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THORACOSCOPIC THORACIC DUCT CLIPPING

Issa

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Thoracoscopic Direct Clipping of the Thoracic Duct Nomair Issa dr.nomair@gmail.com Summary: We present a 31-year-old woman with Hodgkin’s lymphoma who developed high output right chylothorax following a diagnostic thoracoscopic resection of a large right-sided hard lymph node paratracheal. Treatment with octreotide and total parenteral nutrition was unsuccessful. After 14 days the patient underwent a right thoracoscopic thoracic duct clipping using an anterior 3-portal approach. We used the same incisions after the first 3-portal VATS as schown in the video (Re-VATS). The mediastinal pleura between the azygous vein and the esophagus is opened longitudinally using an electro hook. The azygos vein was then carefully dissected, exposed and used as a guide to continue the preparation in the direction of the diaphragm. Gentle blunt dissection, using the suction tip, of the soft tissue intervening between the esophagus anteromedial, the azygos vein posterolateral and the descending thoracic aorta and vertebral column deep to the operative field is performed. The esophagus is retracted anteriorly using a tonsil sponge and the dissection continued bluntly towards the aorta. The thoracic duct was then exposed, inferior to the level of the inferior pulmonary vein, isolated and successfully clipped.

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