Thoracoscopic lobectomy with endoarterial vascular control: an experimental study in swine.
BACKGROUND
Video-assisted lobectomy lacks vascular control and presents the potential for serious hemorrhage in a closed cavity. The use of a lighted, flow-directed balloon catheter in the pulmonary artery as an endovascular control device was evaluated.


METHODS
A modified light-bearing Swan-Ganz catheter was placed in the left or right pulmonary artery using fluoroscopy. The lit catheter was identified easily through the arterial wall at thoracoscopy. Its inflation allowed the control of proximal blood flow as required. Fully thoracoscopic lobectomy was carried out by isolating and dividing the lobar branches of the pulmonary artery, the pulmonary vein, and the bronchus in anesthetized swine.


RESULTS
Forty-two video-assisted anatomic lobectomies were completed in 30 pigs with balloon catheter control of the pulmonary artery. The balloon effectively controlled experimental hemorrhage caused by puncturing arterial branches (n = 4). It allowed the transection of unlooped lobar arteries (n = 42) and the main interlobar pulmonary artery (n = 3). Catheter displacement back to the heart occurred in 5 animals and balloon catheter technical failures occurred in 3.


CONCLUSIONS
The lighted, flow-directed balloon catheter was an effective means of avoiding acute hemorrhage and achieving vascular control in a swine lobectomy model.
Conlan
A A
AA
Division of Cardiac and Thoracic Surgery, University of Massachusetts Medical Center, Worcester 01655-0304, USA. alan.conlan@banyan.ummed.edu
Hsi
C
C
Soller
B R
BR
BelleIsle
J M
JM
Vander Salm
T J
TJ
D000818:Animals; D002407:Catheterization, Swan-Ganz; D004724:Endoscopy / Q000379:methods*; D006470:Hemorrhage / Q000517:prevention & control; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D007431:Intraoperative Complications; D011013:Pneumonectomy / Q000379:methods*; D011651:Pulmonary Artery; D013552:Swine; D013906:Thoracoscopy; D014741:Video Recording