🔍 Key Findings
- Study Design: Canine cadaveric study comparing intercostal thoracotomy (ICT), median sternotomy (MS), and transdiaphragmatic with caudal median sternotomy (TDCM) for accessory lung lobectomy (ALL).
- Main Outcomes:
- Exposure Area: TDCM (193.5 cm²) > MS (106.5 cm²) > ICT (73.5 cm²) (p = .01).
- TDCM provided significantly greater exposure than MS (p = .02) and ICT (p = .02); MS > ICT (p = .04).
- Surgical Time: No significant difference (p = .06).
- Lobe Excision (% by weight/surface area): No significant difference between groups (p = .4).
- Staple Line Leak: Leak at ≤40 cmH₂O in 2/4 ICT, 0/4 MS, 0/4 TDCM (p = .09).
- Complications:
- 1/4 MS cases had iatrogenic damage to an adjacent lobe.
- Technical Insights:
- TDCM approach allowed immediate visualization of all three parts of the right pulmonary ligament.
- The TDCM approach offers improved access without requiring en bloc removal with the right caudal lobe.
- Conclusion: The TDCM approach provides improved exposure for ALL lobectomy with no increase in surgical time or complications relative to other approaches.