Video-Assisted Thoracoscopic Extirpation of the Tracheobronchial Lymph Nodes in Dogs.

Steffey, Michele A; Daniel, Leticia; Mayhew, Philipp D; Affolter, Verena K; Soares, Joao H N; Smith, Andrea

OBJECTIVE To describe a technique for video-assisted thoracoscopic surgery (VATS) extirpation of the tracheobronchial lymph nodes (TBLN), and to describe the quality of biopsy specimens obtained. DESIGN Experimental study. ANIMALS Purpose-bred male hound-mix research dogs (n = 8). METHODS Dogs were randomized to groups of left-sided or right-sided VATS approaches. One lung ventilation was used and TBLN dissection was achieved using a vessel-sealing device. RESULTS TBLNs ipsilateral to the approach were successfully identified and removed thoracoscopically in 7 dogs. A 3-port technique was used in 6 dogs and 4 ports were used in 2 dogs. Observed complications included mild-moderate hemorrhage from the perinodal tissue controlled thoracoscopically (n = 2), inability to locate any TBLN (1), and difficulty achieving or maintaining one-lung ventilation (4). No other major complications occurred and all dogs recovered uneventfully. Median percentage surface area of the bisected lymph nodes affected by crush artifact was 20% (range, 0-40%). Areas of crush artifact were present in central (7/11) and peripheral (9/11) locations. CONCLUSIONS AND CLINICAL RELEVANCE Thoracoscopic TBLN extirpation is a feasible technique in dogs with normal TBLN and may be useful for obtaining more detailed staging on microscopic disease status in oncologic patients with normal-sized TBLNs. Further study is warranted to determine the feasibility and limitations of this technique in clinical patients with overt lymphadenopathy.