a single-incision subxiphoid approach.

MATERIALS AND METHODS

Retrospective study of 10 client-owned dogs with: pyothorax (n=5), pericardial effusion (n=2), bilateral pneumothorax (n=1), retained surgical swab (n=1), cranial mediastinal mass (n=1). With the dog in dorsal recumbency a 3-4 cm incision was made over the xiphoid process. After resection of the xiphoid process, a tunnel was created towards the pleura and open access maintained with an Alexis™ wound retractor. The pleural cavity was explored with a 10 mm 30° or 5 mm 0° telescope and straight laparoscopic instruments.

RESULTS

Median surgical time was 75 minutes. The SISA technique was performed successfully in five of 10 cases and allowed easy and adequate inspection of the intra-thoracic structures. One case was converted to lateral thoracotomy after laceration of the vena cava and one converted to median sternotomy because of adhesions. An additional port was placed in three cases to facilitate triangulation and surgical manipulation. No other intra-operative complications were encountered.

CLINICAL SIGNIFICANCE

In this initial report of uniportal thoracic approach in dogs, this technique allowed excellent access and treatment of mediastinal structures. Further cases are required to assess its suitability for pulmonary surgery.

摘要

目的

报告采用剑突下单切口入路的单孔电视辅助胸腔镜手术在犬类中的早期结果。

材料与方法

对10只客户拥有的犬进行回顾性研究,这些犬患有:脓胸(n = 5)、心包积液(n = 2)、双侧气胸(n = 1)、手术拭子残留(n = 1)、前纵隔肿块(n = 1)。将犬仰卧位,在剑突上做一个3 - 4厘米的切口。切除剑突后,向胸膜创建一个通道,并用Alexis™伤口牵开器保持开放通路。用10毫米30°或5毫米0°的望远镜和直的腹腔镜器械探查胸膜腔。

结果

中位手术时间为75分钟。10例中有5例成功实施了单孔胸腔镜辅助手术(SISA)技术,能够轻松且充分地检查胸腔内结构。1例因腔静脉撕裂而转为侧胸切开术,1例因粘连而转为正中胸骨切开术。3例额外放置了一个端口以利于三角定位和手术操作。未遇到其他术中并发症。

临床意义

在这份关于犬类单孔胸腔入路的初步报告中,该技术能够很好地进入并处理纵隔结构。需要更多病例来评估其对肺部手术的适用性。

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