Cirurgia torácica video assistida sem intubação seletiva com acesso modificado para sutura do esôfago caudal em cães

Abstract

The objective of this experiment was to evaluate two esophagotomy thoracoscopic techniques without selective intubation. In order to do that eight dogs were divided in two groups. Thoracoscopy were performed in the right side of the thoracic wall to approach the caudal portion of the esophagus. The triangulation of the portals was made as the original technique from Freeman et al (1999), on the dogs from group 1. There were modifications on the portals made on the group 2. After esophagotomy was done, the simple continuous suture of the esophagus was made using poliglactyn 910, in a single layer. Esophagogram was made after three and fourteen days following surgeries, in order to evaluate further surgical complications. The esophagotomy could be executed in both groups. Due to over manipulation of the suture material in two surgeries of the group 1, the suture had broken and the maneuvers had to be redone. This same problem occurred in one dog from the group 2. Although the lungs were in the surgical field, especially on the group 1, there were no major difficulties to perform the surgeries without lung exclusion. One surgery on of the group 1 had to be converted to thoracotomy due to hemorrhage, but it wasn t related to the technique. Two dogs developed pneumonia in the postoperative period. All animals survived the surgeries and they were adopted after the evaluation stage. The radiographic studies performed after the surgeries did not show any leakage in the thoracic cavity. The instrumental interaction presented advantages in group 2 comparing with group 1. The suture maneuvers were more difficult on group 1 due to the instruments angles related to the esophagus and the endoscope. Esophageal suture from the caudal portion of the thoracic esophagus with can be effectively done using both approaches through video assisted thoracic surgery, although the modified technique presented minimal interference between the instruments when suturing the esophagus and the selective intubation was not necessary.