Double-Wound O-Ring Retraction for Chylothorax Surgery in Dogs

SIMPLE SUMMARY: Chylothorax is a life-threatening disease resulting in accumulation of chyle in the thoracic cavity due to thoracic duct leakage. In many cases, the only treatment is surgical tying of the damaged duct with a thread or by placing a ligation clip. However, such an operation is technically demanding as it requires suitable exposure of the lymphatic system structures. Stay sutures and/or classical (metal) tissue retractors, as used so far, provide sufficient exposure of the thoracic duct only after several manipulations during the surgery, which prolongs the operation and increases infection risk. In this communication, we present our impressions of using o-ring elastic wound retractors (O-WRs) instead of classical retraction in three large breed dogs. We conclude that the O-WRs provide a static circumferential vision of the operation field and good access to the thoracic duct. The usage of other surgical instruments is not hampered by the O-WRs. In turn, the elastic rings are not damaged by the metal instruments. In addition to classical retraction, the O-WRs, once placed in the diaphragmatic area, do not require further manual retraction. ABSTRACT: A suitable wound retraction is crucial for open surgical treatment of chylothorax in dogs. A single paracostal approach for transabdominal/transdiaphragmatic thoracic duct ligation and cisterna chyli ablation is an effective procedure. For the procedure, the use of stay sutures and handheld or automatic soft tissue retractors is recommended. However, it is often necessary to adjust the retractors several times during the surgery to provide sufficient exposure of the thoracic duct. This prolongs the operation and increases infection risk. In this report, we describe the modified application of two o-ring elastic wound retractors (O-WRs) in three large breed dogs with idiopathic chylothorax. We conclude that the O-WRs provide a static circumferential vision of the operation field and good access to the cisterna chyli, especially to the thoracic duct. The usage of other surgical instruments is not hampered by the O-WRs, and the elastic rings are not damaged by the metal instruments. Once placed in the diaphragmatic area, indeed, they do not require further manual retraction.