Multimedia article. Prone thoracoscopic thoracic duct ligation for postsurgical chylothorax

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Gastrointestinal Surgery

Background:

• Chylothorax is a serious complication after thoracic and abdominal surgeries, with high mortality if untreated.
• Esophagectomy is a common cause of iatrogenic chyle leaks, leading to malnutrition and immunocompromise.
• Nonoperative management often fails, necessitating surgical intervention.

Purpose of the Study:

• To present a novel prone thoracoscopic approach for thoracic duct ligation.
• To evaluate the efficacy and safety of this minimally invasive technique in patients with chylothorax post-esophagectomy.

Main Methods:

• The study involved two patients who underwent prone thoracoscopic thoracic duct ligation after laparoscopic transthoracic esophagectomy and hernia repair.
• The procedure utilized gravity, carbon dioxide insufflation, and three trocars for efficient lung collapse and surgical access.

Main Results:

• Thoracic duct ligation was successfully completed in both patients using the prone thoracoscopic technique.
• Both patients experienced complete resolution of chylothorax and uneventful recovery.
• The prone position facilitated excellent surgical exposure of the diaphragmatic hiatus.

Conclusions:

• Prone thoracoscopic thoracic duct ligation is a safe and effective minimally invasive treatment for chylothorax.
• This technique offers significant patient benefits by timely addressing chyle leaks and preventing severe complications.
• The prone position and CO2 insufflation simplify the surgical procedure, making thoracic duct ligation more accessible.