RAPID MILLER'S KNOT METHOD FOR EMERGENCY LUNG LOBE REMOVAL

Authors

  • DT Crowe

    1. Veterinary Surgery, Emergency and Critical Care Consulting, Athens, GA; All Pets Emergency and Referral Center, PC, Alpharetta, GA; Craig Road Animal Hospital, Las Vegas, NV; Institute of Critical Care Medicine, Palm Springs, CA
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Abstract

A simple and rapid technique for the emergency removal of lung lobes was developed. It has been used successfully in 2 cats and 10 dogs without complications being recognized in any, with a minimum follow-up of four months. The purpose of this abstract is three-fold: 1) To briefly describe how the technique was done; 2) To describe the results of the use of the technique in these 14 emergency cases; and 3) Provide recommendations for the continued use of the technique in emergency cases.

Method: The lung lobe requiring removal was selected and elevated; soft connective tissues around the lung lobe base were separated from the main pedicle using a fine curved scissors. With mild traction applied, 3 curved Halstead or Kelly hemostatic forceps were applied across the entire pedicle, one right after the other except for a break between the last 2 distal clamps. The lung lobe was removed by cutting the entire pedicle with a Metzenbaum scissors between the distal most clamps. The tips of the scissors were tilted slightly to produce a “tissue bumper” of 1–3 mm above the distal most hemostatic forceps left. A Miller's knot of 3–0 to 2–0 polypropylene (cats and very small dogs) and 0 to 1 polypropylene (medium to large dogs) was applied around the entire pedicle under the clamps and tightened as the proximal most clamp was loosened briefly (flashed). The ends of the suture were continued to be carried around the pedicle in the direction they were coursing and then tied. A third ligation of the polypropylene was completed in large pedicles or where added security was deemed necessary such as in cases with a torn lung lobe due to trauma.

Results: The procedure was used in emergency lung lobectomy in 2 cats involving 3 lobes and in 10 dogs. The reasons for emergency lobectomy were lung consolidation in 4 dogs (involving 6 lobes), trauma with severe tears or openings in 4 dogs (involving 6 lobes), a leaking congenital bulla in 1 dog, and 1 abscess/foreign body (wooden stick). Time taken to perform a lobectomy with this technique ranged from 3–7 minutes. No leaks or complications with the pedicle have been observed in any of the cases. Because only limited dissection is needed to perform the lobectomy, the author recommends this method over conventional lobectomy where artery, bronchus and vein are all managed individually.

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