Feasibility of transumbilical anatomic pulmonary lobectomy in a canine model

• Published in: Surgical endoscopy Vol. 28; no. 10; pp. 2980 - 2987
• Main Authors: Yin, Shun-Ying, Chu, Yen, Wu, Yi-Cheng, Yeh, Chi-Ju, Liu, Chien-Ying, Hsieh, Ming-Ju, Liu, Yun-Hen
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.10.2014; Springer Nature B.V
• Subjects: Abdominal Surgery; Animals; Blood Gas Analysis; Blood Loss, Surgical; Body Temperature; Diaphragm - surgery; Dissection; Dogs; Endoscopy; Endoscopy - adverse effects; Endoscopy - methods; Feasibility Studies; Gastroenterology; Gynecology; Hepatology; Leukocyte Count; Lung - surgery; Lung cancer; Lymphatic system; Male; Medicine; Medicine & Public Health; Models, Animal; Operative Time; Ostomy; Proctology; Pulmonary arteries; Rectum; Respiratory Rate; Surgery; Surgical outcomes; Surgical techniques; Thoracic surgery; Umbilicus - surgery; Veins & arteries; United States > US; Japan; Taiwan; Surgical; Endoscopy; Technical; Thoracoscopy
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-014-3561-3

Purpose Transthoracic thoracoscopic lobectomy is the preferred method of surgical treatment for early lung cancer. Current methods require a transthoracic approach and are associated with chronic postoperative pain in up to 25 % of patients. Single-port transumbilical uniport surgery may offer advantages over multiport surgery with less postoperative pain and better cosmetic results. The aim of this study was to evaluate the feasibility of a transumbilical anatomic lobectomy of the lung (TUAL) in a canine model. Methods TUAL was performed in 12 beagle dogs using a 3-cm umbilical incision combined with a 2.5-cm diaphragmatic incision. Variables evaluated for surgical outcomes were operating time, operative complications, body rectal temperature, respiratory rate, white blood cell count, and arterial blood gases. Results TUAL was successfully completed in ten animals. There were six bleeding complications related to surgery. In four animals, an avulsion of pulmonary vessel causes intraoperative bleeding, requiring simultaneous pulmonary artery and bronchus resections. In one animal, slipping of endoclip after vessel clipping caused perioperative bleeding. The other animal encountered bleeding complication during dissection of inferior pulmonary vein. Both animals required conventional thoracotomy to complete the surgery. Conclusions TUAL in the canine model is feasible but associated with significant morbidity. With further development and refinement of instruments, comparative studies between the novel transumbilical lobectomy and the current video-assisted transthoracic lobectomy will clarify the role of transumbilical lobectomy in thoracic surgery.