Thoracoscopy pulmonary biopsy by two portals with a novel pre-tied loop ligature device in rabbits: an experimental study

ABSTRACT: Thoracoscopy is replacing open lung biopsies because it is less invasive, usually the technique is done using three portals and intracorporeal suture technique. This study described the feasibility and efficacy of a novel pre tied loop ligature and to propose a thoracoscopic access strategy with two portals to perform lung biopsy in patients under 5 kg. Ten rabbits were positioned in dorsal recumbency. Total thoracoscopic lung biopsy was performed using a combined transdiaphragmatic approach and a right intercostal approach. A pre tied loop ligature was placed to perform a caudal lung lobe biopsy. Insufflation of the thoracic cavity was not performed. The total surgery time was 41.4 ± 14.5 min. The procedure was carried out free of complications that prevented slippage or tightening the knot or that made it come loose after the lung biopsy; there was no serious complication during the surgical procedure. The samples obtained averaged 1x0.64x0.45 cm (Length, Width, Depth) and were considered satisfactory according to the histopathologic evaluation. Thorax radiographs taken before and after the surgeries were compared and showed no pneumothorax or hemothorax. Necropsy confirmed no knot failure occurred at the biopsy site. The use of the novel pre tied loop ligature is a safe and effective technique, avoiding problems with the limited size of the thoracic cavity in small patients.摘要：胸腔镜手术（thoracoscopy）因创伤性更低，正逐步取代开放式肺活检，该技术通常采用三通道配合体内缝合技术（intracorporeal suture technique）完成。本研究阐述了一款新型预扎环式结扎器（pre tied loop ligature）的可行性与有效性，并提出一种适用于体重5kg以下患者的两通道胸腔镜入路方案以实施肺活检。本研究共纳入10只家兔，采用背卧位（dorsal recumbency）固定。通过经膈入路（transdiaphragmatic approach）与右侧肋间入路（right intercostal approach）联合完成全胸腔镜肺活检，使用预扎环式结扎器实施肺下叶（caudal lung lobe）活检操作，未进行胸腔充气（insufflation of the thoracic cavity）。手术总时长为41.4±14.5分钟。整个操作未出现妨碍结扎环滑动、收紧或术后松脱的并发症，手术全程无严重不良事件发生。获取的活检样本平均尺寸为1×0.64×0.45cm（长×宽×深），经组织病理学评估（histopathologic evaluation）确认符合要求。对比术前与术后胸部X光片（thorax radiographs），未发现气胸（pneumothorax）或血胸（hemothorax）征象。尸检（necropsy）结果证实活检部位未出现结扎失败（knot failure）情况。该新型预扎环式结扎器的应用安全有效，可规避小型患者胸腔空间有限带来的操作难题。