Comparison and description of transdiaphragmatic and abdominal minimally invasive cisterna chyli ablation in dogs

Objective: To develop, describe, and compare transdiaphragmatic (TD) and abdominal minimally invasive approaches to cisterna chyli (CC) ablation.

Study design: Experimental study.

Animals: Adult dogs (n = 18; weighing, 19.0 ± 0.9 kg).

Methods: With dogs in sternal recumbency, laparoscopic camera and instrument portals were established entirely within the craniolateral aspect of the abdomen (AB) or in combination with a TD camera portal. A popliteal lymph node was injected with methylene blue to provide coloration of the CC in both groups. Once the CC was identified, laparoscopic forceps were used to tear and ablate the CC tissue. Ablation was confirmed by necropsy examination and observation of blue fluid leaking into the peritoneal cavity after injection of the ileocecocolic lymph nodes with methylene blue. After censor of the first 2 dogs in each group, the AB and TD techniques were compared using procedural time and visual analogue scale data of procedure ease, hemorrhage, triangulation efficiency, and adequacy of portal placement.

Results: Successful CC ablation was achieved in 7 of the TD group and 5 of the AB group. Failure was because of an inability to identify the CC or tearing of the aorta. Other than a longer procedural time in the TD group, there were no statistical differences identified. Complications encountered during the procedures led to technical refinements.

Conclusions: Both TD and AB minimally invasive approaches can be used to achieve successful CC ablation.