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Duvieusart et al: Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Veterinary Surgery 1, 2025

🔍 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.
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy

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Duvieusart et al: Comparison of three approaches for accessory lung lobectomy in the canine cadaveric model: Intercostal thoracotomy, median sternotomy, and a transdiaphragmatic approach combined with caudal median sternotomy
Veterinary Surgery 1, 2025

🔍 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.

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Multiple Choice Questions on this study

In Duvieusart 2025 et al., on lung lobectomy approaches, which technique provided the greatest surgical exposure?

A. Intercostal thoracotomy (ICT)
B. Median sternotomy (MS)
C. Transdiaphragmatic with caudal sternotomy (TDCM)
D. Thoracoscopic port-assisted
E. Craniocaudal muscle-sparing thoracotomy

Answer: Transdiaphragmatic with caudal sternotomy (TDCM)

Explanation: TDCM had the largest median exposure area (193.5 cm²), significantly more than ICT and MS.
In Duvieusart 2025 et al., on lung lobectomy approaches, what was a key advantage of the TDCM technique?

A. Less postoperative pain
B. Avoidance of chest tubes
C. Shorter surgical time
D. Superior exposure for stapling
E. Reduced hemorrhage risk

Answer: Superior exposure for stapling

Explanation: TDCM approach enabled better access and visibility of the accessory lung lobe.
In Duvieusart 2025 et al., on lung lobectomy approaches, which approach was associated with staple line leaks?

A. TDCM only
B. MS only
C. ICT only
D. MS and ICT
E. All three approaches

Answer: ICT only

Explanation: Staple line leaks occurred in 2 of 4 ICT cases; none were reported in MS or TDCM.
In Duvieusart 2025 et al., on lung lobectomy approaches, what conclusion was drawn about stapler success across techniques?

A. Significantly better in TDCM
B. More reliable in MS
C. Similar across all groups
D. Worse in ICT
E. Unsuccessful in 50% of cases

Answer: Similar across all groups

Explanation: Staplers successfully completed lobectomies in all cases; no group differences noted in success.
In Duvieusart 2025 et al., on lung lobectomy approaches, what percentage of the lung was typically removed by weight across all techniques?

A. 20%–25%
B. 30%–35%
C. 35%–45%
D. 50%–60%
E. 70%–75%

Answer: 30%–35%

Explanation: There was no significant difference in lobectomy weight percentage; the mean was around 32%.

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