Exploring strategies to prevent post-lobectomy space: transient diaphragmatic paralysis using Botulinum toxin type A (BTX-A).
OBJECTIVE
Various techniques to reduce air space after pulmonary lobectomy especially for lung cancer have been an important concern in thoracic surgical practice. The aim of this study was to assess the effectiveness of Botulinum toxin A (BTX-A) injection into the diaphragm to reduce air space after right lower pulmonary lobectomy in an animal model.


METHODS
Twelve male New Zealand rabbits were randomly allocated into two groups. All animals underwent right lower lobectomy. Then, normal saline of 0,1 ml and 10 units of 0,1 ml Botulinum toxin type A were injected into the muscular part of the right hemidiaphragm in control (n = 6) and BTX-A groups (n = 6) respectively. Residual air space and diaphragmatic elevation were evaluated with chest X-ray pre- and postoperatively. Diaphragmatic elevation was measured as a distance in millimetre from the line connecting the 10th ribs to the midpoint of the right hemidiaphragm.


RESULTS
The mean diaphragmatic elevation in BTX-A and control groups were 7.0 +/- 2.5 and 1.3 +/- 1.2 millimetres respectively. Diaphragmatic elevations were significantly higher in BTX-A group (p = 0.0035).


CONCLUSIONS
Intraoperative Botulinum toxin type A injection may reduce postlobectomy spaces effectively via hemidiaphragmatic paralysis in rabbits. Further studies are needed to validate the safe use of Botulinum toxin type A in human beings.
Kaya
Seyda Ors
SO
Department of Thoracic Surgery, Pamukkale University Medical School, Denizli, Turkey. skaya@pamukkale.edu.tr
Atalay
Habip
H
Erbay
Hakan Riza
HR
Ozcan
Ali Vefa
AV
Goksin
Ibrahim
I
Kabay
Burhan
B
Tekin
Koray
K