Thoracoscopic management of cervical thoracic duct injuries after thyroidectomy with lymphadenectomy.
We present a case of postoperative cervical chylous fistula after neck dissection of advanced thyroid carcinoma that was managed successfully by thoracoscopic ligation of the thoracic duct. A double lumen endobronchial tube was introduced for selective single-lung ventilation with the patient under general anesthesia. The patient was placed in the left decubitus position. Four thoracoports were introduced in the collapsed right lung. The thoracic duct was ligated at two points, and two clips were applied. Postoperatively, neck drainage ceased immediately. The chest tube and closed neck drains were removed on postoperative days 2 and 8, respectively. The patient was discharged on postoperative day 9. Thoracoscopy is a safe and effective treatment of chylous fistula in the neck. Compared to the open procedure, the minimally invasive thoracoscopic approach causes less pain and fosters faster rehabilitation and recovery.
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Yoshifumi
Y
Ikeda
D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D008206:Lymphatic Diseases / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects*; D013897:Thoracic Duct / Q000293:injuries* / Q000601:surgery; D013906:Thoracoscopy / Q000379:methods*; D013965:Thyroidectomy / Q000009:adverse effects*
Cervical thoracic duct injury; thoracoscopic approach; thyroidectomy