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Robotic Ligation of Thoracic Duct

Monday, August 13, 2018

Steinberg BM, Biswas KS. Robotic Ligation of Thoracic Duct. August 2018. doi:10.25373/ctsnet.6912884.

A 41-year-old woman developed high output (2 L/day) left chylothorax following the resection of a bronchogenic cyst. Treatment with octreotide (100 mcg SC bid) and nothing by mouth status with total parenteral nutrition was unsuccessful after seven days. The patient underwent a right robotic thoracic duct ligation using the da Vinci Xi robot.

In the left lateral decubitus position, the port was placed anterior to the tip of scapula, with the camera port in the sixth interspace on the anterior axillary line, at the level of the diaphragm midway between anterior and midaxillary line. Upon ligation of the duct, chest tube output ceased. The patient was discharged on postoperative day two.


Suggested Reading

Cerfolio R. Ligation of the Thoracic Duct for Chylothorax. https://www.ctsnet.org/article/ligation-thoracic-duct-chylothorax. Published October 6, 2009. Accessed March 30, 2018.

Comments

There are several options available to solve his vexing and morbid problem. Lymphovenous anatomosis is an option which would require microsurgical techniques which would be difficult in a minimally invasive approach and might necessitate a thoracotomy for exposure of the duct and vessels. Given the previous surgery was on the left and the injury was in the left apex . Access to the thoracic duct is best achieved on the right which cold have compromised the patients postoperative functional status. Use of the DaVinci Xi robot achieved resolution of the problem and the patient was able to be discharged expeditiously with minimal complaints . Thank you for your thoughtful question.

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