Comparison of Different Pneumorrhaphy Methods after Partial Pulmonary Lobectomy in Dogs

Abstract

Pulmonary loborraphy can be performed using manual sutures and staples, although other methods, such as tissue adhesives, are also cited in the veterinary literature. Although the surgery is well tolerated in the canine species, failure in pulmonary aerostasis is still a reality since all the methods described so far eventually lead to air leakage after the use of the partial lobectomy technique in the lungs. Within this context, the aim of this research was to compare the effectiveness of different hermetic sealing methods after partial lobectomy of the right caudal lung lobe (RCLL) in dogs. 30 cadavers models were divided in 6 groups: G1-cobbler suture associated with simple continuous; G2-overlapping continuous suture associated with simple continuous suture; G3-Ford interlocking suture; G4-Stapling device; G5-Tissue glue (cyanoacrylate). After performing the sealing techniques, the lungs were submerged in water and inflated with oxygen at positive ventilatory pressures at physiological (up to 14.7 mmHg, which is equivalent to up to 20 cmH₂O) and supraphysiological levels (above 14.7 mmHg) to evaluate the performance of the sealing methods. At physiological ventilatory pressure levels, there was no difference between groups. Sealing with surgical glue was superior to interlocking sutures and stapling devices at supraphysiological levels of ventilatory pressure.

Keywords: cyanoacrylates; lungs; pneumostasis; surgical technique; tissue glue.

Figure 1

Mean and median values of the variables analyzed in the different groups (G1 = cobbler + simple continuous; G2 = overlapping continuous + simple continuous; G3 = Ford interlocking suture; G4 = staples; G5 = synthetic adhesive). Mean for the variable body weight (Kg), p = 0.1901. Medians for the variable lung lobe width (cm), p = 0.0637. Medians for variable body score of the animals, with the statistical difference between G1 and G3, p = 0.0202. Medians for the variable lung lobe height (cm), with statistical differences between G5 and G4, p = 0.0347.

Figure 2

Median burst pressures (mmHg) referring to the types of synthesis in which there was loss of pulmonary aerostasis, p = 0.0164. G1 = cobbler + simple continuous; G2 = overlapping continuous + simple continuous; G3 = Ford interlocking suture; G4 = staples; G5 = synthetic glue. * indicates significance level at 5%. The groups differ from each other at a 5% significance level.

Figure 3

(A): Photographic image of the cobbler and simple continuous suture in the lung lobe. (B): Photographic image of the RCLL (G1) showing air leakage (arrow) laterally to the suture line at supraphysiological pressure at 18 mmHg.

Figure 4

(A): Photographic image of the overlapping continuous and simple continuous suture in the lung lobe. (B): Photographic image of the RCLL (G2) showing air leakage (arrow) at supraphysiological pressure at 20 mmHg.

Figure 5

(A): Photographic image of the Ford interlocking suture in the lung lobe. (B): Photographic image of the RCLL (G3) showing air leakage (arrow) at supraphysiological pressure at 14 mmHg.

Figure 6

(A): Photographic image of the double row of staples in lung lobe lung. (B): Photographic image of the RCLL (G4) showing air leakage (arrow) at supraphysiological pressure at 19 mmHg.

Figure 7

(A): Photographic image of the Glubran-2 adhesive in the lung lobe. Note the sealant in bronchioles (arrow). (B): Photographic image of the RCLL (G5) showing air leakage (arrow) at supraphysiological pressure at 80 mmHg in a resected area during the aerostasis test.