Thymoma excision
Figure 1 : The CT image above shows the location of the thymoma (white measurement line shown) cranial to the heart and located just underneath the cranial vena cava.
Thoracoscopy was also used to remove a thymoma from the chest of an 11 year old Labrador retriever that had originally presented for difficulty breathing. We diagnosed laryngeal paralysis for which a surgical procedure called a tie-back was performed. At presentation chest radiography had revealed a mass in the cranial mediastinum which was subsequently diagnosed by ultrasound-guided tru-cut biopsy to be a thymoma. Eight weeks after recovery from the tieback procedure we proceeded with thoracoscopic thymoma resection. Pre-operatively a CT scan was used for surgical planning and to define the exact anatomical landmarks of the tumor. This planning is essential to ensure that the mass is not invading the large blood vessels in the cranial mediastinum.
A telescope and instrument port were established that allowed visualization and manipulation of the mass for dissection. Then a mini-thoracotomy approximately 4cm in length was established at the second intercostal space on the left hand side.
 |
Figure 2: Use of the harmonic scalpel (Ethicon Inc.©) greatly facilitated the dissection of the mass within the chest.
Once the mass was completely dissected the mass was inserted into a specialized specimen collection bag. This is an important step as if the tumor is removed straight from the chest it is possible that some tumor cells may be shed onto the chest wall when the tumor is pulled out of the incision leading to the establishment of new tumors.
|
|
Figure 3: After dissection the tumor has been manipulated into a specialized specimen retrieval bag and is being removed from the chest cavity through the mini-thoracotomy that was created.
This dog recovered well from surgery and continues to do well. The use of thoracoscopy to remove this tumor meant that a median sternotomy (a procedure where the bones of the sternum are split with a bone saw to allow access to the chest cavity) was avoided allowing a faster and much less painful recovery.
|
|
 |