Technique and perioperative management of left pneumonectomy in neonatal piglets

Duy T. Dao, Lorenzo Anez-Bustillos, Alison A. O'Loughlin, Amy Pan, Arthur P. Nedder, Dana Bolgen, Charles Jason Smithers, Jill Zalieckas, Craig W. Lillehei, Prathima Nandivada, Meredith A. Baker, Gillian L. Fell, Bennet S. Cho, Mark Puder

Research output: Contribution to journalArticlepeer-review

Abstract

Background Although commonly performed in adult swine, unilateral pneumonectomy in piglets requires significant modifications in the surgical approach and perioperative care because of their smaller size and limited physiological reserve. Methods Nineteen neonatal piglets underwent a left pneumonectomy. They were allowed 5-7 d of preoperative acclimation and nutritional optimization. Preoperative weight gain and laboratory values were obtained before the time of surgery. A “ventro-cranial” approach is adopted where components of the pulmonary hilum were sequentially identified and ligated, starting from the most ventral and cranial structure, the superior pulmonary vein. The principle of gentle ventilation was followed throughout the entire operation. Results The median age of the piglets at the time of surgery was 12 (10-12) d. The median preoperative weight gain and albumin level were 20% (16-26%) and 2.3 (2.1-2.4) g/dL, respectively. The median operative time was 59 (50-70) min. Five of the first nine piglets died from complications, two from poor preoperative nutritional optimization (both with <10% weight gain and 2 g/dL for albumin), one from an intubation complication, one from intra-operative bleeding, and one in the postoperative period from a ruptured bulla. No mortality occurred for the next 10 cases. Conclusions Successful outcomes for unilateral pneumonectomy in piglets require special attention to preoperative nutritional optimization, gentle ventilation, and meticulous surgical dissection. Preoperative weight gain and albumin levels should be used to identify appropriate surgical candidates. The “ventro-cranial” approach allows for a technically straightforward completion of the procedure.

Original languageEnglish (US)
Pages (from-to)146-152
Number of pages7
JournalJournal of Surgical Research
Volume212
DOIs
StatePublished - May 15 2017
Externally publishedYes

Keywords

  • Piglets
  • Unilateral pneumonectomy

ASJC Scopus subject areas

  • Surgery

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