Basic Experiment on Thoracoscopic Aortic Cross-Clamping as an Alternative to Resuscitative Thoracotomy

Hisashi Matsumoto, Hiroshi Yasumatsu, Kazuki Mashiko, Takahiro Yagi and Hiroyuki Yokota

Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, Japan
Department of Emergency and Critical Care Medicine, Nippon Medical School, Japan

^*Correspondance to: Hisashi Matsumoto 

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Abstract:

Background: Aortic Cross-Clamping (ACC) via Resuscitative Thoracotomy (RT) is performed in patients with haemorrhagic shock not only to control bleeding, but also to redistribute the limited blood volume to the coronary and cerebral arteries. In chest injury, RT, including clamshell thoracotomy, is inevitable because haemostasis and repair of damaged organs are simultaneously required. On the other hand, RT with AXC to control bleeding for intra-abdominal injury is considered to be excessively invasive.
Objective: This basic experiment explored the possibility of a minimally invasive “thoracoscopic AXC”.
Method: This experiment was conducted in accordance with the Declaration of Helsinki and the animal experiment guidelines of the author’s institute. A Large Yorkshire pig (female) weighing 44.5 kg was placed under general anaesthesia (1% to 2% isoflurane) and a thoracoscope was inserted through the left intercostal space. Approaching the posterior mediastinum along the left chest wall, the descending aorta was identified and completely clamped with the inserted AXC forceps. The difficulty of the procedure, total time until clamping, and problems encountered during the procedure were recorded.
Results: The approach to the posterior mediastinum was relatively easy, but cross-clamping to the intended position took some time due to obstruction by the pulmonary ligament. The total time from insertion of the thoracoscope to completion of AXC was 3' 58" with no significant change in the pig’s vital signs. The insertion ports of the thoracoscope and the AXC forceps had to be separate.
Conclusion: Although the acquisition of skills to directly and rapidly reach the descending aorta, including setting the insertion points of the thoracoscope and the AXC forceps, is a significant problem, this experiment revealed that this procedure is anatomically feasible. However, since in humans the lung and the pulmonary ligament may hinder the approach to the posterior mediastinum, repeated training may be necessary to shorten the maneuvering time. In addition, development of a device integrating the thoracoscope and AXC forceps might be necessary.

Keywords:

Aortic cross-clamping; Resuscitative thoracotomy; Haemorrhagic shock; Severe trauma

Cite the Article:

Matsumoto H, Yasumatsu H, Mashiko K, Yagi T, Yokota H. Basic Experiment on Thoracoscopic Aortic Cross-Clamping as an Alternative to Resuscitative Thoracotomy. World J Surg Surgical Res. 2018; 1: 1074.