Thoracotomy / Sternotomy

3 Port VATS
Open vs VATS
Size of incision 10 14 inches Approx 1 inch
Average hospital stay 7 10 days Less than 4 days
Return to work /
normal routine
6 8 weeks 7 10 days
Major complications 30% Less than 5%
Objectives
!une 2010 - !anuary 2013
vA1S Llgauon of 1horaclc ducL
8 cases
8obouc: 2 cases
Operative protocol
Llgauon of Lhoraclc ducL
leurecLomy
1 case 1alc pleurodesls
Diagnosis
osL CA8C: 2 pauenLs
Lymphoma: 2 pauenLs
8adlcal neck ulssecuon: 1 pauenL
osL paedlaLrlc cardlac Surgery: 2 pauenLs
osL oesophagecLomy: 1 pauenL
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Conservative Protocol
1rlglycerlde level ln leural lluld
laL lree uleL
lv arenLeral nuLrluon
lv CcLreoude
1alc leurodesls vla draln
Operative Indications
lalled conservauve
managemenL
osLoperauve pauenL wlLh
known Lhoraclc ducL ln[ury
Operative Protocol
reoperauve cream vla nC Lube
3 porLs vA1S
8lghL slde
Mass llgauon of ussue beLween AorLa & Cesophagus
Addluonal leurecLomy / leurodesls
+(,, -./(0%1 %2 3"%'(4.4 564&
+(,, -./(0%1 %2 3"%'(4.4 564&
7.89%: ;%<%04 -./(0%1 %2 3"%'(4.4
564&
Interesting case
1 day osL CA8C, LlMA-LAu, SvC
2 LlLres of Chyle ln le pleura
Le vA1S
Leak from area of LlMA harvesL aL apex of chesL
Interesting case
8lood paLch / Surglcel applled
Cn Lable: leak sLopped
ChesL draln removed aer 2 days followlng
pleurodesls
Postoperative Management
Medela ulglLal Sucuon uraln
no alr leak on nexL day
uraln removed aL leak < 20
Medela Digital Drain
122 cases
Lasy Lo moblllse
ConslsLenL sucuon
LxacL measuremenL of alr leak
Video: Medela Digital Drain
auenL moblllslng wlLh dlglLal draln
VATS Chylothorax: Results
lmmedlaLe resoluuon of ChyloLhorax: 6
Mean PosplLal SLay: 3 days
2 pauenLs: Lymphoma- 8ecurrenL chyloLhorax
Chyle > 200mls per day
8epeaL 1alc leurodesls
VATS Chylothorax: Advantages
Cood Locallsauon / 8euer vlslon
ShorL PosplLal sLay
Less paln
Cosmeucally accepLable
Low morbldlLy
AblllLy Lo record for Leachlng purpose
Conclusion
vA1S: AccuraLe locallsauon of chyle leak
reoperauve cream alds locallsauon
Mass Llgauon of Lhoraclc ducL
Addluon of leurecLomy/ leurodesls