Robot-Assisted Management of Chyloptysis
Raghav A. Murthy, MBBS1, Harrell Lightfoot2, Scott Reznik, MD2, Muhanned Abu-Hijleh, MD2, Kemp Kernstine, MD2.
1Rady Childrens Hospital, San Diego, CA, USA, 2UT Southwestern Medical Center, Dallas, TX, USA.
OBJECTIVE: Chyloptysis is a rare clinical condition in which patients present with the expectoration of chylous sputum, which can result in significant respiratory compromise. We report a case of chyloptysis that was successfully managed with robotic-assisted ligation of the abnormal lymphatic connection, and ligation of the thoracic duct.
METHODS: After securing the airway, cream was infused via a dobhoff tube. Bronchoscopy revealed chylous secretions arising from the right middle lobe bronchus. After docking the robot, all lymphatic tissue were cleared around the bronchus. During the posterior dissection, lymphatic channels feeding the right middle lobe bronchus was identified, and ligated. Next, the tissue on the lateral edge of the aorta and the medial edge of the azygous vein were incised down to the anterior spinous ligament inferiorly in the pleural space. Endoscopic clips were used to ligate the thoracic duct. Fibrin glue was applied and a betadine pleurodesis was performed.
RESULTS: The patient tolerated the procedure without immediate complications. Post-operative bronchoscopy revealed no further secretions. The patient was discharged on post-operative day 1 on a low fat diet. At follow-up, she reported an improvement in her respiratory symptoms.
CONCLUSIONS: We report an interesting case of chyloptysis that was successfully managed surgically. The added dexterity offered by the robotic system allowed for meticulous dissection around the right middle lobe bronchus and identification of the abnormal lymphatic tributary.
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