Electrocautery device does not provide adequate pulmonary vessel sealing in transumbilical anatomic pulmonary lobectomy.
Safe pulmonary vessel sealing device plays a crucial role in anatomic lung resection. In 2014, we reported high rates of massive bleeding complications during transumbilical lobectomy in a canine model due to difficulty in managing the pulmonary vessel with an endostapler. In this animal survival series, we aimed to evaluate the outcome of pulmonary vessel sealing with an electrocautery device to simplify the transumbilical thoracic surgery.



Under general anesthesia, a 3-cm longitudinal incision was made over the umbilicus. Under video guidance, a bronchoscope was inserted through the incision for exploration. The diaphragmatic wound was created with an electrocautery knife and used as the entrance into the thoracic cavity. Using the transumbilical technique, anatomic lobectomy was performed with electrosurgical devices and endoscopic vascular staplers in 15 canines.



Transumbilical endoscopic anatomic lobectomy was successfully completed in 12 of the 15 animals. Intraoperative bleeding developed in three animals during pulmonary hilum dissection, where one animal was killed due to hemodynamic instability and the other two animals required thoracotomy to complete the operation. There were five delayed bleeding and surgical mortality cases caused by inadequate vessel sealing by electrosurgical devices. Postmortem examination confirmed correct transumbilical lobectomy in the twelve animals that survived the operations.



Transumbilical anatomic lobectomy is technically feasible in a canine model; however, the electrosurgical devices were not effective in sealing the pulmonary vessel in the current canine model.
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Hung-Ping
HP
Liu
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Yen
Y
Chu
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Yi-Cheng
YC
Wu
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Ming-Ju
MJ
Hsieh
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Chieng-Ying
CY
Liu
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Tzu-Ping
TP
Chen
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Yin-Kai
YK
Chao
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Ching-Yang
CY
Wu
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Chi-Ju
CJ
Yeh
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC.
Po-Jen
PJ
Ko
Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University, No. 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC. zebraairmail@gmail.com.
Yun-Hen
YH
Liu
D000818:Animals; D004285:Dogs; D004564:Electrocoagulation / Q000592:standards*; D004724:Endoscopy; D023421:Models, Animal; D011013:Pneumonectomy / Q000379:methods*; D011651:Pulmonary Artery / Q000601:surgery*; D011667:Pulmonary Veins / Q000601:surgery*; D014472:Umbilicus / Q000601:surgery
Lung resection; Transumbilicus