Our soft tissue surgery team carry out a range of thoracic surgery, including diaphragm rupture repairs, lung lobectomies, exploratory thoracotomies and thoracic wall resection.
Some procedures, such as pericardiectomy and biopsies, may be performed thoracoscopically (i.e. as a keyhole procedure). Our on-site CT scanner greatly facilitates our thoracic surgery and CT-guided aspirates and biopsies have proven very useful.
Diaphragm surgery including rupture repairs
Most commonly caused by a physical trauma such as a road traffic collision, a diaphragmatic rupture may present itself through symptoms such as collapse, respiratory distress, muffled or displaced heart sound and reduced resonance on thoracic percussion. Our CT, radiography and ultrasonography facilities are helpful in building a clear view of the abdomen and thoracic cavity in order to establish the extent of the rupture and to differentiate between a diaphragmatic rupture and hernia (where displaced or disrupted organs would appear within a hernial sac: an uncommon congenital condition). Patients may require stabilisation followed by surgical repair of the diaphragm. Particular attention must be paid to keep the patient well ventilated during surgery. Twenty-four hour care is available for referred patients post-surgery. It is advisable that patients suffering acute diaphragmatic rupture receive surgical treatment as soon as possible in order to reduce issues during lung re-inflation.
Lung lobectomy
The diagnosis of a lung tumour is often delayed as patients rarely display symptoms such as a cough, weight loss or lethargy, early on. Once suspected, x-ray is an effective tool for identifying larger tumours within the lungs, or alternatively CT can be used to locate nodules within this region as little as five millimetres in diameter. A CT guided biopsy may be performed in order to diagnose the nature of the mass. Both CT and ultrasound can also be useful modalities to evaluate for primary tumours elsewhere.
A lung lobectomy is a procedure that can be used to remove a single tumour, or multiple tumours contained in one lobe via thoracotomy (an opening in the chest cavity). Removing only a lobe as opposed to the entire lung usually means the remaining healthy lung tissue can work as normal and the patient experiences minimal disruption to breathing. Patients undergoing surgery will receive 24-hour care and pain relief. Lung tumours are most frequently a result of metastasis; occurring after cancer cells are carried to the lungs via the blood stream from elsewhere in the body. Therefore, patients may receive chemotherapy from our oncology team, or be provided with a palliative care plan to maintain quality of life.
Pericardectomy
Occasionally heart failure in dogs is the result of a build-up of fluid in the sac around the heart (known as pericardial effusion). Thin fluid (usually similar to dark blood) may be produced by a tumour, perhaps on the heart, or may be ‘idiopathic’ (i.e. we do not know why it is being produced).
Instant improvement may be obtained by draining off the fluid with a special catheter. Unfortunately the fluid will usually build up again, and signs of heart failure will return. A longer solution that avoids repeated drainage is pericardectomy – a ‘window’ is made in the pericardium which allows the fluid to drain from the pericardium. This removes pressure from the heart and the pleura (the membranes around the lungs) can often reabsorb the fluid. It is possible to perform this as a keyhole procedure.