title: Exploring strategies to prevent post-lobectomy space: transient diaphragmatic paralysis using Botulinum toxin type A (BTX-A).
abstract: 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.
authors.affiliation: Department of Thoracic Surgery, Pamukkale University Medical School, Denizli, Turkey. skaya@pamukkale.edu.tr
authors.forename: Seyda Ors
authors.initials: SO
authors.lastname: Kaya
authors.forename: Habip
authors.initials: H
authors.lastname: Atalay
authors.forename: Hakan Riza
authors.initials: HR
authors.lastname: Erbay
authors.forename: Ali Vefa
authors.initials: AV
authors.lastname: Ozcan
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Goksin
authors.forename: Burhan
authors.initials: B
authors.lastname: Kabay
authors.forename: Koray
authors.initials: K
authors.lastname: Tekin