THORACOSCOPIC LOBECTOMY WITH ENDOARTERIAL VASCULAR CONTROL - AN EXPERIMENTAL-STUDY IN SWINE

Background. Video-assisted lobectomy lacks vascular control and presen ts the potential for serious hemorrhage in a closed cavity. The use of a lighted, now-directed balloon catheter in the pulmonary artery as a n endovascular control device was evaluated. Methods. A modified light -bearing Swan-Ganz catheter was placed in the left or right pulmonary artery using fluoroscopy. The lit catheter was identified easily throu gh the arterial wall at thoracoscopy. Its inflation allowed the contro l of proximal blood flow as required. Fully thoracoscopic lobectomy wa s carried out by isolating and dividing the lobar branches of the pulm onary artery, the pulmonary vein, and the bronchus in anesthetized swi ne. Results. Forty-two video-assisted anatomic lobectomies were comple ted in 30 pigs with balloon catheter control of the pulmonary artery. The balloon effectively controlled experimental hemorrhage caused by p uncturing arterial branches (n = 4). It allowed the transection of unl ooped lobar arteries (n = 42) and the main interlobar pulmonary artery (n = 3). Catheter displacement back to the heart occurred in 5 animal s and balloon catheter technical failures occurred in 3. Conclusions. The lighted, flow-directed balloon catheter was an effective means of avoiding acute hemorrhage and achieving vascular control in a swine lo bectomy model.