Uniportal Right VATS Ligation of the Thoracic Duct
A 65-year-old woman was referred from the otorhinolaryngology department to the thoracic surgery department for a prolonged high-volume chyle leak following neck dissection. She had undergone surgery for nodal recurrence of thyroid cancer. The chyle leakage from the neck drains was evident immediately after the procedure, producing 1.5 – 2.0 L/day. She was started on total parental nutritional (TPN) without any benefit. After a week of TPN, octreotide was added. Finally two weeks after the procedure, she had a lymphogram with the intent to deploy coils. The chyle leakage persisted, and the patient albumin and white blood cell count was decreasing and was well below the normal range.
She then underwent uniportal right video-assisted thoracoscopic surgery, during which the thoracic duct was identified, mobilized, clipped, and divided. The chyle leak stopped immediately after the procedure, the neck drains were removed, and she was discharged home in good condition.
Suggested ReadingKumar S1, Kumar A, Pawar DK. Thoracoscopic management of thoracic duct injury: is there a place for conservatism? J Postgrad Med. 2004;50(1):57-59.